Sarah Riehl's Weblog

 

Apr 30 2022

No Blues at the Beach

I hope you enjoyed the beautiful weekend weather. Harriet and I snuck away to the beach and soaked up every beautiful moment (though my laptop seemed to be quite busy!). I finished preparations for Monday’s Faculty Sector meeting and hope you can attend. I also worked on a new grant application and reviewed an MS thesis paper. I was busy, but had time to take some lovely walks. We did not eat out, but we did bring in takeout.

We passed the time on the three hour drives to and from the beach listening to podcasts, transfixed by the Ukrainian crisis and other attacks on the democratic world order. I particularly enjoy the Ezra Klein podcasts and “The New Yorker Radio Hour” for their very thoughtful programming. Putin is providing a playbook for the aggressors who would destroy democracy, even as Zelenskyy, Biden and NATO provide a textbook example of how to defend the liberal world order and freedom, and the principles that have animated our country for almost 250 years.

Good news, training rides are here! BellRinger is a little less than six months away, and it’s time to get back in the saddle. Join BellRinger for regular training rides led by expert leaders. BellRinger isn’t a race and neither are these training rides. The rides will be casual and focus on safe, social group rides. Check out the full list of training rides online here. Everyone is welcome! I am bringing my bike back from the beach so I can get involved in at least some of the rides.

Stay safe and be well.

Lou

 

 


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Apr 25 2022

On the Road Again

So, we just got back home on Sunday evening after an eventful weekend. In Baltimore, COVID has been running through Elana’s family — little Eitan, only 10 months old, was diagnosed on Friday morning and spent that evening in an ER with a fever of 105 degrees. Fortunately, he was able to go home a few hours later, and his fever broke the following morning, Other than being uncharacteristically cranky, he seems to be recovering.

Of course, that put an end to our family’s plans to get together at Elana and Ben’s for a belated family Seder to celebrate Passover together. So, we had a little Seder with Dave and Kelly and their kids on Friday evening and then drove up to Philly on Saturday for another Seder with Ken, Sarah and their kids. It was wonderful, but nothing beats being together as a family.

Speaking of family, we spent Saturday night with Ken, Sarah and their kids and then drove up to New York City (we were more comfortable driving than training up in a maskless passenger train), met my brother Steve and his wife, Ryta, for lunch, and then saw the final performance (masks were mandatory) of his musical, “Penelope.” It is a retelling of “The Odyssey,” except that Odysseus’ wife, Penelope, not Homer, is the poet. It was funny, charming in its classic approach to the musical comedy genre (decidedly not in vogue these days), and the music was great. We drove home after the show. I asked Steve if he could hear the echo of our late parents’ clapping in the midst of the standing ovation that followed the end of the show.

Steve is my younger brother. He began playing the piano at the age of 3 and was a bit of a child prodigy. I remember that when he was about 6 years old, people would ask him to play a simple song, such as “Mary Had a Little Lamb,” by ear. He would do that, and upon request would play it in the style of Bach, Beethoven, Mozart or Gershwin. Even though he was younger than me, I remember figuring out very quickly that he had a special gift, and that it would be far more productive to celebrate his brilliance than to compete with it. We have always been there for each other, appreciating each other’s successes and being there for each other during the hard times. Throughout his adult life, he has mixed his love of musical theater with his work as a clinical psychologist and organizational trainer. He has a musical style that echoes that of Rodgers and Hammerstein, and perhaps a bit of Cole Porter, with very melodic scores that recall the 1950s, even as they address more contemporary topics. He has had a number of shows performed in New York and elsewhere. So, in many ways, seeing his latest show takes me back to my youth, while marveling at our life journey together. Good stuff, indeed.

Speaking of good stuff, please check out the wonderful piece on our local NBC station about the Walking Warriors, who will walk on April 30 to raise money to support breast cancer research here at Georgetown Lombardi. Jeannie Mandelblatt gave a fabulous interview; here is the link to the piece. Thanks, Jeannie, for the fabulous publicity and your great work in leading this wonderful effort!

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

Lou

 

 


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Apr 17 2022

Living Our Principles

This special moment in the year is a confluence of the religious observances of Easter, Passover and Ramadan. It is a time for community, for friends and family, and reminds us of the core principles shared by each of these great religions. If you have or are celebrating any of these observances, I hope this has been a time of love and reflection.

We spent time with family, though we all thought twice about it since I had gone to AACR in New Orleans. From what I can gather a lot of people came back infected with COVID-19; I guess that is what happens when more than 11,000 people from around the world cram together in relatively tight quarters, even if they are fully vaccinated. Fortunately, I appear to have dodged that bullet, but it is a reminder that, while we may not die from COVID, we most certainly need to learn how to live with it more intelligently, for, most assuredly, it is not going away. I think I am going to shy away from potential superspreader events for a while.

Speaking of AACR, I had a truly troubling experience there. I was asked to moderate a press conference on Monday, and one of the three press releases came from a Libyan presenter, describing how the remarkable disparities in childhood cancer outcomes in high vs. low/middle income countries have widened during the pandemic. Prior to the pandemic the survival rate for children in high income countries was 80%, but was only 20% in low/middle income countries.

Stop. Think about this. Relatively few children worldwide get cancer. How much extra money might it cost to assure that every affected child received the care that was needed? The answer: not a lot. Why has this not been addressed previously?

As I tried to process this monstrous disparity, the presenter then showed observational data that the 30-day mortality rate has been 35 times higher in children from low/middle income countries during the pandemic. So, when the presentation ended and I turned the questioning over to the press, I mentioned, “This is really important stuff. It’s unacceptable, and something needs to be done about this.”

The first question came from someone affiliated with a very prominent journal. “So, why is this news? Didn’t we already know about this?” I fought back the urge to snarl, and noted that just because something isn’t brand new, it does not mean that the problem is not urgent and worthy of a call to action. She shrugged and sat down. There were no other questions.

I was stunned. Have we become so smug and comfortable in our privileged lives that we are indifferent to the suffering of others, even if they are children whose parents don’t look like many of us? Is this what we are about? Is this how our religions teach us to behave? The Western world watches in horror (albeit receding) as Ukrainian civilians are wantonly murdered — perhaps because the victims seem to be so much like us?

Sunflowers were planted across the street from the Russian Embassy on Saturday in solidarity with the Ukraine. It was a wonderful gesture. But, who is planting something for the kids who are doomed to die of curable cancers because of the accidents of their births? Better yet, who is actually helping? When science is not linked to the public good, the advances ring hollow to me.

The Sunday New York Times ran an article about how St. Jude has set up a field triage clinic in Poland to navigate Ukrainian pediatric cancer patients for care at appropriate facilities around the world, including in Tennessee. It is a wonderful initiative, but St. Jude should not and cannot be the only answer. Why can’t something similar be done throughout the world?

Stay safe and be well.

Lou

 

 


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Apr 10 2022

AACR

Greetings from New Orleans. I am at the AACR meeting, trying to lay low a bit, but I have specific responsibilities to which I must attend. Louisiana has a remarkably low rate of COVID-19 infections, but there are a lot of people here from around the country, and a few from around the world. Everyone must show proof of vaccination; masks are optional — though I am wearing one most of the time when not eating or speaking from a podium.

So far, so good. I will report more on the meeting after I return on Tuesday.

Last Thursday during a community meeting on Zoom, President DeGioia talked to Victor Dzau, president of the National Academy of Medicine, about Georgetown’s Health Sciences Strategy Initiative (HSSI). Dr. Dzau described our HSSI as the “right time and the right direction.” It does seem to be the right time — particularly as COVID has further illuminated our society’s deep disparities — to design an academic health system that takes advantage of all that Georgetown offers, from laboratory science to health care delivery, health professions training, policy and law, and the humanities. If you missed the meeting a recording is posted. Also, be sure to watch for an email this week that includes a link to a survey that will allow you to weigh in and share your thoughts about our collective aspiration and identity.

Have a good week. Stay safe and be well.

Lou

 


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Apr 03 2022

In Flight

I flew on an airplane for the first time in more than two years this past week. I chair the External Advisory Board for the Chao Family Comprehensive Cancer Center of the University of California, Irvine and flew out Wednesday and back to DC on Friday afternoon. It was like getting back on a bike, but with a mask. The trip was uneventful, though a chance to be together with colleagues was fabulous. I didn’t realize how much I had been missing.

There is a lot going on, as always. I am helping Ben Weinberg finalize a clinical trial based on work we did in my lab for patients with pancreatic cancer. Now I am working on a grant related to that trial. Plus, I am gearing up for another trip — this time to the annual AACR conference in New Orleans. I’ll only be there between Saturday and Tuesday morning, but have a pretty full schedule.

I am reviewing an updated version of the Leadership, Planning and Evaluation section of our CCSG competitive renewal application, which summarizes many important changes we have made over the past few years. We still have over a year before the competitive renewal is due, and we have a great story to tell. Many thanks to Sharon Levy for organizing this work and making sure I stay on track!

Meanwhile, there still are multiple attacks on our communal safety and well-being. Placing internal political discord aside for the moment, coronavirus keeps trying, spinning out variants. Thus far, the numbers are still acceptable, but bear watching. Harriet and I did our part over the weekend by getting vaccinated with our second boosters. As before, we had few if any side effects, and the enhanced immunity can only be helpful.

Last but not least, Putin and his troops keep inflicting horrific tolls on the Ukrainian people, and the atrocities are out there in plain sight. I am beginning to believe that most of the rest of the world has been vaccinated against his particular form of aggression, and so far the immunity seems to be pretty effective. Let’s hope it stays that way.

I hope you’ll be able to attend the Health Sciences Strategy Initiative community meeting and reception this Thursday at 3 p.m. in the Research Building auditorium (or via Zoom). The title is “The Future of Health Sciences: Bench to Bedside to Population to Society,” which it reflects a Viewpoint in The Lancet written by Victor Dzau, president of the National Academy of Medicine. He’ll be at the meeting along with President DeGioia. After their conversation, there will be a discussion about our Health Sciences Strategy Initiative. There’s more information about the meeting elsewhere in this newsletter, but I hope you’ll join.

Stay safe and be well.

Lou

 

 


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Mar 27 2022

Momentum!

Can you feel the momentum? Traffic is worse, the streets are bustling and people are congregating. At least for now, the pandemic is taking a back seat to life. Let’s hope this is a harbinger, and not a brief respite. We can handle a few more hills and valleys here and there, but please, no more mountains and gorges!

I actually took a business trip on Friday. I trained up to Hackensack and then back home, uneventfully, and while there met with an extraordinarily impressive group of clinical investigators and scientists to discuss “big ideas” related to cellular therapy. Yi Zhang and Howard Xue are developing innovative strategies to enhance the fitness of CAR-T cells, and John Theurer Cancer Center has an impressive array of CAR-T clinical trials in multiple myeloma and lymphomas. NK therapeutics are being tested in leukemias, and CAR-NK cell treatments are now being studied in solid tumors. Many of these studies are being opened in DC as well. This is an important part of the future of cancer therapy, and I am glad we are a part of it.

However, while this is a great start, we aspire to lead in this area. While we wait for Howard’s and Yi’s technologies to mature to clinical translation, we will push forward with innovative IITs of CAR-T therapies in multiple myeloma, guided by Noa Biran; of NK therapies in acute leukemias, guided by Jamie McCloskey; and of CAR-NK cells in solid tumors, guided by Martin Gutierrez. Georgetown Lombardi Shared Resources will be critically important, as will the DC-based translational and clinical research infrastructure, amplifying the impact of this work, led by Geoff Gibney, Pashna Munshi and many others. David Perlin, Michael Atkins, Andre Goy and I will work to establish a GMP cell processing capability so we can innovate new cell therapy concepts in small pilot clinical trials. Clearly, this was a great meeting! I plan to return to New Jersey soon for our next meeting, which will focus on the intersection of cancer and infection. Momentum!

My long day on Friday followed a longer Thursday that ended on a thrilling note. After pandemic-induced postponements in 2021, we had an in-person (can you believe it?) gala at a marvelous new venue, The Anthem. Attendance was less than usual, out of an abundance of caution, but the energy was fabulous and we raised a lot of money to support cancer research. I am deeply indebted to Cristy Seth, Sharon Courtin and the rest of the Lombardi Gala team for expertly navigating unprecedented logistical and public health challenges to pull off this great event. Thank you!

In addition to the $1.1M raised at the event, we celebrated the announcement of a $10M gift from David Sumner to support the establishment of a vaccine-focused cancer immunotherapy center developed and led by Samir Khleif. We also acknowledged, with gratitude, the transformational $50M gift from Grant Verstandig, and the Verstandig Family Foundation, to support the Medical/Surgical Pavilion at MedStar Georgetown University Hospital. We were pleased to have Grant’s parents, Toni and Lee Verstandig, join us. As if that were not enough, the attendees were treated to the haunting vision of the cancer center director looking like a clown while impersonating a BellRinger participant. More momentum!

You can see photos and read more about this year’s Lombardi Gala here.

Finally, I want to share a piece from the best writer in our family, my daughter-in-law, Kelly Scriven Weiner. She recently published a piece in JAMA Otolaryngology that places into perspective her experience as a mother and physician when our grandson Clark was born with a serious heart defect. Her piece moved me to tears. Kelly now works at MGUH, and she gave me permission to share this remarkable story.

To access the full article, visit the JAMA Otolaryngology page for the article here, then click the “Access Through Your Institution” option and enter “Georgetown University Medical Center” and your NetID when prompted (see these instructions from Dahlgren Memorial Library for details). Alternately, search for the article: “The Golden Hour—A Pediatric Otolaryngologist Reflects on Becoming a Mom in the Neonatal Intensive Care Unit” using DML’s “Journal Finder” search option.

Happily, Clark continues to do extraordinarily well. Even more momentum!

Stay safe and be well.

Lou

 


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Mar 20 2022

Please, No Cake

We spend so much money to save lives. Newborn and adult ICUs, life-saving cardiac surgeries, cancer surgeries, chemotherapy, immunotherapy, stem cell therapies, chimeric antigen T cells — each of these can cost hundreds of thousands of dollars for each patient, all to treat a single person in the hopes of saving one life.

Add to that the billions spent yearly in the public sector on life-saving therapies, multiplied manyfold by the investments of (and returns to) the pharmaceutical and medical device industries. Saving lives is an affirmative statement of our values and is good business to boot. While the United States is by no means the only nation that values human life, we have, perhaps because of our unprecedented and unrivaled prosperity and resources, taken the concept to its fullest extent to date.

In this country we debate, properly so, whether we can continue these practices in the face of an apparently inexorable climb to fiscally unsustainable levels. Yet we resist, partly because of the billions to be made, but also because the American narrative teaches us that, despite many tragic examples throughout our history, each of us is exceptional, and every life is precious. Putting aside the mind-numbing economics for a moment, think about what this says about how we value each human life. Through our actions, the answer is clear.

This answer resonates throughout our political history. A government of the people, by the people, for the people, a nation based on laws and led by those who guide but ultimately serve the people, is the proper home for a health system that focuses on the needs of individuals, no matter how sick they are. To be sure, the health system is deeply flawed, driven by the twin pillars of greed and intolerance. Far too little attention is paid to affirmative health practices, disease prevention and early disease management across our entire population. However, I challenge you to think of any physician or nurse who has not shed tears when one of their patients has been lost, despite heroic efforts to save their lives. This is who we are. This set of bedrock beliefs defeated the Axis in World War II and has created the miracle of global progress since the end of that terrible war.

Yet, here we are again. At face value, the Russian invasion of Ukraine, which will go down in history as an epoch-altering atrocity, can be viewed as the twisted vanity project of an authoritarian megalomaniac. It’s hard to see past the heartbreaking images that flood our phones and TV screens. Without diminishing our sense of outrage and resolve to “win” this battle — though it’s still too early to know what “winning” means — the larger question here is whether the world to come will be one of laws that permit personal freedoms to flourish in our political, cultural and economic spheres, diminishing the influences of individualistic anarchy or identity-based tribalism. This is what the Ukraine is fighting for, what NATO is supporting, and why losing is not an option.

In the world imagined by Putin and his fellow travelers, only the “right” people will be granted freedoms, and only the privileged few will be granted access to life-saving therapies. The money so saved would be diverted to the self-indulgences of the elites. The rest of us will be advised to go eat cake. It will not be delicious.

Meanwhile coronavirus has rolled out its latest variant of concern. So far, we are in the clear, and in fact we will be holding our in-person Lombardi Gala this Thursday evening at a new venue, the Anthem, at The Wharf. The attendance will be smaller than in the past, but we have already surpassed our pre-Gala fundraising targets!

As we enter into a period of optional mask wearing on campus, let’s give space to those who wish to continue to masks. We don’t know their personal situations or preferences (and we shouldn’t ask). And, as always, stay safe and be well.

Lou

 

 


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Mar 13 2022

Broken Heart, Full Spirit

It is hard for me to not think about the Ukraine, about another war in Europe, threatening to engulf the continent. European wars are part of my family’s history, and those memories, transmitted to me through the experiences of my mother and her family, have shaped my worldview and my personality. I never truly thought that I too would live in a world where it could happen again.

After my mother died, my father spent the last 29 years of his life with Alina, who has become a member of our family. Alina is from Krakow, in Poland, and has lived in the United States for many years, becoming a citizen a few years ago. She retains very strong family ties in Poland and travels there frequently. She went to Poland a few weeks ago to attend the funeral of a dear friend’s mother. However, she did more than visit with family and old friends. Here is a lightly edited account of her trip with two people she did not know. Alina simply showed up to help. It is a reminder that when free people with courage and conviction band together to confront evil, that enemy has no chance. With her permission, this is what she wrote to us earlier in the week.


 

I am in Poland now, and “on the way” from Stalowa Wola to Krakow, I decided to drive to Przemysl, to help bringing Ukrainian refugees inside the country. I had to register as a driver and was able to get inside the “temporary camp” organized in an empty shopping center.

What I saw there was so dramatic that I was not able to take any pictures. I just wasn’t able to take out my camera and, in face of their tragedy, take pictures. WOMEN’S & CHILDREN’S WORLD is what I saw there. Thousands laying down on the floor, resting after their journey through Ukraine.

Olga and Lidia traveled from Charkow, in the Ukraine, for 5 days before reaching the border with Poland. Yesterday, I picked them up in Przemysl and within 2.5 hours brought them to Krakow. Their men didn’t want to hear about leaving Charkow. They stayed to fight. They, with others, stayed “on the streets,” as the women described, because everything is destroyed there.

When I met Olga and Lidia, and they learned that I am taking them to Krakow, they started to cry. A stranger in a strange but friendly country is taking them closer to their families in Krakow and Zurich. I gave them my phone to call their families. Again, tears and emotions.

But of all of this, seeing them meet in Krakow with a 14-year-old grandson of Olga’s, was one of the most beautiful I can remember. Despite more tears.

These women are safe now, but their men are not. I hope for them to meet with their husbands soon in a free Ukraine.

Ukrainian flag emojiMy heart is forever broken.

 


 

Alina’s heart may be broken, but her spirit is not.

Stay safe and be well.

Lou

 

 


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Mar 06 2022

There Are Cancers, and Then There is Cancer

Last week, in the face of a cancer that threatens the Ukraine, Europe and Western civilization, I wrote that words fail. Unfortunately, my worst fears have been realized thus far. I believe that Putin will not stop unless he is stopped, somehow, some way. Only when cancers of the human spirit have been suppressed will the Ukraine have a chance to worry about cancers of the body.

My words may have failed, but other voices are strong. The editor of The Cancer Letter, Paul Goldberg, immigrated to the U.S. in 1973 with his family from the Soviet Union when he was 14 years old. For him, the unspeakable tragedy of this war has a most personal connection. With his permission, I am sharing a truly special issue of The Cancer Letter, focusing on the Ukraine. I hope you find the essays as meaningful and moving as I have. In addition, I’m sharing the WHO Situation Report #1 on the Ukraine emergency, which highlights “Excess morbidity and death from common illnesses due to disruption in services,” including cancer as a public health concern.

Stay safe, be well and count your blessings.

Lou

 


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Feb 26 2022

Words Fail

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

 

 


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