The Cancer Questions Project, Part 12: Siddhartha Mukherjee

Dr. Siddhartha Mukherjee is a physician-scientist with a persistent scientific and clinical interest in acute myeloid leukemia, hematopoiesis, novel therapeutic drug development and cancer biology. He is a Pulitzer Prize-winning author of The Emperor of All Maladies: A Biography of Cancer. He has published articles in Nature, The New England Journal of Medicine, The New York Times, and Cell. Dr. Mukherjee’s research lab at Herbert Irving Comprehensive Cancer Center studies the biology of blood development malignant and premalignant diseases such as myelodysplasia and acute myelogenous leukemia (AML). His goal is to develop new drugs against diseases. He currently serves as an Associate Professor of medicine at Columbia University Medical Center.

Azra Raza, author of The First Cell: And the Human Costs of Pursuing Cancer to the Last, oncologist and professor of medicine at Columbia University, and 3QD editor, decided to speak to more than 20 leading cancer investigators and ask each of them the same five questions listed below. She videotaped the interviews and over the next months we will be posting them here one at a time each Monday. Please keep in mind that Azra and the rest of us at 3QD neither endorse nor oppose any of the answers given by the researchers as part of this project. Their views are their own. One can browse all previous interviews here.

1. We were treating acute myeloid leukemia (AML) with 7+3 (7 days of the drug cytosine arabinoside and 3 days of daunomycin) in 1977. We are still doing the same in 2019. What is the best way forward to change it by 2028?

2. There are 3.5 million papers on cancer, 135,000 in 2017 alone. There is a staggering disconnect between great scientific insights and translation to improved therapy. What are we doing wrong?

3. The fact that children respond to the same treatment better than adults seems to suggest that the cancer biology is different and also that the host is different. Since most cancers increase with age, even having good therapy may not matter as the host is decrepit. Solution?

4. You have great knowledge and experience in the field. If you were given limitless resources to plan a cure for cancer, what will you do?

5. Offering patients with advanced stage non-curable cancer, palliative but toxic treatments is a service or disservice in the current therapeutic landscape?

Some Thoughts On This October Day

by Samia Altaf

I could not believe my luck when I woke up this morning. It had rained last night, but this morning the sky was blue the breeze gentle,and the wild grass along the smelly sluggish, open sewer that meanders through the swanky Defense Housing Authority—home to lush golf courses and palatial villas—past the gates of the elite Lahore University of Management Sciences, was audaciously green. The mango tree in the front yard of my mother’s  house—quiet after a fertile summer of exuberant fruiting—balances the crow’s nest full of chattering chicks in its gently swaying branches. All God’s creations bask in the mellow sunshine. No more the snow and ice and cold of Eastern US. For these weeks, it’s going to be this bliss in Lahore. I was glad to be me, and to be alive. I say to myself “Thank God I am on this side of the earth, rather than under it.” What a beautiful world. So much to see and so much to do. I could live like this for a hundred years like William Hazlitt, who claimed to have spent his life “reading books, looking at pictures, going to plays, hearing, thinking, writing on what pleased me best.” I’ll add eating to that list, at the top of it, fried eggs and buttered toast.

Gayatri Spivak

In addition to the sunshine and the crows, and trees waving gently in the breeze, there are books to read, newspapers to follow, old trunks to sort through and the joy of restoring broken things. And now, thanks to the miracle of YouTube, music to listen to, movies to watch, many enlightening videos to engage with. This is no time to die! Although it seems unlikely, I have been hooked onto Gayatri Spivak since I heard her speak here in Lahore some years ago. That formidable woman and her harangue about the subalterns, a word I associated with the military, which I was quite intrigued to learn that evening applies to me as well. Not a word of what she says about subalterns makes sense to me but I love to hear her speak. She really is something. She said things that evening, to a crowded hall of Pakistani college students, activists and others, about Derrida and Gramsci —names I  heard for the first time. Read more »

“I Assure You, We’re Open”: 25 Years of Clerks

by Mindy Clegg

Jeff Anderson as Randal and Brian O’Halloran as Dante

In 1994, Miramax Pictures released a small, independently made film by an unknown director from New Jersey named Kevin Smith. Made for a mere $27,000 (maxing out credit cards and the proceeds from selling his comic collection), the black and white film—replete with deeply offensive language, references to drug dealing and usage, and philosophical debates on Star Wars—grossed over $3 million and netted the young director not only a career, but accolades from the Cannes and Sundance film Festivals and nominations in three categories at the Independent Spirit Awards that year.1 It’s since been acknowledged as one of the best indie films of the 1990s.

Clerks, it can be argued, functions as a brilliant example of Gen X slacker culture that prized authenticity over slick production techniques and funny but insightful discourse over spectacle. Smith’s career has been built on that authenticity in community and self-expression, even in films that fall outside of his “View Askewniverse.” Generally speaking, Smith makes films that he wishes to see, not what he thinks will sell, and that was very generationally grounded. He infused his love of endlessly examining comic books and sci-fi/fantasy films/shows with the structure of the rom-com and buddy film genres to carve out a career catering not to all mainstream audiences, but to a like-minded audience of fans who love seeing themselves reflected on the screen.

Part of the enduring popularity of Smith’s work represents various shifts within film and TV making that centers on at least some Gen X sensibilities. His work also signaled a shift in Hollywood finally beginning to take speculative fiction seriously, in part to cater to Gen X (and later millennial and Gen Z tastes). The goal was never superstar status as a filmmaker, but a career that allowed Smith to make the kind of work he himself sought out and enjoyed, which mirrors the Gen X relationship to other cultural forms, too—the rise of the current subcultural society that we live in now. Read more »

Poem

For the Artists

I know you just want to be a flute
the wind sings through
to make a melody
or an intricate mistake
like the existence of crystals
in nature, drifting as flakes
to cover a field
in a clean white blanket
or inside a rock,
the tiny, glittering caves.

In other words, you just want to be
a structure
with the beauty
already
built into it.

But I’d guess, like me
you’ve walked through a few
gardens in heavy shoes
accused friends & lovers of things they did
& sins they didn’t do
panicked awake at 3am
to sit alone in the kitchen
trying to sip breaths in
past your choked throat.

Still, I hear a song
alive in you
when the joy sets in along
your spine and through
the fields and caves of your body.
Somewhere within
a tree, a willow
rustles as a cool wind
from some other world begins to blow.

by Amanda Beth Peery

Graz, Austria and me? It’s complicated

by Cathy Chua

Gerlos

Shortly before my first trip to Austria in September, a story did the rounds of  a tourist sued for leaving a review on Tripadvisor complaining of a photographic display of Nazis at a hotel in a little town called Gerlos in the Tyrolean Alps. The case has not yet ended, but for now the Austrian court has granted a temporary injunction against the tourist, in favour of the hotel.

Seeing a Nazi publicly honoured at the hotel had made K and his wife feel indignation and disgust, the post said. “This made us wonder what the hotel owners are trying to tell us with this image. This incident speaks volumes about the current state of affairs in this region of Austria. Sadly, our desire to visit this mountain region has disappeared completely.

For me this raised an issue I often find  myself discussing: is the Far Right in Europe, as it presents itself at the moment, ‘new’? Being a historian, I take the long view and see the continuum. For me,  what is happening isn’t new, it’s connected to the past. Far Right sympathies haven’t stopped, they have from time to time gone into hiding, or disguised themselves, but they have always been there, if not necessarily in plain sight. I hope that is full disclosure of my relevant bias. Read more »

Mark Just Wants To “Bring People Together”: What Could Possibly Go Wrong?

by Joseph Shieber

Imagine a party planner, let’s call him “Mark”. Mark offers his services in party planning to all of the citizens of the town of Happyville.

Now, Mark’s party planning service has an interesting twist.

He begins by throwing a party for a group defined by some close connection — say, a family reunion, or a work party — but then he does something unexpected. He’ll invite some high school friends of the partygoers to the family reunion, or some people with a shared connection to church groups to the work party. What happens then is that people make new connections by getting increased exposure to their friends’ friends — or even to their friends’ friends’ friends.

Almost fifty years ago, the sociologist Mark Granovetter coined the term “weak ties” for these more attenuated connections. There is now a wealth of research tracing the ways that weak ties can affect our lives, from helping us get a job to improving our overall well-being.

Sounds great, right? Mark the party planner is bringing people together, exposing them to new people, and allowing them to harness the strength of their weak ties. What could go wrong? Read more »

Henry David Thoreau, Laundry, and Hypocritical Hope

by Katie Poore

American writer Rebecca Solnit laments that few writers have had quite as much scrutiny directed toward their laundry habits as Transcendentalist writer Henry David Thoreau, best known for his 1854 memoir Walden. “Only Henry David Thoreau,” she claims in Orion Magazine’s article “Mysteries of Thoreau, Unsolved,” “has been tried in the popular imagination and found wanting for his cleaning arrangements.”

It is ostensibly a non-sequitur of sorts, to seek of such a prominent and canonical literary figure an account of laundry done and not done, of clothing cleaned by Thoreau or, as so many of Solnit’s Facebook friends viciously claim, by “‘his sister every week who came to take his dirty laundry.’” How could shirts washed, and by which hands, become such a point of interest for critics of Thoreau?

The answers are probably manifold, but such social media behavior—by which I mean the vilification of someone based off the mundane details of their quotidian behavior—is a practice typically reserved for the denunciation of those who both enrage and perplex us, who seem to have stepped past boundaries we have established and lead us into uncharted (and often contentious) ideological, rhetorical, or political territory. Read more »

Wine, Beauty, Mystery

by Dwight Furrow

Among the best books I’ve read about wine are the two by wine importer Terry Theise. Reading Between the Wines is a thoroughly enjoyable account of his life in wine and a passionate defense of artisanality. But it’s his most recent book What Makes a Wine Worth Drinking: In Praise of the Sublime that really gets my philosophical juices flowing.

Long celebrated for his portfolio of mostly German and Austrian wines as well as grower Champagne, in these two books he articulates a sophisticated, yet non-theoretical philosophy of wine and introduces a badly needed corrective to our fatally constrained and often vulgar approach to wine that confuses marketing with aesthetics. But like any work of philosophy, this book raises profound questions. Here are a few quotes that I think raise the most important questions we need to answer.

Great wine can induce reverie; I imagine most of us would concur. But the cultivation of reverie is also the best approach to understanding fine wine.

What is it about us and what is it about wine that induces a dream-like state, that sets the imagination in motion? Why does wine’s capacity to induce reverie help us understand fine wine?

If wine had turned out to be merely sensual I think for me its joys would have been transitory. I’d have done the “wine thing” for a certain number of years and gone on to something else. What continued to drive me, and what drives many of us, is curiosity, pleasure in surprise, and those elusive, incandescent moments of meaning—the sense that some truth, normally obscure, was being revealed.

How can a beverage reveal truths? What kind of truth is this and how would we know we have it? Read more »

On Harold Bloom

William Flesch and Marco Roth in n + 1:

Like other teachers and sages I’d known and apprenticed myself to for seasons of my life, Bloom performed, but what he didn’t perform was pedagogy or teaching, not for himself and not for us. He just did readings, in the Bloom way, which was an ongoing drama, in words, between the work at hand and the absent works, lines and phrases that the work had brought itself into being from. This isn’t the same as watered down “intertextuality” or “influence studies” or, god forbid, some kind of seminar or salon-like conversation. It wasn’t “New Critical” thing-in-itself close reading, because poems weren’t things in themselves, they were living subjects, and as full of contradictions and private dramas and unconscious desires and hauntings as any other. While some critics thought about the “political unconscious” and others of just the human unconscious, Bloom found a way to surface the poetic unconscious.

He would sit there, channeling, almost always quoting from memory and at the speed of memory, a few teasing questions to set himself off and running. And he would run nonstop until the doctor-mandated “break,” when he might shift his corpulence, button up the shirt and shuffle unaided for water, or sit mopping his brow, or quiet, eyes closed, returning into silence. He leaked humanity.

More here.

Doubting death: how our brains shield us from mortal truth

Ian Sample in The Guardian:

Warning: this story is about death. You might want to click away now.

That’s because, researchers say, our brains do their best to keep us from dwelling on our inevitable demise. A study found that the brain shields us from existential fear by categorising death as an unfortunate event that only befalls other people.

“The brain does not accept that death is related to us,” said Yair Dor-Ziderman, at Bar Ilan University in Israel. “We have this primal mechanism that means when the brain gets information that links self to death, something tells us it’s not reliable, so we shouldn’t believe it.”

Being shielded from thoughts of our future death could be crucial for us to live in the present. The protection may switch on in early life as our minds develop and we realise death comes to us all.

More here.

American ‘Freedom Man’ is Made of Straw

Andrew J. Bacevich in The American Conservative:

Is a penchant for moral posturing part of a newspaper columnist’s job description? Sometimes it seems so. But if there were a prize for self-indulgent journalistic garment renting, Bret Stephens of The New York Times would certainly retire the trophy. 

To introduce a recent reflection on “the global lesson from the regional catastrophe that is Donald Trump’s retreat in Syria,” Stephens begins with a warm-and-fuzzy parable. “The time is the early 1980s,” he writes.

The place is the South China Sea. A sailor aboard the U.S.S. Midway, an aircraft carrier, spots a leaky boat jammed with people fleeing tyranny in Indochina. As he helps bring the desperate refugees to safety, one of them calls out: “Hello, American sailor — Hello, Freedom Man.”

Today, alas, Freedom Man has become “a fair-weather friend,” according to Stephens. Thanks to President Trump, America can no longer be trusted. And “the idealism that stormed Normandy, fed Europe, democratized Japan, and kept West Berlin free belongs to an increasingly remote past.”

How I wish that this litany of good deeds accurately summarized U.S. history in the decades since American idealism charged ashore at Omaha Beach. But wishing won’t make it so—unless, perhaps, you make your living as a newspaper columnist.

More here.

Patricia S. Churchland: The Nature of Moral Motivation

Patricia S. Churchland at Edge:

The question that I’ve been perplexed by for a long time has to do with moral motivation. Where does it come from? Is moral motivation unique to the human animal or are there others? It’s clear at this point that moral motivation is part of what we are genetically equipped with, and that we share this with mammals, in general, and birds. In the case of humans, our moral behavior is more complex, which is probably because we have bigger brains. We have more neurons than, say, a chimpanzee, a mouse, or a rat, but we have all the same structures. There is no special structure for morality tucked in there.

Part of what we want to know has to do with the nature of the wiring that supports moral motivation. We know a little bit about it, namely that it involves important neurochemicals like oxytocin and vasopressin. It also involves the hormones that have to do with pleasure, endocannabinoids and the endogenous opioids. That’s an important part of the story. The details are by and large missing. And what I would love to know, of course, is much more about the details.

More here.

Inside Aspen: the mountain retreat for the liberal elite

Linda Kinstler in 1843 Magazine:

The idea for the Aspen Institute first emerged after the second world war. In 1949 Walter Paepcke, a Chicago businessman, planned a bicentennial celebration of the life of Goethe. Paepcke and his wife, Elizabeth, chose Aspen because it was both beautiful and easily accessible from either coast. The couple felt there was an “urgent need” to understand Goethe’s thought: the world, still recovering from the war, had been cleft in half by the ideological battle between communism and capitalism. The Paepckes saw Goethe as a prime advocate of the underlying unity of mankind. He also worried about the corrosive effects of rapidly proliferating wealth. The Paepckes imagined that Aspen could become an “American Athens”, educating an upper-crust elite hungry for spiritual sustenance in the newly ascendant nation. Such work was vital “if the people of America and other nations are to strengthen their will for decency, ethical conduct and morality in a modern world”. Herbert Hoover, the former president, was named honorary chairman; Thomas Mann joined the board of directors.

In 1950 the Aspen Institute for Humanistic Studies was founded as a place of moral instruction for the “power elite”. The Paepckes didn’t want their creation to be merely a think-tank dedicated to policymakers. Nor were they interested in emulating business schools. They wanted to shape leaders, not merely improve managers. Back then, Aspen’s version of inclusivity meant inviting the men in suits. The new curriculum was modelled on what was known as the “Fat Man’s Great Books Class”, which Mortimer Adler, a philosopher who co-founded the Aspen Institute, had run in wartime Chicago exclusively for executives. The idea was that if thinkers and businessmen were forced into the same room they’d be cured of their mutual suspicion and “join together to supplant the vulgarity and aimlessness of American life”. Through encounters with the classics, executives would learn to restrain the worst excesses of capitalism and politicians would be able to draw on the wisdom of the ages as they reached their decisions. The “Aspen method” was born.

More here.

How evolution builds genes from scratch

Adam Levy in Nature:

In the depths of winter, water temperatures in the ice-covered Arctic Ocean can sink below zero. That’s cold enough to freeze many fish, but the conditions don’t trouble the cod. A protein in its blood and tissues binds to tiny ice crystals and stops them from growing. Where codfish got this talent was a puzzle that evolutionary biologist Helle Tessand Baalsrud wanted to solve. She and her team at the University of Oslo searched the genomes of the Atlantic cod (Gadus morhua) and several of its closest relatives, thinking they would track down the cousins of the antifreeze gene. None showed up. Baalsrud, who at the time was a new parent, worried that her lack of sleep was causing her to miss something obvious.

But then she stumbled on studies suggesting that genes do not always evolve from existing ones, as biologists long supposed. Instead, some are fashioned from desolate stretches of the genome that do not code for any functional molecules. When she looked back at the fish genomes, she saw hints this might be the case: the antifreeze protein — essential to the cod’s survival — had seemingly been built from scratch1. The cod is in good company. In the past five years, researchers have found numerous signs of these newly minted ‘de novo’ genes in every lineage they have surveyed. These include model organisms such as fruit flies and mice, important crop plants and humans; some of the genes are expressed in brain and testicular tissue, others in various cancers.

More here.

Sunday Poem

 Chanting the Mountains

Say: “Mountains are sacred”

because mountains are born from contracting tectonic plates––
because mountains live on a quarter of the planet’s surface––
because mountains shape local and global climates

Say: “Mountains are sacred”

because mountains nourish trees, animals and food crops––
because mountains house native peoples, minorities, and refugees––
because mountains create corridors for migrating species––
because my family lives on a submerged mountain––

Say: “Mountains are sacred” 

because mountains capture moisture from the atmosphere––
because mountains filter aquifers and source rivers––
because mountains provide freshwater for half of humanity

Say: “Mountains are sacred” 

because what else do you call places that are always being desecrated
by corporations, armies, and nations––
who clearcut, detonate, drill, mine, extract, and pollute––
who violently remove mountaintops––
who violently remove entire mountains

Say: “Mountains are sacred”

because we say stop!
this is our center of creation–––stop!
this is where we bury and honor our dead––stop!
this is where we pilgrimage, worship, and make offerings––stop!
you are hurting our mountain elders

Say: “Mountains are sacred” 

because there once was a mountain here––
because this deep opened wound was once home

Say: “Mountains are sacred”  Read more »

Looking at trump through the eye of georges bataille

Ethan Weinstein in 3:AM Magazine:

Through his political and theoretical writings he confronted the fascism and bigotry he saw in his native France. Living in occupied Paris, Bataille gathered a group of anti-fascist intellectuals working to fight totalitarianism. He was a staunch supporter of European Jews, vowing never to shake hands with an anti-Semite. In light of the political and historical turmoil he witnessed in twentieth-century Europe, one might wonder how a thinker with such diverse interests would understand the unlikely rise of a politician like Donald Trump who echoes dictatorial rulers in an uncomfortable, if seemingly haphazard fashion.

By feeding on the bigoted beliefs and economic struggles faced by white, working-class Americans, Trump’s governing style is in line with a wave of fascism rising across the globe. His words fuel his supporters hate, justifying discrimination and causing the Republican party to swing even further to the right. In response to dictators he observed who appeared to wield power more like monarchs than political leaders, Bataille defined a new form of sovereignty fit for his own times: “Let us say that the sovereign (or the sovereign life) begins when, with the necessities ensured, the possibility of life opens up without limit.” The sovereign life cannot exist when one is consumed by the economic struggles of the average citizen. The working man slaves away all day in order to ensure necessities whereas the sovereign man need not work—everything is already guaranteed.

More here.

Our democracy today is dominated by the old.

Astra Taylor in the New York Times:

Older people today hold disproportionate power because they have the numbers and the means to do so. People 65 and older, for example, are more than three times as likely to make political donations as those under 30. As a result, their voices, amplified by money, carry farther politically than those of the young and impecunious.

There are a lot of voices in their chorus. The American electorate is the oldest it’s been since at least 1970 and is graying at a rapid clip, with the well-off living longer than ever before. By 2034, according to the Census Bureau, the population 65 and older will exceed the population under 18; by 2060 the 65-and-older crowd is projected to have almost doubled. There are some 74 million baby boomers alone, and when election time comes, they turn out in droves. During the 2018 midterms, 64 percent of citizens ages 54 to 72 cast a ballot, compared to 31 percent of eligible voters 29 and under.

“Money, numbers and power have been inexorably accruing to the aging ‘baby boomer’ generation for the last few decades,” the political scientist John Seery warned in his 2011 book “Too Young to Run?” The trends show no signs of slowing. Migration to metropolitan centers by people who tend to be younger and more diverse, along with rural depopulation and aging, will only intensify age-based inequities given the geographic biases of the American electoral system. Call it the coming gerontocracy.

More here.