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Monday, May 19, 2014
ONLINE FIRST: SECOND THOUGHTS FROM SEKERES: Of God and Cancer

BY MIKKAEL A. SEKERES, MD, MS

 

We followed the highway, its boundaries occasionally buttressed by cement walls to block sniper fire, past checkpoints in and out of Area C of the West Bank until we arrived finally in Jerusalem. The four of us--an Italian, a Brit, a South African, and an American--specialists in lymphoid and myeloid malignancies, packed tightly behind our 84-year-old tour guide like ducklings following their mother as we left the safety of our small shuttle for the Old City.

After traveling thousands of miles to attend the annual hematology conference organized by Aaron Polliack in Israel, we would have one day to explore this ancient town.

 

We passed through the Zion Gate, the walls forming the arched entrance pocked with bullet holes from the most recent attempt to overtake this conflicted area. Inside, more walls--this time surrounding the Armenian church, a barrier thwarting those who would try to complete their genocide. We stopped after walking a few hundred meters as our tour guide described life in the different quarters--Jewish, Muslim, Armenian, and Christian. As he talked, we noticed that in one small view we could see the remains of an ancient Roman thoroughfare, a Chabad temple, and a Mosque, and we heard the call to prayer.

 

Hawkers in stalls selling textiles, menorahs, hookahs, jewelry, rugs, scenes of Christ and the apostles. “I give you a good price!” We heard over and over as people jostled into one another through the narrow, crowded path. We stopped for lunch, falafels and chicken shwarma, the table and chairs appearing as if out of nowhere. Nearby sat some Chassidic Jews, with black hats and long beards; a tour group of Christians from Holland, we guessed; Jordanians smoking cigarettes. We finished and pressed on.

Throngs of people were entering and leaving the Church of the Holy Sepulchre. Inside, we followed the flow upstairs, to Calvary where Christ is believed to have been crucified. People dropped to their knees almost helplessly to pray. Scenes from the old and new testament on the walls, originally depicted to instruct illiterate parishioners. Downstairs, people pressing hats, scarves, shirts to the Stone of Anointing, where Christ was laid before being transferred to his burial tomb, which was itself encased in a wooden supporting structure donated by England, which in turn was encased by more crowds waiting to enter. A group from Thailand kneeled in an enclave, praying. We heard another tour guide speaking in German. about the multiple iterations of the church’s destruction and construction. “Babylonian stone…Greeks erected a wall dividing the church…Crusades came through and killed everyone…” Their distinct crosses etched in the stone.

 

Through metal detectors as we ended at the Wailing Wall. Our small group splintered now as we walked to the men’s or women’s sides. The Wall was almost blinding as the mid-afternoon sun reflected off of it, but soft to the touch from generations of people wearing its surface down in prayer. A man quietly davined next to me, scraps of paper with prayers written on them stuffed into the Wall’s crevices. As we left, we walked past kids newly enlisted into the Israeli Army, not yet assigned to a unit, still carrying their guns awkwardly. Our shuttle was waiting, and we said goodbye to each other, until ASCO, or ASH.

 

I can’t pretend to even start to understand the history, politics, and religions of the Middle East, the conflicts that have arisen there, or their resolutions. It seemed to me, though, that there are lessons we can take away in how we approach cancer research and treatment.

 

We frequently do research in isolation, trying to develop theories within our narrow disease focus, when those theories may already have been tested and expanded elsewhere. We’d learn a lot more, faster, if we packed a group of people from different disciplines in a shuttle, or at adjoining tables over lunch, and forced them to spend a day together.

 

Too often, we compete against each other, and spend an inordinate amount of time trying to tear down each other’s research in favor of our own. It would be an interesting exercise to assess how many letters to the editor in academic journals are truly about open public debate to test scientific rigor, as opposed to needless self-aggrandizement. We should spend more time building, less time destroying.

 

Oncologists across the world often will not change their practice until trials have been replicated in their own country. There are examples in every cancer. As is the case with many religions, where much of the fundamental moral structure is similar, our fundamental motivation is the same: We want to cure cancer, and we want to treat our patients with the best available drugs. We should trust each other more, and be quicker to adopt the findings of well-done clinical trials conducted elsewhere, so we can improve what we consider standard therapy for our patients, and move more quickly to the next clinical question.

 

Finally, we shouldn’t give our hematology/oncology fellows their “guns” too soon. In other words, we need to devote real time to teaching clinical skills, sound research principles, critical appraisal, and writing tools, and to developing communication prowess before we nudge them out of the nest to enter their own practices, and conduct their own research.

 

Anyway, that’s my religion.

 

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MIKKAEL A. SEKERES, MD, MS,

OT’S Clinical Advisory Editor for Hematology/Oncology and a member of the FDA's Oncologic Drugs Advisory Committee, is Director of the Leukemia Program at the Cleveland Clinic Taussig Cancer Institute and Chair of the Hematology/Oncology Pharmacy & Therapeutics Committee. He is a staff member in the Department of Hematologic Oncology and Blood Disorders and holds a joint appointment in the Departments of Translational Hematology and Oncology Research.

 

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