Dr. Antonio “Tito” Fojo specializes in the management of patients with adrenocortical cancer, malignant pheochromocytoma, neuroendocrine malignancies, and thyroid cancer; his current laboratory efforts are focused on developing therapies to treat such patients. Dr. Fojo has worked to understand the molecular basis of drug resistance, he was involved in the original work relating to several ABC transporters and identified rearrangements involving the MDR-1 gene as a novel mechanism of drug resistance in several cancers. He has also been very involved in research on microtubule-targeting agents. In addition to his clinical expertise Dr. Fojo is involved in the design, conduct and interpretation of oncology clinical trials and his collaboration have helped to pioneer a novel method of analysis that dissects rates of tumor growth and regression as concurrent events.

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 Mindy Clegg

This past week has been a roller coaster in American foreign policy, as we quite nearly ended up in a hot war with Iran. A curious phenomenon reared its ugly head during the fallout of the assassination of Qasem Soleimani, one of Iran’s top generals—comparisons to the start of the First World War’s precipitating event, the shooting of the Archduke of the Austro-Hungarian empire Franz Ferdinand.¹ As we all seriously contemplated another war, some leaned into the notion of its inevitability. Many would have you believe a Third World War was history merely asserting itself once again.² Supporters of a war with Iran (and other wars) might tell you that war is a glorious thing, that our young will cut their teeth on violence and blood, coming out the other side battle hardened, ready to tackle the “real” world with both hands. At the very least, we’ll defeat our enemies and ensure our continued dominance of the world, which we deserve. They might also proclaim that war is the only racket in town that will get our economy jumping again, exciting innovation through shattered bodies. I could not agree less with these assessments, and history most certainly backs me up here. First, with a few exceptions, there is no inevitable path to conflict—history shows us there are always choices. Second, young people are often shattered by participation in war, as our homeless population still replete with veterans of various wars attest. Last, many things can jumpstart innovation. I argue that making parallels to events of the past in order to draw conclusions about the inevitability of particular outcomes (the ones that benefit the fewest and hurt the most, like a war) is to misread or even blatantly misuse history and what it actually tells us about humanity. Read more »

by Brooks Riley

A slow exposure photo from a bus window between Bruneck and Franzensfeste, taken in December of 2019.

by Eric J. Weiner

The allure of fresh and true ideas, of free speculation, of artistic vigor, of cultural styles, of intelligence suffused by feeling, and feeling given fiber and outline by intelligence, has not come, and can hardly come, we see now, while our reigning philosophy is an instrumental one. —Randolph Bourne

Schoolteachers across the grades are responsible for teaching their students how to write. Their essential pedagogical role is instrumental. With particular attention paid to format, grammar, spelling, and syntax, students ideally learn to write what they know, think, or have learned. It matters little if the student is in a class for “creative writing” or “composition,” writing is taught and practiced as a way to record thoughts, compose ideas in a coherent manner, and clearly communicate information. A student’s writing is then assessed for how well she adhered to these instrumental standards while the teacher is assessed for how well she adhered to the standards of instrumental teaching.

By contrast, writing to learn re-conceptualizes our relationship to writing from measurable outcomes to critical/creative processes. It moves the epistemological needle from instrumentality to exploration, innovation, imagination, and discovery. Writing to learn supports the development of what Randolph Bourne (1917) called “poetic vision.” Having poetic vision diverts our “creative intelligence” away from “the machinery of life” and redirects our “creative desires” toward enhancing the quality of life. “It is the creative desire,” Bourne writes, “…that we shall need if we are ever to fly” (from Twilight of Idols). Read more »

by John Schwenkler

What is the point of being courteous, kind, and otherwise well-mannered?

I suspect that most of us are inclined toward an answer that parallels Thrasymachus’ view of justice in the early books of Plato’s Republic. For Thrasymachus, what really matters to us where questions of justice are concerned is all on the side of self-interest. We care about justice in others only to the extent that it brings benefits to us and our friends, and we care about embodying justice in our own lives only to the extent that justice wins us friends, while unjust action carries the risk of punishment and social sanction. The attractiveness of this view comes out in Plato’s famous retelling of the myth of Gyges: given the power to act either justly or unjustly without being detected by others, any of us would choose the life of total injustice. In themselves, the demands of justice are at odds with the desires of naked self-interest, and the only thing that motivates us to respect them is the fear of what will happen to us if we don’t.

An analysis along these lines is even more attractive in connection with the traditional demands of courtesy. Many of us will have the sense that there is — or at least could be — something objectively, universally wrong with stealing, lying, murdering, or imprisoning a person without proper cause. By contrast, no such status accrues to the demand to wear a collared shirt to work or put a napkin on one’s lap while eating: customs like these are contingent, local practices a large part of whose purpose is to mark off the one who observes them as a member of polite society. Meanwhile, even those aspects of good manners whose justification seems more fundamental, such as keeping disparaging thoughts to oneself and refraining from interrupting one’s conversational partners, are all such as to be dispensable in certain situations. What force do they have, then, except as the impositions of an oppressive, socially stratified culture? Read more »

Sughra Raza. “It’s a Shady World”, Boston, September, 2019.

Digital photograph.

Dr. Steven Fruchtman is a hematologist with extensive industry experience in clinical research for myelodysplastic syndromes, hematologic malignancies and solid tumors. He is an author of more than 170 lectures, presentations, books, and chapters. Previously, Dr. Fruchtman served as the Director of the Myeloproliferative Disorder Program at Mt. Sinai Hospital in New York City and established the Stem Cell Transplant Program there. Dr. Fruchtman currently serves as President, Chief Executive Officer and Director at Onconova Therapeutics, Inc. in Pennsylvania. He is also on the board of The Bone Marrow Foundation.

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 Rafaël Newman

When Bob Dylan was awarded the Nobel Prize in Literature in 2016, the poet Nora Gomringer expressed her satisfaction at the recognition thus afforded not only poetry, but in particular songwriting, which she identified as the very wellspring and guarantee of literature, citing in her appraisal such classical forebears as Sappho and Homer. In an article published in the Neue Zürcher Zeitung, Gomringer mocked the conventional Western view of letters, a canon founded on prose and the novel, and now challenged by the award to Bob Dylan: “Literature is serious, it is beautiful, it is a vehicle for the noble and the grand; poetry is for what is light, for the aesthetically beautiful, it can be hermetic or tender, it can tell its story in a ballad and, if especially well made, can invite composers to set it to music…”. But “such categories”, she went on to suggest, “are stumbling blocks and increasingly unsatisfying, since they have ceased to function”, in part because of the Academy’s willingness to step outside its comfort zone and award the prize to a popular “singer/songwriter”.

The Nobel Committee, according to Gomringer, had thus acknowledged the primordially hybrid nature of literature, the inextricable relationship between sound and sense, meter and message that had from the outset refused to differentiate between music and verse, but rather had created the two simultaneously, a marriage of the Apollonian and the Dionysian that would be variously contested by purists in subsequent generations, but would never entirely disappear.

The Academy’s own rationale for its choice in 2016, however – that Dylan was distinguished “for having created new poetic expressions within the great American song tradition” – proposes a slightly different account of the intervening literary history, and a different agenda: an existing musical idiom, it suggested, had been revitalized by the advent of a novel lyrical form. Read more »

by Brooks Riley

by R. Passov

The economics of health insurance is of particular importance today. Health insurance has become a major issue of public policy. Some form of national health insurance is very likely to be enacted within the next few years. —Martin Feldstein ¹

Fifty years ago, when healthcare expenditures were a mere 6% of US GDP, Martin Feldstein was afraid that the seemingly imminent adoption of some form of national health insurance would cause health care spending to grow unchecked.

Turns out, like many economists, he was half right. While a truly national health scheme is still in the making, health care spending is now 18% of GDP, and growing.

Feldstein, known to his friends as Marty, was an interesting guy. For outstanding contributions to economics by an economist under 40, he was awarded the Bates Medal. He was President Reagan’s chief economic advisor, a long-time teacher at his alma matter, Harvard, and managed to retain the presidency and CEO titles at the National Bureau of Economic Research (NBER) from 1977 until his passing in 2019. (He stepped aside from 1982 to 1984 to serve Reagan.)

The NBER describes itself as a private, non-profit research organization and then adds that it has been the source for most leaders of the Council of Economic Advisors. The Council is in fact a government entity, constituting the chief economic advisors to the Office of the President, while the National Bureau, which sounds like it is, is not.

Anyway, fifty years ago, Feldstein took his economics – the ‘markets solve everything’ kind – and reached the following conclusion: The problem with healthcare is Health Insurance. Eliminate insurance wrote Feldstein, and market forces would reign in the runaway price of health services. Read more »

by Bill Benzon

Mark Moffett’s The Human Swarm: : How Our Societies Arise, Thrive, and Fall (Basic Books 2019) is nothing less than a comprehensive review and synthesis of the academic literature on social life in humans and a wide variety of animals, including, among many others, ants, whales, jays, wolves, and chimpanzees. While written for general readers, this book will repay academic specialists of various disciplines in the humanities and social sciences.

It is at heart a work of natural philosophy, an old term not in much use anymore. Moffett is interested in what constitutes society: how do we differentiate between insiders and outsiders? To do so he surveys the animal world and follows the distinction in the evolution of human societies from hunter-gatherer groups to the current day. Though Moffett has the skills and credentials of an academic specialist (he has a Harvard Ph. D.), he has written the kind of book specialists are discouraged from writing. That is all the more reason why those specialists must join interested “civilians” in reading The Human Swarm. For it is in books like this that many narrow specialized understandings are combined and synthesized into a more comprehensive understanding, in this case, understanding of the critically important issue of social identity. Read more »

View from my window of the mountain called Riol in early winter of 2019.

by Bill Murray

This is Part Two in a series. Read Part One here.

Sooner or later even the best laid plans come full stop at the bureaucrat’s desk. At the entrance to Ngorongoro crater, Tanzania, we pull up short at a moldy branch of officialdom, no less out of place than some forlorn Chinese outpost on the Tibetan steppe. This requires twenty minutes of perfunctory paperwork, at night.

Stamp pads come out, ledgers are opened, numbers and details are transcribed and we will not proceed until the clerks accede. Which finally they do.

Difficult to get our bearings, arriving in the dark. There is only the tiny new moon that heralded Eid-al-Fitr, the end of Ramadan, and there are no lights out there because there is nothing built in the crater. We gaze into the gaping chasm for a while and then go off to eat.

I don’t know about this place. The restaurant is thatch-roofed, and the sound of gentle rain is comfy, but it’s scary how big and full the dining room is.

“We have more than 140 guests,” The server beams. I stare into my rice.

You want to be the only ones, the wilderness, the animals – Africa! – all to yourself. But this place is not like that.

Still, the shower is hot and a candle is provided. Alongside the candle is a matchbox with two, count ’em, matches. “Cleanext” brand tissues. Power goes out sometimes. Then it’s so dark you can’t even begin to see a thing outside. Not one thing. Anywhere. Clouds cover the little moon. Just 100% dark. Totality. Read more »