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By Leah S. Dunaief

Leah Dunaief

As they say in literature, it is the best of times and the worst of times. You could almost say it is also a tale of two cities. Yes, the vaccine has now been developed and produced to counter the novel coronavirus. We will require two shots, whether we get the Moderna or the Pfizer-BioNTech brand, and there may even be a third possibility, one from Johnson & Johnson, that will only be a one shot deal. That’s the wonderful news.

Less than wonderful is the distribution thus far. Despite best intentions, it has been spotty and disorganized. Locations that are supposed to be vaccination sites have had to turn people away because they have run out of the vaccine or never received the shipment to begin with. Getting an appointment, as opposed to standing optimistically for hours in a line, has become an exercise of pounding the keyboard of the computer or dialing on the phone for hours on end, looking for a slot with availability. 

Just about everyone I know is being helped by their children and grandchildren in this frustrating pursuit of inoculation. Those who have received the shot are living in a different city from those who have not.

To complicate the already complicated situation, the wily virus is doing what viruses do: mutating ahead of the vaccines. So far, the pharmaceutical companies are saying that their products are effective against the new strains, perhaps a little less so against the variant from South Africa than the one from the United Kingdom. 

Brazil has a variant as well. And while non-American citizens originating in those countries are, for the moment, banned from entering the United States, scientists know those mutations are already here, having arrived before the ban, from Britain and Brazil so far and most probably South Africa as well. 

Worse than potentially evading the vaccines is the increased degree of contagion those viruses already possess. The knowledge that scientists are already hard at work catching up to the newer strains is comforting. Such an adjustment could take six weeks, however, according to Moderna. Or perhaps a third shot of the existing vaccine might work against the variant.

So while the vaccine may be the best of times, we still have to get there, and the worst is now upon us. Sooner or later, we hope sooner, we will get the logistics of distribution worked out, but most of us will not reach that point of inoculation until mid-summer or fall at the earliest. Meanwhile more people will become ill, especially in the poorer nations unable to buy vaccines in large quantities. And with our global interactions, what pathogens exist elsewhere in the world will also come here with their new mutations.

So what can we do to help ourselves through these next few months?

Let’s remember that a simple handful of actions we already have taken can keep the viruses at bay. Washing our hands thoroughly, multiple times a day ( I practically bathe in hand lotion after all those washings); maintaining social distancing of at least 6 feet, preferably 15 feet, inside as well as outside; and wearing masks are effective defenses, if only we follow them. Working remotely and limiting travel have further contributed to containment.

On the subject of wearing masks, and at the risk of boring you with repetition because I wrote about this last week, I want to urge you to consider wearing two masks. Since the new strains are more contagious, meaning they can spread more readily, having a double barrier for them to pass through doubles our chances of escaping the disease. 

The growing recommendation is to wear a surgical mask underneath and a cloth mask on top. I have tried it and find this no more uncomfortable than a single mask, and I am happier with the thought of being better protected. I throw away the surgical mask and wash the cloth one often to preserve its effectiveness, making for myself a sort of double-bagged wall.

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Blood pressure numbers of less than 120/80 mm Hg are considered within the normal range.
Nighttime blood pressure readings may be more accurate predictors

By David Dunaief, M.D.

Dr. David Dunaief

What could we possibly learn about blood pressure that we have not heard already? Studies teach us about diagnostic techniques and timing, as well as consequences of hypertension and its treatment. 

Two arms please

When you go to the doctor’s office, they usually take your blood pressure first. But do they take readings in both arms and, if so, have you wondered why? I take blood pressure readings in both arms, because there may be significant benefit from this.

Researchers analyzed the Framingham Heart Study and Offspring Study and found that when blood pressure was taken in both arms and there was a difference of more than 10 mm Hg in the systolic (top number) blood pressure, they could identify an almost 40 percent increased risk of having a cardiac event, such as a stroke or a heart attack (1).

So, the next time you go to the doctor’s office, ask them to take your blood pressure in both arms to give you and your doctor a potential preliminary indication of increased cardiovascular disease risk.

Night beats daytime

When do you take your blood pressure? For most of us it is usually at the doctor’s office in the middle of the day. This may not be the most effective reading. Nighttime blood pressure readings may be the most accurate, according to one study (2). 

This was a meta-analysis of nine observational studies involving over 13,000 patients. Neither the clinical nor daytime readings correlated significantly with cardiovascular events when multiple confounding variables were taken into account. However, every 10 mm Hg increase at night had a significant predictive value.

With patients, if blood pressure is high in my office, I suggest that they take their blood pressure at home, both in the morning and at night, and send me weekly readings. At least one of the readings should be taken before antihypertensive medications are taken, since these will alter the numbers.

Pass on the salt

There has always been a debate about whether salt plays a role in high blood pressure and heart disease. A compelling British study, called the Health Survey from England, implicates sodium as one potential factor exacerbating the risk for high blood pressure and, ultimately, cardiovascular disease (3). The results show that when salt intake was reduced by an average of 15 percent, there was a significant blood pressure reduction and that this reduction may be at least partially responsible for a 40 percent reduction in stroke mortality and a 42 percent reduction in heart disease mortality.

One potential study weakness was that physical activity was not taken into account. However, this study’s strength was that it measured salt intake through 24-hour urine tests. Most of our dietary salt comes from processed foods we least suspect, such as breads, pastas and cheeses.

Check your eyes

When we think of blood pressure-lowering medications, we don’t usually consider age-related macular degeneration as a potential side effect. However, in the Beaver Dam Eye Study, patients who were taking blood pressure medications were at a significant 72 percent increased overall risk of developing early-stage AMD (4). It did not matter which class of blood pressure-lowering drug the patient was using, all had similar effects: calcium channel blockers, beta blockers, diuretics, and angiotensin receptor blockers.

However, the researchers indicated that they could not determine whether the blood pressure or the blood pressure medication was the potential contributing factor. This is a controversial topic. If you are on blood pressure medications and are more than 65 years old, I would recommend that you get yearly eye exams by your ophthalmologist.

Manage your fall risk

One study shows that blood pressure medications significantly increase fall risk in the elderly (5). Overall, nine percent of these patients on blood pressure medications were seriously injured when they fell. Those who were considered moderate users of these medications had a 40 percent increased risk of fall. But, interestingly, those who were consider high-intensity users had a slightly less robust risk of fall (28 percent) than the moderate users. The researchers used the Medicare database with 5,000 participants as their data source. The average age of the participants in the study was 80.

Does this mean that we should discontinue blood pressure medications in this population? Not necessarily. This should be assessed at an individual level between the patient and the doctor. Also, one weakness of this study was that there was no dose-response curve. In other words, as the dosage increased with high blood pressure medications, one would expect a greater fall risk. However, the opposite was true.

So, we have some simple, easy-to-implement, takeaways. First, consider monitoring blood pressure in both arms, since a difference can mean an increased risk of cardiovascular events. Reduce your salt intake; it appears that many people may be sensitive to salt, as shown by the British study. If you do take blood pressure medications and are at least 65 years old, take steps to reduce your risk of falling and have annual ophthalmic exams to check for AMD.

References:

(1) Am J Med. 2014 Mar;127(3):209-215. (2) J Am Soc Hypertens 2014;8:e59. (3) BMJ Open 2014;4:e004549. (4) Ophthalmology online April 30, 2014. (5) JAMA Intern Med. 2014;174(4):588-595.

Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com. 

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Photo by Pixabay

By Michael Christodoulou

Michael Christodoulou
Michael Christodoulou

During the COVID-19 pandemic, many of us have been forced to work from home. But once we’ve moved past the virus, many workers may continue working from home. More than one-third of companies with employees who started working from home now think that remote work will stay more common post-pandemic, according to a Harvard Business School study. This shift to at-home work can affect people’s lives in many ways – and it may end up providing workers with some long-term financial advantages.

If you’re one of those who will continue working remotely, either full time or at least a few days a week, how might you benefit? Here are a few possibilities:

  • Reduced transportation costs – Over time, you can spend a lot of money commuting to and from work. The average commuter spends $2,000 to $5,000 per year on transportation costs, including gas, car maintenance, public transportation and other expenses, depending on where they live, according to the U.S. Bureau of Economic Analysis and the U.S. Census Bureau. If you are going to work primarily from home, you should be able to greatly reduce these costs.
  • Potentially lower car insurance premiums – Your auto insurance premiums are partially based on how many miles you drive each year. So, if you were to significantly reduce these miles by working from home, you might qualify for lower rates.
  • Lower expenditures on lunches – If you typically eat lunch in restaurants or get takeout while at work, you could easily be spending $50 or more per week – even more if you regularly get coffee drinks to go. By these figures, you could end up spending around $3,000 a year. Think how much you could reduce this bill by eating lunch at home during your remote workday.
  • Lower clothing costs – Despite the rise in “casual dress” days, plenty of workers still need to maintain appropriate office attire. By working from home, you can “dress down,” reducing your clothing costs and dry-cleaning bills.

As you can see, it may be possible for you to save quite a bit of money by working from home. How can you use your savings to help meet your long-term financial goals, such as achieving a comfortable retirement?

For one thing, you could boost your investments. Let’s suppose that you can save $2,500 each year by working remotely. If you were to invest this amount in a tax-deferred account, such as an IRA or your 401(k) or similar employer-sponsored plan and earned a hypothetical 6% annual return for 20 years, you’d accumulate more than $97,000 – and if you kept going for an additional 10 years, you’d have nearly $210,000. You’d eventually pay taxes on the amount you withdrew from these accounts (and withdrawals prior to age 59½ may be subject to a 10% IRS penalty), but you’d still end up pretty far ahead of where you’d be otherwise.)

You also might use part of your savings generated by remote work to help build an emergency fund containing a few months’ worth of living expenses. Without this fund, you might be forced to dip into your retirement accounts to pay for something like a major home repair.

Becoming an at-home worker will no doubt require some adjustments on your part – but, in strictly financial terms, it could lead to some positive results.

This article was written by Edward Jones for use by Michael Christodoulou, ChFC®,AAMS®,CRPC®,CRPS® of the Stony Brook Edward Jones.

Edward Jones, Member SIPC

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Stock photo

By Linda M. Toga, Esq.

Linda Toga, Esq.

THE FACTS: 

My uncle John named my cousin Mike as executor in his will. Mike lives out of state and decided it would be too burdensome for him to serve as executor. Since I was named as successor executor, I had my attorney file a petition asking that the court issue to me letters testamentary. Mike signed a form renouncing his appointment and consenting to my appointment. Now that I am about to close the estate and receive commissions for serving as executor, Mike is insisting that he is entitled to the commissions since he was my uncle’s first choice for executor.

THE QUESTION:

Is Mike correct?  

THE ANSWER: 

Mike is absolutely wrong. Commissions are designed to compensate an executor for the time and effort he spends marshalling the decedent’s assets, paying the decedent’s debts and distributing the probate assets in accordance with the terms of the decedent’s will. Commissions paid to an executor of an estate are statutory. That means that there is a law (Surrogate’s Court Procedure Act, Section 2307) that sets forth the manner in which the commissions are calculated. That calculation takes into account the value of the estate assets and how those assets are addressed in the will. 

For example, if the decedent owned a house and in his will made a specific bequest of the house to his daughter, the value of the house is not included in the commission calculation. If, however, the decedent did not make a specific bequest of the house and simply stated in his will that his entire estate was to be distributed to his children in equal shares, the value of the house would be included in the commission calculations.

The commissions paid to an executor represent a percentage of the value of the estate so, the larger the estate, the greater the commissions. Commissions are awarded on a sliding scale. Generally an executor earns 5% of the first $100,000 of the value of the estate, 4% on the next $200,000 of the value of the estate and so on. 

The percentage on the value of the estate decreases as the value of the estate increases. Calculating commissions is a bit involved since the executor has to take into consideration the value of assets he receives as well as the value of assets paid out by the estate. Those figures may not be the same if, for example, the decedent’s investments lose significant value during the administration of the estate. Commissions paid to an executor are considered income and are subject to income tax. 

Although Surrogate’s Court Procedure Act, Section 2307 gives the executor the right to take commissions, it is not a requirement and it is not uncommon for close family members of the decedent who are also beneficiaries under the will to forego commissions. Doing so results in all of the beneficiaries who are entitled to a specific share of the estate to get a little more. 

That being said, in situations where there are beneficiaries that are likely to be uncooperative, I often recommend that the executor advise the beneficiaries that his decision about taking commissions is dependent on their conduct. Knowing they may get a bit more from the estate if they help rather than hinder the executor is usually enough to get cooperation.

Because of the complexities involved in probating an estate and calculating executor commissions, it is prudent for the person named as executor in a will to retain an experienced attorney to assist with the process. 

Linda M. Toga, Esq provides legal services in the areas of estate planning and administration, real estate, small business services and litigation. She is available for email and phone consultations. Call 631-444-5605 or email Ms. Toga at [email protected]. 

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Rosey
Rosey
Rosey

MEET ROSEY!

This week’s shelter pet is Rosey, a 6 year old grey beauty at the Smithtown Animal Shelter. 

Rosey was left behind when her dad moved. She can be sweet or spicy depending on her mood. She loves to get and give affection, until she doesn’t. 

Rosey has anxiety when she is around other animals and will groom herself naked. She would be best suited for a quiet home where she can be the only pet and the sole recipient of your love. She comes spayed, microchipped and is up to date on her vaccines.

If you are interested in meeting Rosey, please call ahead to schedule an hour to properly interact with her in the shelter’s Meet and Greet Room. 

The Smithtown Animal & Adoption Shelter is located at 410 Middle Country Road, Smithtown. Shelter operating hours are 8 a.m. to 5 p.m. during the week, 8 a.m. to 4:30 p.m. on the weekend. For more information, please call 631-360-7575 or visit www.smithtownanimalshelter.com.

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Photo by Gerard Romano

A NAUTICAL SCENE

Gerard Romano of Port Jefferson Station snapped this photo in the Village of Port Jefferson on Jan. 15. He writes, ‘As I took a walk for a bit of fresh air along the Danford Hotel pier the seagulls were bracing themselves against the stiff breeze. I used my 18-200mm lens to frame one with the Stony Brook University research vessel Seawolf as a bokeh backdrop.’

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By Barbara Beltrami

I don’t know what the time between this writing and its publication will bring, and given recent events, I’m worried. However, my stubborn faith in our democracy and Constitution and a resolution to celebrate the Inauguration and all it stands for inspires this column bearing recipes from a few government sources. Most famous and ubiquitously published is the Navy Bean Soup served in one of the Senate restaurants. Then there’s the late Representative John Lewis’s recipe for Barbecued Chicken and White House Chef (1966-1987) Henry Haller’s popular Cooked Vegetable Salad. 

Senate Navy Bean Soup

YIELD: Makes 8 servings

INGREDIENTS: 

1 pound dried navy beans, picked over

1 pound ham, with bone

2 potatoes, peeled and quartered

Salt 

2 tablespoons unsalted butter

1 large onion, chopped

1 celery rib, chopped 

2 garlic cloves chopped

1/4 cup fresh chopped flat leaf parsley

Freshly ground pepper to taste

DIRECTIONS: 

Put beans in large pot with 3 times their volume in water and put in a cool place to soak overnight. Drain and transfer to a large Dutch oven; add 10 cups water and ham; bring to simmer over medium heat, then reduce heat to low and cook 1 1/2 hours, until beans are tender. Transfer ham to cutting board to cool, then remove bone, cut meat into bite-size pieces and return to pot. 

Meanwhile place potatoes in a saucepan, cover with salted water, bring to boil over medium-high heat, then reduce to simmer and cook until potatoes are fork tender, about 25 minutes; drain, mash and add to beans and ham and stir to combine thoroughly. In large skillet, melt butter over medium heat and add onion, celery, garlic and parsley; season with salt and pepper and cook, stirring occasionally, until vegetables are translucent; add to bean mixture and cook over low heat, adding water if needed, season with salt and pepper and cook one hour. Serve hot with a crispy, crunchy salad.

Rep. John Lewis’s Barbecued Chicken

YIELD: Makes 4 servings

INGREDIENTS: 

2 cups ketchup

1 teaspoon prepared mustard

1 to 2 tablespoons Tabasco or other hot sauce

Pinch cayenne pepper

Pinch black pepper

1 onion, finely chopped

1 frying chicken, cut up or equivalent chicken pieces

DIRECTIONS: 

Preheat oven to 350 F. In a medium bowl, combine ketchup, mustard, hot sauce, cayenne, pepper and onion. Put chicken parts in greased 9 x 13” baking pan; spread sauce over chicken; bake for one hour, basting chicken with juices halfway through. Serve hot or warm with rice, potato salad or sweet potatoes and a green salad.

White House Chef Henry Haller’s Vegetable Salad

Chef Henry Haller

 

YIELD: Makes 4 servings

INGREDIENTS: 

2 cups tiny green peas, cooked, drained, cooled

2 cups diced carrots, cooked, drained, cooled

2 cups diced celery

1 cup peeled and cored diced apple

Salt and pepper to taste

3/4 cup mayonnaise

DIRECTIONS: 

In large bowl combine vegetables with celery and apple, salt and pepper. Add mayonnaise and toss lightly with a fork. Serve with soft rolls and butter.

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Sleep clears toxins from the brain. METRO photo
Exercise and sleep are crucial to clearing the clutter

By David Dunaief, M.D.

Dr. David Dunaief

Considering the importance of our brain to our functioning, it’s startling how little we know about it. 

We do know that certain drugs, head injuries and lifestyle choices negatively impact the brain. There are also numerous disorders and diseases that affect the brain, including neurological (dementia, Parkinson’s, stroke), infectious (meningitis), rheumatologic (lupus and rheumatoid arthritis), cancer (primary and secondary tumors), psychiatric mood disorders (depression, anxiety, schizophrenia), diabetes and heart disease.

Although these diseases vary widely, they generally have three signs and symptoms in common: they either cause altered mental status, physical weakness or change in mood — or a combination of these.

Probably our greatest fear regarding the brain is a loss of cognition. Fortunately, there are several studies that show we may be able to prevent cognitive decline by altering modifiable risk factors. They involve rather simple lifestyle changes: sleep, exercise and possibly omega-3s.

Let’s look at the evidence.

Clutter slows us down as we age

The lack of control over our mental capabilities as we age frightens many of us. Those who are in their 20s seem to be much sharper and quicker. But are they really?

In a study, German researchers found that educated older people tend to have a larger mental database of words and phrases to pull from since they have been around longer and have more experience (1). When this is factored into the equation, the difference in terms of age-related cognitive decline becomes negligible.

This study involved data mining and creating simulations. It showed that mental slowing may be at least partially related to the amount of clutter or data that we accumulate over the years. The more you know, the harder it becomes to come up with a simple answer to something. We may need a reboot just like a computer. This may be possible through sleep, exercise and omega-3s.

Get enough sleep

Why should we dedicate 33 percent of our lives to sleep? There are several good reasons. One involves clearing the mind, and another involves improving our economic outlook.

For the former, a study done in mice shows that sleep may help the brain remove waste, such as those all-too-dangerous beta-amyloid plaques (2). When we have excessive plaque buildup in the brain, it may be a sign of Alzheimer’s. When mice were sleeping, the interstitial space (the space between brain gyri, or structures) increased by as much as 60 percent.

This allowed the lymphatic system, with its cerebrospinal fluid, to clear out plaques, toxins and other waste that had developed during waking hours. With the enlargement of the interstitial space during sleep, waste removal was quicker and more thorough, because cerebrospinal fluid could reach much farther into the spaces. A similar effect was seen when the mice were anesthetized.

In another study, done in Australia, results showed that sleep deprivation may have been responsible for an almost one percent decline in gross domestic product for the country (3). The reason? People are not as productive at work when they don’t get enough sleep. They tend to be more irritable, and concentration may be affected. We may be able to turn on and off sleepiness on short-term basis, depending on the environment, but we can’t do this continually.

According to the Centers for Disease Control and Prevention, four percent of Americans reported having fallen asleep in the past 30 days behind the wheel of a car (4). And “drowsy driving” led to 83,000 crashes in a four-year period ending in 2009, according to The National Highway Traffic Safety Administration.

Prioritize exercise

How can I exercise, when I can’t even get enough sleep? Well there is a study that just may inspire you.

In the study, which involved rats, those that were not allowed to exercise were found to have rewired neurons in the area of their medulla, the part of the brain involved in breathing and other involuntary activities. There was more sympathetic (excitatory) stimulus that could lead to increased risk of heart disease (5). In rats allowed to exercise regularly, there was no unusual wiring, and sympathetic stimuli remained constant. This may imply that being sedentary has negative effects on both the brain and the heart.

This is intriguing since we used to think that our brain’s plasticity, or ability to grow and connect neurons, was finite and stopped after adolescence. This study’s implication is that a lack of exercise causes unwanted new connections. Human studies should be done to confirm this impact.

Consume omega-3 fatty acids

In the Women’s Health Initiative Memory Study of Magnetic Resonance Imaging Study, results showed that those postmenopausal women who were in the highest quartile of omega-3 fatty acids had significantly greater brain volume and hippocampal volume than those in the lowest quartile (6). The hippocampus is involved in memory and cognitive function.

Specifically, the researchers looked at the levels of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in red blood cell membranes. The source of the omega-3 fatty acids could either have been from fish or supplementation.

It’s never too late to improve brain function. Although we have a lot to learn about the functioning of the brain, we know that there are relatively simple ways we can positively influence it.

References:

(1) Top Cogn Sci. 2014 Jan.;6:5-42. (2) Science. 2013 Oct. 18;342:373-377. (3) Sleep. 2006 Mar.;29:299-305. (4) cdc.gov. (5) J Comp Neurol. 2014 Feb. 15;522:499-513. (6) Neurology. 2014;82:435-442.

Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com. 

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METRO photo

By Matthew Kearns, DVM

February is National Pet Dental Health month so I thought a discussion of periodontal disease is appropriate. Pets tend to suffer less from dental disease, and more from periodontal disease. 

Dental disease refers to pathology specifically related to the tooth like caries (superficial decay in the enamel), cavities (deeper decay in the enamel), and tooth fractures. Periodontal disease refers to pathology related to the structures around the tooth. These structures include the gingiva (gums), periodontal ligament (thousands of strands of microscopic strands of connective tissue that hold the tooth in the socket, or jaw), and the perialveolar bone (the bone of the jaw around the tooth).

Periodontal disease usually starts with a buildup of plaque. Plaque is a thin film of saliva, old food and bacteria that can accumulate on the surface of the tooth within 24 hours. If this plaque is not removed, it mineralizes and becomes tartar. Tartar allows a matrix where pathologic bacteria can hide. These bacteria cause chronic inflammation and this inflammation will lead to recession of the gums, breakdown of the periodontal ligament, and resorption of the perialveolar bone. This process is slow and painful because while single rooted teeth may just fall out without intervention, many teeth are multi rooted where one or two roots could be rotten and the third intact. That requires dental extractions at your veterinarian’s and I have yet to meet a pet owner that is happy to hear that. 

The key to intervening in this pathology is preventing plaque. No plaque, no tartar. No tartar, no periodontal disease. How do we prevent plaque? Let’s go through the options: 

Brushing — brushing is very effective, but also the most frustrating option in my opinion. Brushing needs to be done every day to be effective. If you have the time and your dog or cat is more patient than mine, go for it. Make sure you use pet safe toothpaste. Human toothpaste has too much sodium, fluoride, and is sweetened with saccharin.

Treats, toys, or diets — there are certain toys, treats, chewies, and even special diets to help to clean the teeth. These items will have an abrasive action similar to brushing, increase the production of saliva, and some are treated with special enzymes or compounds to help control the production of tartar. Make sure that if you look in the pet store you find the Veterinary Oral Health Council (VOHC) seal of approval on the packaging or ask your veterinarian which products they recommend. 

Do be careful. Many of the treats and diets tend to be calorie dense and can cause an increase in weight if overused. Also, remember you don’t want anything that’s too hard and may cause damage to the enamel or a fractured tooth. There’s a saying, “If it’s something you wouldn’t want to get hit in the knee with, it’s too hard for your pet to chew on.” 

I hope this information helps. Remember, “keep on smiling.”

Dr. Kearns practices veterinary medicine from his Port Jefferson office and is pictured with his son Matthew and his dog Jasmine. 

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From left, Research Assistant Onur Eskiocak, CSHL Fellow Semir Beyaz and graduate student Ilgin Ergin. Photo by Gina Motisi, 2019/CSHL.

By Daniel Dunaief

It’s a catch-22: some promising scientific projects can’t get national funding without enough data, but the projects can’t get data without funding.

That’s where private efforts like The Mark Foundation for Cancer Research come in, providing coveted funding for promising high-risk, high-reward ideas. Founded and funded by Pamplona Capital Management CEO Alex Knaster in 2017, the Foundation has provided over $117 million in grants for various cancer research efforts.

Tobias Janowitz

This year, The Mark Foundation, which was named after Knaster’s father Mark who died in 2014 after contracting kidney cancer, has provided inaugural multi-million dollar grants through the Endeavor Awards, which were granted to three institutions that bring scientists with different backgrounds together to address questions in cancer research. 

In addition to teams from the University of California at San Francisco and a multi-lab effort from Columbia University, Memorial Sloan Kettering Cancer Center and Johns Hopkins University School of Medicine, Cold Spring Harbor Laboratory scientists Tobias Janowitz and Semir Beyaz received this award.

“We are absolutely delighted,” Janowitz wrote in an email. “It is a great honor and we are excited about the work.” He also indicated that the tandem has started the first set of experiments, which have produced “interesting results.”

The award provides $2.5 million for three years and, according to Janowitz, the researchers would use the funds to hire staff and to pay for their experimental work.

Having earned an MD and a PhD, Janowitz takes a whole body approach to cancer. He would like to address how the body’s response to a tumor can be used to improve treatment for patients. He explores such issues as how tumors interact with the biology of the host.

Semir Beyaz

Semir Beyaz, who explores how environmental factors like nutrients affect gene expression, metabolic programs and immune responses to cancer, was grateful for the support of the Mark Foundation.

Beyaz initially spoke with the foundation about potential funding several months before Janowitz arrived at Cold Spring Harbor Laboratory. When the researchers, whose labs are next door to each other, teamed up, they put together a multi-disciplinary proposal.

“If the risks [of the proposals] can be mitigated by the innovation, it may yield important resources or new paradigms that can be incorporated into research proposals that can be funded by the [National Institutes of Health] and other government agencies,” Beyaz said.

Janowitz wrote that he had a lunch together in a small group with Knaster, who highlighted the importance of “high-quality data and high-quality data analysis to advance care for patients with cancer.”

Michele Cleary, the CEO of The Mark Foundation, explained that the first year of the Endeavor program didn’t involve the typical competitive process, but, rather came from the Foundation’s knowledge of the research efforts at the award-winning institutions.

“We wanted to fund this concept of not just studying cancer at the level of the tumor or tumor cells themselves, but also studying the interaction of the host or patient and their [interactions] with cancer,” Cleary said. “We thought this was a fantastic project.”

With five people on the Scientific Advisory Committee who have PhDs at the Foundation, the group felt confident in its ability to assess the value of each scientific plan.

Scientists around the world have taken an effective reductionistic approach to cancer, exploring metabolism, neuroendocrinology and the microbiome. The appeal of the CSHL effort came from its effort to explore how having cancer changes the status of bacteria in the gut, as well as the interplay between cancer and the host that affects the course of the disease.

From left, Becky Bish, Senior Scientific Director, Ryan Schoenfeld, Chief Scientific Officer and Michele Cleary, CEO of The Mark Foundation at a workshop held at the Banbury Center at Cold Spring Harbor Laboratory in September 2019. Photo by Constance Brukin.

These are “reasonable concepts to pursue, [but] someone has to start somewhere,” Cleary said. “Getting funding to dive in, and launch into it, is hard to do if you can’t tell a story that’s based on a mountain of preliminary data.”

Beyaz said pulling together all the information from different fields requires coordinating with computational scientists at CSHL and other institutions to develop the necessary analytical frameworks and models. This includes Cold Spring Harbor Laboratory Fellow Hannah Meyer and Associate Professor Jesse Gillis.

“This is not a simple task,” Beyaz said. The researchers will “collaborate with computational scientists to engage currently available state-of-the-art tools to perform data integration and analysis and develop models [and] come up with new ways of handling this multi-dimensional data.”

Cleary is confident Janowitz and Beyaz will develop novel and unexpected insights about the science. “We’ll allow these researchers to take what they learn in the lab and go into the human system and explore it,” she said.

The researchers will start with animal models of the disease and will progress into studies of patients with cancer. The ongoing collaboration between CSHL and Northwell Health gives the scientists access to samples from patients.

With the Endeavor award, smaller teams of scientists can graduate to become Mark Foundation Centers in the future. The goal for the research the Foundation funds is to move towards the clinic. “We are trying to join some dots between seemingly distinct, but heavily interconnected, fields,” Beyaz said.

Beyaz has research experience with several cancers, including colorectal cancer, while Janowitz has studied colorectal and pancreatic cancer. The tandem will start with those cancers, but they anticipate that they will “apply similar kinds of experimental pipelines” to other cancer types, such as renal, liver and endometrial, to define the shared mechanisms of cancer and how it reprograms and takes hostage the whole body, Beyaz said. 

“It’s important to understand what are the common denominators of cancer, so you might hopefully find the Achilles Heel of that process.”

While Cleary takes personal satisfaction at seeing some of the funding go to CSHL, where she and Mark Foundation Senior Scientific Director Becky Bish conducted their graduate research, she said she and the scientific team at the foundation were passionate to support projects that investigated the science of the patient.

“No one has tried to see what is the cross-talk between the disease and the host and how does that actually play out in looking at cancer,” said Cleary, who earned her PhD from Stony Brook University. “It’s a bonus that an institution that [she has] the utmost respect for was doing something in the same space we cared” to support.

The CSHL research will contribute to an understanding of cachexia, when people with cancer lose muscle mass, weight, and their appetite. Introducing additional nutrition to people with this condition doesn’t help them gain weight or restore their appetite.

Janowitz and Beyaz will explore what happens to the body physiologically when the patient has cachexia, which can “help us understand where we can intervene before it’s too late,” Cleary said.

The CSHL scientists will also study the interaction between the tumor and the immune system. Initially, the immune system recognizes the tumor as foreign. Over time, however, the immune system becomes exhausted.

Researchers believe there might be a “tipping point” in which the immune system transitions from being active to becoming overwhelmed, Cleary said. People “don’t understand where [the tipping point] occurs, but if we can figure it out, we can figure out where to intervene.”

Scientists interested in applying for the award for next year can find information at the web site: https://themarkfoundation.org/endeavor/. Researchers can receive up to $1 million per year for three years. The Mark Foundation is currently considering launching an Endeavor call for proposals every other year.

 

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