Archive for September, 2020

 

Sep 26 2020

Life in the Time of Corona(virus) – Day 195

by at 11:47 am

I write this blog on Saturday, as Yom Kippur starts Sunday evening and I will be out of commission through Monday evening. This time of year makes me reflective.

As we pass grim milestones — 7 million cases, 200,000 dead, we find that COVID-19 has exposed and widened fault lines in our society. We live in an era marked by suspicion of science, of what constitutes truth, and of the enshrinement of political opponents as enemies rather than fellow citizens. The battle between those who crave power and those who aspire to empowerment is not new, but it sure has new urgency.

What does this all mean for the field of cancer research and therapy? First of all, it depends upon who controls the purse strings. Until now, our national biomedical research enterprise — symbolized by three towering American institutions, the NIH, the FDA and the CDC — has been broadly supported and left relatively unscathed by political interference. Those days are gone. What happens to the NIH over the coming months and years will reverberate throughout extramural university-based research, so it really matters who is in charge, and how they view the value of scientific research, even when its conclusions are inconvenient.

Healthy skepticism is, well… healthy. But when the truth becomes entirely fungible, we head into dangerous waters. We may roll our eyes when a public figure embraces quack treatments, be they related to COVID-19 therapy, vaccine safety or cancer cures. In some instances, our patients embrace those ideas, and the public support for rigorous investigation, be it clinical, basic or population, wanes.

When I was younger, boxing was very popular. It was, and remains, a tough, even brutal sport, but there are rules of order. No biting, no eye gouging, no knees or punches to the groin. Championships are earned honorably. It reminds me of the world as it was. Now, boxing has faded, replaced by the enormously popular UFC, which is essentially no-holds-barred brawling, mixing the toughness of boxing with the more outrageous and entertaining aspects of professional wrestling. I believe this is an apt metaphor of our society.

What does this mean for research and medicine? First of all, money will be tight. Our patients will have more information, but may not be better informed. They will feel empowered, perhaps enough so to more aggressively guide their own therapies, shopping around until they find a doctor who agrees with them. We are entering into a new world, and must be brave. Beware the dark side of the force.

As for me, I have decided to dance with the bear. Biomedical informatics is here to stay. We need to avidly incorporate information to improve medical practice, and must find a way to share that information with our patients in a manner that facilitates their engagement in a structured manner that serves their best interests. Finally, and most importantly, we must continue to insist that facts matter, and that they are the building blocks of human progress.

Stay safe and be well.

Lou

 


The views, thoughts, and opinions expressed in the text belong solely to the author, and not necessarily to the author’s employer, organization, committee or other group or individual.

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Sep 21 2020

Life in the Time of Corona(virus) – Day 190

by at 7:30 am

We are headed up to Baltimore to welcome another member of our clan into the world. We will be helping Elana and Ben with the other kids, and Harriet is able to be at the hospital as well.

A new baby for the new year! In the Jewish tradition, we are in the midst of Rosh Hashanah, literally translated as the “Head of the Year.” This holiday is usually a joyous but also somber and reflective start to the 10 Days of Awe on the Jewish calendar culminating in Yom Kippur, the Day of Atonement. Sadly, the holiday began with the death of Supreme Court Justice Ruth Bader Ginsburg, an iconic figure in the fight for equality and for women’s rights in particular. She was a hero to many, and a shining example of core Jewish values such as tzedakah. In its highest form, tzedakah is the act of making the world right through your actions, not to gain acclaim, and not to please a deity, but because it is the right thing to do.

You may have read the statement, “Let her memory be a blessing,” which is commonly used by rabbis on the occasion of someone’s death, and it has been used frequently over the past few days. This is not a hackneyed phrase born of idle tradition. Rather, it is a call to action. The blessing is a reminder to live out the values of the deceased and to make the world right (the phrase, “tikun olam,” means to heal the world). So, the challenge before me, and indeed before all of us, is to reflect upon RBG’s life and work, and to apply those lessons — to act, and not just eulogize.

We are lucky. The work we do is, at its core, the essence of tikun olam. We aim to heal the world through cancer research and care, impacting not only large populations, but one person at a time. How lucky we are to have that privilege. However, much is left to do. Have we fully included issues of equity in our research? Even a basic scientist can think about the larger problems, such as the diseases that disproportionately affect underserved minorities, and look for opportunities to align research with those challenges. Population scientists can focus their work (as so many do) on addressing biological truths with the many forces that conspire, deliberately or unknowingly, to impair access to better health practices, prevention, early diagnosis and effective therapy. Clinicians on the front lines have a wonderful opportunity to design clinical care algorithms and clinical research to assure that nobody is ignored. Health systems can adjust priorities to assure that poverty is not a death sentence. And universities can reflect on fundamental inequities in access to education and in providing platforms for change.

It will take all of us, working together, to help fulfill RBG’s dream of an equitable society. Let us honor her life’s work. May our new grandson grow up in a world with an arc more fully bent towards justice. Finally, may the memory of Ruth Bader Ginsburg be an enduring blessing.

Stay safe and be well.

Lou

 


The views, thoughts, and opinions expressed in the text belong solely to the author, and not necessarily to the author’s employer, organization, committee or other group or individual.

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Sep 14 2020

Life in the Time of Corona(virus) – Day 183

by at 7:30 am

There is not much new to report on the coronavirus front. DC-based infections and hospitalizations remain low, and there have been few deaths. The month of September will be critical, as we absorb the multiple impacts of Labor Day, school reopenings and the relaxation of social distancing.

As promised, I have spent the weekend digesting the Bob Woodward interview of President Trump, and found my thoughts centering on the tortured relationships of facts with truth. I remember reading a statement by an advisor to then-President George W. Bush, asserting that the administration, not the facts, defined the truth. In other words, the people in charge get to determine which facts matter, and to define what is true. It’s chilling, but this is nothing new. Facts and truth have always had a tenuous relationship, because power depends not upon using facts, but rather on defining truth.

Facts are sometimes wrong — Lamarck’s accepted views of evolution were upended by Darwinian natural selection. Facts are sometimes inconvenient — Galileo was excommunicated for his assertion that Copernicus was correct in that the Earth revolved about the sun. Those facts were, and remained, correct, but were rejected because they were deemed heretical. In our time, former Vice President Gore raised the alarm about global warming in the unforgettable “An Inconvenient Truth.” In the case of global warming, opposing beliefs based on “alternative facts” have thus far carried the day in our country.

Facts can accumulate to create larger truths. However, those truths may require the accumulation of more facts than are available at any given time. For example, the Philadelphia Eagles are objectively far more talented than the Washington Football Team, but got waxed because they were not the better team on this day. In the case of that football game, the impact of injuries that decimated the Eagles’ offensive line rendered the other facts moot.

The same thing happens with cancer — all the time. Every ineffective cancer therapy enters clinical trials supported by a mountain of facts that uphold its use, but do not create the hoped-for truth. Every call for social justice based upon the unequal treatment of individuals or groups creates masses of conflicting statistics that support either moving toward social justice or doubling down on repressive tactics to maintain the status quo. Whose truth wins? It just depends upon who is in charge.

I understand that facts can be interpreted and rearranged to support vastly differing conclusions by people of good faith. This happens all the time in science, and this friction, abetted by rigorous peer review, is essential if we are to uncover truths. But what happens if this process happens in the absence of good faith? In science, we call this fraud. In contemporary America, we call it politics.

In the world of cancer research, we revere facts, and we accumulate them to uncover truths. As we uncover facts related to the coronavirus pandemic, we instinctively (and properly) align them to create truths — the virus is dangerous, it is hard to treat the infections, and social distancing and masks can mitigate risks. Hence, our outrage when these facts and plausible conclusions are contradicted by political leaders who ignore the warnings in pursuit of their alternative views and facts.

Over the summer I read “The Splendid and the Vile,” a marvelous biographical account of Churchill’s leadership during the London Blitz of World War II, by Erik Larson. Faced with the inescapable facts of German air raids, Churchill told the British people the truth, gave them the needed facts, and articulated a path forward that would lead to victory. The results speak for themselves. Public policy is most effective when it emanates from truths based on facts.

Woodward documents that the President knew about the dangers of the coronavirus in early 2020 and chose to ignore the facts to support his electoral prospects. He not only ignored the facts and their aligned truth, but has actively and consistently undermined actions that could have mitigated the impact of the pandemic. This fundamental and knowing betrayal of the truth has cost countless thousands of American lives, millions of jobs and trillions of dollars. History will not remember this as our finest hour.

Stay safe and be well.

Lou

 


The views, thoughts, and opinions expressed in the text belong solely to the author, and not necessarily to the author’s employer, organization, committee or other group or individual.

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Sep 11 2020

Life in the Time of Corona(virus) – Day 180

by at 7:30 am

It has been a busy week under the pressures of the upcoming EAC meeting, grant deadlines and the usual tsunami of urgent administrative responsibilities. The DC coronavirus infection rate has dipped below 2%, though the impact of Labor Day gatherings has yet to be felt. So, I decided it was time to go back to physically seeing patients in my clinic today. It felt reassuringly normal, and I was a bit excited to return. I took all of the mandated precautions — mask, face guard, frequent hand-washing — but I did not feel as if I was in a battle zone, as I did back in the spring. I am far less concerned with fomites than I am with respiratory transmission of the virus, so I did not feel the need to wash down my briefcase, etc., and did not treat my clothes as nuclear waste when I got home.

I don’t think I am complacent as much as I am data driven. Over the past couple of weeks I have been meditating about risk-adjusted behavior, and I think it is a wise approach that can keep me safe and sane. Should there be a spike in coronavirus infection rates, I will act appropriately. However, I will confess that it feels good to be cautious but not somewhat frightened when going about my day. To be clear, I still believe that social distancing and appropriate mask use are vitally important measures as we await effective vaccines and better therapies.

I am still trying to process the recent set of bombshells related to the taped interviews of the President by Bob Woodward. While I struggle to understand the timing of the release of the information, I find the revelations most troubling, to say the least. I may have more to say on the subject — really, a meditation on transparency and leadership — once I have had a bit more time to gather my thoughts. Until then, please have a good weekend.

Stay safe and be well.

Lou

 


The views, thoughts, and opinions expressed in the text belong solely to the author, and not necessarily to the author’s employer, organization, committee or other group or individual.

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Sep 08 2020

Life in the Time of Corona(virus) – Day 177

by at 7:30 am

I’m back!

So, that was one weird summer. It was vaguely normal(ish). I spent a fair amount of time during August in Delaware, but the Zoomiverse knows no geography as long as the internet works. So I got a lot of work done. Important strategic planning, active recruitments, weekly clinics, financial and workforce management have not detracted me from submitting an R21 grant exploring the interactions of NK cells with pancreatic stellate cells in pancreatic ductal adenocarcinoma. A new R01 focused on resistance mechanisms to antibody-dependent cellular cytotoxicity is almost done. The lab is back to about 25% activity, and we are churning out data and papers. Normal(ish).

We are gearing up for an important External Advisory Committee meeting in a couple of months. However, the news this fall undoubtedly will be the upcoming elections. This can only be characterized as abnormal, and there is no “ish” about it. I won’t even begin to unpack the events of the past month, but do think that a good barometer is to consider which candidates are most likely to promote conditions that will advance patient care and cancer research.

Speaking of cancer, I think of the current political climate as being dominated by a potentially lethal, multifocal cancer that must be excised through the exercise of the ballot box. Adjuvant therapy will be needed, and for far more than six months, to prevent or minimize relapses. However, our country suffers from pre-existing conditions related to fundamental social injustice in all its malignant forms. Even after the overt malignancy has been eliminated, another cancer will inevitably emerge if we don’t address social injustice based on race and class. I suspect that eliminating the cancer will prove to be easier (though it is by no means certain, and will not be easy) than truly addressing these pre-existing conditions. But we do these things (with apologies to President Kennedy) precisely because they are hard. They are the challenges — our Moonshots — that will define our communal legacy.

Meanwhile, coronavirus continues on its merry path of destruction. We are up to about 188,000 deaths, and based on what I saw in Delaware, we should brace ourselves for a surge in cases over the coming weeks. It is not time yet to drop our guards. So, it’s back to Instacart living for us. Please remember that until we learn whether a surge is in our future, it is urgently important that we maintain discipline at home, at work and in our communities.

Stay safe and be well.

Lou

 


The views, thoughts, and opinions expressed in the text belong solely to the author, and not necessarily to the author’s employer, organization, committee or other group or individual.

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