Michael Caligiuri, a renowned physician-scientist is the President of City of Hope National Medical Center, and Deana and Steve Campbell Physician-in-Chief Distinguished Chair. He directed The Ohio State University Comprehensive Cancer Center for 14 years prior as well as being the chief executive officer of The James Cancer Hospital and Solove Research Institute for 10 years. Caligiuri’s research focuses on the development and activation of human natural killer cells and their modulation for the treatment of leukemia, myeloma, and glioblastoma. He is a fellow and the immediate past president of the American Association for Cancer Research and has been elected to the National Academy of Medicine (NAM), one of the highest honors in the fields of health and 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 Eric J. Weiner

Caring for myself is not self-indulgence, it is self-preservation, and that is an act of political warfare. —Audre Lorde

As I write this introduction, I struggle against becoming overwhelmed by too many things: The mass shootings that occur on a regular basis; the daily gun-related murder and maiming that occur throughout the country everyday; the normalization of white supremacy/nationalism; the poverty you can see in the eyes of children in shelters and on the street; a twittering billionaire president who mugs for the cameras of “the enemy of the people” as children are concentrated in “camps” at the southern border; the increase in crimes against immigrants, African Americans, Jews, Muslims, women, and gay people; the gouging prices of life saving drugs like insulin; and the smugness of those in congress who summer far from the death and chaos, muttering to the press about mental illness, second amendment rights, the “free” market, cultural deficits, and anything else that might distract from the callousness and cynicism that drives what poses for public policy these days. And I could go on.

But I know that if I am overwhelmed then I will not have the energy to resist, talk back, confront, fight, struggle, reflect, transform, teach, and renew.  In this essay, I will discuss what it means to develop what I am calling a praxis of pleasure as both a strategy and tactic of resistance. As a tactic, a la Michel de Certeau, it is a practice of reclaiming a modicum of power within an established geography of inequitable power relationships. As a strategy, it is a guide toward living well so that we may rise to fight another day. Read more »

by Brooks Riley

by Bill Murray

Thirty years ago this week two million people joined hands forming a human chain across 676 kilometers of Estonia, Latvia and Lithuania. Known as the Baltic Way, the visually arresting stunt was a cinematic cri de coeur for freedom.

In time freedom was theirs. The Russian military fled, sometimes trashing their barracks and looting along the way the way. As a measure of the state in which the Soviet Union left the Baltics, still now, thirty years on it takes around seven hours to travel by train between Tallinn and Riga, the capitals of two European countries separated by scarcely 200 miles. Imagine.

The Estonian and Latvian railways have finally co-ordinated their timetables, but you still have to walk across the platform to change trains at the border. By contrast, the drive takes perhaps four and a half hours, and, as both are now Schengen countries, your vehicle breezes through the abandoned border post without slowing down.

Much of that drive, after the tidy Estonian border town of Parnu, takes you south along the coast of the Gulf of Riga. Estonia and Latvia are lovely during this early bit of Baltic autumn, grasses with full summer growth waving in fields skirting Baltic shores. Read more »

by Sarah Firisen

I’ve just come back from a lovely vacation in Ireland. We did a lot of driving and usually had the radio on, often to RTE, the state run station (the equivalent to the BBC in the UK). At least once an hour an advertisement would come on reminding people that they need to get a TV license, which costs 160 Euros, $177 a year. I grew up in the UK, where a license is 154.50 sterling,  $187 a year, and remember the ads when I was a child that warned of the TV detector van coming around and catching people who hadn’t paid their license. Of course, that was in the days of very obvious exterior antennas on houses. When TV licenses were first issued in the UK after the second world war, they funded the single BBC channel. Even when I was a child, there were only 3 channels, then when I was a teen 4, and two of those were the BBC. In the UK today, a license is needed for any device that is  “installed or used” for “receiving a television programme at the same time (or virtually the same time) as it is received by members of the public”. In Ireland, as the many ads I heard made clear, the license is for a physical TV, regardless of what it’s used for, including gaming or streaming YouTube videos. In the UK, you don’t need a license if you watch anything else on your TV, including using catch-up devices and players for BBC shows, except if you use the BBC iPlayer services, but you do need a license if you watch live TV or use the BBC iPlayer on any device.  

Listening to these repeated ads in Ireland, it struck me how regressive this license charge is. Reading up on the differences in the UK, their rules seem fairer at least. On my return, I read that Ireland is actually changing its licensing rules in the future and that “The Government is to scrap the current licence fee and replace it with a charge that will hit virtually every Irish home, regardless of whether a television set is present…It will mean that anyone with a laptop, a tablet or a smartphone at home will be liable to pay.” 

I’m not really debating the virtue or utility of such licenses. There’s clearly a valid debate about the need for state owned TV and radio stations in this day and age, but that’s not my point to debate here either. Rather, my thoughts are about government’s ability to keep pace with technological changes. Read more »

Self-portrait in reflection on the entrance doors of the showroom of famous chandelier-maker, Faustig, in Brixen, South Tyrol, in October of 2014.

by John Schwenkler

The community of philosophers is mourning the loss of Barry Stroud, one of the great philosophers of the past half-century, who died on Friday, August 9 of brain cancer. Stroud earned his B.A. from the University of Toronto and his Ph.D. from Harvard University. From 1961 he taught at the University of California, Berkeley, where I knew him during my time as a graduate student there.

Stroud’s important paper of 1968, “Transcendental Arguments,” followed Immanuel Kant in distinguishing two sorts of question that a philosopher can raise about the concepts human beings use in thinking about ourselves and our world. The first, which Kant associates with John Locke, is the question of fact that concerns which concepts we do have and how we came to possess them. To explore our concepts in this way is to engage in what Kant, in his Critique of Pure Reason, called a “physiology of human understanding.” It is to give a causal account of how our minds came to be the way they are—an important project, but not one that is distinctively philosophical, since empirical disciplines such as psychology, sociology, and anthropology also take it up.

Kant’s other way of reflecting on human concepts, which is the one he undertakes in the first Critique, raises instead a question of right. This question asks, given that we have the concepts we do and have come to possess them in whatever way we did, whether we really are justified in possessing those concepts and using them to think about things. It is a question of whether our ways of thinking allow us to have an objective grasp of reality rather than a merely subjective conception of how things are. Read more »

by Bill Benzon

While cruising the web on the evening of July 22, 2019, I learned that Dick Macksey had died earlier in the day. He was a legend at Johns Hopkins University, had been for years – a prodigious polymath who speaks who knows how many languages, a tireless teacher, a genial host, and an indefatigable conversationalist who owns more books than the Library of Alexandria, though only a few of them are quite that old. Everyone had spoken of the legend for decades, and Everyone is now retelling it.

The thing about legends is that they are based in fact, but the amplification serves to create distance from facts behind the legend.

I had worked with Macksey for seven years between 1966, the spring of my freshman year at Johns Hopkins, and the fall 1973, when I went to SUNY Buffalo to get a doctorate in English literature. I have had occasional contact with him since then, both in person and over the phone. I knew the legend of course. But I also glimpsed the man. Read more »

Einstein & Etta James

(reading below)

I’m fourteen when Einstein is
in Princeton

he’s old & heading out of breath
as I am fresh and new at breathing
in some

but there the landscapes of the space
between our ears divides

Al used levers of mind to lift
mass in time while mine
took to bass of R & B
which thumped in heads
and loins in adolescent
instants

Einstein’s gone, but his poster’s on our wall
—if you were stepping down our stairs you’d
glimpse him

in overcoat and hat strolling through our stairwell
wry smile, moustache, life-sized, black and white,
shedding light on light (you couldn’t
miss him)

same moment: mid-fifties
bluesy Etta James, was desirably
winsome

she was strong and sexy
beautiful and sure

so I weighed the heft of
his and hers and took them both
to mind and heart and lately find,
in terms of back-and-forths between the two,
there certainly has
been some

I admired them both and
then some
.

by Jim Culleny
12/15/18
https://clyp.it/0vecuqux

by Michael Klenk

I live and work in two different cities; on the commute, I continuously ask my phone for advice: When’s the next train? Must I take the bus, or can I afford to walk and still make the day’s first meeting? I let my phone direct me to places to eat and things to see, and I’ll admit that for almost any question, my first impulse is to ask the internet for advice.

My deference to machines puts me in good company. Professionals concerned with mightily important questions are doing it, too, when they listen to machines to determine who is likely to have cancer, pay back their loan, or return to prison. That’s all good insofar as we need to settle clearly defined, factual questions that have computable answers.

Imagine now a wondrous new app. One that tells you whether it is permissible to lie to a friend about their looks, to take the plane in times of global warming, or whether you ought to donate to humanitarian causes and be a vegetarian. An artificial moral advisor to guide you through the moral maze of daily life. With the push of a button, you will competently settle your ethical questions; if many listen to the app, we might well be on our way to a better society.

Concrete efforts to create such artificial moral advisors are already underway. Some scholars herald artificial moral advisors as vast improvements over morally frail humans, as presenting the best opportunity for avoiding the extinction of human life from our own hands. They demand that we should take listen to machines for ethical advice. But should we? Read more »

by Jonathan Kujawa

Nearly four years ago here at 3QD we talked about how Euler became interested in a trifling little puzzle in 1736. He asked if it was possible to take a walk through the city of Königsberg, Prussia and cross each of its seven bridges once and only once. It seems like a silly thing to spend your time on and is obviously of no use to anyone. My former senator would have an aneurysm at the idea of funding such research. Fortunately for us, Frederick the Great was more of a visionary.

Being no slouch, not only did Euler solve the problem (spoiler: it’s not possible), he invented two major fields of modern mathematics in the process. Four years ago we followed one of those rabbit holes and were led to the field now called topology. It is the study of geometry when you don’t care about angles, distance, and the like. Topology is a rich and exciting area of modern research with all sorts of applications. It leads to subway maps, the use of homology to study the structure of huge data sets, motion planning for robots, and gives us that one easy trick for solving labyrinths like a Theseus.

The second rabbit hole is the one we follow today. It leads to another area of modern mathematics now called graph theory.

In mathematics, a graph is nothing more than a collection of nodes and connections between them (sometimes called vertices and edges, respectively). Graphs can be drawn where each node is a dot and each connection is a line connecting the corresponding dots. Read more »

Dr. Steven T. Rosen is the Provost, Chief Scientific Officer, Director of the Comprehensive Cancer Center and the Beckman Research Institute for the City of Hope. He also holds the Irell & Manella Cancer Center Director’s Distinguished Chair and is the current Chair of the Medical Science Committee of the Leukemia and Lymphoma Society. Dr. Rosen’s laboratory research focuses on experimental therapeutics and hematologic malignancies. With over 400 scientific papers he has been an advisor to more than a dozen NCI Comprehensive Cancer Centers. Dr. Rosen serves on the Board of American Society of Clinical Oncology’s Conquer Cancer Foundation, Leukemia and Lymphoma Society and NCI’s Frederick Advisory Board.

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 Elizabeth S. Bernstein

To follow the popular discourse about the gender wage gap in the United States is to confront perpetual confusion. It is a confusion created at least in part by pronouncements of the type many of us have heard: “Women are paid only 82 cents for every dollar men earn! It is high time for women to earn equal pay for equal work!” Two sentences, each true standing alone, but in juxtaposition creating the impression that the 82-cent figure was derived by comparing men and women in similar jobs.

The commonly used statistic does not however represent any comparison of men and women doing equal work. It is simply a comparison of the median wages earned by each gender in the whole assortment of jobs they hold. Though the calculation is typically limited to full-time workers, defined as those working at least 35 hours per week, men and women do not work the same number of hours. There are more women than men working between 35 and 39 hours, more men than women working over 40. On any of a number of measures – the dangers inherent in their work, the amount of travel required – the jobs worked by men and women are not the same.

This is not to say that outright wage discrimination doesn’t exist. To tease out that part of the gap, economists control for an assortment of measurable differences between men’s and women’s employment situations. Some portion of the “unexplained” gap that remains is assumed to reflect discrimination. In 2016, Glassdoor compared the earnings of men and women who were not only of similar age, education, and years of experience, but who also worked for the same employer, in the same location, with the same job title. (They did not, however, control for number of hours worked.) The resultant gap was 5.4%. In 2019, Payscale compared the median salaries of men and women with the same jobs and qualifications, and found the gap to be 2%.

Whether that “controlled” gap is two cents or five, whatever part of it is due to gender discrimination is wrong, and illegal. The good news is that that portion of the gap has decreased steadily over the decades. The women who have fought to accomplish that deserve great credit. Read more »

by Adele A. Wilby

On occasions, while meandering the various English countryside and woodland paths, I have been pleasantly surprised to come across anglers. I have met fishermen dangling their lines in either a pond in some remote corner of the low-lying areas, or wading in water and casting a line down through the waters of a gently flowing river.

Brief dialogues with these men, and they have all been men, on how far they have been successful in their catches yield different responses: some are satisfied that they have indeed caught several fish and subsequently returned them to the water, while the response of less successful anglers is to express optimism that by the time they leave at the end of the day, they will most certainly have landed a fish!

However, arguably more interesting than whether or not the hooks have snared a catch is the demeanour of the men involved. Decked out in their layered fishing jackets with pouches containing various equipment adding inches to their already substantial, ageing girths; sturdy boots at various levels on the way up their calves, waterproof trousers well tucked in; hats of different shapes and sizes and colours; tackle boxes splayed open revealing their array of hooks and other stuff I have no knowledge about; standing or sitting, sometimes with the rod in hand, or not infrequently,  just circling the same spot eyeing their rods, they exude more  a sense of enjoyment and ease at the tranquillity of the natural environment in which they are immersed, than the actual fishing; it is their space, and they appear to relish the moment.

Nevertheless, neither a hunter of either animals or fish myself, the fascination over the pleasure these men, and some women, obviously experience in the challenge to catch a fish has frequently perplexed me. Why would anybody want to sit on the edge of a pond in any type of weather, sink a line and hook and wait to catch an innocent fish, or stand deep in water consistently casting a line back and forth down or up a stream, until a hungry fish in the wrong place and at the wrong time is snared on a hook? Read more »

by Brooks Riley

by Chris Horner

To become mature is to recover that sense of seriousness which one had as a child at play. —Nietzsche

Freud is supposed to have claimed that the two key things for happiness in life are work and love. If he did, he should have added a third: play. It’s this that Nietzsche is referring to in the quotation above. The aphorism states a paradox: we are told that to be ‘mature’ (whatever that is) we must return to playing like we did as a child. And what to make of that ‘sense of seriousness’ in a child’s play? Surely Nietzsche is thinking of the complete absorption and focus that a child is supremely capable of experiencing. If we are lucky we can recall times in our childhood when we were completely lost in the thing we were doing, seeing or hearing: serious play. As adults this can all too often elude us. It can seem a thing belonging to the lost time of childhood. But we should not give up the quest for it: it is a key to joy in life.

But let’s not idealise or sentimentalise the child. Children are in fact often intolerant of frustration, easily bored and keen to get shiny new stuff. And adults really can learn important habits of discipline and perseverance that children find so irksome. But they are also capable, to a degree that many adults find difficult, of the opposite of all that. A distinction needs to be made between childish and childlike. With the former we have all the characteristics associated with immaturity: a tendency to be easily distracted or bored, the urge for immediate gratification, demand for toys, and so on. All characteristics, incidentally, that our society tends to encourage in the adult. One of the key features of our time, surely, is divided attention, distraction and the promotion of multi-tasking. We even have an ‘attention economy’ in which corporations compete to distract us. And we know about the twitchy addiction to the smartphone and to social media. But all this hyperactivity, this constant busyness, can actually block us from attending to what is important. A drifting, distracted attention actually narrows our focus, because it thinks it knows what it wants, that it is looking for ‘something interesting’. It stays one step ahead of boredom – for a while.

To be childlike is quite different. Read more »

by Anitra Pavlico

It is difficult nowadays not to be mindful of how ubiquitous the mindfulness movement has become. A Fortune article from 2016 described meditation as a “billion-dollar business”: “From Bridgewater’s Ray Dalio and Salesforce’s Marc Benioff to Goldman Sachs traders and Google programmers, Big Business loves meditation.” This is perhaps reason enough to stay away from it, or at least to stay away from anything that charges you money to do something that you can easily do for free–namely, sit and do nothing. But a surprising number of observers have pointed to other shortcomings or even dangers in meditation and mindfulness practices. 

There have been so many articles on the incredible benefits of meditation (which I’ll use interchangeably with mindfulness) that you come to feel you’re putting yourself in harm’s way by not doing it. As Masoumeh Sara Rahmini wrote recently in The Conversation, however, citing a study published in Perspectives on Psychological Science, “scientific data on mindfulness is limited . . . Studies on mindfulness are known for their numerous methodological and conceptual problems.” She notes that the journal PLOS ONE retracted a meta-analysis of mindfulness, citing concerns over methodology as well as undeclared financial conflicts of interest. Rahmini also takes issue with the Westernized version of Buddhism that is sold to modern mindfulness practitioners–one that is divorced from centuries of Buddhist tradition. She credits, or blames, Jon Kabat-Zinn, among others. Kabat-Zinn, the founder of the popular Mindfulness-based Stress Reduction (MBSR) program offering mindfulness training to help with stress and pain, has argued that the MBSR technique contains the “essence” of Buddhism, which he says is universal and supported by science. 

The trouble is that what used to be a spiritual practice, supported by a framework of teachings and in an organized setting, with spiritual guides, is now a definition-less practice, unmoored from tradition, lacking a scaffolding in case you should trip, devoid of a philosophy. Read more »

Alpine meadow near my house in July, 2019.