Dr. Larry Norton, a breast oncologist, is well-known as a leader in the development of drug treatments for breast cancer. His research has established the importance of using sequential combinations of drugs — a strategy aimed to overcome different drug sensitivities among the cells in a tumor. He has served in leadership positions in several national cancer-related organizations, including serving as president of the American Society of Clinical Oncology (ASCO) in 2001-2002, and is chairman of the board of directors of the ASCO Foundation. Currently, Dr. Norton is serving as the Senior Vice President at Memorial Sloan Kettering Cancer Center and a Professor of Medicine at Weill-Cornell Medical College with over 350 published articles and book chapters to his name.

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?

by Anitra Pavlico

“Vivi felice (live happily)” —Domenico Scarlatti, in the introduction to his Essercizi per Gravicembalo (Exercises for Harpsichord), 1738

Domenico Scarlatti (1685-1757) refuses to be put into any particular category, despite generations of music historians’ efforts. Scarlatti scholar W. Dean Sutcliffe begins his 2003 book The Keyboard Sonatas of Domenico Scarlatti and Eighteenth-Century Musical Style with the blunt statement, “Domenico Scarlatti does not belong.” Scarlatti was born in Italy, but spent the last thirty years of his life in Spain. He was not quite Baroque, not quite Classical. In his review of the Sutcliffe book, Michael Talbot describes Scarlatti as a “cult figure” who is “neither inside nor outside the canon. He is not seminal in the sense of forming a link in a historical chain either of composers or of performers, but his influence is clearly perceptible in the literature of keyboard instruments from Haydn to Ligeti.” As disparate as their styles might appear, Franz Liszt was an early champion of Scarlatti’s sonatas, and was perhaps the first to perform them publicly. Chopin was also an admirer. Talbot says that Beethoven must have written the second movement of his Op. 54 piano sonata with the ghost of Scarlatti looking over his shoulder. 

Sutcliffe views the concept of “disdain” as central to Scarlatti’s approach: the term, first applied to the composer by Italian musicologist Giorgio Pestelli, connotes a deliberate rejection of convention. Scarlatti is well-versed in, but does not fully adopt, the conventions of the galant musical language in vogue at the time. In short, the galant style was a response to the complexity of the Baroque period and featured simpler melodies, phrasing, and harmonies. Rules are well and good for lesser composers, apparently, but Scarlatti reportedly was of the opinion that his deviations from the rules were “sanctioned by the pleasure that they gave the ear.” Janet Schmalfeldt writes that Scarlatti is “intriguing” in his evasion of stylistic classification, a “smart move” on his part: he was seemingly ahead of his time, given the modern disillusionment with stylistic categories and sharp boundaries between historical periods. Read more »

by Michael Klenk

Moral psychology has shaken up moral philosophy in recent years (see, e.g., here and here). The upheaval is welcome. Understanding better how ethical judgements work should eventually lead to positive behaviour change. For example, we might hope for more altruism to solve collective action problems like climate change, and less in-group vs out-group thinking, to curb racism.

So far, however, moral psychology’s impact on ethical conduct has mostly been within the narrow confines of academic journals. The philosophers who took up moral psychological findings mainly focus on rather abstract questions about the theory of knowledge and methodology in ethics. For example, a significant debate concerns the question of whether moral judgments remain warranted given evidence of their psychological origin (see, for example, some of my previous blogs here and here).

Notwithstanding the fascinating nature of such meta-ethical questions, it is a long way from progress in these theoretical debates to effecting positive behavioural change in people. Indeed, moral psychology’s practical impact has not been a focus of much academic work yet.

Our hope may rest on what we can call ‘trickle-down ethics,’ where the revelations of ethicists trickle down to all of society eventually. Moral psychology may impact moral philosophy, and so the impact of moral psychology on moral philosophy may finally be felt in practice, too. However, there is no clear evidence for the success of trickle-down ethics, and blindly trusting it can be frustrating. After all, engaging in moral philosophy is a way to understand what ought to be done, and why, and then to do it – not merely hoping that something eventually gets done. Even if moral philosophy as a discipline has illuminated the ‘understanding’ part, we leave the ‘practice part’ almost entirely to an ill-founded hope in trickle-down ethics. So, blind trust in trickle-down ethics is probably up for a displeasing reality check, especially if the frail prospect of trickle-down economics is any indicator. Read more »

by Brooks Riley

by Shadab Zeest Hashmi

One autumn I’m suddenly taller than my mother. The euphoria of wearing her heels and blouses will, for an instant, distract me from the loss of inhabiting the innocence of a child’s body—the hundred scents and stains of tumbling on grass, the anthills and hot powdery breath of brick-walls climbed, the textures of twigs and nodes of branches and wet doll hair and rubber bands, kite paper and tamarind-candy wrappers, the cicada-like sound of pencil sharpeners, the popping of coca cola bottle caps, of cracking pine nuts in the long winter evenings— will blunt and vanish, one by one.

That the sensory life is dulled just as the cerebral life is intensified, is no accident; at school, boys and girls are separated for a special talk on how the changing body requires a set of rules, a sense of restraint. The talk is grave and ends with alarming details of the impending burden of academic work that will make or break us. As if the process of adapting to a new life in a new body were not hard enough, we are told that we are under scrutiny for following the prescribed path of success as well as for containing the challenges that gender poses.

The body is as unforgiving as the social norms it finds itself in the clutches of; it is more often a tempest than a temple. Growing pains, at least for girls, must be strictly private. How you decipher and piece together the physical, emotional and social puzzle of your life is entirely and urgently your own responsibility and never without open and free scrutiny and judgement. The present is a perpetual shore to an ocean of future anxiety; there is no turning back. Without sisters or close female company, I am alone now in this space of being a girl and I always will be as a woman. Read more »

by Chris Horner

The question of how to program AI to behave morally has exercised a lot of people, for a long time. Most famous, perhaps, are the three rules for robots that Isaac Asimov introduced in his SF stories: (1) A robot may not injure a human being or, through inaction, allow a human being to come to harm; (2) A robot must obey orders given it by human beings except where such orders would conflict with the First Law; (3) A robot must protect its own existence as long as such protection does not conflict with the First or Second Law. These have been discussed, amended, extended and criticised at great length ever since Asimov published them in 1942, and with the current interest in ‘intelligent AI’ it seems they will be subject for debate for some time to come.  But I think the difficulties of coming up with effective rules of this kind are more interesting for what they tell us about the difficulties of any rule or duty based morality for humans than they are for the question of ‘AI morality’. 

Duty based – the jargon term is ‘deontological’ – morality seem to run into problems as soon as we imagine them being applied. Duties can easily seem to clash or lead to unwelcome outcomes – one might think that lying would be justified if it meant protecting an innocent person from a violent person set on harming them, for instance. So which duties should take precedence in the infinite number of future situations in which they might be applied? Answering a question like that involves more than coming up with a sequence of rules, as there seems to be something one needs to add to any would-be moral agent for them to really exercise an adequate moral judgment. Considering the problems around this is more than a philosophical parlour game as it should lead us into more realistic ways of thinking about what it takes to act well in the real world. What we are looking for, I think, is an approach that takes into account the need for genuinely autonomous moral thinking, but also connects the moral agent to the the complicated social world in which we live. Read more »

On the tarmac at Innsbruck airport just before boarding this Airbus A320 jet to Berlin last week. It is always exciting to land at or takeoff from Innsbruck because of the surrounding high mountains.

by Adele A Wilby

It is unlikely that any of us will escape the experience of grief during the course of our lifetime. Throughout that experience, many of us will struggle to find the words that adequately convey what happens to us during that period, and the disruption to our lives that grief brings will be understood as normal in the circumstances. Unable to console the bereaved, and with good intentions, ‘time’ they reassure us, ‘is a great healer’, and there is some truth in that adage.  But ‘time’ itself can also be the very source of confusion in grief, although most of us fail to recognise it as such throughout a bereavement, and we are left wondering what it is about that feeling of being out of the world that I, for one, experienced following the death of my husband. Why, apart from all the other manifestations of grief, did I feel ‘suspended’ from life, yet still alive and living, as I stood and stared out the window of my sitting room, and watched the world go by? I considered myself to be a competent person capable of ordering my life, yet I was impotent in my ability to change what was happening to me. Why did I find it so impossible to act, and get back ‘into’ the world? Read more »

by Tim Sommers

We are all in some sense equal. Aren’t we? The Declaration of American Independence says that, “We hold these Truths [with a capital ‘T’!] to be self-evident” – number one being “that all Men are created equal.” Immediately, you probably want to amend that. Maybe, not “created”, and surely not only “Men” – and, of course, there’s the painful irony of a group of landed-gentry proclaiming the equality of all men, while also holding (at that point) over 300,000 slaves. But don’t we still believe, all that aside, that all people are, in some sense, equal? Isn’t this a central and orienting principle of our social and political world? What should we say, then, about what equality is for us now?

In September, Professor Elizabeth Anderson was awarded a MacArthur Fellowship, a so-called “genius grant”, for her work in political philosophy. Though the Foundation specially cited the way she applies her views, pragmatically, to “problems of practical importance and urgency” (most recently with books on race, “The Imperative of Integration”, and work, “Private Government”), the theoretical backbone of her view is a new, original account of social equality – relational or democratic egalitarianism. In a seminal 1999 article, “What is the Point of Equality?”, Anderson asked rhetorically, “If much recent academic work defending equality had been secretly penned by conservatives, could the results be more embarrassing for egalitarians?” Her point was that at the same time that new egalitarian social movements, or at least newly reinvigorated egalitarian movements, focused on race, gender, class, disability, sexual orientation, and gender expression, the dominant form of academic egalitarian political philosophy (“luck egalitarianism”) spent a lot of time arguing about lazy surfers, people “temperamentally gloomy, or incurably bored by inexpensive hobbies”, and those who couldn’t afford the expensive religious ceremonies they wanted to perform. Granted, the characters that inhabit philosophical hypotheticals are bound to be a quirky lot, nonetheless, Anderson wondered what had happened to oppression as the main subject of political philosophy?

Well, here is one way, probably the dominant way in political philosophy, of thinking about equality before Anderson. The notion of equality seems to demand a quantitative comparison. To be equal is to have an equal amount of something. An egalitarian society, then, is one where (certain) things are distributed equally. Call this distributive justice. Read more »