Sarah Riehl's Weblog

 

Oct 11 2021

50 Years of Progress

On December 23, 1971, President Richard Nixon signed the National Cancer Act. At the time, the federal investment into cancer research was about $200 million. The actual amount of new investment provided by the act was, in retrospect, relatively modest, but the act of focusing federal attention was transformative. Federally designated cancer centers, such as Georgetown Lombardi, were established and today house much of the nation’s fundamental cancer science and cutting-edge translational research. The current NCI budget exceeds $6 billion yearly. Spurred by transformative discoveries in the public sector, the pharmaceutical industry has prioritized new cancer diagnostics and therapeutics. Effective early detection and even powerful prevention strategies, such as smoking cessation, have blossomed.

The net result is a remarkable decline in cancer deaths from 50% in 1971 to 33.7% in 2020, even though cancer incidence has risen as our population has increased (from 207 million in 1971 to 331 million today), increasing the number of at-risk individuals. Median life expectancies have increased from 71.11 years in 1971 to 77.3 years (dropping by 1.5 years due to COVID-19) in 2020. This is the direct result of improved care based on cancer research. In the absence of progress, we would have expected about 900,000 cancer fatalities in the United States in 2020; instead, about 600,000 people were lost. In other words, 300,000 lives were saved. To place this in context, the city of Pittsburgh, Pa., had a population of 299,718 in 2020. It’s a nice city, and that’s a lot of people. This progress began about 30 years ago and is accelerating for many reasons, including improved therapies for common diseases such as lung cancer.

So, as we head into the homestretch of this 50-year journey, all of us who have dedicated our lives to the elimination of cancer should step back and note with some satisfaction that we have made remarkable progress in the past half-century. So many happy birthdays, graduations, new grandchildren and quiet moments of happiness for survivors and their families — these happened because of the inspired work of so many, including us.

Now, what can we do about the people who will not survive their cancers? How about everything we can possibly do? Let’s save another 300,000 lives per year within a decade. I truly believe that goal is achievable through continued improvements in prevention, early detection, therapy and equitable health care delivery. The year 1990 marked the end of the beginning; we just didn’t know it yet. Right now, we are at the beginning of the end, if we are collectively up to the task.

It’s time to get this done.

Stay safe, and be well.

Lou

 

 


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Oct 03 2021

Moving Forward

Greetings on a beautiful Sunday afternoon. This weekend has been bookended by a pair of retreats. On Friday, we had the second session of our virtual immuno-oncology retreat; I marveled at the depth and creativity of work and collaborative opportunities we have. It was very exciting. Many thanks to Mike Atkins for putting this together, and for leading our collaborative efforts. Punctuating the end of the retreat was a Grand Rounds presentation by Yi Zhang, a new LCCC member based in New Jersey, who is one of our three METRO program co-leaders. Yi does great work in the T cell immunology space, and is looking for translational collaborations. Welcome to Georgetown Lombardi, Yi!

On Monday I have a four-hour Zoom retreat for all NCI-designated cancer center directors. We’ll learn more about the new NCI guidelines for cancer centers, though we believe we have a good understanding of what the expectations will be. The retreat theme will continue on Wednesday and Thursday with an in-person meeting of the Georgetown Board of Directors’ Committee on Medical Center Affairs (COMCA), followed by a board dinner at Mt. Vernon (outdoors) and then a full meeting of the board on Thursday morning. As if that is not enough, I have a meeting of the Israel Cancer Research Fund International Scientific Council (a virtual meeting) that afternoon.

I used to deride retreats as unproductive exercises that waste time and effort. I have come to appreciate the value of stepping back and evaluating progress as an important way to move forward. I sure hope that’s true at the end of this week!

Oh, by the way, we have our LCCC External Advisory Committee coming up in one month. All hands on deck!

Have a great week. Remember that, while the coronavirus infection rates are declining, this is no time to let down our collective guard. Stay safe and be well.

Lou

 


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Sep 26 2021

It’s Getting Real

Greetings on a beautiful early autumn Sunday evening. Our weekend was highlighted by a Saturday-evening reunion of people from my old lab at Fox Chase. It had been a while, and it was simply wonderful to catch up. There is something magical about friendships that span decades.

My work week was notable for a two-hour virtual meeting with the NCI Centers program staff to lay the groundwork for our competitive CCSG renewal application in May. I was joined by Sharon Levy, and we both felt that the meeting went very well. I presented our progress, and it was clear that our colleagues appreciated improvements in our research depth, the organization and impact of our Consortium partner, Institutional Commitment, dynamic, increasingly diverse new Senior Leadership, Community Outreach & Engagement and strengthening of our Education & Training, Administration & Planning and Organizational Capabilities. We also described our vigorous efforts in clinical research. The NCI staff noted important, achievable areas for improvement and clearly expect continued investments in success. In short, no surprises. I think we are in a good place. Now, it is time to execute our plans.

This is clearly a viral moment. The delta variant continues its not-so-merry journey through our country, though its incidence may have peaked. Continued vigilance certainly remains in order. Moreover, a gastrointestinal illness reported on Georgetown’s campus appears to be norovirus (a nasty GI bug), so please exercise appropriate enteric hygiene precautions. You don’t want to catch this bug. Finally, please remember to get your flu vaccine. Watch for an email this week with dates for flu shots to be offered on campus. Remember when this was pretty much the only infectious pathogen we all we had to worry about?

I guess that’s my way of saying, “Stay safe and be well.”

Have a great week.

Lou

 


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Sep 19 2021

The Bell Still Tolls

I write this week’s blog on an absolutely beautiful Sunday morning. I am gearing up for a meeting on Monday with the NCI Center’s branch for our pre-CCSG application meeting. This is an important milestone, as we aim to receive NCI notification of our eligibility to submit our competitive renewal. Needless to say, this has been my top priority. I am optimistic, but know how important it will be to get NCI feedback.

I also have optimism that I will soon be able to resume my normal level of physical activity, as my Achilles tendinitis symptoms continue to improve. However, intensive training will have to wait.

As you may have heard, BellRinger, our inaugural charitable bike ride to end cancer, will be postponed until next fall amid concerns about the Delta variant and out of an abundance of caution to ensure we retain the confidence of our larger community as a responsible steward of public health. While I am disappointed, I am also excited that we have built a movement of over 300 riders and virtual riders who have raised over $400,000 to support research here at Georgetown Lombardi. This doesn’t mean we should let up. This postponement just gives all of us more time to grow our teams and train (and time for my Achilles injury to fully heal). You should all be very proud of your efforts, and we will continue moving this forward for an even greater ride next fall. The BellRinger team will be in touch to announce the new date and additional activities over the next year, but, in the meantime, don’t hesitate to reach out to me or Jonathan Thomas at jonathan.thomas@georgetown.edu.

Meanwhile, remember as always to stay safe and be well.

Lou

 


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Sep 12 2021

Achilles’ Heel

Well, this was an interesting summer. It was the summer of my Achilles’ heel. All of my lofty plans to get in shape for BellRinger were thwarted by sharp pain that got worse when I walked, and biking did not help. I was advised to rest the foot, and while I still have some residual aching, I have begun to gently resume discretionary movement.

It was the summer when our cat died, rather suddenly. He loved only three things —Harriet, me and water dripping from a faucet — and despised everything else. Even though he was not a pleasant creature, we persistently kept him from hurting others, and he eventually mellowed out before he died in his old age. I don’t miss him, but smile when I think of him.

It was a summer of intense effort, surrounding our CCSG competitive renewal. I wrote my Director’s Overview, reviewed and carefully edited several CCSG sections, prepared and presented an update of our progress to a subcommittee of our EAC, and prepared a slide deck and talking points for our September 20 pre-submission meeting with the NCI Centers Branch. I am not the only one who worked hard. Special thanks to Sharon Levy, to our Lombardi senior leadership and to our Huron Consulting Group colleagues, led so ably by Bev Ginsburg and Ellen McLaughlin. Our hard work is paying off, with improved organization, powerful support from our sponsoring institutions and an ongoing influx of talented researchers.

It was a summer that started with so much promise, with COVID-19 on the run. But that changed, with a delta caused by the delta variant of SARS-CoV-2. I truly believed, and I suspect many of you agreed, that Labor Day would be nearly carefree, and that a return to school and in-person activities was around the corner. My prognostications did not take into account two factors.

First of all, I underestimated the power of viral mutations to generate a more infectious variant that could sicken (thankfully with a very low risk of fatal outcomes) even fully vaccinated people, and could kill unvaccinated hosts. By now, we all know that fully vaccinated people who contract COVID-19 infections are 11 times less likely to die than those who are unvaccinated. A fully vaccinated person has only a one in 1,000,000 chance of succumbing to COVID-19. These enormous differences ordinarily would lead to a massive acceptance of vaccination by the American public. Well, we know how that went down. Even now, we are well short of even a 70% fully vaccinated goal; and an even higher rate might be required to protect our population from the delta variant and its yet-to-emerge mutants.

So, this was the summer of the American Achilles’ heel, a foul brew of toxic individualism and suspicion of authority. Those impulses, which energize in smaller doses and are at the core of the peculiar energy of our society, have become dominant drivers of our national discourse that have encouraged irresponsible and tragic individual decisions about health care options.

My Achilles’ heel is cooling down as a result of persistent rest and the judicious use of anti-inflammatory agents. It will likely flare up from time to time, but I won’t let it destroy me. Perhaps that is a prescription for the American Achilles’ heel that has directly prolonged this pandemic. If we maintain a persistent focus on doing the right thing (in other words, vaccines, appropriate social distancing and masking) and pay less attention to the toxic rhetoric, always pushing forward, our response to the pandemic may yet show us the way forward.

Have a great week and, as always, stay safe and be well.

Lou

 


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Aug 02 2021

Midsummer

Happy Monday. I hope you had a nice weekend. Our kids in Philly were in town this weekend for a party and have been with us at our home in DC. Though we have seen them in Philly and at the beach, we realized it had been more than 18 months since they had been in our home. What a crazy turn of events…

Work has been pretty much all CCSG, all the time. I am still polishing my Overview and Essential Characteristics sections, highlighting our Transdisciplinary Collaboration and Coordination section. I decided to organize the section around high impact, collaborative publications in this first pass, and have identified about 120 papers published in journals with impact factors of at least 10 in the past three years. That’s a pretty good haul, and the list is incomplete. I suspect that at many as 15% of our publications will prove to be “high impact” (recognizing that this is an imperfect measure of true impact) at the time of our CCSG competitive renewal submission. Not bad!

I had been looking forward to the coming weekend for months. Paul Tagliabue, former NFL Commissioner, former chair of the Georgetown University Board of Directors and a longtime great friend of Georgetown Lombardi, is being inducted into the NFL Hall of Fame. It’s a big deal, and I was deeply honored to be invited to attend the proceedings as his guest. Unfortunately, it turns out we cannot attend. We’ll have to go to Canton sometime in the future to see Paul’s bust in the Hall.

The coming week will be filled with CCSG preparations, BellRinger meetings and lunches, and grant reviews. I am glad that GUMC is opening back up for real this week, and hope everyone observes COVID-19-related precautions to assure that the return is safe and productive for everyone.

I plan to spend about two weeks at the beach beginning on August 12, one for pure vacation, and the other for some relaxation admixed with important calls and work responsibilities. This will be my last blog for a few weeks; they will resume in September.

Have a great month of August. Now, more than ever, stay safe and be well.

Lou

 


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Jul 25 2021

Eye of the Hurricane?

This past week has been pretty much about writing my sections of the CCSG Director’s Overview, mixed in with some BellRinger activities. I was at two BellRinger lunches on the CCC Podium last week, one of them on Wednesday for all comers, and the other on Thursday for the Department of Radiology. We are getting the word out! One of the really nice parts of hanging out on campus is the chance to run into colleagues and friends and just chat. I had almost forgotten how important these seemingly random encounters weave into a tapestry of conversations that both build community and get important work done. I didn’t realize how much I have missed that.

I hope you enjoyed your weekend. We drove to the beach on Friday and go home tonight. We were lucky to have great weather and shared it with family, and then on Sunday night had a lovely dinner with some friends. Not bad! But, even as we open up our campus, the looming specter of the COVID-19 delta variant is beginning to worry me. Is this pandemic really waning, or will the “pandemic of the unvaccinated” derail our plans to reopen our lives for good? Is the storm behind us, or are we merely in the eye of the hurricane, with more misery around the corner?

I have no inside information of any kind, but will not be surprised if we find it necessary to take additional precautions, even here in DC, in the weeks and months ahead. With any luck, enough vaccine refuseniks will change their minds as infections and serious illnesses swell, and we can prevent another surge.

Meanwhile, please join me in congratulating four of our colleagues on their recently awarded and amply deserved promotions. They are:

  • Suzanne O’Neill – promoted to Tenured Professor
  • Randi Williams – promoted to Assistant Professor
  • Luz Romero Sanchez – promoted to Assistant Professor
  • Ivana Peran – promoted to Assistant Professor

Please join me in congratulating Suzanne, Randi, Luz and Ivana on their accomplishments, with a special shout out to Suzanne, as her promotion recognizes her substantial career-long contributions in research, teaching and service. And the best is yet to come!

Stay safe and be well. This is not yet over.

Lou

 


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Jul 18 2021

Pandemic of the Unvaccinated

Anybody paying attention can see what is happening. The CDC director has described the current situation as the Pandemic of the Unvaccinated. The highly infectious Delta variant of SARS-CoV-2 is tearing through the country. Lots of people are getting infected, but primarily only unvaccinated people are getting really sick. There is a simple, safe way to protect against illness, but some people just don’t want to be confused by the facts.

Meanwhile, life on campus is slowly stirring. I came into work two days last week, once just for meetings and the other for clinic. I have found it easiest to bring in my own lunch; perhaps that will change when classes are in session. I’ll be on campus at least two days this coming week, and certainly will be there on Wednesday at 11:30 a.m. for the BellRinger lunch on the Podium near the CCC building. I hope to see you there! My training for BellRinger has been slowed over the past two weeks because of nagging plantar fasciitis of my right heel. It has been a slog. If I don’t improve soon, my plans for 100 miles are in jeopardy. I know I can do 25 miles, and hope to do at least 50.

I have spent the last few weeks on my draft of the Director’s Overview for the CCSG competitive renewal. The Overview draft is essentially finished, and I have also completed drafts of two (Space and Center Director) of the 6 Essential Characteristics descriptions. Four more to go… I hope to have everything done by August 1.

Have a great week. Most importantly, stay safe and be well.

Lou

 

 


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Jul 12 2021

Normal(ish)

Life after the time of coronavirus is ramping up. The virus is still with us, and will be for a long time, but those of us who are fully vaccinated are safe. Society has certainly opened up, and we are rapidly approaching full activity at Georgetown, though with appropriate precautions in place. Almost 70 percent of Americans have had at least one shot. Many of the remainder will not, and we should continue to educate and support healthy decision-making. However, some of the “refuseniks” are resolute in their convictions, and their minds won’t be changed. There will be no vaccines, and perhaps no masks to protect themselves or others. It is what it is.

What to do? I can only speak for myself, but I am comfortable resuming normal activities when they are permitted, as I am fully vaccinated. I try to follow the science. I might become infected, but am very unlikely to get very sick, even from the Delta variant. I am willing to take that chance. Pfizer states that boosters supercharge host immunity, but the data to date suggest that those of us who are fully vaccinated retain effective immunity against all of the prevalent coronavirus variants. Unvaccinated people will remain at risk; many will get infected and propagate the virus, which will spin out new variants. Some of these unvaccinated people will get sick, and some of them will die needlessly. Meanwhile, life for vaccinated people will continue, inconvenienced, but more or less undisturbed.

I am totally comfortable being with my vaccinated coworkers, family members and friends. I worry a bit about my unvaccinated grandchildren, though. To illustrate the point, one of my extended family members is a passionate anti-vaxxer; her views predate the pandemic. She will never allow herself to be vaccinated. She does not want to be confused by the facts, only by her anecdotal pseudo-truths. She is wonderful, sweet and wrong. It is what it is. However, we will not see her until our grandchildren are vaccinated; in the event she infected them and they got really sick, either directly or through us, I would not be able to forgive myself.

So, life is becoming “normalish.” I spent all day Wednesday in the office, though it’s still awfully quiet on the GUMC campus. There’s really no convenient place to get lunch, and we all wear masks. I’ll spend at least two days in the office this week, and will work from home the rest of the time. We visited family on Friday after I took care of some of my father’s estate documents and then we had a wonderful weekend with dear friends on Long Beach Island, one of the Philly area’s major beach destinations.

We no longer live in the coronavirus’ world, but now are living in a world of our own making, through the miracle of science. In time, the rest of the world will catch up, too. I hope it happens quickly. Coronavirus is and will be a part of our world for the foreseeable future, and we will accommodate it, but it’s time to get back to the business of living, working and making this world a better place. It’s time.

Don’t forget the BellRinger! The first weekly BellRinger lunch will be held on the Podium near the hospital this Wednesday starting at 11:30 a.m. Please stop by, have a bit to eat, and sign up for the ride.

Stay safe and be well.

Lou

 


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Jun 28 2021

Life in the Time of Corona(virus) – Day 468

Life is slowly ramping up to normal. I spent some time on campus on Wednesday, and it was wonderful to run into colleagues and chat informally; that is one thing that will never be replaced by Zoom. While wandering around the Research Building, I was still struck by the quiet and the sparse foot traffic. I can’t wait until we are back to the usual hustle and bustle.

The week was highlighted by a presentation to COMCA, the Georgetown Board of Directors’ Committee on Medical Center Affairs. The agenda was compressed, but I provided a 10-minute overview and Marc Lippman provided a wonderful example of the value of thinking “outside the box” to address critical issues in breast cancer.

My presentation included a “vision for the future” slide that was linked to our strategic plan, abridged to address the moment and to give COMCA an insight into the ways we can make future progress. I’ve included the slide at the end of this blog post. If you don’t see yourself in it, please don’t fret. It was not meant to be exhaustive, but rather illustrative of the ways we can move forward, particularly in collaboration with MedStar Health and Hackensack Meridian Health.

Have a great week, and a wonderful July 4 holiday. My blog will return in two weeks.

Stay safe and be well.

Lou

A PowerPoint slide with text, transcription follows image

Text of slide is as follows:

Vision for LCCC’s Future

Expand High Volume Clinical Care to Blood Cancers
– Make LCCC the “place to go” for people with blood cancers in the DC region

Cellular lmmunotherapy
– LCCC to be the dominant provider of cutting-edge cell therapies (e g., BMT, CAR-T cells) in DC and NJ
– LCCC research will inform the design and analysis of cell therapies

Expand Portfolio of Investigator-Initiated Clinical Trials Connected to LCCC Science
– Offer tomorrow’s treatments today, further marking MH and HMH as “go-to” destinations for cancer care

Robust Technology Platforms to Support Cutting Edge Research
– Shared resources to promote biomedical research
– Computational biology/data science

Virtuoso Research with an Expanding Funding Base — Aim for $30M ADC Cancer-Focused Funding by 2025
– Research Programs

– Breast Cancer (BC)
– Cancer Prevention and Control (CPC)
– Molecular and Experimental Translational Research in Oncology (METRO)

– Research Themes

– Precision Medicine, Tobacco Control, Survivorship, Genomics, Tumor: Host and Tumor: Microbiome Interactions, lmmunotherapy, GI Cancers, Minority Health Disparities, Aging, Global Health

Community Outreach and Engagement
– Create a highly visible presence in DC and NJ with a focus on underserved minorities

Cancer Research Training and Education
– Cancer-focused training and mentoring from middle school through professorial appointments, with focus on underserved minorities

Everything Informed by a Commitment to Diversity, Equity and Inclusion and Georgetown’s Jesuit Principle of Cura Personalis

 


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