Archive for February, 2022

 

Feb 26 2022

Words Fail

by at 8:37 pm

I write this week’s blog on Saturday night. Words fail. I cannot do justice to current events, but I feel that I must lend my voice to the chorus. This is too important.

Just as we begin to emerge — tentatively and perhaps maskless — from the oppressive coronavirus pandemic, however transient the reprieve might be, we are gut punched by a more familiar type of bogeyman. This specter from the 20th century, and if we are honest, from all of human history, is a homicidal tyrant hell-bent on domination, with no regard for human life. He chose this past week to live out his particular Rambo-style fantasy on a nation filled with innocents who will needlessly die for the sin of existing in a particular place at a particular time. For who? For what? We, who struggle to save one life at a time, cannot comprehend the enormity of this evil.

I only know what I see and read, but here is my take. The Ukrainian people have thus far fought valiantly, and no doubt will continue to do so. The president of the Ukraine reminds us of the essential differences between false bravado and true courage, demonstrating profound grace under pressure. I pray for his survival and success. With enormous disadvantages in troops, munitions and air power, I fear the Ukrainian people will lose the battle for Kiev soon, but they will eventually win this war, for they have tasted freedom for too long and will never lose the memory of that taste. With the rest of the world aligned in a manner I have not seen since the aftermath of 9/11, the Ukrainian people will get long-term assistance, and Russia will be isolated and constrained while Putin and his buddies deal with an increasingly outraged citizenry that will prefer food and jobs over abstract megalomaniacal notions and forced military conscription. Those poor oligarchs, what will they do without their yachts, private jets and multi-million-dollar homes around the globe? How can they possibly live without buying everything in sight at Art Basel?

Putin has previously succeeded in crushing his opposition after earlier rebellions in Chechnya and the Ukraine, but this time the bear has poked a much larger creature. Might this outrage be the impetus for the United States to rediscover some of its common values and purpose as it leads a global coalition in resistance to Putin’s plans to destroy world order? Russia will be a pariah state as long as Putin rules, and his impending victory in the Ukraine ultimately will prove to be hollow.

The next days and weeks promise to be awful. As this is the first large-scale war fought by a military superpower in the era of Facebook, Twitter, Instagram and a communications-enabled populace, the truth will emerge, and the fearsome savagery of war and of these oppressors will be on full view. People will be more outraged than cowed. I remember how a photo showing the execution of a Viet Cong colonel in 1968 galvanized protests against the Vietnam War. That was just one picture. Imagine what will happen when the atrocities to come emerge fast and furious on our smartphones — all day, every day, everywhere. I just hope that the Western alliance holds, does not lose its resolve, and that the United States rises to the challenge of world leadership, as it must.

At moments like this, we are faced with the awful truth that research, prevention and treatment of human disease necessarily take a back seat to the carnage of war. It is no accident that the end of the golden era of NIH doubling coincided with the U.S.-led invasion of Iraq in 2003. More important, it feels almost disrespectful to write about anything but Ukraine this weekend.

However, I cannot help but note that this past Friday’s Grand Rounds speaker, Dr. Elana Fertig from Johns Hopkins, gave a marvelous talk that demonstrated the power of computational biology to guide cancer immunology research. As one of her scientific mentors and collaborators, I was so proud. Having helped to raise her since she was a very little girl, my heart was bursting with parental pride. She, and so many other spectacular emerging research stars, are reminders that while we might be forced to focus on the dark clouds we see during times of trouble, the sun will shine again, brightly, warming the future.

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.

No responses yet | Categories: Uncategorized

Feb 20 2022

The Value of a Single Life

by at 4:23 pm

Presidents’ Day Weekend will always have a special meaning for me. I remember the joyous agony, over a three-day period just one year ago, of saying goodbye to my father and then welcoming our youngest grandchild, who was about to embark on a perilous, life-threatening journey. All this in the shadow of the COVID-19 pandemic, which by then had claimed millions of lives around the globe, each of them equally precious.

My dad still lives in so many ways, animating our family as we remember the example of his life story and remarkable spirit. My favorite photo shows him near the end of his life, ravaged by age and myelodysplastic syndrome, sitting on a deck chair overlooking the ocean, his once athletic body wrapped in a blanket, the paper-thin skin on his right wrist bruised and partially covered by a large bandage. His face, tilted up, is bathed by the morning light and lit by a wide smile as he contemplates the rising sun, the reflection of which is seen on the sliding glass door in back of him. Even in this diminished state, his magnificent life force shines through. That photo is framed and hangs on an inside wall adjacent to that sliding door, over a small table that holds an ashtray and one of his lousy cigars. He would like that, I think.

A baby sits in a stroller

Clark is healthy, physically robust, emotionally connected, impossibly curious and constantly in motion.

I have documented Clark’s medical adventures over the past year or so, starting with a prenatal diagnosis of coarctation of the aorta, leading to corrective heart surgery when he was only one week old. We simply could not have asked for a better outcome as we celebrate his first birthday. He is healthy, physically robust, emotionally connected, impossibly curious and constantly in motion. His eyes sparkle with warmth, and like my dad he possesses an unstoppable life force and a smile that lights up his face and everything around him. One year after his tenuous arrival into this world, he has a future and a chance to strive for both goodness and greatness. He is fortunate to have had the incredible support of loving parents who put his heart in their hands, and an extraordinary team of surgeons whose daily grind creates miracles. Our gratitude is immeasurable.

Since that weekend, COVID-19 has claimed millions of additional lives around the world. Each life lost is an unspeakable tragedy. This has nothing to do with politics, ineffective nanny states, toxic individualism or any of the incessant messages the talking heads scream at us. How many new poems, new discoveries, new businesses or great performances have we buried and lost for all time? How many children have been deprived of a mother’s caress, a game of catch with a grandfather or the joy of welcoming a new child into the world? And now, the world faces the looming specter of a completely unnecessary but unquestionably devastating war in the Ukraine, which will accomplish nothing more than finishing the job that COVID-19 started there. Utter madness.

This is why I chose a life in medicine and medical research. This is why I am an oncologist. I cannot change the world, but I can strive to improve the human condition. With luck, I can alter the life trajectories of my patients, one at a time. In a very real way, I hold their hearts in my hands, and I am ennobled by that sacred responsibility. Through research, I hope to move the needle, ever so slightly, in the direction of effective new therapies for life-threatening diseases. I recently spoke at a Library of Congress symposium on cancer immunotherapy and was inspired by the remarkable progress that has been made by the field. Change is possible. Maybe, just maybe, I am making a bit of a difference. My father would approve, and with luck, my youngest grandchild will grow up in a better, healthier and more welcoming world.

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.

No responses yet | Categories: Uncategorized

Feb 13 2022

Contours of Normalcy

by at 10:21 pm

I had a very busy workweek, and spent at least some part of four weekdays in the office or clinic, chairing an all-day Zoom cancer center EAB meeting from home on Thursday. We then used the weekend to visit family in Philadelphia to celebrate a few birthdays. It felt shockingly normal. Both DC and Philadelphia have plummeting COVID-19 infection rates. Maybe, just maybe, we’ll get a respite from pandemic precautions. We all have certainly earned a break!

I hope so, because next week we plan to celebrate our youngest grandson’s first birthday with parents Dave and Kelly, sister Clara and Kelly’s parents. Clark started life so tenuously, with a coarctation of the aorta that required major heart surgery shortly after his birth. Now he is huge, happy, healthy and developmentally normal in every possible way. We plan to party “heartily” together (meaning a second glass of wine), celebrating our little miracle. Clara will have to settle for apple juice. What a difference a year makes.

It was a long drive home, so I am going to abbreviate this week’s blog. 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.

No responses yet | Categories: Uncategorized

Feb 06 2022

Just for Show?

by at 7:57 pm

Noting that nothing in today’s blog represents anyone’s opinion but mine, I need to get something off my chest. On Friday night, Harriet and I watched “Real Time with Bill Maher” on HBO. The host is very bright, funny, abrasive, contrarian and provocative. He ticks off a lot of people, and seems to like it. His end-of-show monologue typically takes a steely eyed look at current events from the perspective of an enlightened libertarian with a bit of mean streak. More often than not, I take away something useful from it. But not too much on Friday.

Maher took aim at medicine and research, scorning ideas and guidance that, in retrospect, were either flat out wrong or slow to adapt to rapidly changing knowledge. He tore into the way AIDS was approached, conveniently neglecting that within a decade of its appearance, effective therapies emerged that have added decades, not years, to people’s lives. Could we have done better? Of course. But can you imagine the scourge of that disease had it emerged in 1880 or even 1950? And now, with the COVID pandemic, he seems to conveniently minimize the utterly extraordinary fact that today, a mere two years following the recognition that COVID was even a thing, we have widely available vaccines that are highly effective in preventing severe illness and death, and an emerging arsenal of effective antiviral therapies that can mitigate the severity of illness in those who develop symptomatic disease. In other words, he dismisses a miracle that unfolded before our very eyes.

He primarily targeted the way COVID has been managed, chiding public health experts and governmental agencies for taking excessive precautions, especially early in the pandemic, with respect to masking, wiping down groceries and closing down businesses. He believes that only the old, sick and vulnerable in our society should have been protected — perhaps he might have liked to see a modern leper colony (that is my editorial comment) — leaving the rest of us, especially children, to live our lives normally. He implies that “we” know nothing, and cannot be trusted.

Methinks he doth protest for the sake of protesting. Medicine has always had to mix science and art. Art is necessary because science rarely provides unimpeachable answers to complex, multifactorial medical problems. We rarely have all the knowledge we need to make ironclad predictions and prescriptions. In the beginning of COVID, we had a smidgeon of information that had not yet aggregated into a body of knowledge that could reliably inform either physicians at the bedside, global health experts who inform policy, or governmental officials charged with developing and executing those policies.

Hippocrates instructed physicians, “above all, do no harm.” As the pandemic unfolded, and even to this day, adherence to that timeless advice is wise. So, why on earth would anyone with responsibility for the lives of others be cavalier with recommendations that could lead to deaths? Until we knew for sure the dominant means of viral transmission was respiratory, why not wipe down groceries and wear gloves? Why would we not protect everyone until we knew who was safe and who was not? We needed to rely on the art until science gave us the answers we needed.

My visceral reaction to Mr. Maher’s prescriptions for this particular crisis aside, he does make some good points. He seems to be against broad vaccine mandates, and at this point I am not sure he is wrong. I have preached that everyone who is eligible should get vaccinated and boosted. I am proud of that; it saves lives. But by now, everybody knows about the vaccines and they are highly available. People who choose to live unvaccinated lives surely know the risks by now and have made the conscious choice to either take those risks or deny their existence. I wish them well, even though their choices also risk the welfare of others. All physicians interact with patients who choose to not follow what we believe to be lifesaving recommendations, and all we can do is our best and accept that our patients have agency in making decisions about their health. That too is part of the art in medicine.

Maher seems to think that masking and social distancing rules are ridiculous, and are increasingly unenforceable. These practices reduce viral transmission, but at some point we must always keep in mind that, on occasion, the perfect is the enemy of the good. Those practices primarily protect the vulnerable — most notably, the unvaccinated — who don’t want us to protect them. Other vulnerable groups can be dealt with in ways that are specific to their individual (e.g., immunosuppressed people or health care workers) or collective (e.g., nursing home residents) situations. The data do not suggest that children are especially vulnerable, though the loss of any child is, in my view, unacceptable. When the Omicron surge has more fully receded, I believe it will be very important to deal with this issue.

It is time to engage in serious discussion and real action to modify how we deal with this pandemic and begin to reopen society. Bill Maher makes excellent use of his retrospectoscope, but I think history will judge that the pandemic was handled clumsily in many ways, but remarkably well in others. Science saved the day. We were very careful when it was necessary to protect lives, and now that lives have been protected, let’s think about how to protect our way of life.

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.

No responses yet | Categories: Uncategorized