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 »

Two young men greeted a new crew member on a ship’s quarterdeck almost 60 years ago to the day and, in a matter of weeks, by simple challenge, introduced this then 18 year-old who’d never really read a book through, to the lives that can be found in them.  —Thank you A. Gaeta and E. Budde for your life-altering tinkering.

Narragansett —New Year

… —A night walk to the base library

The bay to my right (my rite of sea and asphalt:
I hold to shoulder, I sail, I walk the line)

the bay moved as I moved, but retrograde
as if the way I moved had something to do

with how the black bay moved
(as if in animation) backward, how it tracked

how it perfectly matched my pace, but
in direction opposed (Albert would have

a formula or two to say about this
if he were here), behind, over shoulder

a steel grey ship at pier transfigured
in cloud of cool white light— a spray

from lamps on tall poles ashore, and aboard
from lamps on mast and yards

among pins of antennae
that gleamed above its raked stack—

an electric cloud, a photon aura edges
feathered into night enveloped it as it lay

upon the shimmering skin of bay,
from here she’s still as the thought

from which she came: upheld steel on water
arrayed in light, heavy as weight, sheer as a bubble,

the line of pier beyond etched clean
as if cut by horizon’s knife

… ahead, a library
… behind, a ship at night

the bay to my right (as I said) slid dark
as the confluence of all nights

the light of low barracks and high offices
of base ahead spread west and skip off bay

each of its trillion tribulations jittering at lightspeed
fractured by bay’s breeze-moiled black surface in splintered sight

ahead the books I aim to read,
books I’ve come to love since Anthony & Ed

in the generosity of their own fresh enlightenment
teamed to bring bright tools to this greenhorn’s

stymied brain to spring its self-locked latch
to let crisp air in fresh as this breeze —and how

that breeze blew across a bay from where to everywhere
troubling Narragansett from then to me here now!

Jim Culleny
12/16/19

by Anitra Pavlico

As I sit here marveling at the inexorability of deadlines, even in the midst of holiday cheer, I consider that I should, in the absence of time for research ventures, write about “what I know.” Isn’t that the default advice for people who don’t know what to write about and don’t want to come across as false? Well, I spend at least half of my time, and most of my psychic energy, on tasks stemming from being a mother. But do I “know” anything about it? For example, how do you get your child to become a good person, and by that I don’t mean compliant or obedient, but ethical? I spend a lot of time fretting about it, but I don’t know if I have any answers.

There are different schools of thought. One uses promises of gifts or other rewards. My husband’s friend has recommended Oreos as a relatively inexpensive behavior modification device. A variant of this philosophy cajoles children into thinking that whenever they act rightly, some outside entity, beyond the family unit, will reward them. Santa Claus is an outcropping of this parenting-out-of-desperation. One problem with this is that, as they grow older, young people soon realize that there is no one who necessarily rewards them when they act in a moral or ethical manner. Who’s to say whether children who became addicted to rewards following right actions might abandon the high road when the rewards stop coming?

Another school of thought relies on the threat of force or other recrimination. Sadly, these methods have waned, but haven’t completely gone out of style. Do this, or I will do that. Don’t do this, or I will take away that. Yet even children are aware that bad behavior is not always punished. After all, if you do something wrong while the strict teacher’s back is turned, there may be no repercussions at all. Instead of a sense of guilt, there is exhilaration at escaping a harrowing punishment. It is hard to see where the learning takes place. Read more »

Leopold Blaschka and Rudolf Blaschka. Rotten Apples: Botanical Models of Diversity and Disease

“…  models of rotting apples infected with various fungi and bacteria. Also included are models of rotting and scabbing plums, pears, and apricots. The exhibition is part of Harvard’s Ware Collection of Blaschka Glass Models of Plants …”

More here, here, and here.

Dr. Alan Burnett has a main research interest in the development of treatments for Acute Myeloid Leukemia. He has served on numerous advisory committees and is a past President of the British Society of Haematology and Chair of the UK National Training Programme. Professor Burnett was appointed as Chair of the National Cancer Research Institute Haematological Oncology Study Group. He was elected as a Fellow of the Academy of Medical Science in 2002, was awarded the Gold Medal of the British Society for Haematology in 2004 and gave the prestigious Ham Wasserman Lecture at the American Society of Hematology meeting in 2012. Currently, he is a Professor at the University of Glasgow in Scotland.

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 Elizabeth S. Bernstein

In 1885 Mary Terhune, a mother and published childcare adviser, ended her instructions on how to give baby a bath with this observation:

When perfectly dry, his flesh sweet and pure with the exquisite lustre imparted by bath and friction, he is the most kissable object in nature.¹

A quarter century later, at the tail end of the Victorian era, another mother and author, Marion Foster Washburn, offered a similar assessment of infant massage:

Nothing on earth is so delicious to the touch as the firm, fine flesh of a healthy baby! In these strokings and kneadings, something of your mother-love and magnetism passes over into the baby, and you are more closely bound to each other. . . . Touch is especially the love-sense, and we, who cannot yet make little children understand the words, can tell them, through our hands, how dear they are to us and how tenderly we care for them.²

“Tenderness,” in English translation, is also the word Sigmund Freud regularly used to describe the relationship of parent and child. But in his case it was used primarily in the context of warning. The mother, he wrote in 1905, “supplies the child with feelings which arise from her own sexual life; she pats him, kisses him, and rocks him, plainly taking him as a substitute for a perfectly valid sexual object. . . . Excessive parental tenderness surely becomes harmful, because it ‘spoils’ the child and makes him unfit to renounce love temporarily, or to be satisfied with a smaller amount of love later in life. . . . [N]europathic parents, who usually display excessive tenderness, often awaken with their caressing a disposition for neurotic diseases.”³

How much tenderness was too much? Read more »

by Michael Klenk

While some people voluntarily act out their private lives on the public stage, the vast majority tries to maintain some privacy – by drawing a firm distinction between their private and public lives. But at the same time, almost all of us are using connected technologies like mobile phones, wearable devices, social media, search engines, or web-shops. By using connected technologies, we leave a conspicuous trail of data traces, and to the trained eye, innocuous traces can tell exciting stories – no less (and perhaps more) revealing than the party-pictures some voluntarily share on Facebook.

For example, the New York Times recently used readily available phone-usage data to trace, amongst other things, someone frequently visiting roadside motels at night-time for an hour each. The Times could have easily revealed the name of that person and determined what exactly was going on at the motels, which illustrates that data scientists, modern-day trappers if you will, need less and less effort to read such intimate stories off these seemingly innocuous traces. Almost anyone is thus opening up about their private lives in the public domain.

In consequence, privacy may well be dead – killed by the ubiquitousness and necessity of using connected technologies – at least if we maintain an old conception of privacy that needs a distinction between the public and the private sphere. We may not find that distinction born out by the world anymore, and consequently, we might be looking for privacy in vain. And yet, most people do not conclude that privacy is dead – instead, they offer new interpretations of the concept of privacy in response to the new realities created by connected technologies. Read more »

by Brooks Riley

by Tim Sommers

A 2011 survey by Michael Norton and Dan Ariely, of Harvard’s Business School, found that the average American thinks the richest 25% of Americans own 59% of the wealth, while the bottom fifth owns 9%. In fact, the richest 20% own 84% of the wealth, and the bottom 40% controls only 0.3%. An avalanche of studies has since confirmed these basic facts: Americans radically underestimate the amount of wealth inequality that exists – and the level of inequality they think is fair is lower than actual inequality in America probably has ever been. As journalist Chrystia Freeland put it, “Americans actually live in Russia, although they think they live in Sweden. And they would like to live on a kibbutz.”

Thomas Piketty ramped up the inequality debate, a couple of years later, with “Capital in the Twenty-First Century”, a massive 250-year survey of wealth inequality. He discovered that r > g. That is, the rate of return on investment is always greater than growth. The rich really are getting richer – and the poor? Well, not so much. The post-war middle-class, Piketty warned, may well have been a historical anomaly. Economic inequality is likely to get worse – and never get better – without coordinated international action. The good news is that not one, but two, serious candidates in the current Democratic Presidential Primary are endorsing versions of Piketty’s “Wealth Tax” – Bernie Sanders and Elizabeth Warren. (And, by the way, the English-translation of Piketty’s latest book, “Capital & Ideology” is due out in March.)

So, what should the distribution of wealth be? What does justice have to say about wealth inequality? Read more »