by Syed Tasnim Raza

When I was a young attending surgeon on the faculty in the Division of Cardiothoracic Surgery, one of the things I got frequently called for was management of malignant pleural or pericardial effusions. Once a patient develops malignant pleural or pericardial effusion the median survival is only two months, so I would do things that would relieve the acute symptoms and perhaps try to prevent fluid from reaccumulating, but nothing drastic or major. One evening in late October, one of the nurses who had known me called to say that her father was being treated for lung cancer but had to be admitted with a large pleural effusion and that she and her father’s Oncologist would like me to manage it. I met the fine 72-year old retired banker, and while he was short of breath even as he talked, he was in a very upbeat mood. I decided to insert a chest tube to drain the pleural fluid and relieve his symptoms. As I was doing the procedure at the bedside the patient mentioned to me that his oncologist has assured him that once his fluid is out he will start him on a new regimen of chemotherapy and he should expect to live for a few more years. I was disturbed to hear the false hope he was being given.

Later on, his daughter asked me what I thought of his prognosis and I asked her if I should be honest. She said yes, please. I explained to her that I was concerned by the false hope the oncologist had given her father, that he may indeed live many more years, but the chances are he will not see Christmas in the following year, and at least he should be prepared for such an outcome. The next day the patient asked me directly and I gave the same answer, in other words one should hope to live long and beat the odds, but always be prepared for the alternative. After he was discharged and went home, he organized a big Thanksgiving dinner for his extended family, including his three sisters he had not seen in many years. He died in mid-December of that year. I went to his funeral and his daughter and wife hugged me and thanked me profusely for being so honest and what a wonderful Thanksgiving he had before he died. And he was able to say goodbye to his loved ones. In my own practice I have felt that it is good to give patients hope, but it should be realistic and honest.

In her remarkable book “The First Cell,” Azra (full disclosure: Azra is my younger sister) has been brutally honest at every level. Read more »

by Ali Minai

Your love stirs the ocean into reckless storms.
At your feet, the clouds drop their pearls.
Dark smoke rises in the sky, a fire burns
Where your love’s lightning strikes the earth.

These energetic lines open Moon and Sun: Rumi’s Rubaiyat, Zara Houshmand’s brilliant translation of selected ruba’iyat – quatrains – by Molana Jalaluddin Rumi, and set the tone for an inspiring and exhilarating sojourn through the passions of the peerless Sage of Konya.

It has become almost a cliché to cite Rumi’s status as the most widely read poet in America today. If that is so, it is only because of the many translations of his works into English by poets as distinct as Robert Bly and Coleman Barks. Clearly, all of these translations have something that touches the hearts of 21^st century Americans in ways that even modern American poets seldom do. Perhaps it is because this poet who lived thousands of miles away and eight centuries ago has a strikingly modern sensibility – a directness of expression and connection that, couched in appropriate words, can grab a reader across the gulf of centuries. But finding those words also requires a creative act – a re-ignition of the original fire, so to speak. In many cases, translations of Rumi have succeeded by glossing over the complexity of the original, or injecting it with a little modern – even Western – attitude. Most translations have drawn on Rumi’s matchless didactic work, the Masnavi, which is a tapestry of poetic tales embedded within tales, each taking the reader to deep ethical and existential insights. Unlike most other classical Persian poetry, the Masnavi is written in a direct – almost modern – voice. As such, poems from it can be – and have been – translated well by focusing on the stories they tell and the moral conclusions they reach, without worrying too much about replicating Rumi’s poetic diction. The other body of Rumi’s work that has been translated extensively are his ghazals from the Divan-e Shams-e Tabrizi, ranging from A.J. Arberry’s beautiful literal translations to Nader Khalili’s more poetic ones and the impressionistic renditions of Kabir Helminski – all satisfying and lacking in distinctive ways, as must always be the case in translations of this genre. The task undertaken by Zara Houshmand in Moon and Sun is distinct from all these predecessors. Read more »

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 »

by Pranab Bardhan

Einstein had called nationalism ‘an infantile disease, the measles of mankind’. Many contemporary cosmopolitan liberals are similarly skeptical, contemptuous or dismissive, as its current epidemic rages all around the world particularly in the form of right-wing extremist or populist movements. While I understand the liberal attitude, I think it’ll be irresponsible of us to let the illiberals meanwhile hijack the idea of nationalism for their nefarious purpose. Nationalism is too passionate and historically explosive an issue to be left to their tender mercies. It is important to fight the virulent forms of the disease with an appropriate antidote and try to vaccinate as many as possible particularly in the younger generations.

Populists advocate a culturally narrow, narcissistic, nostalgic, xenophobic form of ethnic nationalism—from the Christian nationalism of evangelicals in the US or the Catholics in Poland or the Slavic Orthodox-church followers in Russia to the Islamic nationalism in Turkey or Indonesia to the Hindu nationalism in India. The alternative, more inclusive, form of nationalism often counterposed to this is some variant of what is called ‘civic’ nationalism.

But first a brief historical note. As a form of community bonding on the basis of some tribal or ethnic-territorial roots proto-nationalisms of different kinds have been quite old and durable in different societies. But as Ernest Gellner, one of the foremost theorists of nationalism, pointed out, nationalism in the form as we know it is of relatively recent origin. Of course, historical memories and myths (mythology is often blurred into historical facts and legends), symbols and traditions are constantly invoked in the name of ethnic nationalism, even though, as the distinguished historian, Eric Hobsbawm famously pointed out, many of the so-called traditions are actually of recent ‘invention’. The influential 19^th-century French scholar, Ernest Renan had pointed out how ‘historical error’ is used in the creation of a nation. Gellner even points to cases of nationalism based on not a great deal of history: “The Estonians created nationalism out of thin air in the course of the 19^th century”.

But it is often overlooked that there is a clear distinction between nationalism based on some social bonding principle and the nation-state that became a predominant political unit, at least in Europe since the Treaty of Westphalia (1648). The former refers to a sociological community based on some homogeneous binding element like religion, language, ethnicity or culture, whereas the latter is a political community which need not contain a singular sociological nationality. Read more »

Sughra Raza. Power in The Sky.

Digital photograph, Porto Alegre, 2014.

by Joan Harvey

Nightfall. Outside a low elongated cave entrance a small group of humans sit waiting on stone ledges facing the dark aperture. Kestrels begin to soar close in the late evening sky. Snakes too are gathering below, we’re told, but they aren’t in view. This is Bracken Cave, 20 miles from San Antonio, where 20 million bats, females and their pups, literally hang out. We’ve come from Austin, through miles of pick-up truck dealerships and mini-malls. At first our driver couldn’t find the cave, which is not open to the public, but eventually, guided by people from Bat Conservation International, the nonprofit that owns and protects the cave, we arrived. At dinner we were filled with Texas barbecue and many bat facts, and now everyone is quiet. Waiting. A strong odor permeates the air. Slowly small dark beings emerge, then more and then more, thousands shooting off, darkening the sky. So many they can be seen on radar, and a nearby Air Force base has to shut down each evening as the bats would interfere with flights. We watch the procession very quietly, each feeling in their own way this strange life form that is connected to us and yet so different, familiar and yet unfamiliar, this webbed mammal, this flying thing that has so engaged our imaginations.

Bats are beings who go too high, shooting up into the air — the species from this cave, the Mexican free-tailed bat, can fly at altitudes over 10,000 feet— but also too low, swooping down to face level, or, when they return from their nocturnal hunt, diving like furry missiles into the low entry of the cave to avoid the waiting predators. They’re fast, faster than birds, holding the horizontal speed record at over 160 kilometers (99 miles) per hour. As mammals they’re more closely related to us than birds, and they live almost everywhere we live, yet we rarely see them, and most of us know almost nothing about them. They’re nocturnal, dusty, silent, though when they fly by us in the thousands we can hear a low rush of wings like the rumble of water over rocks. Read more »

Dr Bruce Chabner has had immense experience in the discipline of cancer drug discovery and development. During his career at the National Cancer Institute, he worked as a Senior Investigator in the Laboratory of Chemical Pharmacology, Chief of the Clinical Pharmacology Branch, Director of the Clinical Oncology Program, and Director of the Division of Cancer Treatment. His research significantly added to the development of high dose chemotherapy regimens and standard therapies for lymphoma. Additionally, his research led to the development of Taxol. He currently serves as a Professor of Medicine at Harvard Medical School and Director of Clinical Research at the MGH Cancer Center at Massachusetts General Hospital.

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?

Driving Lolita in the World’s Most Militarized Zone

A boy, I hid
in grandpa’s study.

An art dealer
he loved books

with gilded edges,
Aristotle to Zola

all stuck together
in the humidity.

I snuck Lo out
to his black Chevy

rifled for the dirty bits
(should ’ve looked harder, I guess),

drove her away for a spin
teen tunes swirling in my head

I Want to Hold Your Hand.
A crackdown in downtown ‑—

mothers hid their young sons.
“We fear they’ll take them away.”

A soldier rained pellets
on a nymphet’s face,

light of her mother’s eye.
“Moji,” nymphet said,

“Nothing can be seen,
as far as the eye can see.” Read more »

by Mary Hrovat

The roof of Notre-Dame de Paris, lost in the fire of April 15, 2019, was nicknamed The Forest because it used to be one. It contained the wood of around 1300 oaks, which would have covered more than 52 acres. They were felled from 1160 to 1170, when they were likely several hundred years old. It has been estimated that there is no similar stand of oak trees anywhere on the planet today.

Even in the twelfth century, sourcing the wood for cathedral construction was not always easy. When the Basilica of Saint-Denis was under construction in the mid-twelfth century, it was assumed that the nearby forests could not supply the wood needed for the project because they were depleted. Abbot Suger reportedly found a local stand of timber suitable for the job and attributed his discovery to faith and divine intervention. Causes of medieval deforestation include clearing of land for agriculture and the expansion of urban areas. Read more »