by Azra Raza

All of the articles in this series can be found here.

Ninety percent cancers diagnosed at Stage I are cured. Ninety percent diagnosed at Stage IV are not. Early detection saves lives. Unfortunately, more than a third of the patients already have advanced disease at diagnosis. Most die. We can, and must, do better. But why be satisfied with diagnosing Stage I disease that also requires disfiguring and invasive treatments? Why not aim higher and track down the origin of cancer? The First Cell. To do so, cancer must be caught at birth. This remains a challenging problem for researchers.

Cancer is a silent killer. To sight its diverse neonatal guises and behavior, we need to get more creative. Maybe change direction and look for the earliest stages of carcinogenesis in people who don’t have cancer yet but are at high risk of developing it. But what should we be looking for? Among many possibilities, one answer is Giant cells. This installment of the series on cancer is devoted to how, when and why these weird distended, strikingly abnormal looking gigantic cells appear in tumors and in the blood of cancer patients.

Giant cells: Hiding in plain sight

First identified in 1838 by Muller, and described with beautiful accompanying illustrations by Virchow in 1858, bloated giant cancer cells with many nuclei, have been regularly seen in tumors and labeled as dying or degenerating cells, incapable of dividing, and therefore of no importance. Besides, in fully formed cancers, they are extremely rare, close to negligible. Their number increases during relapse of cancer after treatment has destroyed the majority of tumor cells. Giant cells appear when there are no other cancer cells and disappear when cancer cells reappear.

A pair of coincidental happenings led me to conclude that cancer might originate in two cells that fuse and cooperate for mutual benefit, forming a Giant cell. Most likely, an exaggerated response to stress in the organ (infection, toxic exposure?). Read more »

by Usha Alexander

[This is the eleventh in a series of essays, On Climate Truth and Fiction, in which I raise questions about environmental distress, the human experience, and storytelling. All the articles in this series can be read here.]

In the beginning, the god of the Biblical creation myths makes the Earth and sky. Over the next several days, he makes the sun, moon, and stars, grasses and fruit trees, most of the animals, and rain. Then, scooping up a bit of fresh mud, he molds a being who looks much like himself, a man, and into this homunculus he breathes life. As a dwelling place for this newborn Adam, he plants a lavishly abundant garden, filling it with beautiful and delicious plants. The creator tells Adam, “Of every tree of the garden thou mayest freely eat. But of the tree of the knowledge of good and evil, thou shalt not eat of it, for in the day that thou eatest thereof thou shalt surely die.” Then, realizing that Adam might feel lonely, the deity gives him cattle, fowl, and all the “beasts of the field.” Yet none of these quite seems a suitable companion, so from one of Adam’s ribs, god fashions a woman.

Quite pleased with his handiwork, the divinity instructs his new humans on how to live. He tells them they must increase their population. They must also replenish the Earth, and in doing so, subdue it and exercise dominion over all its living things. The almighty then leaves the newlyweds alone to get on with their business of eating, procreating, replenishing, and dominating, which they apparently take to just fine. Indeed, neither of the pair has any memorable comment on their situation, until the day Serpent piques Eve’s curiosity, telling her that if she and Adam were to eat from the one forbidden tree, rather than die, “your eyes shall be opened, and ye shall be as gods, knowing good and evil.” Now Eve takes new notice of this tree, understanding that it could make her “wise.” Enticed, she picks a fruit and munches it. Whatever she discovers then—new knowledge or wisdom or just fine flavor—is simply too good not to share with her husband and, despite their creator’s clear injunction to him, Adam follows his wife’s lead. Yet soon the hapless couple realize that this new state they find themselves in—their eyes having been opened—is indeed problematic. They seem to have transgressed some cosmic order and find themselves possessed now of a discomfiting self-awareness, of moral judgments and political motives, just like the god who made them—and distinctly unlike the beasts they lived among. Read more »

by Pranab Bardhan

All of the articles in this series can be found here.

In long plane journeys I do not sleep well. But some years back in one such journey I was tired and fell fast asleep. When I woke up, I saw a little note on my lap. It was from the captain in charge of the plane. It said, “I did not want to disturb you, but from our computer log I could see that your total travel so far with our airlines group just crossed 3 million miles. So congratulations! It seems you travel almost as much as I do.” I made a quick calculation, 3 million miles is like 6 return trips from the earth to the moon. With a deep sigh I chanted to myself, as our plane was hurtling through the night sky, a word from an ancient Sanskrit hymn: Charaiveti (keep moving!)

There was a time when, for me as a young boy, a rare trip from one part of my city to another was a breathless adventure. I grew up in the mean streets of Kolkata (then known to others as Calcutta), spending much of my boyhood and youth in a cramped rented house on a narrow by‐lane of north Kolkata, with no running water or flush toilet, and all the rooms packed with refugee relatives from East Bengal, recently displaced by the violent Partition of India. My father, as an educator, was not very poor by Indian standards, but for a time he had to support most of those relatives. He had no savings as whatever was left of his paltry income he spent on good food and books. Very early in my childhood he instilled in me an appetite for both, and also the habit of rational, irreverent thinking and a deep sense of irony. Read more »

Helina Metaferia. The Empress returns, 2018.

Collaged paper.

More here, here, and here.

Thanks to Anjuli Raza Kolb for the tip!

by Michael Abraham-Fiallos

The day is a collision.

The day is a collision of the body with itself, of the body with the space in which it finds itself, of the body against the sunlight which only ever heralds bad news in a mind like mine. Restlessness seizes all four limbs (an inconsistent phenomenon, brought on today by antipsychotics and an iced coffee), and anxiety churns in the stomach, in the empty spaces of the chest. The eyes look but don’t see; the eyes rush around, from this corner of the room to that corner of the room. The floor is mopped, the bathroom scrubbed. But there is the kitchen to do and a pile of laundry on the bedroom floor. These are little matters. These should not bother so much, I tell myself: “You should breathe. You should listen to your father and refuse to sweat the small stuff.” But, the day is a collision. There is no past to this day, nor is there any future in it. There is only the day, its imbalance, its summertime mad feeling, its ennui. I try sleeping in late to run the clock down, but I don’t sleep. I try to watch a movie to block out the brightness outside, but my toes just tap-tap the floor. I walk the dog, and I feed the cat. I lie down again. But, the body collides with the body, twists and folds and tenses. This is summertime. 

You have had days of collision, I’m sure. They’re silly, really, on the other side of them. There is nothing silly about them as they happen however, and there is nothing silly about having the kind of brain which experiences collision less as a matter of the day as it does a matter of the season. I decide finally that what I’ll do is hit the daylight head on, that when it reaches late afternoon, and the day is at its hottest, I’ll go to the pool, Thomas Jefferson Pool on E 112th, in the park. My husband says he would rather nap, and secretly this is good: his day is not a collision; it has the normal dose of future and past in it, the normal dribblings of good cheer. “Why not go by yourself and get it out of your system?” he asks. When he says this, I know he means: get the desire to swim out of your system. I take it differently though. Out of the system, yes; something begs to be expurgated from the system. As I walk to the gas station to buy my summer padlock (you’ve got to have a padlock for the pool, and I lose mine every fall), in my husband’s Nike slides and cute trunks, a Dragonball Z t-shirt and bright pink knock-off Ray Bans, I recognize a kind of pilgrim feeling inside myself, the gentle hush that comes over those who march somewhere sacred. How funny to feel like the public pool is a shrine. I told you: days of collision are silly.  Read more »

by Danielle Spencer

My parents keep an official list of “Things We Disagree About.” There are many prerequisites for a disagreement to make the list, but the most important is that it must be both meaningful and intransigent. They tend to maintain a cheerful agreement about the list rankings, which evolve over time—though the number one slot is always the same: the designated hitter rule in baseball. My mother is anti, my father pro, and never the twain shall meet (though the twain shall probably never stop debating it).

Now, the DH rule doesn’t come up so often in everyday life, or at least not much in the off-season. But there’s one item that does arise all year round, one that’s part of their shared lives, every day. When we open this Pandora’s box and slide out the top drawer, we start plucking out matters of taste and preference; but if we reach in for the larger bottom drawer, we find ourselves hefting the unwieldy building blocks of their respective ideologies. This issue is a daily enactment of—and metaphor for—their lives together. It is a timeless debate: How to load the dishwasher.

In fact they do agree about some of the basics. To pre-rinse or not to pre-rinse: that is a question so fundamental that it’s hard to imagine how any couple can successfully straddle the divide. Thankfully my parents, for the most part, both come down peaceably on the no pre-rinsing side. But then what typically happens is that my father loads the dishwasher somewhat haphazardly, using perhaps half of the dirty dishes piled on the counter and absently adding some wood-handled knives. When, with blissful satisfaction, he starts to close it, my mother intervenes. “You can fit so much more,” she mutters, busily re-ordering and compacting the plates, adding all the remaining dishes from the counter and removing the knives. Of course she’s right—she can usually fit about twice as much as he does—but inevitably he stands in a pool of annoyance, watching her re-do his labors. Read more »

by Brooks Riley

I learned from reading Terry Donahue’s obituary in the Los Angeles Times he became head coach of UCLA’s football team in the same year I became a Bruin freshman. And we spent our formative years as neighbors but since we were 14 years apart, we never met.

Read more »

by Rafaël Newman

History is the one true fatality: you can re-read it as much as you like, but you can’t re-write it. —Laurent Binet

One of my oldest friends, an economic historian who serves as the Academic Director of a museum of Jewish life in northern Germany, is, like me, a child of May; and, during our recent birthday month, as is our custom, we exchanged gifts by post. Since we also share a love of books and history and a taste for grand, occasionally outlandish theory, as well as an abhorrence for futuristic science fiction, the novels we sent each other were in equal measures fantastical and backward-looking: examples of counterfactual historical fiction, what has come to be known as uchronia, the imaginative remaking of a bygone era that is the temporal counterpart to utopian geography.

The birthday book I received from my friend, Der Komet (2013), by Hannes Stein, a German foreign correspondent in the US, re-imagines the 20th century without the colossal conflicts that grew out of the assassination of Archduke Franz Ferdinand in 1914. “One billiard ball clicks against the next,” Stein writes, in an appendix detailing the events elided (or avoided) by his alternative history: “The shots fired in Sarajevo >> the First World War >> the Second World War >> the end of the colonial empires, since imperialism had become too costly for the colonial powers.” Stein’s intricate, multi-character novel is set in an Austro-Hungarian Empire still in existence in the year 2000, one in which the Polish and Ukrainian questions have been settled in a series of minor skirmishes and peaceful negotiations, and assimilated Jews pursue their careers unmolested by a fringe party of anti-Semites. Stein mingles nostalgia for the Habsburgs with an implicit and rueful recognition of the progress that was in fact born of war in the actual 20th century: not only the waning of colonial domination, which in Stein’s world is still carried out only by the “barbarian” Japanese in China, but also the spread of pan-European female suffrage, which in Der Komet has only come, with veritably Swiss tardiness, following the revolts of 1968.

Der Komet’s resuscitation of vanished empires is reminiscent of the encomia for imperial cohabitation that appeared in some otherwise liberal quarters when the USSR was disintegrating, and Yugoslavia was going up in smoke, in the 1990s. The Ottomans and the Habsburgs may have been bigoted and repressive, the argument ran, but at least they (and, in their image, the regimes of Gorbachev and Tito) had kept the inter-ethnic peace. And indeed, Stein, a naturalized American and right-of-center moderate who switched his party affiliation from Republican to Democrat only with Trump’s rise, has one of his novel’s more sympathetic characters preemptively eulogize the Austro-Hungarian Empire (spoiler alert!) as “reactionary, progressive, and humane”. Read more »

by Alexander C. Kafka

During the pandemic, my family binge-watched the National Geographic Genius miniseries about Albert Einstein, Pablo Picasso, and Aretha Franklin. We imagined ourselves the producers for such a project and considered whom we would select as geniuses to feature.

On my short list would surely be the choreographer, dancer, and entrepreneur Alvin Ailey, whose dance company has become a lasting juggernaut of artistry, entertainment, and pride. 

The entertainment aspect has sometimes bred jealousy and resentment. Some critics have focused on the company’s beautiful, athletic bodies they see as stereotyped, idealized symbols of the Black experience. Ailey scoffed at that critique. If his astonishingly skilled and conditioned dancers raised the physical bar for American concert dance, so be it. And if audiences could understand and relate to his work, all the better. 

“The Black pieces we do that come from blues, spirituals, and gospels are part of what I am,” he shot back. “They are as honest and truthful as we can make them. I’m interested in putting something on stage that will have a very wide appeal without being condescending, that will reach an audience and make it part of the dance, that will get everybody into the theater. If it’s art and entertainment, thank God, that’s what I want to be.”

The pride component is complex. Ailey’s work celebrates Black American pride, of course, but audiences around the world relate and respond to his themes of oppression, struggle, and transcendence. Ailey’s multiracial company became an international craze, through State Department touring, before it became an American one.  Read more »

Shadow self-portrait of my wife and me on the red clay tennis courts in Vahrn, South Tyrol, in mid-June of this year.

by Bill Murray

It wasn’t effortless but we managed to mollify, sidestep and defy enough authorities to be legally resident in Finland for the month of July. Never mind shoes and belts off and toothpaste in a plastic bag. No, do mind; do that too. But add PCR test results, Covid vaccination cards and popup, improvised airport queues. And a novel Coronavirus variant: marriage certificates on demand. 

The pandemic shines stark light down into the engine room, onto the unoiled grinding of international gears. A year and a half in, the lack of coordination between countries is everywhere on woeful display.

The Finnish parliament, unambiguously and unanimously, declared that “Anyone who has proof of being fully vaccinated or having recovered from Covid within the previous six months will be able to travel to Finland without having to undergo a Covid test.”

But then a Delta Airlines official peered into her screen and told us, “it says here no one is allowed to go to Finland, period.” Whereupon the haggling began, and it turns out production of a Finnish passport and our marriage license was sufficient qualification for access to our seats, payment for which was happily accepted with no questions long ago. Read more »

by Azra Raza

All of the articles in this series can be found here.

Cancer has occupied my intellectual and professional life for half a century now. Despite all the heartfelt investments in trying to find better solutions, I am still treating acute myeloid leukemia patients with the same two drugs I was using in 1977. It is a devastating, demoralizing reality I must live with on a daily basis as my entire clinical practice consists of leukemia patients or leukemia’s precursor state, pre-leukemia. My colleagues, treating other and more common cancers, are no better off. I obsess over what I have done wrong and what the field is doing wrong collectively.

Cognitive Biases in Cancer Research

The Nobel Laureate Daniel Kahneman was speaking to Krista Tippet on NPR about the faulty hardwiring of our brains and the cognitive biases that provide ongoing confirmation for the erroneous assumptions we regularly and naturally make (May 9, 2021). To illustrate his point, Kahneman recounted a sweet personal story. Some years ago, he and his wife returned from dinner with friends and were casually talking about the couple they had been with when his wife declared, “He is sexy.” As Kahneman pondered this possibility, trying to decide if he agreed or not, she then said something quite shocking, “He does not undress the maid himself.” Kahneman stared at his wife in disbelief. What could she possibly mean by this bizarre statement? What he should have done next was to ask himself, “But this is so uncharacteristic of her that there must be an error on my part”. Instead, he demanded to know what on earth she meant. And of course, what she had actually said was, “He does not under-estimate himself.”

There are some 180+ entries listed by Wikipedia as examples of these cognitive biases. Among these, the confirmation biases are particularly problematic where scientists are concerned. Science is a discipline devoted to the strictures of methodology based on formulating a hypothesis, designing experiments to test the hypothesis, and modifying the original proposal as needed through precise measurements and observations. Critical evaluation is the backbone of the scientific method. Yet, given the tendency toward cognitive biases, we become less critical, more readily accepting of emerging information that confirms our existing hypothesis, and we ignore the parts that don’t quite fit in. With time, this type of “confirmation bias” in support of a half-baked hypothesis builds up and an entire field is hijacked by its loud and powerful proponents.

I have regularly witnessed this during a four-decade long career in oncology research. Read more »

Michael Armitage. Pathos and The Twilight of the Idle. 2019.

Oil on Lubugo bark cloth.

More here and here.

by Claire Chambers

Covid-19 has led to various reactions akin to the various phases in the process of grieving. Davide Bertorelli observes in his chapter for The World Before and After Covid that ‘people have experienced differing degrees of anxiety, panic and disruption in every aspect of their lives’. Given what Bertorelli calls our current ‘mild collective psychosis’, it behoves us to learn from the previous global pandemic, the HIV/AIDS crisis.

HIV is a virus that contains single-stranded ribonucleic acid (RNA), as does SARS-CoV-2. Transmission is by blood-borne infection through bodily fluids: blood, semen, and saliva. Typical routes are via sex, needles for intravenous drugs or blood transfusions, or vertical transmission from mother to baby. Like all viruses, HIV (human immunodeficiency virus) gets taken up into the host’s cells, mostly the white CD4 T cells. The virus then uses the host’s equipment to reproduce its own RNA. After killing off the helper T cells, HIV bequeaths the host an immunodeficiency.

HIV infections have three different phases. First is the primary infection stage, known as seroconversion, when the disease is caught. It usually takes seven to 21 days for patients to show the illness in flu symptoms and a rash. Then they get better and the virus lies dormant, possibly for years. The second phase is persistent generalized lymphadenopathy: carriers manifest swollen glands for quite some time but are otherwise healthy. The third phase is acquired immune deficiency syndrome itself, where patients develop an AIDS-defining illness. Opportunistic infections such as aspergillosis, cryptococcosis, candidiasis, toxoplasma, and cryptosporidium have famously been devastating for people with AIDS. Their immune systems cannot cope, whereas healthy people can easily fight off such infections. In addition to the AIDS-defining illness, the other characteristic of AIDS is that sufferers have a low CD4 count. Read more »