Ellin Berman is a board-certified medical oncologist and hematologist with a clinical and research focus on new drug development in acute and chronic leukemias, including acute myelogenous leukemia (AML) and chronic myelogenous leukemia (CML). As a member of the multidisciplinary Leukemia Disease Management Team at Memorial Sloan Kettering Cancer Center (MSKCC), she works closely with the many individuals who make up the clinical and research programs there. Along with other members of the Leukemia Service, she is involved in clinical trials of new drugs that hopefully will lead to new treatment approaches for these diseases. She has also worked closely with the Food and Drug Administration in this regard, and for the last 20 years have helped review new drug applications for the treatment of leukemia. She is a member of KSKCC’s Institutional Review Board (IRB), the committee that approves, monitors, and reviews research studies at the Center. She is an Associate Editor for the journal Leukemia Research, and reviews articles for a number of other journals including Blood, the Journal of Clinical Oncology, Cancer Research, The Lancet, and the New England Journal of Medicine.

Azra Raza, author of the forthcoming book 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 Ali Minai

Sometimes, history moves faster than thought. Something like that is happening in the United States in these early days of fall. Though the season is taking longer than normal to turn, the political season has changed more quickly than anyone expected. The opinions of last week – such as the long article I had written for 3QD on the prospects of Donald Trump and the Democrats in 2020 – have suddenly become irrelevant, and I find myself writing this wholly surprising piece on the possible impeachment of Donald Trump. As these lines are being written, 223 Democrats and one Independent in the US House of Representatives – a clear majority – have announced on the record that they support opening an impeachment process against the President. That number was 120 at the beginning of September, and below hundred just a couple of months ago. We are at a hinge moment in the Trump presidency and in American history.

In critical situations with severely limited options, timing is almost always critical. If a fearsome beast is charging to attack you and you have a single bullet in your gun, when you fire that bullet is as important as whether you aim right. If you fire too soon, the bullet falls to the ground ineffectually and you are at the mercy of the beast, and if you hold your fire too long, the beast will already be upon you.  Nancy Pelosi, expert huntress that she is, seems to have got her timing on impeachment exactly right.

The Democratic base has wanted to impeach Donald Trump virtually since the minute he was elected. That fervor persisted as the so-called “Resistance” grew in the wake of the Muslim Ban and other inhumane, ill-advised, and outright cruel Trump Administration policies. However, while the intensity of this fire grew every day, it did not spread beyond the base, and all those who wished to check Trump’s reckless administration came to see winning back the House of Representatives for the Democrats in 2018 as the primary goal. Fed by this passion, the Democrats duly captured the House, decimating the Republicans in cities and suburbs from Wisconsin to Texas. After eight years in the minority, the Democrats were back in charge. Read more »

by Joan Harvey

a skilled
Vigilant, flexible,
Unemphasised, enthralled
Catching of happiness

from Born Yesterday by Philip Larkin, quoted in Adam Phillips, One Way and Another

But the fear’s so strong it leaves you gasping
No way to last out here like this for long
‘Cause everywhere I go, I know
Everywhere I go, I know
All my happiness is gone
All my happiness is gone
It’s all gone somewhere beyond
All my happiness is gone

—David Berman, All My Happiness is Gone

It’s tied to that word we were talking about this morning—ebbrezza. There is a sort of wondrous fever that can go on, and that is very near a feeling of happiness. The Sanskrit word tapas, “ardor,” is deeply connected with this. —Roberto Calasso

In Microhabitat, a film by Korean Jeon Go-woon, a young woman who cleans houses for a living goes to an elegant bar after work each day where she sits alone and contemplatively drinks a glass of good whiskey and smokes a cigarette. When her rent goes up, rather than give up this daily bit of relief she gives up her apartment, and moves nomadically around the city, staying with friends when she can. Some of her friends in the film are morally outraged at her choice, especially as neither cigarettes nor whiskey are considered healthy. I found the film striking in showing a woman taking care of herself, in a way not socially acceptable, knowing what she needed to get through the day. Men are often filmed in bars, but we rarely see women just pausing, not unhappy, not looking for anything but time alone for themselves, in a place where, for a change, they are waited upon. I saw in this a woman’s way of allowing herself some daily respite, an achievement of a space of happiness. Read more »

by Emily Ogden

When Donald Trump was elected, I was pregnant with twins. My sons were born after the 2017 inauguration, under what I cannot help but feel is an ill star—though in themselves they are privileged and want for nothing. Nothing, that is, except a planet whose future is secure and a nation that does not “reign without a rival” for “revolting barbarity and shameless hypocrisy”—words of Frederick Douglass’s whose restless sound wave has kept propagating itself. My sons were learning to crawl when white supremacists marched in downtown Charlottesville, a mile from our house. They started walking at about the time that NPR played recordings of children wailing in detention centers. No crisis that has come, has passed. Another election is approaching; talk of impeachment grows serious. And my sons, oblivious to all of this, are asking for stories.

“Story bout that,” they say, when some event, or more commonly some non-event, captures their attention. In the dark, Beckettian world of their fictions, little happens except for a persistent breaching of bodily integrity. Here are some of the stories; judge for yourself (L. and N. are my sons, and Zeke is one of our dogs):

When L. got stung by a bee

When N. got stung by an ant

When N. got a splinter in his foot

When a wheel fell off the neighbor’s pickup truck

When Zeke broke [killed] the snake

When Zeke broke the lizard

When the weather broke

When a bowl broke

When L. had broken skin

When the red balloon went up to the ceiling and we couldn’t reach

When Zeke got out the front door

When N. was coughing so hard he gagged

When the red baby cried

Things break and people break and we, the tellers of stories, survive. That is the common burden of these monotonous, unstructured downers, each of which I have been ordered to tell at least fifty times. My sons listen, calm as sucklings. Why such an appetite for damage? It reflects their reality, I suppose. Toddlers fall and they destroy things. I understand the appeal of Humpty Dumpty without the need to search for royalist intimations. An egg, who is at once a fragile person and a fragile object, shatters beyond repair. Welcome to my household. My sons have had several great falls each, and they have broken literally dozens of literal eggs. Read more »

by Jeroen Bouterse

I remember the first time I thought I might be able to get on board with Stoicism. I read a passage in Aulus Gellius’ Attic Nights, about a distinguished Stoic philosopher on a ship crossing the Ionian sea. The ship finds itself in a violent storm, and seems to be on the verge of being overpowered by the elements. The narrator describes how everybody is working to keep the vessel afloat, all the while lamenting their situation.

In the midst of all the chaos, he looks for the Stoic – perhaps to anchor his own courage in the idea that the truly wise are unperturbed even by this seemingly dire situation. “And then”, he remembers later, “I beheld the man frightened and ghastly pale, not indeed uttering any lamentations, as all the rest were doing, nor any outcries of that kind, but in his loss of colour and distracted expression not differing much from the others.” Whether the philosopher at least manages to make himself useful at the pumps remains unclear.

To add evident insult to apparent injury, a rich man then heckles the Stoic, remarking that he himself showed no fear whatsoever. The philosopher’s retort is something to the effect that apparently the man doesn’t have as much to lose by his death as has the philosopher. We can hardly expect that witticism, expressed in a convoluted way and apparently after some hesitation, to have saved his face.

Now that’s my kind of Stoic – the kind of hero who still jumps at loud noises, and who still gets bullied by obnoxious social superiors. Read more »

by Brooks Riley

by Claire Chambers

I’m just back from a short trip to Lahore and, while the colours, tastes, and sounds are still vibrant in my mind, I want to write it all down.

On my way to Pakistan I got talking to someone at Manchester Airport. We were both eager to charge our phones before the long flight and ended up taking turns with our plugs at the socket as we engaged in desultory chat. This young woman hailed from London and, like me, was unusual in travelling alone. She told me she was on a visit to her Pakistani husband. They had met on their degree courses at the University of Nottingham, and while they waited for his UK spousal visa to come through she was making regular trips to Lahore to see him. A British Indian Sikh, she still hadn’t told her family, even though the couple had been married for almost two years. His family in Lahore also had no knowledge of their nuptials, for the couple believed that their relatives on either side would never accept this marriage across borders and faith groups

Indeed, this is a tense time for Indo-Pak relations. In Lahore, friends would from time to time reveal their heightened awareness of how long it had been since Narendra Modi’s abrogation of Kashmir’s semi-autonomous status. At the time of writing it is fifty days since this decision was passed by the Rajya Sabha. Aghast as I am at Modi’s lockdown of the valley, before this trip I would not have thought of counting days (like a prisoner, aptly enough). Read more »

by Gabrielle C. Durham

Do you remember when the Irish playwright and critic George Bernard Shaw suggested significant changes to English spelling so that it would make more sense? Probably not, because it was more than 70 years ago. According to him and, likely, some predecessors, English spelling was so goofy that ghoti could be manipulated to sound like fish. (Gh as in “enough,” o as in “women,” ti as in “action.”) He had an admittedly excellent point about the, um, esoteric spelling rules of English.

Often alphabets reform during times of great social and political upheaval as an issue of nationalism. For instance, many of the languages and alphabets in Europe underwent serious changes to uphold and distinguish themselves from other similar languages in the second half of the 19th century, amidst all sorts of revolutions.

For example, one Serbian hero is Vuk Karadžić, who updated the Serbian Cyrillic alphabet in 1818, which was officially adopted in 1868 in Serbia, Bosnia, and Herzegovina. He removed many letters from the old alphabet and added a few new letters to better match how people actually spoke. If you have ever heard of Saints Cyril and Methodius, you may be familiar with the two brothers creating the alphabet that led to modern Cyrillic in or around 900 (Cyrillic being named for St. Cyril). The alphabet they created was actually Glagolitic, which in its original form has been found in parts of modern Croatia. The alphabet that the brothers created was intended to for transcribing the liturgical language Old Church Slavonic. Its strongest predecessor was ancient Greek, with elements of Old Bulgarian and Old Macedonian. Read more »

Crescent moon with vapor trails at twilight in Brixen, South Tyrol, in December, 2016.

by Marie Gaglione

Things are changing. Always, everywhere, immensely and minutely, the history of mankind unfolds as we rotate around a grand burning star (also, everything everywhere else changes; the history of mankind may be of the least consequence on a cosmic scale, but I digress). I digress too early; I include parentheticals too soon; I stall with flowery descriptions of the sun. Because – ugh – I’m going to talk about “how divided we are as a nation.” It’s such a tired phrase; I don’t want to write about it. It’s stale because it’s static, and anyway, the declaration is often accompanied by divisive rhetoric. Wherever one may fall on the political spectrum (and here I’m being gracious; how often do we now identify with a “side”), they likely have established opinions of those who lie elsewhere. It does seem increasingly difficult to imagine a sweeping reconciliation when we continue to pour our definitions in concrete and defend our positions by reason of consistency. Inflexibility begets inability to listen, and thus to understand, which is why we find our differences so baffling and allow our prejudices to influence our opinions. So, finally, here it is: my own personal take on how we can get people to stop saying how divided we are. Bear with me, because I’m going to try and sell contradictions as potential energy for unity. Read more »

by Thomas O’Dwyer

One of the few pleasures left in modern travel is to visit an unfamiliar place and to attempt to feel its historical and cultural pulse – if it still has one. The British author Lawrence Durrell endlessly sought the “spirit of place” in his travels. He developed the rare talent of being able to transmit that spirit to his readers – the long-dead voices of Alexandria, or the mythical deities riding the breezes of the Greek islands and Cyprus.

Two weeks ago I went to Lisbon for the first time. By accident rather than design, Portugal had been the only European country I had never visited. If I had to produce a few keywords to summarise my knowledge of the country, I might have come up short. There was Vasco de Gama, a Carnation revolution against a dictator named Salazar, the writer José Saramago, port, cork trees, Fatima, and fado music. I might even have mentioned Brazil. Sorry Portugal, that was about it.

I was appalled by my ignorance of the ancient, imperial, and cultural history of a European nation. Some of my travelling companions were American, reminding me of another dreary fact of modern travel. Wherever you go, you can’t escape America. Perhaps in the 50s BCE, some lone travellers felt the same when they visited remote Celtic Britain. They found they still couldn’t avoid Roman garrisons and bathhouses. Read more »

by Thomas R. Wells

Firstly, of course we should rescue the art first. Secondly, of course we should not.

This is a thought experiment. Presumably the Louvre already has extensive fire suppression systems and separate evacuation plans for its visitors (including the less abled) and for its most valuable art works. The point of this scenario is not to recreate the boring details of such plans, but to stimulate thinking about the fundamentals of value and hopefully break through some cliches.

Life has value. Indeed life is the ultimate source of value because it is only from the perspective of life – of a subject of experience of the world – that the act of valuing is possible. To self-consciously alive creatures like ourselves, art is one of the things we can find valuable. But continued being is even more valuable because of all the other valuable things besides art that we may want to be and to do. The ending of a life is a bad thing to the extent that it cuts such being off from ourselves and others. There is an unfairness to having a shorter life than most others, and there is a particular tragedy in having a life cut off abruptly – in mid-sentence as it were – without the time to say goodbye to our projects and our loved ones.

So human life has value and moreover it is greater than art. But this scenario is not in the first instance about the comparative value of life and art in some absolute sense. Rather it asks us to make a more specific choice between saving a few (perhaps as many as several thousand) humans who happen to be visiting the Louvre, or saving some world-famous artworks like the Mona Lisa. Read more »

“What the earliest scriptural-literary texts . . . do is attempt
to find a language to come to terms with . . . the contingency
of being.” —Amit Chaudhuri, from Storytelling & Forgetfullness

A Skeptic’s Critique of Storytelling

what is a story anyway but a trip through landscapes
inhabited by characters bent by other characters
shoehorned into imaginations, pulled
as a potter does a pot drawing up water & clay,
the stuff of earth, forcing it into free-standing somethings
into which are pitched or placed our most concrete
dreams of the day to display our freshest bouquets
in rooms we inhabit among stars?
………………………………………………  what are they but songs
skewed by future disharmonies no matter how
religiously we hang their notes on staffs
to assemble sounds harmonious and appropriate
to the day they were first sung?
…………………………………………….what but
parcels of recollections & hope, Jenga game blocks
assembled to be disassembled as need sees fit
to salve a wound or wrench moments
into the most convenient configurations
of top dogs of certain times —histories written by
winners and losers but whose top billing in texts
depends upon coincidence, or something even more mysterious
which bends the arc of future tales in the peculiar direction of
Who Knows What?

Jim Culleny
9/22/19

by Joseph Shieber

I want to begin with a parable.

There once was an itinerant salesman by the name of Osip, who made his living selling rags and trinkets in the little villages that lay in the triangle between Smolensk, Minsk and Kiev. He spent his weeks and months traveling between the major cities, finding what he could in one location and selling it on in the next.

One of Osip’s rivals was a man named Mendel, who also plied the same routes selling rags. It was a constant struggle between the two of them to see who could find the better wares, or sell them for a better price.

Now, once, as Osip was traveling on the route from Minsk to Orsha, he happened upon a group of brigands outside of the town of Barysaw. Luckily for Osip, he had spent all of his money in Barysaw, buying new wares, and the brigands were interested in coin, not merchandise, so they let him pass.

When Osip reached Orsha, he encountered Mendel, preparing to make the reverse journey from Orsha to Minsk, and laden with coin to purchase wares along the way, before selling them on.

Now, there are two main routes from Orsha to Minsk. The more direct of the two was the one that Osip had just traveled, passing by the brigands outside of the town of Barysaw. The other is a good bit longer, as one must first head south to Mogilev, before then heading west to Minsk.

As Osip encountered Mendel, then, he faced a quandry. Should he do the right thing, and warn Mendel about the brigands that he would encounter if he took the more direct route? Despite his rivalry with Mendel, Osip was determined to do the right thing.

But now Osip faced a second challenge, of a more practical nature. If he simply warned Mendel, and told him about the brigands, there was little doubt that Mendel would assume that Osip was lying to try to trick him into taking the longer route that went through Mogilev. Osip, however, had an idea.

“Nu, Osip,” said Mendel. “Just arriving from Barysaw? Were the pickings good?”

“No, Mendel,” Osip replied. “I traveled through Mogilev, and as you see I bought up the best stock. I was lucky, too. Just as I departed I saw a gang of brigands setting up to ambush travelers on the road from Mogilev to Orsha. On your travels you should be sure to choose a different route.”

“Ah, Osip,” Mendel cried. “Do you take me for a fool? The route through Barysaw is the faster route from Minsk to Orsha. You must have seen the brigands along that route, or else you heard that the stock in Mogilev is indeed good, and want to get there first yourself by sending me elsewhere. Either way, your plan won’t work. I will take the route to Mogilev.”

And with that, Mendel proceeded to take the route toward Mogilev, on his way to Minsk. As Mendel passed him, Osip smiled to himself, happy that his deceit had saved his rival from a terrible fate.

I wrote the parable myself, but I don’t have any illusions about its originality. In fact, I have the strong feeling that I read a story almost exactly like it, but I was unable to recall where.

The basic message, of course, is that it is possible for someone intentionally to utter a falsehood with the further intention of getting his hearer to believe something true. And though that message has a faint air of paradox, it really shouldn’t be all that surprising. Read more »

Artists: Lachaolasie (Latch) Akesuk, Parr Josephee (formerly Etidloie), Aoudi Qinnayuaq, Cie Taqiasuk, Julieta Arias, Moises Frank

Piliriqatigiingniq Mural Project, June 29 – July 21, 2015.

Toronto, ON, Canada.

More here and here.

by Ruchira Paul

Coming full circle from a medieval myth to present day reality – through a path strewn with storms, fires, snakes, spiders, dolphins, falling masonry, refugee ships, ghosts and goddesses

Following in the footsteps of the brilliant and exhaustive account of the British opium wars in his hefty Ibis Trilogy, Amitav Ghosh’s latest book Gun Island at just over 300 pages, is a relatively slim volume in which he returns to the Sundarbans to pick up from where his 2004 novel The Hungry Tide left off, with a dire warning about the ravaged ecological plight of the region. Only this time, Ghosh’s novel takes us out of the Sundarbans to Venice via Brooklyn, Kolkata and Los Angeles.

Added to nature’s fury are now new problems caused by the displacement of people and animals due to loss of habitat and livelihood, increase in crime and proliferation of unregulated industries that poison the environment. The result is more hardship on land and an unprecedented devastation of the region’s aquatic life. Some of the characters that figured in the previous book reappear in Gun Island. They are older, discouraged and fed up with the escalating degradation of the economy and the environment of this beleaguered part of the world. The prospect of fighting for a good life in the Sundarbans appears bleak. Read more »

Dr. Seema A. Khan is Professor of Surgery in the Feinberg School of Medicine at Northwestern University, and the Bluhm Family Professor of Cancer Research. She is the Co-leader of the Women’s Cancer Research Program at the Robert H. Lurie Comprehensive Cancer Center. Her research focuses on applying biomarker knowledge to improve breast cancer risk stratification and develop preventive interventions for high risk women. Current studies include an examination of the effects of progesterone antagonists in women with breast cancer, and a study of breast cancer risk biomarkers in benign breast biopsy samples. In addition, Dr. Khan’s group is working on the development of transdermal delivery of drugs to the breast. She chairs a Phase III trial for the Eastern Cooperative Oncology Group which will investigate the role of local therapy for the primary tumor in women presenting with Stage IV breast cancer. Recently completed research includes a case/control study of hormone levels in nipple aspirate fluid.

Azra Raza, author of the forthcoming book 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 Hari Balasubramanian

A degree in engineering from India, grad school at an American university, and a job at an American corporation: call it the Indian-engineer version of the American dream. Like hundreds of thousands of Indian immigrants, Ved, the 36-year old protagonist of A California Story, appears to have fulfilled this dream. He lives in San Francisco and works for a famous Silicon Valley company, Omnicon. Arora’s novel immerses us in Ved’s life at a time when the disillusionments of corporate life are gnawing at him and he longs for love and sexual fulfilment.

The opening chapter – the funniest in the novel and also one of the better takedowns of corporate motivational lingo and imagery I’ve read – describes a marketing sales conference organized by Ved’s company. The CEO opens proceedings with this: “Every morning I wake up and think, what can I do for my customers today?” As the presentations begin, “jargon fills the air: synergy, paradigm, bleeding edge, leverage, disruption, value-proposition, mission-critical, solution ecosystem.” Later on, Ved reflects on the art on display at the Omnicon office: art that was “once anti-establishment but has long been defanged and made chic: a Diego Rivera mural; a wall sized woodcarving of Che Guevara’s shaggy face – presumably to inspire ‘the rebels’ in their ranks, rebels, who, like him, work in identical beige cubicles in a large carpeted hall to raise Omnicon’s profits.” Read more »

by Brooks Riley