Editor’s Corner
A Few of My Favorite Things
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ASH Clinical News
T SEEMS THAT my last “Editor’s Corner” column (“These Are
a Few of My Least Favorite Things …,” March 2015) resonated
with many of my fellow hematologists. I’ve convinced myself
that the only people who ignored it entirely were those oncologists who were too busy refreshing their wardrobes at Neiman Marcus to read it and likely others too preoccupied with
learning how to spell argatroban, idelalisib, and a host of other
indecipherable drug names.
Anyway, based on the generous feedback, I fear I was pegged
as a cranky, crabby, cantankerous malcontent. So, to make
amends and to restore some balance to the universe, I will focus
on a more positive outlook on life. Wish me luck.
First, I love the human genome. I want to keep one as a pet,
name him Darwin, and have him sleep at the foot of the bed.
What an awesome thing the genome is. I love that I can blame
it for my expanding girth, my love of pinot, and my ginger children. And, we are still at the dawn of the genome era. Eventually, we will all have our genomes sequenced, understand how our
drugs work, clarify the origins and evolution of cancer, eradicate
or modify inherited diseases – and perhaps males that are better
looking than me.
I mean, why would you not want your genome sequenced?
Sequencing is cheap and easy, and, sooner or later, we will be
able to analyze the genome at the click of a button, and your
genome will never change in 100 years of life. So, sign me up for
the human genome Twitter feed.
My second confession is – drumroll, please – I like drug
companies! Yes, I said “drug companies.” They are brilliant: My
patients benefit (a lot), my work is consequently more enjoyable, and, importantly, they sustain my fantasies that my own
research might yield a magical cancer-eliminating pill that I can
sell for astronomical prices that only Americans can pay for.
(Take that, Europe!)
Kidding aside, some of my best friends are in the pharmaceutical industry. Well-meaning people in our profession have
chosen career paths dedicated to criticizing the drug industry.
These critiques mostly allege that drug companies corrupt gullible physicians like you and me, and, more recently, the high
cost of modern therapeutics. Both sets of critiques, undoubtedly, can be backed by egregious examples of maleficence, but I
challenge the critics to deliver their scolding rebukes in front of
a room with 5,000 patients with chronic myeloid leukemia who
are only alive to listen because of imatinib. I think my friend
Todd, who was 36 years old when he started imatinib 10 years
ago, would happily provide the audience with tomatoes to throw.
Do you think that would prompt the critics to dial back on
the hyperbole? To me, at least, it seems uncharitable to blame a
drug company for selling revolutionary products like rituximab,
lenalidomide, ibrutinib, and carfilzomib and making a profit in
the process, when the law and health-care systems allow them to.
I would advocate for some balance in the debate. We need to
find a common ground, where
patients can live longer and
healthier lives, drug companies
can make a reasonable profit,
pharmaceutical research and
development remains vibrant,
doctors can educate doctors, and
academics can partner with drug
companies in an atmosphere of
collaboration and transparency.
A. Keith Stewart, MBChB,
Then, the pharma-scolds can get
MBA, is Carlson and Nelson
back to doing something with
Endowed Director Center for Inpositive, not negative, momendividualized Medicine and Vasek
tum. That said, I am still kind of
and Anna Maria Polak Professor
of Cancer Research at Mayo
mad that Celgene stole one of
Clinic in Scottsdale, Arizona.
our nurses.
I am also in the early
phases of a great romance with
immune-based therapies – waiting for the phone to ring to hear
that they are now ready to take on myeloma. Until recently, I
was a recovering gene therapist deeply scarred by the failures of
my early research career using adenoviruses to deliver cytokine
genes. My inner pendulum had swung to cynicism. What a difference a year or two makes! From checkpoint inhibitors to CAR
T cells to bi- and tri-specific T-cell engagers, within months
my poorly hidden disdain for decades of failed “vaccine” trials
is replaced by the kind of enthusiasm generally displayed by a
clinical instructor escaping Harvard.
Moving on to the personal element, I like my colleagues in
myeloma land – and the medical residents who see the light
and want to join our ranks. I like almost every nurse I have ever
worked with and I’m especially fond of the colleagues who cover
for me without complaint. Hell, even the allogeneic transplanters are okay every third Wednesday.
I like the organizations that bring the hematology community together: the American Society of Hematology, the Leukemia
and Lymphoma Society, the Multiple Myeloma Research Foundation, the International Myeloma Foundation, and the National
Cancer Institute.
Many other things make my “favo &