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A Few of My Favorite Things

December 30, 2021
Keith Stewart, MBChB, MBA
Carlson and Nelson Endowed Director, Center for Individualized Medicine, and Vasek and Anna Maria Polak Professor of Cancer Research, Mayo Clinic in Scottsdale, Arizona

It seems that my last "Editor's Corner" column ("These Are a Few of My Least Favorite Things …,") 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. Then, the pharma-scolds can get back to doing something with positive, not negative, momentum. That said, I am still kind of mad that Celgene stole one of 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 "favorites" list: anything Scottish, , blood donors, hospitals run by physicians, people who never wear bowties, getting to know my patients better throughout their lives (made longer thanks to all the good people making drugs that work), normal platelet counts, and the word "cure."

So, there's my rant with a positive slant. All in all, I like being a hematologist. It's a good life if you don't weaken.

The content of the Editor's Corner is the opinion of the author and does not represent the official position of the American Society of Hematology unless so stated.

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