Kanti R. Rai, MD, is professor of medicine at The Karches Center for Oncology Research, The Feinstein Institute for Medical Research; director of the Center for Oncology and Cell Biology, Long Island Jewish Medical Center; and professor of medicine and molecular medicine at Hofstra University Northwell School of Medicine. He has been involved in diagnosing and treating Chronic Lymphocytic Leukemia for almost 40 years and the staging system that bears his name came out of his early breakthrough research. His research led to the eventual development of idelalisib (Zydelig) as a second-line treatment for patients with CLL and ibrutinib (Imbruvica), used to treat mantle cell lymphoma, CLL, and Waldenström macroglobulinemia. He has been collaborating with other CLL scientists at The Feinstein Institute for years establishing the importance of fludarabine, now a standard-of-care treatment for CLL, and demonstrating the effectiveness of cladribine in treating hairy cell leukemia. Dr.Rai is an active investigator in the Chronic Lymphocytic Leukemia Research Consortium, the International Workshop on CLL, and Cancer and Leukemia Group B. He is a member of the American Society of Clinical Oncology, the American Association for Cancer Research and the American Society of Hematology (ASH).

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 Robert Fay

In 1899 at the age of 59 Henry James began work on The Ambassadors, the first of his brilliant, ground-breaking final three novels that included The Wings of the Dove and finally The Golden Bowl. James’ biographer Leon Edel writes, “The Ambassadors was told by James in a complex, indirect style he had never attempted before…rather than accept the old tradition of the novel which told everything, James allowed his readers to know only as much as one learns in life.” And R.P. Blackmur wrote of these final novels, “James made a spiritual trilogy which, with each succeeding volume, approaches nearer and nearer the condition of poetry.”

James is the exemplar of producing unparalleled, distinctive work late in life when the artist must confront, not only the specter of death, but the more intimidating nemesis of one’s previous output, duel foes which can freeze one into a morbid nostalgia. I’m reminded of the Reverend Gail Hightower in William Faulkner’s Light in August, who cannot escape the chimera of his grandfather’s battles in the Civil War, and how this fixation destroys his marriage and his ministry. The past can strangle us indeed.

The challenge of doing true important “late work,” or “late style” as Edward Said called it, should stoke the ambitions (and anxieties) of all serious artists. And while it’s not an impossible mountain to summit, the list of accomplished mountaineers and their treks is intimidating, for it includes: Beethoven’s Late String Quartets; Philip Roth’s great late novels, American Pastoral (published when Roth was 64), I Married a Communist and The Plot Against America; as well as works from Picasso’s Late Period (though there are still critics who disparage these pieces), to name a few. But there is more here than the individual artist bravely exploring his own dimensions, there is the effect on the surrounding culture which (in our present age) is deprived of mature thought, being seduced by the lazy discourse of the adolescent and the crudely juvenile (I’m not speaking of chronological age here). And if you think I’m overstating it, go see what’s trending right now on your favorite social media platform. Read more »

by Rafaël Newman

It was Ramadan on Mother Teresa Street, so the professor and his wife were discreetly abstaining. Their daughter, an aspiring YouTuber, had been granted special dispensation and was gorging herself on chocolate ice cream and Coca Cola, along with me and my colleague, an Israeli poet who had won an award from the Ministry of Culture, Sport and Youth the evening before, both of us treated to refreshments at one of the many outdoor cafés that lined the pedestrian zone in the middle of Prishtinë.

It had taken us a while to reach the café, constantly interrupted in our progress from one end of the mall to the other by passersby greeting the professor – colleagues from the local university and its sister institutions elsewhere in Kosovo; relatives and well-wishers, offering our host “respekt”; and an instrument vendor, who insisted on the professor’s demonstrating his prowess on the qifteli, a long-necked, two-stringed local guitar – so I was delighted when I heard myself greeted, as we took our place at the café, by a Kosovar of my own acquaintance from the French-speaking region of Switzerland, who happened to be in town to visit family.

The Israeli poet and I were in Prishtinë on the last leg of a three-day stay in Kosovo. Our time had been spent not in the capital but in the town of Pejë, in the northwest of the country near the borders with Montenegro and Albania, once a significant stop on the trade route between Dubrovnik and Istanbul. We had been attending a literary festival there, taking part in readings, lectures, and a dizzying round of awards ceremonies. Most of the writers in attendance – largely poets – were “ethnic” Albanians, from the eponymous country to the west, from the significant minority community in Macedonia, to the south, as well as from Kosovo itself, our host. Read more »

by Maniza Naqvi

Grief stages its unfurling
Towards the promise of sorrow,
Strips away to beauty
Peels in layers
Sheds
Skin,
Leaks
Bleeds.
Sheds and sheds.
A friend texts
A song by Daniel Johnston.
An icon. Gone.
Says: Transitioned,
As you would say.
It has taken years, eight
To get here
To rescue stone.
This state.
To transform.
An avocado’s stone
Witness peel
Slip away
Pit turn to flesh
Shed
Dye.
Stone turned flesh,
Weeps,
Bleeds,
Dye.
Heart, pit, stone.
Reborn as stain.
On white sheet.
Tree.
Now washed:
Now bathed,
Now dipped,
Now dunked,
Now immersed,
Now lifted.
Now stained,
Faded rose red,
The hue of that stone
We picked for you
Now glimpses
Glimmers
Gold scapes
Sea blues,
And yes shades,
Crimson and beyond
Brushes and
Strokes
Thoughts
Eternity.
Struggle.

by R. Passov

When I arrived in California, when I was born, I joined 15 million inhabitants, including my parents.

They were part of a long wave of predominately eastern European descendants who came in such numbers as to pull west much of post-WWII American culture.

In the year I found California, 16 million people lived in New York State. It was the New York of West Side Story and the Bronx Bombers, the year when the Boys of Summer would play their first game in Los Angeles.

In the early 1970s my family took a cross-country road trip. For four days we drove toward our history.

I was in school with children of the East, growing in the seams of our parent’s dreams of leaving places with exotic names like Brooklyn, Hoboken and best of all, the Bronx. That’s where we aimed on that cross-country drive to visit my great grandparents, so old by then they no longer moved.

Two floors up a dark stairwell on the Grand Concourse, once the boulevard of dreams for Jews, the lights of Yankee Stadium shown in their summer windows. Sitting on their tattered sofa surrounded by their old country furnishings, wearing the same formal clothing that protecting them across the Atlantic, they were old-country old. How glad I was that my parents had come west.

In 1997 I left California’s then 32 million inhabitants to move East, thereby adding one to New York’s 18 million. Read more »

by Akim Reinhardt

It doesn’t take much. A small piece of gravel, spit out by a truck’s wheel, ricochets off the windshield, taking a tiny chip of glass with it. A microscopic divot and discreet little lines, like crow’s feet at the corner of an eye. Barely noticed for months, the accordion of heat and cold compress and expand, adding and relieving pressure. Then finally, the scratches spread out across the glass like an avant garde spider web.

The windshield has not fractured into zagged plates or smashed into a thousand glass pebbles. Perhaps that is its future, but for now it is merely degraded and slightly obscurant. Yet it was never true. Tinted, laminated, curved, and often dirty, the windshield always presented a slightly skewed image of the outside world. Not grotesquely wrong, but fundamentally distorted in minor ways difficult to detect from inside the car. Now, however, the little cracks have suddenly made you aware that the image upon the glass is subtly warped.
*
As in many countries, if not most, American school children are indoctrinated with nationalistic history that incorporates heroic narratives and stirring interpretations. From kindergarten through high school, state sanctioned curricula present a range of facts and viewpoints that coalesce into what can fairly be called imperial mythology. Most of it is technically correct, but the total image produced is often heavy on the rah-rah and short on critical self-examination. Of course some states are worse than others, and some teachers better than others, but the overall effect across society is consistent. Read more »

by Brooks Riley

by Bill Murray

The first part of this century West Africa was no place to be. Liberia was led by Charles Taylor, now serving a fifty year sentence for “aiding and abetting as well as planning some of the most heinous and brutal crimes in recorded human history.” In Sierra Leone’s civil war, entire families were gunned down in the street. Children and adults had their limbs hacked off with machetes. 

A few years later in 2010, Laurent Gbagbo, the incumbent president of Côte d’Ivoire, refused to cede power following elections. Subsequent clashes led to 3000 deaths. (Gbagbo was acquitted of war crimes in January of this year).

In the late 1990s though, you might casually catch a flight to Abidjan on now defunct Air Afrique for a bit of innocent, if unlikely, tourism.

It was still the era of guidebooks. Here is the then-current Lonely Planet Guide to West Africa:

“On the northwest edge of town near the beginning of the road to Dabou is the Parc du Banco. Several hundred meters beyond the dirt road entrance to the park you’ll see … Africa’s largest outdoor laundrette – some 750 fanicos (washermen), mostly Burkinabé and none Ivorian, jammed together … in the middle of a small stream frantically rubbing clothes on huge stones held in place by old car tyres.” Read more »

What is peculiar about this photo is that what you see behind the metal frame of the door is not a supermarket. It is a giant photo of the supermarket affixed to the wall which is a couple of meters behind this door. The actual supermarket shown in the photo on the wall is off to one side. I don’t know why. Photo of photo taken last week in Vahrn, South Tyrol.

by Bill Benzon

September 4, 2019: Adam Satariano, “The World’s First Ambassador to the Tech Industry”, The New York Times, September 3, 2019.

In 2017, Denmark became the first nation to formally create a diplomatic post to represent its interests before companies such as Facebook and Google. After Denmark determined that tech behemoths now have as much power as many governments — if not more — Mr. Klynge was sent to Silicon Valley.

“What has the biggest impact on daily society? A country in southern Europe, or in Southeast Asia, or Latin America, or would it be the big technology platforms?” Mr. Klynge said in an interview last month at a cafe in central Copenhagen during an annual meeting of Denmark’s diplomatic corps. “Our values, our institutions, democracy, human rights, in my view, are being challenged right now because of the emergence of new technologies.”

He added, “These companies have moved from being companies with commercial interests to actually becoming de facto foreign policy actors.”

Here we go, I thought, I’ve seen this kind of thing before.

September 12, 2019: Miriam Pawel, You Call It the Gig Economy. California Calls It ‘Feudalism’. The New York Times, September 12, 2019.

Labor leaders cheered in the balcony and lawmakers embraced on the floor of the California Senate on Tuesday as it passed a landmark measure that defines employees, a move that could increase wages and benefits for hundreds of thousands of struggling workers. […]

The “new economy, the gig economy, the innovation economy” is “feudalism all over again,” said the Assembly speaker, Anthony Rendon, a Los Angeles Democrat.

Bam! Another one.

What kind of thing is that? – you ask. Virtual Feudalism, that’s what.

* * * * *

Abbe Mowshowitz is a mathematician and computer scientist interested in the impact of computing technology on society. I’d met Abbe when I was on the faculty at The Renssalaer Polytechnic Institute in the previous century. He was interested in how the deployment of computer technology was creating virtual organizations that would lead to a virtual feudalism. He would eventually publish a book on the subject [1]. Before that, however, he commishioned me to to ghost an article on the subject. Alas, that article never got published. Here it is. The ideas are Abbe’s. The prose and stories are mine. Read more »

Robert Freeman. Abundant Life, 2019.

Oil on canvas.

More here and here.

Thanks to Laura Weinstein for connecting us!

by Chris Horner

In my years in education I have regularly come across what I call the lightbulb fallacy: the view that people have degrees of brightness and that it is the job of education to measure the wattage of learners in order to find the best social sockets to plug them into. It is a noxious idea. The notion that intelligence is a measurable ‘something’ that is possessed by people in varying degrees is one of the ways in which we end up with an education system that fails the majority of those it is supposed to be helping. It damages not just those in schools and colleges but people in general, and it is based on a fallacy about what it is to learn and understand.

One can see a number of reasons why adopting a notion like this would seem useful for an education system like ours: if people have amounts of intelligence that can be identified and measured, then people can be classified and fitted into the place in education, and later in the economy, that will suit their degree of ‘brightness’. But the problem is that people aren’t like lightbulbs with differing degrees of wattage, and this essentialising approach, that imputes a fundamental, intrinsic trait to an individual, leaves most people experiencing education as a demotivating process in which they learn to experience themselves as failures. Examinations put the seal on this by placing students in an ascending hierarchy of brightness. The effect of this on many, if not most, learners is unhelpful, to put it mildly. As an educator I have had to deal with numerous situations in which students have in effect used this as an alibi for giving up, since if those other students are brighter than oneself, why bother? Of course, not every learner reacts to lower marks in that way – but most get the message, in the end, that they cannot get far up the ladder of educational achievement, and that success is the preserve of a small number of the very bright. Read more »

Wadih Arap is the Director of the Rutgers Cancer Institute of New Jersey at University Hospital and Chief, Division of Hematology/Oncology in the Department of Medicine at Rutgers New Jersey Medical School. He has served on the National Cancer Institute’s Board of Scientific Counselors, several review boards for the National Institutes of Health and the U.S. Department of Defense’s Prostate and Breast Cancer Research Program. His research is based on the premise that differential protein expression in disease tissues enables the development of novel, targeted drugs to treat human disease. By integrating genomic analyses and analytical high-throughput technology, functional protein-protein interactions can be manipulated to develop clinical strategies for effective disease management.

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 Anitra Pavlico

Most of the modern revival of Stoicism has centered on the works of Seneca, Epictetus, and Marcus Aurelius–all from the “Late Stoa,” or the third phase in the history of Stoicism. No complete works survive from either the early or middle period. 

Chrysippus (c. 279-206 B.C.E.) was one of the most influential early Stoics. He studied with Cleanthes, who studied directly with Zeno, who founded the school in 262 B.C.E. You won’t see his quotes on any inspirational desktop art, but Chrysippus was perhaps the one most responsible for keeping Stoicism alive in its early years. A later Stoic saying was, “If Chrysippus had not existed, neither would the Stoa.” 

Chrysippus was prolific, having reportedly written over 705 books. No single book remains, and today we only have around 475 fragments. He was the second great logician, after Aristotle. Diogenes Laertius reported in his Lives of the Philosophers that most people believed that if the gods were to pursue dialectic, they would adopt Chrysippus’ system alone. The seemingly airtight logic of many Stoic approaches to life, as they have filtered down to us, stems directly from Chrysippus. The Stoic philosophy featured three branches: logic, physics, and ethics. The scope of logic also included the analysis of argument forms, rhetoric, grammar, propositions, perception, and thought. [1] Josiah Gould points out that Chrysippus felt that logic should be studied before the other two branches of the philosophy. [2] While Gould notes that it is lamentable that we do not have a single full logic treatise when they have such “tantalizing” titles as On Negative Propositions, An Introduction to the Study of Ambiguity, On Imperatives, and Reply to Those Who Think that a Proposition Can be Both False and True, he maintains that we can reconstruct some of his views based on the fragments we possess. Read more »

by Elizabeth S. Bernstein

In 1973 Betty Friedan traveled to France to have a conversation about the state of feminism with Simone de Beauvoir, whom she regarded as a cultural hero. Friedan’s own opinions had evolved considerably in the decade since the publication of The Feminine Mystique. She would elaborate those changes sometime later in a new book, The Second Stage, in which she argued for women’s work in the home to be viewed as “real work” and included in the gross national product. Now, in her meeting with Beauvoir, Friedan asked her opinion on ways to recognize the value of that work, such as crediting it for social security purposes, or distributing vouchers which parents could either use to buy childcare or collect on themselves as full-time caregivers. Perhaps Friedan wondered if Beauvoir’s thinking too might have changed since she stated in The Second Sex that the work of a woman at home “is not directly useful to society, it does not open out on the future, it produces nothing.” If so, she got her answer: Beauvoir, holding out for a total remake of society, believed that even in the meantime “No woman should be authorized to stay at home to raise her children …. Women should not have that choice, precisely because if there is such a choice, too many women will make that one.”

Rhetoric is one thing, and given the many ideological variations within the women’s movement, any attempt to attribute to it some particular position on women’s work in the home would almost certainly invite fierce disagreement. But it is much harder to dispute what has actually happened in the last half-century. In certain respects the women’s movement has had enormous success. Women’s levels of education, employment, and income have all surged. In that sense the situations of men and women are far more alike than they once were. Through their inroads into realms previously closed to them, women have obtained a share of the status which was once conferred far more heavily on men.

I would be hard-pressed to say, though, that there has been any improvement in the status of “women’s work.” (I mean by that the traditional work of women, whether performed by women or by men.) The essential functions without which no society can exist – the care of children, the preparation of food, the keeping of a house, the care of the elderly and infirm – continue to be devalued. Read more »

by Brooks Riley