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Kindred Spirits

December 30, 2021
David Steensma, MD
Edward P. Evans Chair in MDS Research and Institute Physician at the Dana-Farber Cancer Institute; Associate Professor of Medicine at Harvard Medical School; Editor-in-chief of ASH Clinical News

"Kindred spirits are not so scarce as I used to think. It's splendid to find out there are so many of them in the world." ― L.M. Montgomery, Anne of Green Gables

Despite the cultural and political differences that divide us, humans across the globe are remarkably similar. As Sting once sang, "We share the same biology, regardless of ideology." Bone marrow and blood cells, for instance, work more or less the same in Bishkek and Brasilia as they do in Birmingham or Boston, and our bodies are prone to break down in identical ways.

So when physicians gather together – no matter where we practice medicine or what our native tongue is – we find that we speak a common language. Like other doctors, hematologists everywhere wrestle with similar questions about diagnosis and treatment, and – thanks to the internet – we now read the same research papers and clinical trial reports, from the East to the West and from North to South.

Travelling to meet such kindred spirits across the country and around the world is one of the great joys of academic medicine. After waking up in a strange city, nothing is more energizing than taking a taxi or rickshaw to a hospital and meeting another hematologist who has that intangible ocular sparkle – someone bright and eager who is struggling with the same treatment problems that you are, is just as fascinated by blood biology, and desires to make things better for suffering patients just as you do.

I was reminded of the global connectedness of our hematology community recently at Highlights of ASH Asia-Pacific, which was held in Brisbane, Australia this year. More than 750 hematologists from 23 countries participated, and with support from the Wallace Coulter Foundation, ASH generously sponsored 70 hematology trainees from 17 countries to attend the meeting. These young hematologists dressed very differently from the Boston academic vernacular (the male version – of which there are several variants in my closet – includes a button-down blue shirt, loose-fitting khaki pants, and brown shoes), and they hailed from exotic places I'll probably never visit (Myanmar, Bangladesh, Cambodia, Taiwan, Kyrgyzstan, and other countries that New Englanders encounter primarily in newspaper articles and pub quizzes). And yet these smart young doctors asked wonderful, thought-provoking questions and told me with justifiable pride about the new allogeneic transplant programs or hemophilia centers they are building in their home countries.

I've come across such fellow travellers in the most unlikely of places. Some years ago I had the chance to go to Moscow as a visiting professor, and, as part of the visit, junior doctors from several hospitals in the city presented a series of cases to me for discussion. I was taken aback when the doctors described how all but one of the patients with myelodysplasia and marrow failure were splenectomized as part of their initial treatment. (Splenectomy for myelodysplastic syndrome [MDS] is apparently a common practice in Russia, but not standard care in other places.) Politely, I expressed some doubt about the value of spleen removal in this setting, but my concerns about its efficacy were quickly dismissed.

After the session, a grandmotherly woman from Vladivostok – a dizzying 4,000 miles and seven times zones distant – came up to me with a sparkle in her eye. "Doctor, we never take the spleen out for MDS in our city," she proudly announced. When I asked how that could be, since clinical care in Russia is centrally planned, she whispered, conspiratorially, "As we say in the Russian Far East: God is high above, and the Tsar is far away." I wanted to hug her.

Of course, we American academics don't always have to be the ones doing the traveling. The ASH annual meeting may have "American" in its name, but it is really everyone's meeting – with half of the abstracts and a large proportion of the speakers originating from other countries. Numerous programs bring visitors from all over to our academic centers to teach and to learn.

Small meetings provide special opportunities for making connections. At the biennial scientific symposium of the Aplastic Anemia & MDS International Foundation, for instance, Neal Young, MD, from the National Institutes of Health, managed to scrape up funding to invite several hematologists from Southeast Asia, where aplastic anemia is endemic; every two years, these enterprising souls come and tell us how they creatively manage to treat this disease with, for example, a workforce of fewer than 20 hematologists in a country of 60 million, and without access to horse anti-thymocyte globulin.

No matter where we live, what we wear, the color of our skin, or whom we vote for (if we are lucky enough to be able to vote), we Homo sapiens are not so very different from one another. Those of us who are hematologists all dream of a day when blood diseases will finally be defeated, when the great scourges that afflict our species – the thalassemias, thromboses, leukemias, and their ilk – will go the way of smallpox and the Guinea worm. Until then, we work together, even when we are working far apart.

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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