Letter From the Editor

Bruce D. Cheson, MD

Well, it is that time again, the end of the month when my Letter From the Editor is due. As I fly home from a day in Hong Kong (it was a long way to go to get decent Chinese food!), I thought I would have plenty of time to come up with some witty idea before I landed in San Francisco that would be all polished by the time I arrived at Dulles. No such luck. I had a few potential candidates: I could write about my impending trip to Nagoya, Japan (164.3 miles southwest of Tokyo) on October 13, and whether I should heed the concerns of friends and family that I am nuts to even consider going to a country where the air, water, and soil are being contaminated by radiation. But, come earthquake, tsunami, and nuclear disaster, I am confident these people will return from the depths of adversity. A colleague of mine in Tokyo stated that the devastation was “indescribable.” I feel some sort of need to show my support, which a visit will fulfill. However, I guess I will wait and watch what happens over the next few months and see which way the wind blows and the water flows.

A second idea was to provide readers with another book recommendation (something to read when they have finished the current issue of Clinical Advances in Hematology & Oncology!). The Emperor of All Maladies: A Biography of Cancer, by Dr. Siddhartha Mukherjee, tells the story of how we got to where we are in cancer biology, therapy, and patient care, intertwined with a fascinating tale full of the many characters, leaders, and mavericks—plus even some villains—whose contributions I had followed as my career was just beginning. It also tells the stories of patients who struggled but succumbed before a therapeutic advance was available and of those fortunate enough to have benefited from the novel treatments. It reminded me of how much we thought we knew, how much we learned, and how much we still really don’t know after all. Nowadays when I mention names such as Gertrude Elion, Goodman and Gilman, Sidney Farber, Henry Kaplan, Howard Temin, David Baltimore, George Canellos, Bob Mayer, Tom Frei and Jay Freireich, Al Knudson, or Janet Rowley to our fellows, they look at me as if I were reciting random names from some phone book I picked up in Huntington Beach, California. It would be the same if I had mentioned Halsted, Bonadonna, or Fisher. The current crop of youngsters haven’t a clue as to the contributions these scientists and clinicians made that literally changed the world. This book should be required reading for everyone involved in cancer medicine, especially hematology/oncology fellows. The road to where they are going will be much steeper if they don’t know where they have been.

Which segues to the third topic I considered: It is March/April, the months of interviewing fellowship candidates. We receive a substantial number of applicants from which we cull only a few to invite for a visit. They all come in with their black suits and white shirts, men and women alike. Their applications suggest that most would make very good fellows; they have splendid recommendations, have puddles of publications, have done some community service involving an impoverished population that was a life-altering experience. It is their short biography that I always find the most entertaining. When I was younger, there was a game called Mad Libs. The moderator would have a story in front of him that the players couldn’t see. They were asked to provide whatever noun, verb, adverb, or adjective that came into their head. The word was inserted into a blank in the story which, when read back to the participants was usually hilarious, at least for an 8th grader. The fellows’ letters are also fill-in-the-blanks; they all start with that moment from which their enduring enthusiasm for hematology/oncology arose, always that special patient or family member who inspired them. As a result, they will dedicate their lives to the conquest of the Emperor. They all want to go into “academics,” yet few understand what that means more than “I wanna teach, see patients, and do some clinical research.” I ask about their strengths and weaknesses, which usually elicits a deer-in-the-headlights response. They have rehearsed answers to the most likely questions, about their training, their research; but they generally aren’t prepared to think on their seats. When they ask me what I want in a fellow candidate, hoping I will describe precisely them, I respond simply that I want a person who will make a difference. That is usually the showstopper. Like our fellows who don’t know the giants of the past, these candidates are rarely informed even about the people who will be trying to get to know them as well as one can in an hour. I read their application, the least they could do is to know what I do. I was suitably impressed recently, however, by one young man who wanted to find out more about how I came up with the ideas for those entertaining letters I write for Clinical Advances in Hematology and Oncology. Needless to say, he got my vote for a slot!

So as my flight prepares to land and the last verses of “My Back Pages” play on my iPhone, I realize that I still don’t have a clue as to what I should write about.

Maybe I will next month…

Bruce D. Cheson, MD