The son of my wife’s sister, my nephew, is older than I was when I met him.
It’s not so surprising, then, that he would be getting married, especially not after a long-term relationship that transitioned years ago from a matter of if to when in terms of marriage.
Still, it’s hard to imagine the next generation entering these milestone moments when I feel like my wife and I only recently got married, which clearly wasn’t such a recent event.
One of my first memories of my nephew, who was six years old when I babysat for his younger brother while he and his parents went to see “The Lion King” on Broadway, was of this enthusiastic child who wanted to participate in adult conversations.
On his way out the door, he promised to give me a thorough review of the show. While he was gone, his brother and I called my future wife. His younger brother pretended he was me and kept asking me what to say. Fortunately for him, my wife is as playful as he, and went along with the gag for a giggle-fest of a conversation.
A few years later, my sister-in-law told me she overheard her children discussing my marriage to their aunt. Her younger son was excited to add the title “uncle” to my name, while the older one wasn’t sure he wanted to call me “uncle.”
Not eager to stand on ceremony, I told him he could continue to call me “Dan,” although the uncle title quickly became a natural part of our interactions.
Over the years, I have reveled in his achievements, enjoyed hearing about his adventures, travels and jobs and have admired the joy he feels when he spends time with his fiancée.
He laughs, shares stories and dances with her at family parties.
With their wedding approaching in the next few days, it’s hard to believe that my wife and I will be members of the older generation.
Unlike my uncles and aunts, who attended my brother’s wedding in the summer and, generally, passed on my wedding in the winter, my wife and I have every intention of spending most of the wedding on the dance floor.
Yes, we’re older, and we likely won’t have the same modern dance moves that the next generation will likely display, but we love a great party and, what’s more, we love to celebrate life together.
As I did when we had a party for our daughter’s 16th birthday, I will likely sweat through my button down shirt and will probably drape my suit jacket over the back of the chair and won’t touch it until we’re clearing out the room.
At some point, someone with a video camera may come over to my wife and me, asking us to share our thoughts on this auspicious occasion.
I’m sure I will think about my antediluvian uncle, who was asked a similar question at my brother’s wedding.
After a long, reflective pause and with his customary flat affect, he looked directly into the camera. “It’s a sense o’ hyum’ah,” he suggested.
Listening to his wife whose voice cut through concrete as she exclaimed about everything from how much she loved my younger brother the best to how wonderful and delicious the food at any event was, I could see the importance of humor.
While my wife and I have reveled in making each other laugh, I don’t think I’ll repeat that line, even if it does apply, in part because it belongs to my uncle.
Instead, I may tell them to dance as often as they can and to enjoy the little moments, like the sound of a child’s laughter or the excited review of a Broadway show from a six-year-old.
Stony Brook Breast Cancer Screening mobile truck. (8/24/18)
By Daniel Dunaief
Some groups of people on Long Island have a much higher incidence of a particular type of cancer than others.
On an age adjusted rate, African American men, for example, were almost twice as likely to develop prostate cancer from 2014 to 2018 as Caucasians. Out of 100,000 African American men, 216.6 had prostate cancer compared with 123.9 out of 100,000 white men, according to data from the National Cancer Institute.
Dr. Linda Mermelstein. Photo from Stony Brook Medicine
Dr. Linda Mermelstein, Associate Director of Stony Brook Cancer Center’s Office for Community Outreach and Engagement, is working with her team to address those stark differences and to empower members of the community to protect their health and make informed decisions.
“A lot of our focus is on addressing disparities” in cancer care in various communities throughout Long Island, Dr. Mermelstein said.
The Cancer Center Outreach and Engagement office has taken numerous steps to inform the public about research and care. The center has a Mobile Mammography Unit, which travels into communities to provide access to screening for breast cancer.
On June 5, at the Latina Sisters Support Inc. Spanish Fair in Brentwood, the Cancer Center’s Community Outreach and Engagement staff provided mobile mammography screening and cancer prevention and screening education.
At that event, the Suffolk County Department of Health Services provided human papillomavirus and Covid-19 vaccines and Stony Brook School of Health Professionals offered blood pressure screening.
An information chasm
Dr. Jedan Phillips. Photo from Stony Brook Medicine
Dr. Jedan Phillips, Medical Director for Stony Brook Health Outreach and Medical Education and Associate Professor of Family, Population and Preventive Medicine at the Renaissance School of Medicine, explained that Covid-19 exposed the “chasm” between what the health care profession believed and the reality of what works and what doesn’t.
During the pandemic, Stony Brook University brought a vaccination pod to Uniondale in Nassau County, which is a predominantly African American community. “Because we had no relationship there, we might have wasted over 200 doses of the vaccine” as residents were reluctant to get vaccinated, he said. “Even though [Stony Brook] offered something that would help, people chose against it. It’s not about the vaccine. It’s something deeper.”
Dr. Phillips said East Elmhurst, Queens, where he grew up, was “ravaged by Covid. I know at least 10 people in my community who were regular figures in my life that died. I saw how vulnerable of a position we were in as a group and I felt I needed to get involved.”
Dr. Phillips, who has a family medical practice in East Patchogue, together with Dr. Yuri Jadotte, Assistant Professor and Associate Program Director for the Preventive Medicine Residency in the Department of Family, Population and Preventive Medicine at Stony Brook, created three focus groups to survey the views and understanding of African American men on prostate cancer.
Many African American men don’t get screened for prostate cancer, even though such screenings could lead to earlier treatment and better outcomes.
By listening to what inspires African American men throughout Long Island to take action, Dr. Phillips hopes to tailor information to that type of delivery.
“It’s important to listen and understand,” Dr. Phillips said. Understanding what motivates people and seeking to provide the formats in which they prefer to access information can help establish a community connection and demonstrate cultural compassion.
Part of Dr. Phillips’s focus on preventive medicine comes from his experience with his father, who died from complications related to diabetes. His father, who was an inspiration for him, “didn’t live life in a preventive way,” which made managing his health more difficult, Dr. Phillips said.
With the numerous programs offered by the Office for Community Outreach and Engagement, Dr. Mermelstein said the group has four primary goals.
Dr. Jedan Phillips provides medical care.
“We want to monitor and understand what is the cancer burden in our catchment area” which includes Nassau and Suffolk County, she said. “Much of our activities are identifying the issues in terms of cancer” and understanding any barriers towards cancer care, like education, screening, diagnosis and treatment.
Secondly, she wants to provide cancer prevention services, screening, education and community navigation. Third, the group has a bi-directional engagement, with researchers getting to know the community and community advocates and the community learning about the research process.
Finally, the group seeks to catalyze the research by focusing on disparities, providing research services to the entire community based on specific needs.
One of Dr. Mermelstein’s first actions after heading up this team in 2019 was to create a community advisory council for the Stony Brook Cancer Center.
Janine Logan, Vice President of Communications and Population Health with the Long Island Health Collaborative, serves on that advisory council.“What I’m most excited about is that the committee understands the importance of knowing what your community thinks and needs,” Logan said.
Logan is pleased with the work the Stony Brook Cancer Center has done to educate residents about the lifestyle behaviors that can contribute to cancer, such as smoking, inactivity, and nutrition.
“They’ve done a lot of work in reaching out and educating communities to help them understand that these simple, modifiable behaviors can reduce their risk” of developing cancer, Logan said.
The effort at the Cancer Center to educate the public about the danger’s of the sun dovetails with some of the work she has done at the Long Island Health Collaborative.
Indeed, the Cancer Center Community Outreach and Engagement hosted a “Block the sun, not the fun” gathering on May 7 at the Smith Haven Mall in Lake Grove.
The Stony Brook Cancer Center is also working with the Suffolk County Department of Health Services Cancer Prevention and Health Promotion Coalition to provide information about sunscreen safety.
In addition to the disparity among African American men who develop prostate cancer, the outreach effort also addressed the difference among hispanic women who have a higher incidence of cervical cancer than the non-hispanic Caucasian population.
In Suffolk County, about 10.2 Hispanic and Latino women out of 100,000 Hispanic and Latino women develop cervical cancer, which is higher than the 5.9 per 100,000 for white, non-Hispanic women, according to the National Cancer Institute.
Human papillomarvirus is estimated to cause about 36,500 cases of cancer in men and women every year in the United States. The HPV vaccination, which works best before exposure to the virus, can prevent 33,700 of those cancers. Because the vaccine doesn’t prevent all cancers, women still need screening to protect themselves.
Previously employed for 22 years with the Suffolk County Department of Health Services, Dr. Mermelstein, who has a medical degree and a master’s in public health, briefly retired, before taking this job at Stony Brook.
“I wanted to do something to help address cancer after I retired, and so I contacted Stony Brook Cancer Center and began in this position about four months after I retired,” she explained.
Those interested in reaching out to the Office for Community Outreach and Engagement can call 631-444-4263 or email [email protected].
I was born in March, so, of course, I wished I were born in the summer.
My brothers were both born in the heat of the summer, which means they could go to a warm beach on their birthdays, sail across some waterway around Long Island, and celebrate the passage of another year without a midterm on their big day or, even worse, the day after their birthday.
But, the real reason I wished my birthday came during the summer was so that I could attend a Yankees game.
When my birthday rolled around, pitchers and catchers were often reporting to spring training, getting ready for the marathon of each baseball season.
When my son was born in July, sandwiched between a host of other family birthdays on both sides of the family, I figured he would have the chance to pursue the kind of unfulfilled baseball fantasy that I could only imagine as I was memorizing facts, figures and formulas for another set of tests before, during and immediately after my annual rite of passage.
Recently, we celebrated his birthday by going to one of the last few Yankees games before the All-Star break.
We had the privilege of attending a weekend game, when neither of us felt the need to work or meet a deadline.
My son is taking a summer course for which he was supposed to have a virtual test the day before we went to a game. The computer system crashed that day, and the professor suggested everyone take it the next day.
The system, however, continued not to work, perhaps obeying a secret wish my son made over his customized birthday cake, giving him the opportunity to enjoy the entire day with little to no responsibility other than to reply to all the well wishers and to compliment them on their melodic singing.
The game itself became a blowout early, as the Yankees scored run after run, and the Red Sox seemed to retreat to the safety of the dugout soon after coming up to bat.
Both of us ate more than we normally do in a day, celebrating the outing and reveling in the moment, high-fiving each other and the reveling strangers in Yankees jerseys in front of us.
While the packed stadium started to clear out when the game seemed out of reach for the visitors, we remained in our seats until the last pitch, soaking up the sun, predicting the outcomes of each pitcher-hitter match up and observing the small games-within-a-game that comes from watching the defense change its positioning for each hitter.
It still confounds me that a team could leave the third base line completely open, shift all the infielders towards right field, and still, the hitter won’t push the ball in a place where he could get a single or double. After all, if they heeded the advice of Hall of Famer Willie Keeler who suggested they “hit it where they ain’t,” these batters could get a hit, raise their batting average and contribute to a rally just by pushing the ball to a huge expanse of open and unprotected grass in fair territory.
Amid the many relaxing and enjoyable moments of connection with my son, he shared that he kind of wished he had born in the winter. After all, he said, he loves hockey and always imagined going to an NHL game on his birthday.
I suppose the grass is always greener, even on your birthday.
To be fair, though, he did add that wasn’t a genuine wish, as he was thrilled to attend baseball games on his actual birthday, and he was pleased that, in every other year, he didn’t have to worry about exams.
Paolo Boffetta. Photo by Jeanne Neville/Stony Brook Medicine
By Daniel Dunaief
Screening for cancer can help people take steps to head off the development of a disease that could threaten the quantity and quality of their lives.
During the start of the pandemic, people around the world stopped screening for cervical, breast and colorectal cancer, according to a recent study led by Paolo Boffetta, Associate Director for Population Sciences at Stony Brook University’sCancer Center.
The results of the study were recently published in the journal JAMA Oncology.
Compared to 2019, screenings for breast cancer dropped in the first few months after the start of the pandemic by 35.6 percent for breast cancer, 41.8 percent for colorectal cancer, and 54.1 percent for cervical cancer compared to the same period in 2019.
Paolo Boffetta. Photo by Jeanne Neville/Stony Brook Medicine
Boffetta chose these three cancers because they are the ones public health authorities recommend for the population at large. Screenings can improve patient outcomes.
“For some/ most cancer, the earlier the better for detection,” explained Stony Brook Cancer Center Director Yusuf Hannun.
Boffetta, who is also Adjunct Professor at the Icahn School of Medicine at Mount Sinai in New York City, suggested that the longer-term impact of a reduction in screenings in the early part of the pandemic won’t be clear to doctors or patients in the short term.
“It will take a little bit of time to have a full understanding of this,” said Boffetta. Depending on the specific type, cancers “that are detected by screenings would not otherwise appear for a few years.”
Boffetta suggested that the pandemic, apart from the illnesses and symptoms that threatened the health of people who were battling the virus itself, affected public health services. He believes several factors likely contributed to the decrease in screenings. Patients around the world were reluctant or restricted in their ability to leave their homes amid lockdowns.
Additionally, some cancer centers likely reduce the number of people they monitored to cut back on the density of patients in health care facilities, although Boffetta did not gather any data on the reduction in the number of screenings at health care centers.
The positive news amid this study, which surveyed cancer screening data in PubMed and other medical journals from 19 countries from January 2020 through December 2021, was that the number of patients screened returned to a more normal level within several months of the start of the pandemic.
“An important finding is that by the summer of 2020, the decrease in screenings for breast cancer and cervical cancer seem to have disappeared,” Boffetta said by phone from Italy, where he is a part-time professor at the University of Bologna. “For colorectal cancer [the decrease in screenings] lasted longer,” through the end of 2020.
Boffetta described the reduction in screenings and then a return to normal as a U-shaped curve, with an initial decline followed by a recovery. Doctors typically screen for colorectal cancers by using a colonoscopy. This technique requires several hours in the hospital. Patients may have been “more reluctant to go back to such a complex procedure, compared to the mammography or pap smear” which screen for breast and cervical cancers, respectively.
Boffetta is conducting a broad study of the cancer literature from early findings to clinical diagnosis to treatment. At this point, he has finished a paper on the frequency and types of clinical diagnoses amid the pandemic. He is collecting data for another study that will examine cancer treatment.
“We are interested in how the pandemic affected each of these stages,” he said.
Hannun suggested that Boffetta’s work expertise help address important health care questions related to the pandemic and other threats to public health, adding, “Epidemiology is essential for understanding the pandemic and many chronic diseases, especially cancer with exposure issues.
A lab update
Boffetta joined Stony Brook University in April of 2020, soon after the start of the pandemic.
Also a Professor in the Department of Family, Population and Preventive medicine at the Renaissance School of Medicine at Stony Brook University, Boffetta will return to the United States in a few weeks from Italy.
Boffetta has added Research Coordinator Germana Giupponi and postdoctoral fellow Malak Khalifeh to his research efforts at Stony Brook.
Germana Giupponi
A native of Italy, Giupponi, who started working with Boffetta in July of 2020 and provides administrative support and coordination with Boffetta’s collaborators, earned her master’s degree from the University of Milan.
Khalifeh joined Boffetta’s lab in March, is originally from Lebanon and conducted her PhD research in France at the University of Bordeaux. She is studying the link between the exposure people have to various chemicals in drinking water and bladder cancer. The bladder is especially susceptible to toxins from the environment.
Boffetta, meanwhile, has started teaching some graduate level classes at Stony Brook on cancer epidemiology for master’s and PhD students. He will teach one class this fall.
He is also continuing his studies with survivors of the World Trade Center attacks.
He has been comparing the survival of these first responders to the overall population in New York, comparing how the risk of cancer changed over the course of the 21 years since the attacks.
Boffetta has been working with Ben Luft, Director of the Stony Brook WTC Wellness Program at the Renaissance School of Medicine. Luft has provided clinical and research support for WTC responders.
Boffetta continues to have academic affiliations with other academic institutions, including Harvard University and Vanderbilt University.
Boffetta and his wife Antonella Greco, who have been living in New York City, plan to move to the Stony Brook area. Their three daughters live in Brooklyn, Italy and Argentina. Now that pandemic restrictions have lifted, Boffetta has been able to return to the opera and museums and has done some skiing and hiking.
As for this study, Boffetta suggested that the findings about screenings were consistent with what he might have expected during the beginning of the pandemic.Delaying screenings could mean that some people discover cancers at a more advanced state by the time they diagnose them, he said.
The English language makes no sense. As soon as you create a rule, exceptions crop up like mushrooms colonizing an open field.
Let’s start with the plural form of nouns.
“Add an ‘s’ and be done with it,” you might say. While that’s a simple solution, the language laughs in the face of such elegant simplicity.
Take the words “chief” and “thief.” Chief” becomes “chiefs” easily enough, as Kansas City football fans will readily tell you.
But then thief changes everything. The plural becomes “thieves,” as if someone robbed the word of its “f” and replaced it with something that sounds more vile and villainous.
The plural for hoof, as in the bottom of a horse’s foot, is hooves, but the acceptable plural for roof, which also only has one different letter way at the start of the word, is roofs. Yes, I know people say “rooves,” but that doesn’t make it accurate.
A root at the bottom of the tree that draws nutrients from the ground becomes roots. A single owl calling to another across the treetops utters a hoot. Several owls responding reply in hoots. So far, so good.
But then, what’s wrong with those things that are important for walking and that smell up a room when they sweat too much? How is it that foot, which also only differs in the initial letter, becomes feet?
Then there are the plural forms of animals. A mouse hunting for food with his rodent pals becomes mice, while a moose eating in a field with his family becomes, well, moose.
The moose, however, hasn’t cornered the market on words that describe an individual and a group. Deer, sheep, salmon and trout also don’t budge when switching from one to several.
And why are the words for a group of animals different? Couldn’t they all be packs, herds, groups or schools?
Wolves banding together to hunt, live and howl form a pack. A family of giraffes is, fittingly, called a tower. That seems appropriate for animals that are born 6 feet tall.
But what about a collection of bears? They’re a sleuth, while a group of bats is a cloud.
One goose pooping on a field is inconvenient and messy, but is still a goose. Two of them are geese. A group of them walking on the ground is a gaggle, while those same birds in flight become a skein.
People often describe the challenge of bringing people together as akin to herding cats. While the verb is accurate, the name for a group of cats is not: they are a clutter, a glaring or a pounce, although numerous other words also describe a cat confab.
Now, more than one dolphin, those adorable marine mammals that make cool clicking sounds and perform at aquariums, becomes a school, which is also true of more than one fish, even though other marine mammals, such as walruses become herds or pods
When several ducks get together, they aren’t a flock, despite the fact that they are birds. They are a raft, perhaps reflecting the fact that they look like independent floats sitting on the water. Sea lions also become rafts when they’re together in the water.
Returning to those hooting owls, they become a parliament. Sure, that makes sense.
A group of hippos is called a bloat. While hippos average 3,310 pounds as an adult, the same word doesn’t apply to the larger elephant, which is part of a herd.
A number of crows is a murder, reflecting, perhaps, their ominous role in literature.
Penguins may take the word group crown, having a wide array of terms for them when they get together. A group is called a colony, rookery or huddles. It doesn’t end there. Swimming penguins, like ducks, are a raft. More likely than not, you might guess the name for walking penguins: they are a waddle.
Markus Seeliger, third from left, with members of his lab, from left, Terrence Jiang. Aziz Rangwala, Ian Outhwaite, Victoria Mingione,YiTing Paung, and Hannah Philipose. Photo from Markus Seeliger
By Daniel Dunaief
When a dart hits the center of a target, the contestant often gets excited and adds points to a score. But what if that well-placed dart slipped off the board before someone could count the points, rendering such an accurate throw ineffective?
With some cases of cancer treatments, that’s what may be happening, particularly when a disease develops a mutation that causes a relapse. Indeed, people who have chronic myeloid leukemia typically receive a treatment called Imatinib, or Gleevac.
The drug works, hitting a target called a kinase, which this white blood cell cancer needs to cause its cells to continue to divide uncontrollably. Patients, however, develop a mutation called N368S, which reduces the effectiveness of the drug.
While mutations typically make it more difficult for a drug to bind to its target, that’s not what’s happening with this specific mutation. Like the dart hitting the center of a board, the drug continues to reach its target.
Instead, in a model of drug resistance several scientists have developed, the mutation causes the drug to decouple.
Pratyush Tiwary with this year’s US top 20 students who are going to the international chemistry olympiad. Photo from Toward
A team of experimental and computational researchers including Markus Seeliger, Associate Professor of Pharmacological Sciences at Stony Brook University, and Pratyush Tiwary, Associate Professor in the Department of Chemistry & Biochemistry at the University of Maryland, published two research papers explaining a process that may also affect the way mutations enable resistance to other drugs.
Seeliger described how different disease-associated mutations bind to Gleevac in a paper published in the Proceedings of the National Academy of Sciences.
Working with scientists at Memorial Sloan Kettering Cancer Center and Goethe University in Frankfurt, Germany, Seeliger used nuclear magnetic resonance spectroscopy, or NMR. The researchers showed how the drug bound to its target and then released.
Understanding the way diseases like cancer develop such resistance could affect drug discovery, giving pharmaceutical companies another way to prepare for changes diseases make that reduce the effectiveness of treatments.
A ‘hot paper’
Tiwary published research in which Seeliger was a coauthor in late April in the journal Angewandte Chemie that the publication labeled a “hot paper” for its implications in the field. Tiwary developed a way to simulate the kinetic processes that enable the mutated kinases to release the drug.
Tiwary created an artificial intelligence model that extended the time he analyzed the drug-protein interaction from milliseconds all the way out to thousands of seconds.
“Even within the simulation world, if you can quantitatively predict a binding affinity, that’s amazing,” Seeliger said. “It’s extremely hard to calculate kinetics, and he got that right.”
Tiwary, who started talking with Seeliger about five years ago and has been actively collaborating for about three years, uses experimental data to inform the dynamics that affect his simulations.
Seeliger “had done the experiments of the dissociation rates beforehand, but did not have a way to explain why they were what they were,” Tiwary explained in an email. “Our simulations gave him insights into why this was the case and … insight into how to think about drugs that might dissociate further.”
Drug discovery
Tiwary hopes the work enables researchers to look at structural and kinetic intermediates in reactions, which could provide clues about drug design and delivery. While he worked with a single mutation, he said he could conduct such an analysis on alterations that affect drug interactions in other diseases.
He wrote that the computations, while expensive, were not prohibitive. He used the equivalent of 16 independent 64 CPUs for one to two weeks. He suggested that computing advances could cut this down by a factor of 10, which would enable the exploration of different mutations.
“The methods are now so easy to automate that we could run many, many simulations in parallel,” Tiwary explained. Machine learning makes the automation possible.
Given what he’s learned, Tiwary hopes to contribute to future drug begin that addresses mutation or resistance to treatment in other cancers. He also plans to continue to work with Seeliger to address other questions.
Next steps
Seeliger said he plans to extend this work beyond the realm of this specific type of cancer.
He will explore “how common these kinetic mutations are in other systems, other diseases and other kinases,” Seeliger said.
He would also like to understand whether other proteins in the cell help with the release of drugs or, alternatively, prevent the release of drugs from their target. The cell could have “other accessory proteins that help kick out the drug from the receptor,” Seeliger said.
The concept of drug resistance time comes from infectious disease, where microbes develop numerous mutations.
Seeliger, who is originally from Hanover, Germany, said he enjoys seeing details in any scene, even outside work, that others might not notice.
He described how he was driving with postdoctoral fellows in Colorado when he spotted a moose. While the group stopped to take a picture, he noticed that the moose had an ear tag, which is something others didn’t immediately notice.
As for the research collaboration, Seeliger is pleased with the findings and the potential of the ongoing collaboration between experimental and computational biologists.
“The computational paper, aside from using interesting new methodology, describes why things are happening the way they are on a molecular level,” he said.
Iread bumper stickers, buttons, fortune cookies and messages on T-shirts. They are a form of poetry that captures a moment, an approach, an attitude, and a message in fewer words than some of the soupier birthday cards.
Like birthday cards, sometimes these messages work, are amusing, evoke a reaction, or make me laugh for intentional and unintentional reasons.
In the modern world, in which so many interactions seem less than optimal or contrary to the intentions, I have some suggested messages that reflect the current state of customer service and civility, or lack thereof.
— Please don’t interrupt. I’m in the middle of looking busy. When I started working many years ago, someone told me to balance between looking busy and being under control. She suggested I walk quickly and purposefully, even if just to the bathroom, to suggest that I’m too busy to tackle something new that might involve lots of administrative work.
— Yes, I am talking to you. Those of you old enough to have seen the Robert De Niro film “Raging Bull” will understand this one instantly. This message captures the prevalence of confrontations.
— I have no idea what’s good. I don’t eat here. Diners often ask waiters and waitresses, “what’s good.” More often than not, they tell people what’s popular dishes or their specials. The subtext here is that some of them don’t, can’t or wouldn’t eat where you’re eating, especially after spending considerable time in the kitchen.
— Everything and nothing is special today. Keeping with the dining theme, while blending in some grade inflation, waiters could provide something philosophical for their diners to consume.
— I believe in building suspense. The assignment, the job, or even the entree may be later than someone wanted. This message could suggest the tardiness was deliberate and was designed to enhance appreciation and add drama. So, you’re welcome.
— Sure, you can ask. I like the buttons people wear at Yankees games that encourage fans to ask a question. On a day when these customer service professionals are feeling tired or hung over, they could don messages that encourage people to move along or to figure out how to drive home to Pennsylvania from the Bronx on their own.
— How can I appear to help you? Life is all about optics. Yes, we should be helping and yes, people are paid to help each other, in person, on phone and on the Internet. Sometimes, the person (or artificial intelligence programs) that is offering assistance isn’t delivering much.
— I brought my own questions, thanks. I would love it if a politician wore this button to a debate. On one level, it could suggest the candidate has questions that are hopefully substantive for his or her opponent. On the other, it could be an honest way of acknowledging the disconnect between a question about the environment and an answer about the person’s commitment to family.
— What can you do for me? This is a way of turning the tables, literally, on a hostile or inappropriate customer. It also discourages people from asking too much of someone who is not eager to deliver.
— Is there anything else I can’t do for you? I’ve been on numerous calls with people who haven’t done anything, particularly when dealing with traveling details, who then ask if there’s anything else they can help me with. When they haven’t helped me with the first question, it’s hard to imagine they can help with a second. A more honest message might suggest that they also anticipate not being able to provide any help with a second problem or question.
— What did you get me for my birthday? People often want, or expect, something, even from strangers, on their birthday. They don’t often consider that the person from whom they expect service, help or extra treatment had a birthday they likely missed.
Members of the CanCan team, from left,Oliver Maddocks, David Lewis, Johan Vande Voorde, Bette Caan, Marcus Goncalves, Eileen White, Mariam Jamal-Hanjani, Tobias Janowitz, Karen Mustian, Janelle Ayres andToni Hui
By Daniel Dunaief
If a team Cold Spring Harbor Laboratory Assistant Professor Tobias Janowitz co-leads succeeds, researchers will know more about the end stage of numerous types of cancer that involves the loss of tissue and muscle mass.
Tobias Janowitz
Recently, lead scientists Janowitz; Eileen White, Rutgers Cancer Institute of New Jersey Deputy Director and Chief Scientific Officer; and Dr. Marcus DaSilva Goncalves, Assistant Professor of Medicine at Weill Cornell Medicine received $25 million in funding as a part of a Cancer Grand Challenge, which is a combined trans-Atlantic funding effort between Cancer Research UK and the National Cancer Institute in the United States.
The cachexia group was one of four teams to receive funding among 11 finalists.
Bruce Stillman, president of Cold Spring Harbor Laboratory, described cachexia as “one of the most difficult clinical problems with late stage cancer.”
Stillman added that the collaboration is promising because it brings together a group of “remarkable” scientists, including White, who was a postdoctoral fellow in Stillman’s lab. “It has great potential for making a difference in the lives of patients.”
Stillman believes Janowitz is an ideal co leader for this challenging project because he has an MD and a PhD and is clinically certified as an oncologist.
CanCan team
For his part, Janowitz is looking forward to the opportunity to team up with other ambitious research efforts to create a virtual institute.
Eileen White
“It’s incredibly exciting to get the chance to do something you think is higher risk with a large group of people who have come together around this problem,” said Janowitz. “We often talked about how it would be nice to bring team members from other disciplines into this area.”
Indeed, the cachexia team, which White named CanCan for Cancer Cachexia Action Network believes cachexia is a tumor-driven metabolic imbalance. The group is pursuing different areas of research, including metabolism, neuroendocrinology, clinical research, and immunology, among others, to define clinical subtypes with the hopes of creating individualized therapies.
While the effort brings together a range of scientists with different expertise and technological skills, researchers don’t expect an immediate therapeutic solution within that time frame. Rather, they anticipate that their experiments and clinical data will help inform future approaches that could enhance efforts to prevent and treat a wasting disease that causes severe declines in a patient’s quality of life.
“What we would deem as a success is, if in five years time, we have maybe one to three strong lead hypotheses that comes out of our shared work on how we can either prevent or treat cachexia as it emerges,” Janowitz said.
The complexity of cachexia
Dr. Marcus DaSilva Goncalves
As a complex process that involves an understanding of numerous interconnected dynamics, cachexia has been a challenging field for researchers and a difficult one for funding agencies looking for discrete problems with definable results and solutions.
Cachexia research had “never reached this critical mass that people were seeing where we can say, ‘Okay, there’s enough work going on to really unravel this,’” Janowitz said.
The CanCan team has several scientific themes. Janowitz will be involved with metabolic dysregulation. He would like to understand the behavioral changes around appetite and food intake.
Additionally, the group will explore the interaction of normal cells and cancer cells by looking at the tumor micro environment. This research will explore how cancer cells can reprogram healthy host cells.
“We’ve got a really exciting axis of research” within the network, Janowitz said.
Searching for signaling molecules
Janowitz said Norbert Perrimon, James Stillman Professor of Developmental Biology at Harvard Medical School is one of the leading experts in fly genetics and fly biology. Perrimon has created a model of cachexia in the fruit fly. While that sounds far from patients, Perrimon can use single molecule resolution of the entire organism to get an insight and understanding of candidate molecules.
“We are hoping to search for new signaling molecules that might get involved” in cachexia, Janowitz said. Once the research finds new candidates, he and others can validate whether they also work in mouse models of cancer and cancer cachexia.
With numerous clinical groups, Janowitz hopes to contribute to the design and execution of experimental medicine studies.
The Cancer Grand Challenge will distribute the funds based on what members need. Janowitz described the allocation of funds as “roughly equitable.” He will use that funding to support a postdoctoral researcher, a PhD student and a technician, who can help with specific projects he’s merging in his lab to combine with the team effort.
The funds will also support his salary so he can supervise the work in his lab and help with the coordination of this effort.
The funding agencies have an additional budget to organize conferences and meetings, where researchers can discuss ideas in person and can ensure that any clinical and laboratory work is standardized and reproducible in different facilities.
Cold Spring Harbor Laboratory will host the first full gathering of the cachexia team in November.
Challenging beginnings
When he was a doctor in the United Kingdom, Janowitz was fascinated and confounded by cachexia. In the early years of his training, he saw patients who had a small tumor burden, but were so sick that they died. Those experiences made “such a strong imprint” that he wanted to help unravel this process as a junior oncologist, he said.
Getting funding was challenging because cachexia was complex and didn’t involve a finely defined project that linked a receptor protein to a cell type that led to a diseased condition.
Janowitz, among others in this field, felt passionate enough about this area to continue to search for information about cachexia. After he restructured his research into a narrower focus, he secured more funding.
An unsolved mystery
With enough researchers continuing along this path, Janowitz said the group developed an awareness that this is “one of the big, unsolved mysteries of cancer progression.”
Janowitz appreciates the opportunity to work with a team that has accomplished researchers who work in fields that are related or synergistic, but aren’t necessarily considered part of the cachexia field.
The significant funding comes with expectations.
“The grant is both a great joy, but also, essentially, a mandate of duty,” he said. “Now, you have to utilize this grant to make significant contributions to understand and hopefully treat this debilitating condition.”
We don’t usually go to bed thinking, “what if I’m wrong?” We don’t get up asking ourselves the same question.
We develop our beliefs, stick with them and, as time goes on, we defend them or push for change based on something we think, or are fairly certain, we know.
But it’s worth considering the possibility that we might be wrong, particularly in connection with something as important as the only habitable planet we know.
If you don’t believe climate change is a threat and you think rules restricting environmental pollution are unnecessary and a federal government overreach, have you considered the consequences of being wrong?
I won’t trot out all the climate science experts who have what they consider incontrovertible proof that the climate is warming based on years of data.
You’d probably come back with the argument that the data can be interpreted in other ways or that science itself rarely has complete certainty.
You might even suggest that a warmer climate would mean we wouldn’t need to use as much heat during the winter months and that some crops might grow better during a longer, hotter growing season.
While I don’t ascribe to those thoughts —which a headline grabbing Republican recently espoused — because of the danger to so many staple crops from a warmer season that could include droughts and storms that cripple cities and destroy crops, I want those who don’t believe climate change is real to consider what might happen if they are wrong.
At the time of this writing, the Supreme Court hadn’t ruled on West Virginia vs. Environmental Protection Agency. If the conservative majority, who have been reshaping the political and legal landscape at a rapid pace, rules as expected, the EPA will have less authority to regulate power plant pollution.
That would mean power plants won’t have to comply with federal rules that limit the gases they emit into the environment and the pollutants they send into the air.
These companies may be able to make more money by continuing to operate as they had in the past. Yay for them? Right? Well, not so fast.
What’s the risk if they are wrong? We all make decisions when weighing risks, whether it’s the types of stocks we invest in, the places we go that might be dangerous at night, or the undercooked foods we eat.
So, if they’re wrong, the world continues to heat up, storms such as hurricanes move more slowly, dumping more rain on any one area, crops get destroyed, glaciers continue to melt causing sea levels to rise, and biodiversity declines, wiping out species that might have otherwise led to cures for disease or provide future food sources.
Some areas also become uninhabitable.
Our children, grandchildren and future generations can’t come back to tell us who was right. What we do or don’t do, however, will undoubtedly affect them.
Using the same logic climate change deniers use to suggest that nothing is certain, it seems critical to hedge their bets, protecting us from a future they believe is possible but unlikely.
Even if the Supreme Court acts (or acted, depending on the timing) as expected, we don’t have to be fatalistic or cynical about the next steps in the battle against our own gaseous waste.
Utilities and other companies that produce these gases have to take responsibility for their actions, regardless of what the Supreme Court says or does. Even reluctant legislators have to consider what might happen if they are wrong. Yes, leaders have numerous other problems.
We can’t ignore the Earth. If some people consider the consequences of freeing up companies to send carbon dioxide into the only air we have, they might be making a one-way mistake. They must consider what will happen if they are wrong.
While looking after the physical and mental well-being of patients who come in for care, Suffolk County hospitals are also focused on protecting staff, patients and visitors from the kind of violence that has spread recently throughout the country.
Over the past six months, hospital security staff and administrators have added a host of procedures to enhance safety and are considering additional steps.
“New measures have been put in place to minimize risk and better secure our buildings from a variety of threats,” Frank Kirby, Catholic Health Service line manager, wrote in an email. Catholic Health includes St. Catherine of Siena in Smithtown and St. Charles in Port Jefferson, among others.
“All Catholic Health facilities have an ‘active shooter’ contingency policy, which includes training for our employees on what to do in such an event,” Kirby wrote.
Executives at several health care facilities shared specific measures they have put in place.
The safe room
“Over the last six months or so, we have created something called the safe room,” said Dr. Michel Khlat, director at St. Catherine of Siena. Inside that room, hospital staff can hide and can find emergency items, like a door stop, medical supplies, gauze and first aid equipment.
St. Catherine recommends putting all the tables down in the safe room and hiding.
Khlat added that the hospital recommends that staff not open a door where another staff member knocks, in case a criminal is squatting nearby, waiting for access to the hospital.
Kirby added that Catholic Health facilities actively conducts drills across their hospitals, medical buildings and administrative offices to “sharpen our preparedness for any potential crisis that could impact safety and security.”
Catholic Health hospitals have onsite security guards and field supervisors who have prior military or law enforcement experience, Kirby added.
Northwell Health
As for Northwell Health, which includes Huntington Hospital, Scott Strauss, vice president of Corporate Security at Northwell, said the hospitals have an armed presence that includes many former and active law enforcement officers.
Strauss himself is a retired New York Police Department officer who, as a first responder on 9/11, rescued a Port Authority officer trapped by the fall of the World Trade Center.
Northwell is researching the possibility of installing a metal detection system.
Strauss suggested that the security program could not be successful without the support of senior leadership.
He suggested that staff and visitors can play a part in keeping everyone safe by remaining vigilant, as anyone in a hospital could serve as the eyes and ears of a security force.
The security staff has relied on their 15 to 35 years of experience to deescalate any potentially violent situations, Strauss said.
Northwell hospitals also offer guidance to staff for personal relationships that might
be dangerous.
“People don’t realize they’re in a poor relationship, they might think it’s normal,” Strauss said.
Across social media and the Internet, the communications team at Northwell monitors online chatter to search for anything that might be threatening.
“We evaluate it and notify the police as needed,” said Strauss.
Aggressive behavior
Strauss urged people who see something threatening online to share it with authorities, either at the hospitals or in the police force. “You can’t take a chance and let that go,” he said.
At this point, Northwell hasn’t noticed an increase in threats or possible security concerns. It has, however, seen an increase in aggressive behavior at practices and in
the hospitals.
In those situations, the security team investigates. They offer to get help, while making it clear that “threatening in any way, shape or form is not tolerated,” Strauss said. “There could be consequences” which could include being dismissed from the practice and filing police reports, Strauss said.
Anecdotally, Strauss believes Northwell has seen an increase in police reports.
When the draft of the Supreme Court’s decision that will likely overturn Roe vs. Wade, the landmark 1973 case that made it unconstitutional for states to restrict abortions, became public, Strauss was concerned about the potential backlash for health care providers.
So far, Strauss said gratefully, Northwell hasn’t seen any violence or threats related to the pending decision.
Stony Brook
Stony Brook University Hospital has an accredited and armed law enforcement agency on campus, in addition to a team of trained public safety personnel within the hospital, explained Lawrence Zacarese, vice president for Enterprise Risk Management and chief security officer at Stony Brook University.
Zacarese indicated that university officers are extensively trained in active shooter response protocols and are prepared to handle other emergency situations.
He added that the staff looks for ways to enhance security.
“Our training and security activities are continuous, and we are committed to exploring additional opportunities to maintain a safe and secure environment,” he explained in an email.
Kirby of Catholic Health Security suggested that hospitals do “more than provide care for surgical and medical inpatients. They also need to guarantee safety for all who enter our grounds.”
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