The First Cell: Azra Raza Argues We're Approaching Cancer Wrong

In a new book in October 2019, oncologist Azra Raza argues that we are pouring far too many resources into killing the last metastatic cell in cancer - including through "precision medicine," when we should be redoubling efforts to prevent cancer or detect and treat it early.  She on the faculty of the Columbia University College of Physicians and Surgeons as the Chan Soon-Shiong professor of medicine.

Her new book is "The First Cell: The Human Costs of Pursuing Cancer to the Last," and is published by Basic Books.    Amazon here.

See her recent op-ed in the Wall Street Journal, here.

An extract about the book:

"We have lost the war on cancer. We spend $150 billion each year treating it, yet -- a few innovations notwithstanding -- a patient with cancer is as likely to die of it as one was fifty years ago. Most new drugs add mere months to one's life at agonizing physical and financial cost. 

In The First Cell, Azra Raza offers a searing account of how both medicine and our society (mis)treats cancer, how we can do better, and why we must. A lyrical journey from hope to despair and back again, The First Cell explores cancer from every angle: medical, scientific, cultural, and personal."

For another doctor skeptic about the overall total impact of the precision medicine war on the last metastatic cell, see Vinay Prasad at OHSU, here.  His PubMed here.

Time Flies

I couldn't believe it's almost ten years since the 2010 publication of "The Emperor of All Maladies," by Siddhartha Mukherjee, a 22 hour audiobook or 608 page book I still haven't attacked.  Just the same age is Daniel Carpenter's "Reputation and Power," about the FDA, weighing in at 856 pages. 

Three Impactful Books (Birthday Post) (Doughty, Lynch, Mitford)

A few thoughts that came together this week as I turned 61.

Three Impactful Books

DOUGHTY

Over the past year, I have tracked an interesting woman with a Youtube channel called Ask A Mortician (Caitlyn Doughty; she's foxy and clever and has almost a million subscribers.)  A college major in medieval studies who went into funeral work, she's become a social media celebrity and published three books (the first a memoir, the second recording her world-travels looking at funeral customs.)   A few weeks ago I saw her at a new-book reading in downtown Los Angeles at a sold-out 300-person nightclub.   And I thought, this is good, and it's good in part because she brings the same joie-de-vivre to the topic that Thomas Lynch does.

LYNCH

Thomas Lynch? 

Around 1998-2003, I closely watched HBO's "Six Feet Under," about a cockeyed LA family that ran a funeral home.  (The house used for exteriors was about a mile from my own.  And we were in girl scouts later with one of the actresses).   In 2008, at LA's beautiful 1920s downtown public library, I saw an interview and book reading with Alan Ball, the series creator, and Thomas Lynch, a Michigan undertaker, poet, and author of several books of both thoughtful and whimsical essays.   So I read several of Lynch's books around 2008 when I saw him, which I am certain were helpful in working through the death of my mother a few years later in 2011.   

I hadn't picked up Lynch for a long time, but the Doughty book reminded me of him.  Is he still around?  Google says: He is, and published a book recently and another one to be released in November; he's giving a book reading somewhere in Michigan this month.  So he's still vertical.  Not having his email, I wrote a letter thanking him for his work and stamped it and sent it off in this week's post.   I'm now listening to the audiobook of his most popular book, "The Undertaking: Tales from the Dismal Trade" - such as today's hike in the hills.  (His next title:  "Bodies in Motion and at Rest.")

So Lynch.

MITFORD

Somewhere between Doughty and Lynch, I recalled an experience in high school and saw it in a new light.   In the middle of nowhere in rural Iowa, our high school library had a copy of "The American Way of Death," by Jessica Mitford.  You may know; Mitford was a Brit from a famous family and wrote an "expose' " of the American trade in the early 60s.   Did that influence my choice of pathology as a medical residency?   Let's call it one factor.    But here's what's new.   Mitford's book is an exercise in taking something fairly familiar, and unpacking it, taking the back off, looking at it upside down and sideways and showing how all the gears and levers move.   That's something I love.   Later in life, in 2001, I left medicine and armed with a fresh MBA, plunged into a new world of strategy consulting, which involves looking at things upside down and sideways and proposing what the gears and levers are and how to move them.   Is there a connection between my experience of Mitford's creativity and investigation in 1975, and that career shift in 2001, 25 years later at age 40?   Let's call it one factor.

Humor / The Erich Honecker Parodist on Twitter

As PDF in cloud here.

Live Twitter feed here. @DerWahreErich



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Klima Twitter trail here.

What Happened to the Honeckers?  Here.

Humor / Fun with Statistics

https://hbswk.hbs.edu/item/using-models-to-persuade?cid=wk-rss

MOYNIHAN Documentary (2018)

In 2018, I enjoyed seeing a trailer for a documentary about Patrick Moynihan, but it played very briefly in theaters so I waited a long time for it to appear on DVD and video on demand (VOD).   Had a chance to see it this week.

I remember Moynihan from my high school years in the mid-70s (he served in both LBJ and Nixon administrations) and he was later a Senator from NY (replaced by Hillary Clinton in 2001); he died in 2004.   He was an example of self-recreation, from poor/broken family, worked on docks while going to City College for free at night, ended up in military which paid for his PhD at Tufts, later served multiple presidencies and Harvard.

Was reminded many times of Shakespeare's observation, "What's Past is Prologue."   Here are a few themes from Moynihan's life :

(1) Early case study in the pile-on phenomenon re political correctness, re his 1965 white paper on the Negro Family and broken households leading to "blaming the victim" accusations.
(2) Close to idea of Universal Income with Family Assistance Program (FAP) (not passed) and later Earned Income Tax Credit (IITC) which did pass.  This is still a theme in 2019 Democratic debates.
(3)  Theme of "democracy in crisis" was fully voiced in 60s, as it is in 2010s.  In UN speeches, he said that democracies were about 25 of 140 nations, and there were "sharks in the water" for the rest.
(4)  He was criticized as being an embarrassing and loud nutcase in his representation of US at UN, and saying too much, and in the wrong way, leading to worsening of situations.
(5)  Ethnic groups vs melting pots.  In writing Beyond the Melting Pot, he talked about the preservation of ethnicity in US, still a big theme today (balance of ethnicity vs melting pot; foreign language in public schools, etc).  Similarly in US and Europe re: integration or isolation of Muslim cultures.

Film Website
http://danielpatrickmoynihan.com/

Hollywood Reporter Review
https://www.hollywoodreporter.com/review/moynihan-1149047

LA Times Review
https://www.latimes.com/entertainment/movies/la-et-mn-capsule-moynihan-review-20181011-story.html

Rotten Tomatoes
https://www.rottentomatoes.com/m/moynihan

Amazon (both DVD & VOD)
https://www.amazon.com/Moynihan-Daniel-Patrick/dp/B07MWQ9CMB

Trivia

Henry Kissinger is still around (96 in 2019) and is interviewed several times in the film.  (So is George F. Will).  For a very rare clip of Kissinger interviewed in German (2014), on Youtube, here.

Thoughts on Seeing Caitlyn Doughty Live (September 2019)

Sometime in the last year or two, I've run across several women with eclectic and richly informative YouTube channels and quite engaging video personalities.*  Last night I got to see one of them perform live at a book reading in the Old Financial District in downtown LA (DTLA).

Overview

Caitlyn Doughty is a "mortician, author, blogger, and YouTube personality," the YouTube channel being Ask A Mortician, here.   Her YouTube channel has 850,000 subscribers.  Find her at Wikipedia here and her personal website here.  She also co-founded a "death acceptance" organization called Order of the Good Death that runs a website and conferences - see also Wiki here.

click to enlarge

Background

Born in 1984, Doughy grew up in Hawaii, where her father was a high school teacher, and went to college at University of Chicago.

After her degree in medieval studies, she migrated to Oakland (like you do) and worked in a low-level job in a crematory while, well, finding herself.  She later went to mortuary school and migrated to LA, where she runs (ran) a small funeral service with several partners and specialized in both home funerals and green burials.  She recently announced the funeral home Undertaking LA, was closing but may reorganize.

Live On Stage

On September 9, 2019, she did a book reading, book signing, extended Q&A at the funky old Regent Theater (built 1914; now a nightclub) at 4th and Main in the old LA banking district.  The reading was sponsored by Skylight Books, one of LA's best independent booksellers, on North Vermont (Vermont and Hollywood Blvd).   Caitlyn was a lively and natural on-stage presence, joie-de-vivre instead of joie-de-mort.

Books x 3

Her three books are "Smoke Gets In Your Eyes," a coming-of-age memoir, and "From Here to Eternity," subtitled, "Traveling the world to find the good death." 

And newly, "Will My Cat Eat My Eyeballs?" - in the format of Q&A about unusual death situations for, ah, "young readers."**   All are available with author-read audiobooks.  See a video where she talks about her career path, here.

Further Thoughts

Jessica Mitford
I went to med school and became a pathologist, but my encounters with Death Theory precede and follow.

Long ago, in high school in rural Iowa, our library had a copy of The American Way of Death (1963)  by Jessica Mitford, a fascinating book that I couldn't put down as a 16 or 17 year old circa 1975.    The book is an expose of the American funeral home industry and its sales methods.

In addition to the morbid curiosity and the business strategy value, it occurred to me this week that the book may have been formative in another way, because it revealed an elaborate web of drivers, levers, and machinations going on behind the surface of something as simple-seeming as a funeral home in a small town.   It was a trigger to think about everything (How does this bus system work?  Why is it this way?) to which I owe a lot.

Thomas Lynch
Later, in the 2000s, I ran across the essays (and a PBS video) about Michigan mortician and wonderful essayist Thomas Lynch.  See his essay books "The Undertaking" and "Bodies in Motion and At Rest" and "Booking Passage" (most circa 1995-2005).  I saw him on stage downtown at the LA Public Library in 2005 (paired with Six Feet Under creator Alan Ball) - here.   I drew on Lynch's writings as I went through the experience when my mother died in 2011.

Caitlyn Doughty
And that brings up to today, where in the past year or two I've found the works and videos of Caitlyn Doughty both enlightening and meaningful.   That, and bike rides now and then through the fabulous Hollywood Forever Cemetery, just a mile from my home, where on the last pass through I ran across both the 93rd annual Valentino Memorial underway (August 26) and the crypt of Mickey Rooney.



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* Other women with serious/eclectic YouTube channels include Cari with Easy German (460,000 subscribers), an entertaining and education intermediate-German series - here.  And Anja, who runs the similar-but-different eponymous Learn German With ANJA! channel - here.    450,000 subscribers.

** For another woman's book on cats and death, see "Waiting For My Cats to Die" by New Yorker Stacy Horn, here.  Though not related to cats, another woman writing on the death topic is Mary Roach with "Stiff: The Curious Lives of Cadavers."

Three Books from Trump Insiders

While Michael Wolff's two extremely aggressive books about the Trump White House are well known, this summer I breezed through three books by Trump insiders.

• George Sorial, a Trump organization lawyer and executive, produced "The Real Deal: My Decade Fighting Battles and Winning Wars with Trump" in June 2019.   
• Anthony Scaramucci, a Harvard Law grad and Wall Street executive who was Communications Director briefly in August 2017. Produced "Trump: The Blue Collar President" in October 2018.  
• Chris Christie produced "Let Me Finish" in January 2019. 

Some points from Let Me Finish.   

Christie frequently and bitterly disagrees with Steve Bannon's descriptions of events (which figure prominently in Michael Wolff books).   Christie recounts a statement of Bannon and adds, "That flatly never happened" or similar remarks.   Here is the story of the elaborate Transition Planning work - "two dozen three ring binders" - that were tossed the day after the election.   Instead, seemingly random interviewers were summoned at odd intervals to Trump's New Jersey estate.

Christie would have taken Chief of Staff in the new White House; DOJ was locked down by Jeff Sessions who long before had endorsed Trump in the first hours when it became possible.   However, he felt railroaded out by Kushner and Bannon.   This was a second slam-down, the first having being the transition plan.

There is an interesting story that Christie was dangled, and would have taken, head of the Republic National Committee, but this proved to be another bait and switch that really p--d him off and he couldn't take that gang any more.

He talks about his early strong interest in opioid treatment programs, and that he was trying to wrangle $300M out of New Jersey health plans (Horizon BCBS) for this in 2017, leading to a budget shutdown and the infamous picture of him on the empty beach. 

Christie is quite proud of his rule as chairman of an Opioid Policy commission that produced an elaborate roadmap report in November 2017. 

See Christie on Bill Maher, February 2019, here.
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The Scaramucci book was entertaining; I listened to most of it as an audiobook.   He had written several books before this one and he has had an interesting career up to his current age 55.  Scaramucci was a working-class Long Island kid who worked himself up to Harvard Law and Goldman Sachs and later started his own hedge fund.  He says he reads 60 books a year (1800 in 30 years.) Tidbit: he likes audiobooks himself. 

Scaramucci's book is clearly an update of his prior "Hopping Over the Rabbitt Hole," which describes his business career and learnings up to 2016.  Publication date October, 2016.  His "Trump" book from late 2018 reprises (simply copies) large swaths of his prior autobiography while appending several chapters on the 2016 campaign and the August 2017 White House adventure.   

Both Christie and Scaramucci detest Bannon.  For more on Bannon, see the recent documentary The Brink (here, here).

The Soriol book was a little too hagiographic to be sustaining, but an easy skim-through.  Or pass on the book, and invest an hour in the podcast/interview at CSPAN BookTV "After Words" from June 2019 (online here). 

Soriol's book is the only one that prominently lists a co-author on its cover; Christie's book lists a co-author in fine print.

All three books available as audiobooks; Christie and Scaramucci narrate themselves.

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The Michael Wolff books are #1, Fire and Fury (January 2018), and #2,  Siege:Trump Under Fire (June 2019).