How One Woman’s Breast Cancer Experience May Revolutionize Cancer Care

Unknown-23 — mammograms for early detection

I love to write about good news. I especially enjoy elaborating on advances in the world of science during these times when science is too often attacked. This story shares some qualities with my recent post about the extraordinary Nobel Prize Winners in Physiology or Medicine.

Like the Nobel discovery, this one seems destined to save lives and dramatically reduce suffering. It’s the result of one brilliant woman’s using her own status as a breast cancer survivor to create potentially dramatic changes in the detection and treatment of the disease.

My new hero is Regina Barzilay, PhD. She isn’t a physician, yet she seems to be upending medical practice for the better through the use of artificial intelligence (AI).

Barzilay is a professor of computer science at the Massachusetts Institute of Technology (MIT) and a certified genius: in 2017, she was the recipient of a MacArthur Fellowship “genius grant.”

She and her team, which now includes experts from both MIT and Massachusetts General Hospital (MGH), have created computer algorithms that predict the likelihood of a patient’s developing breast cancer in the next five years.

The model they designed began with a database containing pathology reports of more than 100,000 women treated at MGH over 30 years. Barzilay and her team then “taught” the computers to provide specific information from mammograms of more than 60,000 patients.

According to an article in MIT News,

“Trained on mammograms and known outcomes from over 60,000 MGH patients, the model learned the subtle patterns in breast tissue that are precursors to malignant tumors.”

Barzilay told Susan Gubar, who wrote about this remarkable work in Science Times, the special Tuesday section of The New York Times, that

“machines work more effectively than human eyes. They can register subtle changes in tissue—influenced by genetics, hormones, lactation, weight changes—that we cannot see.”

Barzilay showed Gubar the results of her own mammograms from 2012, 2013, and 2014. The cancer that was diagnosed in 2014 was, in fact, evident in the two previous views.

I found myself deeply touched by that information, imagining what it must have been like for her to learn her cancer could have been caught and treated two years earlier, and seeing how heroically she turned her personal knowledge into this bold campaign to prevent other women from experiencing similar anguish—or worse.

Gubar reports that

“The enthusiasm Dr. Barzilay brings to this undertaking is fueled by her dismay at current approaches to cancer care. While being treated at MGH, she was struck by the high degree of uncertainty surrounding treatment of her disease.

“Why did her questions go unanswered about how other patients at the same hospital with similar tumors fared with this or that drug or with this or that surgery? Why was there so little information?”

The apparent explanation was that oncologists rely on the results of clinical trials in determining treatment regimens. That’s not surprising; they seek evidence-based medicine.

The problem Barzilay saw was that the trials enrolled just about 3 percent of eligible women, meaning 97 percent weren’t part of the picture.

Barzilay termed this approach a “primitive practice” that was a “travesty,” Gubar reports, “especially because large volumes of information about patients accumulate in every hospital.” (Emphasis mine)

But a stumbling block to the work she proposed was that the data are written in “free-text” English, rather than in a form a computer could process. That’s when she and her colleagues began building the databases.

In one study, the Barzilay team’s model identified 31 percent of patients as high risk for future breast cancer, in contrast with the existing clinical standard, which identified 18 percent. That difference encompasses a great many women.

Once this work is more fully implemented, the result, Gubar writes, will be that

“New patients will be empowered by learning how tumors with particular characteristics responded to specific treatments. Machines accessing subsets of the population will also make it faster and cheaper for clinicians to identify patients with particular disease characteristics and to enroll them in clinical trials.”

One particularly valuable aspect is that the cancers are detected regardless of the patient’s race—an important consideration in view of the much higher breast cancer mortality rate among African-American women.

According to Gubar, similar efforts are occurring at Google, where AI specialists are examining scans for lung cancer. It seems reasonable to me, as a nonscientist, that this approach is potentially replicable with all sorts of cancers. (I’d welcome hearing from anyone with expertise in AI, cancer, or the intersection of the two fields.)

Barzilay knows buy-in from oncologists is critical to this effort. She sought to learn whether oncologists were reaching out to AI researchers; when she found that they weren’t, she also made one of her aims to enlighten them about these new possibilities.

Writes Gubar:

“Dr. Barzilay and her collaborators want to usher in the day when no woman is surprised by a late-stage diagnosis and when all breast cancers are curable.

“They also hope to solve the problems of over- and under-testing. Instead of a one-size-fits-all practice, the frequency of screenings and biopsies could be customized with sufficient data.”

That could be a huge benefit to patients. For example, at present, the MIT article notes, there is a discrepancy in screening guidelines, with the American Cancer Society recommending yearly screening beginning at age 45, while the U.S. Preventative Task Force says screening should be every two years, beginning at age 50.

And for implications for individual patients, Gubar points to the young women she knows who are aware that they have an inherited BRCA genetic mutation, which can substantially increase their risk for breast cancer (as well as for ovarian cancer).

With great anxiety, they are contemplating prophylactic double mastectomies—although there’s no assurance that such drastic surgery is necessary for them. The numbers of such women are increasing now that genetic testing is so readily available.

Barzilay’s work can help women better face this difficult decision. In responding to Gubar’s query about such affected women, she stressed:

“With a CD of their scan, we would be able to tell them their personal risk.”

I wish Dr. Regina Barzilay a long and productive life as she continually refines and expands her invaluable work.

Annie

The Drabble Liked My Dabbling!

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I am a fairly verbose writer who’s long been wedded to my nonfiction status and believed myself incapable of writing fiction.

But on just my second try, my bite-sized piece of fiction has been accepted by The Drabble, a blog featuring fiction, nonfiction, and poetry of 100 words or fewer. That’s quite nice, so I’d like to tell you about it.

The story began a few months ago, when I’d been blogging for just about a year. Suddenly, a strange black ink blot sort of thing appeared in my email. Some of you may recognize it, as it inspired my first Drabble effort, titled “What Is…?,” published here on July 1.

That ink blot, which I find ominous, is The Drabble avatar. They’re kinda mysterious there, so I’m not sure who’s behind The Drabble. Whoever he/she/they are (I’ll go with “they”), they had “liked” two of my lengthy nonfiction pieces.

I looked them up, and I then learned from other sources about the fascinating literary history of the drabble (going back to Mary Wollstonecraft Shelley and including a foray by Monty Python, as I explained here, in the Note beneath “What Is…?”). So I decided to try.

I sent “What Is…?” to The Drabble and, true to their word, they responded within a month. That one didn’t work for them, but they encouraged me to try again.

This effort occurred just as I was becoming aware (in a “Duh!” moment) that I was surrounded by short fiction. Indeed, “flash fiction”—brief little stories—are all the rage in the blogosphere.

I’ve since also become acquainted with fictional “prompts” that offer writers the challenge of weaving tales around individual words, photos, or maxims, with story limits set at 25 words, 37 words, and the like.

I’ve never tried one, but people seem to enjoy composing them. Turns out there are oodles of writers conjuring lots and lots of teensy tales—many of them very good.

And here I must mention Tetiana and Tony, who blog together as “Unbolt Me” and surely take the virtual prize: they often write stories that are six words long. As I suggested to them in a comment, six-word stories seem to me like hijacked haiku and come dangerously close to being a blank page. Yet they do it–provocatively!

I now see that there are even prompts for six-worders, and the prolific Fandango, who’s full of fun and ingenuity, frequently responds to those. There are undoubtedly many others dabbling diminutively whose talents I haven’t yet had the pleasure to discover.

But I digress. I published my second short fictional post on my blog in August and called it “The Limitation of Limits.” It is actually a satire on the genre.

Fortunately, The Drabble folks have a sense of humor because they informed me a few days ago that they’d accepted it for publication, and it would appear that very afternoon.

Again true to their word, it did appear. For one day “The Limitation of Limits” was the most prominent Drabble on their post.

Each day, a newly featured Drabble assumes that premium real estate. So if you check out my Drabble there, you now have to look under “Older Posts.” (It’s dated October 31, 2019.) And if you like it, please feel free to click Like—and comment if you so choose. Here’s the link.

The Drabble printed my original post verbatim, albeit with a different illustration from mine (above), and the descriptor I provided:

“After decades writing what others asked of me, I am thrilled to have the freedom to follow my curiosity wherever it takes me. Not incidentally, I’ve always wanted my words to change the world—preferably for the better!” – the writer

Thanks to all of you for your continuing support through thick prose, thin fiction—and a smattering of poetry. Who knows what’ll spring up here next? I certainly don’t, though I have some ideas and works in progress. Last week it was my confessions of beetlecide (concluding with my first haiku).

I try to stay true to my self-imposed mission–and hope you think I hit the mark more often than not: to encourage “Dialogue to Inform, Enlighten, and/or Amuse You and Me.” Stay tuned…

Annie

OMG! What Would Albert Schweitzer Have Said?

Last night, I committed premeditated Murder One.

Specifically, it was beetlecide. Doing so was not my first preference. If a nearby window had been open, I would happily have deposited the little being where it belonged. That is my normal modus operandi.

Albert Schweitzer had an influence. Schweitzer, who was awarded the Nobel Peace Prize in 1952 for his philosophy of “Reverence for Life,” reportedly believed that

“The ethical person goes out of his way to avoid injuring anything that is living; he doesn’t tear leaves from trees or step on insects…”

But this particular insect was wending its way along the parameters of a plastic bag to the left of my bedroom bureau—where I keep an untidy, in fact helter-skelterly overflowing mountain of such stuff to recycle as liners in our wastebaskets.

The fact that it (the beetle) was in an area so close to my bed raised the stakes vis-a-vis its imminent fate. Bedbugs would have been terrible, but bed beetle was not, to my mind, much better.

So while the beetle clung to the edge of the plastic bag, I carried it into the bathroom, where I committed it to an untimely watery death. At least I think I did. But who knows?

Lacking an entomology background, I couldn’t do an adequate I.D. It might be (present tense) a water beetle, in which case it could be gleefully swirling in the toilet eddies, soon to reascend—and possibly head straight toward my bed. It might even, next time, be accompanied by some compadres. So many tiny legs, marching in unison…

Still, I felt hypocritical. Last week, my post quoted the great spiritual leader Ram Dass about loving those one protests against as much as one loves oneself. Perhaps the beetle was lovingly calling my attention to those dreadful plastic bags—showing me that they had no place in my home—even if reused:

“Remember the post you wrote about climate change recently, Annie? Do you realize what damage you’re doing with all that plastic?”

(Wise emissaries show up in odd forms sometimes, don’t you think?)

And what did I do? I did not return its love. I did not even think of its possible message until it was too late. Instead, I used that pernicious plastic bag to transport it to what at best was a locale it hadn’t chosen to visit at that time.

Where was the lovingkindness that’s so central to my mindfulness experience? I take it very seriously. And yet, without a backward glance, I had flushed it down the toilet. (To my regret, the ambiguous “it” in the previous sentence is both literal and metaphorical.)

Perhaps Ram Dass will forgive me? But I don’t think Albert Schweitzer would. As to my Inner Critic, the voice in one’s head that we imperfect mindfulness meditators know we must accommodate and not fight against or dwell upon—well, let’s just say we’re negotiating.

Alas, I just looked up a photo of a water beetle. No resemblance. Hence, my act was irretrievable. So the least I can do is create a memorial.

Haiku for a Dead Beetle

Merely existing
Luminescence and strangeness
Undeserving end

Annie

Can “Love Thy Enemy” Be a Winning Political Strategy–as Well as a Healing Balm for a Divided People?

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We know that the US is riven by deep divisions—and that other countries are going through similar struggles. We also know that most people are unhappy with the anger and hostilities—and anxiety about politics and world events is high.

Against this backdrop, I found the final question in the fourth Democratic Presidential debate, held in Ohio on October 15, instructive. Moderator Anderson Cooper asked each of the 12 candidates (the largest group of debaters ever) this question, involving Ellen Degeneres, a popular US talk show host who gained praise in 1997 when she publicly announced she is gay:

“Last week, Ellen Degeneres was criticized after she and former President George W. Bush were seen laughing together at a football game. Ellen defended their friendship, saying, we’re all different and I think that we’ve forgotten that that’s OK that we’re all different.”

“So in that spirit, we’d like you to tell us about a friendship that you’ve had that would surprise us and what impact it’s had on you and your beliefs.”

I’m touching on the responses that I found most relevant (regardless of my opinion of the candidates who voiced them). I’ve shortened them from their verbatim rendering in The Washington Post’s transcript.

Julian Castro: “Some of the most interesting friendships that I’ve had have been with people…who thought different from me…and I think that that should be reflected more in our public life. I believe that we should be more kind to other folks. And there are people, whether it’s our former president, George W. Bush, or others…just as we should be kind, we shouldn’t be made to feel shameful about holding people accountable for what they’ve done.”

Amy Klobuchar: “For me, it’s John McCain, and I miss him every day…I remember being at his ranch when he was dying. He pointed to some words in his book because he could hardly talk. And the words say this: ‘There is nothing more liberating in life than fighting for a cause larger than yourself.’”

Cory Booker: “The next leader is going to have to be one amongst us Democrats that can unite us all,…teach us a more courageous empathy, and remind Americans that patriotism is love of country, and you cannot love your country unless you love your fellow countrymen and women.

“And love is not sentimentality. It’s not anemic. Love is struggle. Love is sacrifice. Love is the words of our founders…the end of the Declaration of Independence that if we’re ever going to make it as a nation, we must mutually pledge to each other our lives, our fortunes, and our sacred honor.”

Pete Buttigieg: “I think about the friendships that I formed in the military, people who were radically different from me, different generation, different race, definitely different politics. And we learned to trust each other with our lives…It’s also about building a sense of belonging in this country, because I think that’s what friendship and service can create.

“I think we have a crisis of belonging in this country that is helping to explain so many of our problems, from our politics being what it is to the fact that people are self-medicating and we’re seeing a rise in the deaths from despair…The purpose of the presidency is not the glorification of the president. It is the unification of the American people [to] pick up the pieces and guide us toward a better future.”

I’m focused on these responses because they capture what I believe is the most important and difficult task our next president will have: uniting us as a people. And that effort is needed in many other areas throughout the world.

Cory Booker’s exhortations to love reminded me of an exchange I had with one of my fellow bloggers: Gary Gautier, who blogs as Daedalus Lex and calls his blog “Shake My Head Hollow.” Gary is a very thoughtful guy who often examines philosophical and ethical concerns on his blog. (He also writes wonderful poetry).

Gary’s recent post–which stimulated this inquiry–was titled:

“The political thing no one wants to hear”

The post itself consisted solely of a quotation from Ram Dass, a revered spiritual leader (and former Harvard psychologist, then known as Richard Alpert) who has pursued numerous spiritual approaches, including Hindu, Zen Buddhism, Sufi, and Jewish mystical studies, according to his biography. His most influential work is the book Be Here Now, which has been called “the Western articulation of Eastern philosophy and how to live joyously a hundred percent of the time in the present, luminous or mundane.”

Here’s the Ram Dass quotation, followed by my discussion with Gary, who has graciously agreed to my including our exchange as well:

“You can only protest effectively when you love the person whose ideas you are protesting against as much as you love yourself.”

My Query to Gary:

I saw Ram Dass interviewed a while back. His stroke seriously impaired him, but as I recall, he reflected that he has been happier since then because now he really has time to observe and reflect.

I am having difficulty envisioning the kind of protest he describes. Did Martin Luther King and John Lewis love their oppressors? Forgive? Probably. Understand? Very possibly. But love? And Mandela? Same question.

Can anyone protesting the people who put babies in cages and open the gates to genocidal acts feel love for those they’re protesting against?

What am I missing here, Gary?

Gary’s Response (with citations):

When Mandela entered the prison on Robben Island, his white guards were predictably brutal, and yet he never gave up on them; he engaged them, believing that “our occupation of the moral high ground could make it possible for us to turn some of the warders round,” and as years passed he won many of them over into “appreciating our cause,” and several of those guards became allies and attended his first inauguration. (Anthony Simpson’s biography, 214, 275, Part II).

And how, Gandhi asked, could he be angry with his colonial oppressors when “I know that they sincerely believe that what they are doing today is right” (Autobiog, 166). Gandhi’s bottom line is that “it is quite proper to resist and attack a system” but one should never “attack its author” (242).

I think both had found Ram Dass’s truth – that beneath vicious action is generally a confused or mangled soul. Fight for what you know is right, fight against those who wreak havoc on humanity, lock them up if you have to, but don’t give up on the spiritual imperative to help those who are most morally fallen – from people on death row to the politicians whose actions you find vicious.

I believe Martin Luther King had reached the same transcendental space of love. In contrast to today’s woke crowd, who all-too-enthusiastically reduce people to “enemies” and “racists,” King saw white people as much more than just racists and was ultimately much more optimistic about America’s founding principles and about the American people — including white people.

This is all hard to see as we duke it out at street level, but these spiritual masters were able to view it from a million miles above, from the perspective of unlimited compassion, viewing themselves below fighting the good fight in the trenches, and viewing their opponents and all others in the same light.

I’m sticking with Baba Ram Dass on this one.

And My Response…

I thank you, Gary. I practice mindfulness meditation, and an important aspect of that is lovingkindness: “May you/I/we be filled with lovingkindness.” I have often sought common ground in my blog posts. I do try very hard to walk in the other person’s shoes, so I don’t rail against the folks at the hate-filled rallies with the vehemence of many people I know.

But I am a long way from loving those in power whose cruelty and/or indifference is damaging so many individuals and our society/world.

I shall try to dig deeper—without faulting myself if I fail. The Ram Dass bar is exceedingly high for us mere mortals.

My Questions for You, Dear Readers…

We are all tearing ourselves apart with our political hatreds now. It’s no good for us as a country, as members of the world community, and certainly as individuals: think of the levels of stress-induced cortisol coursing through our bodies. We need a better approach.

Can we get beyond this point via the Ram Dass message? Regardless of which side of the political divide we’re on, can we “hate the sin but love the sinner”?

If you share my strong feelings about this president and those complicit in his actions, can you and I, personally, look beyond all the devastation that we feel President Trump is wreaking on people and nations and try to find compassion for the clearly damaged, wretched soul that resides within him—and the frightened, worried people working with him or supporting him? (That doesn’t mean we don’t hold him/them responsible for their actions!)

If you’re on the other side of the political divide, can you find it in your heart to feel that those of us who differ with you politically are not your enemies? That our wants and needs as human beings are, on the most basic levels, quite similar to yours?

(I realize I’m leaving out the vast middle here, those who are just unhappy that things in their personal lives aren’t going as well as they’d like—and are simply trying to make do from one day to the next.)

Can we all shift our focus from people to problems, and work together for the greater good?

Just days ago, we lost an invaluable American statesman: Congressman Elijah Cummings from Maryland, who died at age 68. “A Pillar of Baltimore Who Was ‘Loved by All,’” wrote The New York Times. In his years in Congress, he worked assiduously across the aisle to get things done for the people he represented and the country he loved.

Apparently, when President Trump attacked him on Twitter this summer, calling his district a “rodent-infested mess,” some of Cummings’ constituents wanted a full-throated response. Instead, Cummings calmly observed: “Mr. President, I go home to my district daily. Each morning, I wake up, and I go and fight for my neighbors.”

Unknown-13 — Congressman Elijah Cummings

Being “nice” to the President was an example of the spirit that made him unique, according to his friends. His church pastor said Cummings was…

“…so much larger than what he was…He was something so different. He was not the angry protester. He was not the passive peacemaker. He was the deliberate man who stood for right and wrestled wrong until right became the natural winner.”

I have a strong sense that Congressman Elijah Cummings was the embodiment of the Ram Dass credo that Gary Gautier has brought to our attention.

Tell me, please: What do you think of all this—as political strategy and/or guidance for life? Can you accept the concept of loving the person whose ideas you are protesting against as much as you love yourself? Even embrace the idea and consider/try putting it into practice? Feel it’s a fine idea, but…?

Or does this concept strike you as naive and unworkable? Do you think I’m nuts to even raise the issue in today’s political climate?

If the latter, do you have any other ideas concerning how we as individuals move ourselves out of our current angry divisiveness?

Annie

Here’s Why This 2019 Nobel Prize Is Breathtaking…

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Do any of the following apply to you?

—You’re hard-pressed to find some good news in the public sphere
—You’re troubled about the anti-scientist trends swirling around
—You have, have had, or know someone who’s had anemia
—You have, have had, or know someone who’s had a heart attack or stroke
—You have, have had, or know someone who’s had cancer
—You’d like to live in a place with a higher altitude than you currently can handle
—You’d like to improve your sports performance

If so, you may find the 2019 Nobel Prize in Physiology or Medicine as exciting as I do. And the above list of diseases and circumstances is merely the beginning of what scientists believe will be the impact of the work the Nobel Committee has just recognized.

The three recipients, two Americans and a Brit, pieced together a series of discoveries—their own and some preceding and/or complementing their work—to discern what one scientist called the “thermostat” that enables cells to regulate the amount of oxygen needed to do its work: convert food into energy. The Nobel Committee referred to this mechanism as “one of life’s most essential adaptive processes.”

As the Nobel Prize press release states:

“The fundamental importance of oxygen has been understood for centuries, but how cells adapt to changes in levels of oxygen has long been unknown.”

The “thermostat” the honorees discovered is comprised of a series of molecular occurrences by which cells sense too much or too little oxygen and respond accordingly.

Describing the Breathtaking Work

(From the Nobel press release)

“Thanks to the groundbreaking work of these Nobel Laureates, we know much more about how different oxygen levels regulate fundamental physiological processes. Oxygen sensing allows cells to adapt their metabolism to low oxygen levels: for example, in our muscles during intense exercise.

“Other examples of adaptive processes controlled by oxygen sensing include the generation of new blood vessels and the production of red blood cells. Our immune system and many other physiological functions are also fine-tuned by the O2-sensing machinery.

“Oxygen sensing has even been shown to be essential during fetal development for controlling normal blood vessel formation and placenta development.”

These are the three new Nobel Laureates: William G. Kaelin Jr., MD, of Harvard University in Boston, Massachusetts; Gregg L. Semenza, MD, PhD, of Johns Hopkins University in Baltimore, Maryland; and Sir Peter J. Ratcliffe, FMedSci, of Oxford University in the United Kingdom.

Concerning the relevance of their findings to major diseases, the Washington Post quoted Isha Jain, a scientist at the University of California in San Francisco:

“If you think of the main causes of death in the US, three out of five are related to lack of oxygen,” [including heart attack, stroke, and respiratory diseases]. “Understanding how the body senses and responds to low oxygen is pretty fundamental to all these diseases.”

Semenza said he and his colleagues hope that new therapies may increase the passage of blood into tissue with reduced blood flow “in diseases such as coronary heart disease and also limb ischemia, which is a major problem, particularly in diabetics, leading in some cases to limb amputation.”

And then there’s cancer. The Nobel press release explains:

“The oxygen-regulated machinery has an important role in cancer. In tumors, the oxygen-regulated machinery is utilized to stimulate blood vessel formation and reshape metabolism for effective proliferation of cancer cells.”

Semenza told the Associated Press:

“Whereas most of the chemotherapy drugs are designed to kill dividing cells that are well oxygenated, there are no treatments that are approved to treat the hypoxic cells within the cancer. We believe it’s these cells that survive the therapy and come back and kill the patient.”

From “Bench to Bedside”…

Or from lab to life-saving: such action is well under way, the press release reports.

“Intense ongoing efforts in academic laboratories and pharmaceutical companies are now focused on developing drugs that can interfere with different disease states by either activating, or blocking, the oxygen-sensing machinery.”

The first clinical application, a drug to combat anemia, was recently approved in China, and it is now under consideration in several European countries.

Semenza’s work was seminal to the total effort. In the 1990s, he and his group identified genes that were activated when oxygen levels were low to raise the levels of erythropoietin (EPO), a hormone secreted by the kidneys essential to producing the oxygen-laden red blood cells.

The oxygen-sensing mechanism was originally believed to be located only in the kidneys, but both Semenza and Ratcliffe subsequently found, among other things, that it exists in nearly all cells.

Moving from the profound to the less-so, The Washington Post notes that:

“This is the same basic mechanism behind doping, in which endurance athletes try to increase their supply of oxygen-carrying red blood cells.”

Though Semenza’s early article describing that research has now received thousands of journal citations, it was initially rejected by the “top tier journals,” which, he said, “didn’t find it to be of sufficient interest to warrant publication.”

(A note of encouragement to all who aspire to publication in any field of endeavor, don’t you think?)

For those who are interested in the scientific nitty-gritty, the Nobel release provides the road map of individual discoveries by the three researchers and others that yielded this dramatic finding.

Lessons Beyond the Discoveries Themselves

One of the things I especially like about this story is that these men, while working independently over decades, also shared their unpublished data with one another—“sometimes at scientific meetings, sometimes at the bar,” said Kaelin.

No secret patents here; no rivalry to be “the first.” As one made a discovery that he knew was an important piece of the puzzle, he described it to his colleagues.

I’ve no idea whether, or to what extent, this collaborative approach was influenced by their funding sources, but it’s worth noting that a National Institutes of Health (NIH) press release touted the US government’s role in supporting both American scientists’ work, and the American Heart Association stated it underwrote Semenza’s early work. The European Research Council (ERC) supported Ratcliffe’s work.

Two more issues are worth noting. One is that Semenza, who is a professor of genetics at Johns Hopkins, credited his wonderful high school biology teacher, the late Rose Nelson.

“She used to say to us, ‘When you win your Nobel Prize, I don’t want you to forget that you learned that here.’ She just assumed that one of us was going to do that…She was my inspiration, and I think that is the importance of teachers, to serve as that kind of spark.”

The other is Kaelin’s emphasis, as the Washington Post reported:

“The prize underscores the importance of doing research to follow curiosity and unravel basic biology. He and the other scientists hoped, but did not know, that unraveling how cells sense oxygen could spark ideas for new approaches for human diseases, including stroke and cancer.”

Said Kaelin:

“This kind of research is increasingly under threat. It’s much easier for fundraisers and policymakers to say we will support scientists, but…tell us how it will improve outcomes in five years.

“When you’re doing real science, you have to be prepared to take the road where it takes you—and if you’re doing science, it’s hard to predict where the road is going to take you.”

Will you join me in a virtual round of applause for scientists dwelling for decades on basic research, facilitated by public funding?

Their research won’t always take us where these three eminent researchers have—but when it does, the benefits to us, individually and worldwide, can be immeasurable.

Annie

Doggone It! Where’s My Doggie?

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I am severely dog-deprived. I smile at every canine within yards of me and pat any whose companion humans give me permission.

Today I accidentally happened upon a blog post someone wrote about the loss of her pup. She included a video of him, in his prime, singing what she assured us was “Happy Birthday to You.” It made me weep.

My grandnephew and his fiancée have a dog that might well have been a disaster. Much to our dismay, they acquired him from a pet store, where he’d spent the first six months of his life in a crate.

But he is now a wonderful, lovable mush, nicely trained, and I would dognap him in a millisecond if I could get away with it.

I’ve heard that rescued dogs are aware of their good fortune and express their gratitude with good humor and special devotion. I don’t know whether there’s science behind this claim, but I choose to believe it.

(I’ve learned, though, that there are clear exceptions. Please bear with me here.)

I do have two wonderful granddogs, as well as a lovely grandcat, but they are not within the daily/hourly stroke-and-cuddle distance necessary for my fixation.

Are you wondering why I don’t have a dog? My husband, himself a dog aficionado, is emphatic that our fourth dog was our last. To some extent, this is a body-clock-based dispute. He is an early riser who hits the gym daily before 7 am. I am, well, not.

He maintains that adding the walking and feeding of a dog to his morning routine simply isn’t feasible. I have promised I would arise early, care for this soon-to-be-beloved being, and go back to sleep.

Although he is not seriously hard of hearing, this affirmation has fallen on deaf ears.

In fact, his resistance is based, at least in part, on our experiences with dog #4—a caramel-colored rescue shipped up from the Carolinas that had the sweetest face and warm brown eyes.

But we ignored what we later realized was a warning sign from our first meeting with Lexi. She was fine with me, but she barked at my husband—a lot.

The adoption folks assured us it was because of his hat. He removed it. She persisted.

Nevertheless, we were both determined to find a furry companion two years after the loss of our treasured Vic—a collie-shepherd gentle giant—also a rescue, a dog we knew at the outset was ours. Or he knew and chose us: as we walked by his wire enclosure, he stood up on his hind legs and wrapped his arms, that is forelegs, around us, holding tight with his paws.

In retrospect, we should have compared that scene with our introduction to Lexi. In retrospect, we should have done a lot of things differently. In retrospect, we should have said, “Sorry; this isn’t the dog for us.”

Instead, we took Lexi home, and thus began 5 months of hell and thousands of dollars spent on training—lots and lots of training, beds (she shredded them), toys (she destroyed them), the best quality food to make sure she got all her nutrients.

We tried a variety of leads and leashes to see what might gently but effectively restrain her from taking off after squirrels on the multiple daily walks we gave her to ensure she used up enough energy to settle down.

And then there was the dog park visit when my daughter—a professional dog trainer—and her husband were in town visiting and trying to help. Free to roam off the leash, Lexi instead attacked my son-in-law’s brand-new coat, tearing a large gash that was unmendable.

She terrorized our poor cat, who’d been Vic’s best friend. (I’ve written about their relationship previously.) That meant we had to keep Lexi and the cat apart with all sorts of gates and other paraphernalia.

Oh, yes—another thing. Although her papers stated that she’d been spayed, the rescue service representative told us she couldn’t find the scar. But no worries: if Lexi were to go into heat, they would cover the costs of subsequently spaying her. So it wasn’t a complete surprise…

We then had to be on the lookout for the neighborhood rakes that were drawn to Lexi’s newly acquired aphrodisia perfume. Here, the elements were not in our favor.

Although we had a fenced-in yard, it was a rough winter, and an enormous snow pile provided just the boost Lexi needed to scale the fence. Solution: quickly surrounding the yard with a much higher fence. Ka-ching! Add that to the toll on our daughters’ inheritances.

Once Lexi’s heat period was over, the spaying occurred—followed, of course, by the large plastic cone she had to wear around her neck to prevent her from tearing the stitches. Just another source of misery for her and for us.

But the issue that makes me understand my husband’s resistance most clearly was the “game” that Lexi ultimately invented.

For several nights, as we were having dinner, she walked around the table to my husband’s chair, pushed her adorable snout through the open slats, and nipped his behind. She then slowly walk away, seemingly very pleased with herself. Our remedy was to isolate her in part of the kitchen, an act that increased her frustration.

Lexi was not without redeeming social values. She was extremely quick to learn commands (except in the presence of squirrels), and she loved scavenger hunts for treats, which she readily found wherever we hid them.

Despite her charms, why we put up with all this for so long escapes me now. But we were dog people: we figured eventually we’d get it right. When our dog-training daughter said sympathetically, “You’ve done everything you could,” we knew what our next steps had to be.

The rescue service found a foster home for Lexi, and we drove her there with considerable sadness. During the long drive to a rural area, I sat with her in the back seat, a bit teary as she placed her head in my lap and looked up at me with those lovely, expressive eyes.

We left her with a family that had several other dogs and children and wide open spaces where she could run around. She didn’t look back as we drove away.

We recognized, at long last, that Lexi and we were simply not a good fit. She needed a more active life and more diverse companionship than we could provide. We hope she eventually found both in what the animal rescue community calls a “forever home.”

I have a friend with a connection to a group that places German Shepherds. These are wonderful dogs but they’ve failed guide dog training for some reason that would not prevent them from being fine pets.

I am waiting for the right moment to broach this possible source of the dog of my dreams to my husband. Do you think he’ll bite?

Annie

About Those Guns…This Time, Some Better News (Part 2 of 2)

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Treating Gun Violence as a Public Health Epidemic

There’s broad agreement, as noted in Part 1 of this post, that gun violence (indeed, all violence) should be viewed as a public health issue.

That idea was clearly stated by Dr. Gary Slutkin, an epidemiologist trained in infectious diseases, when he returned to the US after a decade spent in Somalia, Uganda, and other countries where epidemics of such diseases as cholera, tuberculosis, and AIDs were common. In his final assignment before coming home, he was tasked to design interventions.

As he describes in a 2013 TEDMED talk, he was looking for something to do when he began hearing stories of children shooting other children.

When he asked friends how America was addressing this issue, one response was through punishment.

But, he said, “We who had worked in behavior know that punishment was something…that was highly overvalued” because it wasn’t a main driver of either behavior or behavior change.

What’s more, it reminded him of responses to epidemics long ago—before science cast better light on issues.

The other response was what he called the “‘everything’ theory, or EOE: Everything on Earth:” fix the schools, home, community, family, etc. He said he realized from treating other problems that you don’t always need to treat everything.

Assuming violence behaves like a contagious disease, Slutkin describes three things necessary to counter it.

First: interrupt transmission by detecting and finding the first cases, which includes identifying and training special workers to locate those cases, eg, “someone who’s very angry because someone looked at his girlfriend or owes him money.”

Second: “to prevent further spread…find out who else has been exposed,” but not as severely, and manage them as well.

Third: “shift the norms.” This is an extensive effort involving community activities, public education, helping people improve communication and resolve their conflicts peacefully.

Slutkin notes:

“And then you’ve got what you might call group immunity. And that combination of factors is how the AIDS epidemic in Uganda was very successfully reversed.”

Slutkin and his colleagues put all these ideas together in 2000, and tried them out in the West Garfield neighborhood in Chicago—“the worst police district in the United States at the time.” The result: a 67% drop in shootings and killings.

What Slutkin began in Chicago became an organization originally called “CeaseFire,” but more optimistically renamed “Cure Violence.” It’s now a national model, with local groups operating under various names.

And several of those local groups are in the California Bay Area, which is the subject of the year-long examination that Lois Beckett and her colleagues at The Guardian have undertaken. (See Part 1 of this post.)

The reduction in violence in this region from 2007 to 2017 is remarkable—even more so because it occurred while homelessness caused by gentrification has been rising.

Due to the impact of Silicon Valley, writes The Guardian,

“For each new millionaire household the San Francisco Bay area has produced, there are at least four new people living below the poverty level.”

Nevertheless, gun homicide was down substantially in the ten-year period in more than 100 cities throughout the region. In Oakland, a 44% decrease. In San Francisco, 49%. In Richmond, 67%. With Stockton as an outlier (98% increase), the overall drop in the region was 30%.

Writes The Guardian:

“There’s early evidence that local violence prevention strategies—including a refocused, more community-driven ‘Ceasefire’ policing strategy, and intensive support programs that do not involve law enforcement at all—were a ‘key change’ contributing to these huge decreases.”

Lest anyone conclude that gentrification resulted in the reduced gun violence, it’s noteworthy that there was no uptick in violence in the suburbs to which the people forced out of the city moved.

One local activist noted:

“The idea that gentrification is more responsible for the reduction in shootings and homicides is offensive to the hundreds of outreach workers, community members and practitioners on the frontlines actually doing this work daily.”

As Slutkin had observed, pinpointing the source of the infection is critical to containing it. The Guardian quotes experts:

“Longtime community outreach workers and violence interrupters, many of whom are formerly incarcerated, are crucial to making these public health strategies effective.”

A Richmond official, DeVone Boggan, who’s developed a nationally recognized fellowship program for men at highest risk for violence, says:

“We have to extend the idea of what public safety is beyond policing and incarceration, to include these things like intervention, outreach, and neighborhood empowerment.”

In line with using data wisely, Oakland did a 2017 study of every homicide over 1-1/2 years and found that 0.16% of Oakland’s population (about 700 men) were responsible for the majority of the homicides. That enabled more effective interventions.

Here’s something both fascinating and integral to program success: Boggan says some credit must go to the shooters who are no longer shooting, who are now making “healthier decisions…I think these individuals have to be a productive part of the solution. They have to be embraced and brought into the discussion.”

One young man, now a college graduate entering business school, sounded remarkably like Slutkin, the epidemiologist.

“Gun violence is pretty much a form of disease. Once it starts affecting one person, it starts spreading.”

He’d never considered carrying a gun until he was shot listening to fireworks one July 4th. He went to jail for illegal possession, but later entered Boggan’s fellowship program “with other young men caught up in the long-running cycle of local fights and retaliations,” writes The Guardian.

Says this young man:

“To have somebody who believes in you, and knows you’ve got the potential to go for it, stuff like that makes you want to keep going right.”

The situation isn’t nirvana at present. Throughout the region, black residents are 22 times more likely to be killed with a gun than white residents, and many residents, black and white, still don’t feel safe. Property crime has risen significantly.

But the improvements are dramatic, and the cluster of approaches seems to work.

These programs can cost tens of millions of dollars—and they require sustained attention. But consider that amount when compared with the costs of the damage done by gun violence.

Sadly, as of 2017, Cure Violence was woefully underfunded in Chicago, the city where it began, existing on just a few grants. That meant a dearth of Violence Interrupters. The group’s leaders attributed an increase in Chicago’s violence to that drop in funding, reported The Trace.

I’m not sure the program exists at all any more, though Chicago neighborhoods are in such ongoing crisis that one would think the funding could be found.

Congressman Danny Davis, testifying just days ago (September 26, 2019) before a Congressional subcommittee hearing on The Public Health Consequences & Costs of Gun Violence, cited a University of Chicago Crime Lab estimate that gun violence costs Chicago and its residents $2.5 billion a year.

He stated:

“Despite the high cost of gun violence, not one penny of the approximately $624 million raised by federal taxes on guns and ammunition in 2018 went to gun violence prevention. Rather, all gun and ammunition excise taxes go to fish and wildlife conservation.”

I’m all for fish and wildlife conservation, but there seems to be a huge disconnect here.

Hospital Emergency Departments and the “Teachable Moment”

One of the most promising developments in breaking the cycle of violence is Hospital-based Violence Intervention Programs.

Originating in the 1990s in community groups in Oakland, California, and Milwaukee, Wisconsin, they resulted from hospital medical staffs’ recognition that, from their location on the “front lines,” they could work with “trusted community-based partners who were well-positioned to provide intervention to violently injured youth after hospitalization.”

The umbrella group is now called The Health Alliance for Violence Intervention. I’m quoting from their White Paper, which I found extremely valuable.

Based on the premise that victims of interpersonal violence may well then retaliate as a “natural response borne out of societal pressure,” the programs begin when the youth is hospitalized and continue well after release.

Trained Intervention Specialists serve as mentors at the “teachable moment”—a time when the youths are believed most receptive to changing their behaviors and making changes in their lives.

Follow-up includes mental health care when needed to address the psychological traumas, and broad additional assistance: academic, vocational, housing, and help in honing in on the youths’ skills and interests to guide them toward productive careers.

A number of studies have documented the effectiveness of these efforts in reducing violence and costs that result from it.

“Collaborating With Gun Owners on Suicide Prevention”

Just as Cure Violence collaborates with actual shooters to turn them away from gun violence, a program based in Salt Lake City, Utah collaborates with gun owners on suicide prevention as part of a public health approach to reducing gun deaths.

As noted in Part 1 of this post, nearly 2/3 of gun violence consists of suicides, and we know the presence of guns exponentially increases the lethality of these attempts.

In Utah, reports Morissa Henn, Community Health Program Director at Intermountain Healthcare, that rate is 85%. Henn also testified at the September 26, 2019 Congressional subcommittee hearing.

The number has increased since 1999, when Surgeon General David Satcher called for the US to “address suicide as a significant public health problem.”

Henn says the high rate is due to the country’s failure to address “the inextricable link between suicide and firearms.” Although there’s not much evidence in support of most existing suicide prevention programs, she says,

“One of the only empirically based, high-impact suicide prevention strategies is reducing access to lethal means—which, in the United States, means reducing access to firearms for people who are at risk for suicide.”

Although lethal means reduction isn’t widely discussed in the US, awareness has grown since Surgeon General Regina Benjamin called for it in a 2012 National Strategy tied to a public health approach to suicide prevention in individuals at high risk.

Henn is part of a coalition of health professionals, gun owners, and others seeking to prevent suicide by firearms in Utah. Of this unlikely partnership, she says:

“In my experience, building productive and trusting relationships with gun owners on suicide has made us all think bigger, rooted the efforts in real-world context, and connected the data with culturally relevant messages and best-positioned messengers.

“Over time, I have learned that advancing these non-traditional partnerships is not only possible, but is a critical step if we are going to move the dial on gun death in America.”

“Similar to the way that shifts in social norms around drunk driving did not require all-out bans on cars or alcohol, a shift in voluntarily putting space and time between a suicidal impulse and a gun is framed in our coalition as a preventive, not prohibitive strategy. That small shift in framing opens the door to dialogue.”

Some accomplishments:

*an emergency department study found that among gun-owning parents of suicidal youth, 33% had unlocked guns at home before training; none did after training.

*with bipartisan support from the coalition, the state legislature passed a Suicide Prevention and Gun study that has gathered important data being applied to prevention. “It exemplifies how gun-related research can bring people and data together to drive collective action.”

*they developed a suicide prevention module for firearm instructors that the state adopted for permit seekers that’s won support from 79% of concealed carry instructors.

*a Safe Harbor Law permits gun owners or those they live with to temporarily store firearms with law enforcement for free if they believe someone in the home is a danger to self or others.

*They’ve joined with government, faith, business, and firearm stakeholders in a statewide media and education campaign with private dollars matched by public funds to extend awareness of suicide and lethal means reduction.

Though they don’t yet have impact data, they are optimistic because of the momentum they’ve built and what they’ve accomplished to date—and Henn recommends similar steps on the federal level. She believes it’s important to:

“Create political space in Congress for more open dialogue—engaging firearm owners and non-firearm owners in trusting partnerships can help us advance life-saving messages and behaviors.”

Sandy Hook Promise (SHP)

Our country was struck to its core by the horror of Sandy Hook, the 2012 mass shooting that killed 20 6- and 7-year-olds, as well as 6 adults. Some of those grief-stricken parents have built an enduring legacy to their children by trying to prevent similar violence through identifying people at risk and getting them help before they act.

It’s an extensive program, and I can’t do justice to it here. I encourage you to explore the website.

SHP calls itself a “modest, above-the-politics organization that supports sensible program and policy solutions that address the ‘human side’ of gun violence by preventing individuals from ever getting to the point of picking up a firearm to hurt themselves or others.”

On the website, a March 22, 2019 press release describes the impact of SHP’s “Say Something” program.

When students at a Connecticut Middle School, who had just received the training, “saw disconcerting information and behaviors coming from one of their peers“ they averted a potentially violent situation in their school.

The Missing Piece…

After discussing the hopelessness that so many Americans feel about gun violence in Part 1 of this post, I felt the need to shed light on some programs that are, in fact, preventing gun violence.

But none of this should detract from what I—and the vast majority of Americans—feel is an imperative: the passage and enforcement of meaningful federal gun safety legislation.

All the above programs may well be more effective—and less urgently needed—if we can enact sensible laws to reduce the carnage that has affected individuals, families, and our society so deeply.

I thank my friend Dennis—one of the untold numbers of volunteers and staff in gun violence prevention organizations and elsewhere who are working so hard to keep us safe by bringing such laws to fruition. Dennis has directed me to a number of the sources that I’ve used here.

Annie

About Those Guns…

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The front page of Sunday’s New York Times and the story within carry snapshots of the 126 most recent victims of mass shootings. “Inside a Deadly American Summer,” reads the page 1 headline. “An American Summer Stained in Blood,” is the inside title.

Both tap into the fear, anxiety, even terror that the overwhelming majority of us feel about mass shootings. “And all we could do is ask why,” notes The Times. “And wait for it to happen again.”

What if I told you that the media’s approach to these clearly horrendous mass shootings, which are increasing in number and frequency, may actually be making us less safe?

Suppose we are viewing the issue of gun violence through too narrow a lens—and we are therefore standing in the way of what could be real progress in reducing and preventing the deaths and serious injuries in our gun culture-run-wild?

A friend who spends a great deal of his time trying to make us all safer by volunteering for a prominent gun control organization alerted me to a most informative segment of NPR’s program On the Media. I’m linking to it here, but for those who can’t listen to the entire discussion, I’m also summarizing it (with some added references).

The segment is titled “How to Report on Gun Violence in America.” The host, Brooke Gladstone, interviewed Lois Beckett, a senior reporter for The Guardian, who has been covering gun violence for seven years.

Gladstone began by quoting journalist Margaret Sullivan, who said that whenever a mass shooting occurs,

“we reflexively spring into action. We describe the horror of what happened, we profile the shooter…we talk about the victim’s lives…we get reactions from public officials.”

This is gut-wrenching work, she says. But…

“If journalism is supposed to be a positive force in society, and we know it can be, this is doing no good.”

And that’s a problem.

Beckett says the same thing, perhaps more emphatically. Media reporting of mass shootings is misguided, she says. Even now, these rampages account for 1%-2% of all gun deaths. They’re so dreadful that they’re making us view our institutions and ourselves differently—and to take what may be the wrong steps in reducing gun violence.

Almost 2/3 of gun fatalities result from suicides, she points out. And many other victims are caught in “everyday” shootings in poverty-stricken segregated areas in cities.

With the focus on mass shootings, “We’re trying to prevent 1% from dying and not caring about the other 99%.”

Beckett credits the Parkland students, who rose far beyond the trauma of their own ordeal to call attention to the fact that “America’s gun debate has been racist for decades.”

According to statistics reported by Everytown Research, black Americans are 10 times more likely to die of gun homicides than are white Americans.

Everytown also reports that “firearms are the second leading cause of death for American children and teens and the first leading cause of death for Black children and teens…, and Black children and teens are 14 times more likely than white children and teens of the same age to die by gun homicide.”

The situation is untenable, and these awful crimes are committed by only a small proportion of individuals in these areas.

So we know that if we’re serious about preventing gun violence among those most affected, the media must draw our attention to approaches that actually help people at risk for suicide and/or living in poverty-stricken segregated areas.

And though suicide is a mental health issue, guns are a critical component: Everytown reports that access to a gun triples the risk of death by suicide, gun suicides occur mostly in states where there’s heavy gun ownership, and guns increase the fatality of a suicide attempt dramatically: less than 5% of suicide attempts succeed when a person doesn’t use a gun, but 85% are lethal when guns are used.

In her work with The Guardian, Beckett and colleagues have been exploring efforts that have made a difference in poverty-stricken areas, and she points to some “tremendous programs at the state level” that need more visibility to push back against the immobilizing views that nothing is possible; nothing can be done.

The Guardian is giving those efforts more visibility, and I found them so encouraging that I’ll describe them in Part 2 of this post.

“Looking at the big picture,” Beckett observes, “we need a real public health approach.” That’s a position that physicians’ groups and others have been advocating for years.

Beckett didn’t elaborate on this point, but my understanding is that a public health approach must begin with sufficient funding to yield solid data (that doesn’t solely rely on the Centers for Disease Control (CDC), as Brady, the oldest gun violence prevention group, has explained), and include background checks, banning assault weapons and the magazines and ammunition that enable the quick, devastating damage we’ve seen, and other interventions that we have reason to believe will be effective.

We know, for example, that banning assault weapons works because we had such a ban from 1994 until its expiration in 2004.

Discussing current proposed gun laws, Beckett said something I found concerning: When Colorado and Washington state passed background check legislation, the number of checks didn’t increase much because the laws weren’t being strictly enforced.

If, as a vast majority of Americans hope, strong federal background check legislation does finally pass, perhaps a newly aroused public will demand greater accountability.

We also know strong gun laws make a difference. According to Giffords Law Center, “On average, fewer people die from gun violence in states with strong gun laws, and more people die in states with weak gun laws.” Alaska has both the highest gun death rate and some of the weakest laws, while Hawaii is the reverse: strong laws, few gun deaths.

Beckett says she looks for legislation based on policies with science behind them, such as red-flag laws that depend on the judgment of people closest to the person at risk: law enforcement, social workers, schools, parents—laws that don’t remove a person’s gun rights forever, but try to line up with what’s happening now. Some states have already enacted such laws.

She says that although these proposals, which have support among some conservatives, have gained attention because of mass shootings, they can also help with many people who might be in danger of harming themselves or others—the 99% noted earlier.

One positive that has emerged from these dreadful mass shootings, she feels, is the numbers of white suburban parents getting involved in the gun control movement—and learning, for example, that homicides of black children often occur in circumstances different from what they expected.

I’m assuming she means that in so many of these fatalities, the child is doing nothing wrong—is simply in the wrong place, is the victim of mistaken identity, or other tragic situations.

Beckett cautions that advocating for the wrong thing is extremely dangerous. She believes almost all the efforts to make schools safer are having the opposite effect. This comment led me to further research.

In The Conversation, three researchers discuss efforts that have been called “target-hardening”:

“attempts to fortify schools against gun violence through increased security measures. These measures may include metal detectors, lock-down policies, ‘run, hide, fight’ training, and surveillance cameras.”

The researchers, who have collaboratively written about these approaches elsewhere, point out that surveillance cameras didn’t stop Columbine, and school lockdown policies didn’t save the children at Sandy Hook.

“We believe what is missing from the discussion is the idea of an educational response. Current policy responses do not address the fundamental question of why so many mass shootings take place in schools. To answer this question, we need to get to the heart of how students experience school and the meaning that schools have in American life.

“An educational response is important because the target hardening approach might actually make things worse by changing students’ experience of schools in ways that suggest violence rather than prevent it.”

All these target-hardening methods tell students that schools are “scary, dangerous and violent places,” the researchers say. And they may lead teachers to begin assessing students “not as budding learners, but as potential shooters…The more teachers think of students as threats to be assessed, the less educators will think of students as individuals to nourish.”

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Beckett believes the press must focus on the things that readers or listeners have the power to do. They need to think more about providing information for people who are worried about someone close to them and don’t know what to do. She believes that:

“The biggest enemy is not the NRA: it’s cynicism and exhaustion of everyday Americans who don’t see evidence of help.”

When Gladstone asked Beckett how she felt about the Walmart CEO’s determination to no longer sell assault weapons and ammunition, Beckett observed that Walmart had actually stopped selling handguns in 1993.

“Walmart’s policies on the dangerous threats are more in line with data than our whole debate is.”

She added that actions like Walmart’s do matter, and change is possible. Gun owners are a minority in the US (and many of them now support gun safety legislation). Seventy to 80 percent of Americans don’t own guns, and 60% live in homes with no guns.

“It’s important to recognize that extreme gun absolutists are fewer than 10% of gun owners”—a very aggressive group, but a small number of people.

“If even a small number with a different view can organize against them, they can change the debate. It’s taken a long time, but we’re seeing it happen now.”

Unquestionably, these mass shootings have increased, and they have caused an enormous level of fear and anxiety. The danger Beckett finds is that the reflexive focus on these shootings is leading more Americans to arm themselves—which could result in more suicides and domestic violence (as well as accidents). “Our fears are going to make us less safe.” To counter that, she says,

“We need to remind ourselves to de-escalate and trust each other and not be afraid.”

Please join me next week when, in Part 2, we explore programs that do just that.

Annie

My Presidential Nominee Wish List

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Thursday night was the third debate among the Democratic candidates for President. The field has tightened: due to the rigid qualification rules, a mere ten candidates made the cut this time.

Barring changes, the same ten will take the stage in October, plus Tom Steyer, the veryvery wealthy man who launched his “Need to Impeach” campaign way back in October, 2017.

I found the debate a bit more revelatory than the two previous ones, and I thought the ABC moderators did a decent job. But I’m still not getting the sense of the candidates that I’m seeking. I’m wondering how many of you feel the same.

Despite the over-trodden, unilluminating, and needlessly divisive discussions about extending Obamacare vs Medicare for All, I don’t think the candidates are so far apart on any of the issues.

They all support ensuring universal healthcare; countering our nation’s growing economic inequality; implementing sensible gun safety legislation; beginning immediately to vigorously address climate change; reversing the anti-immigration policies that are damaging our values and threatening our economy; and seeking ways to heal the terrible divisive racial and other wounds that currently exist in our country.

But we still need more discussions centering on their foreign policy views.

Perceptions differ, and I do worry about the electability of the three current front runners.

I wonder whether/to what extent they can both energize the base and build the diverse coalition to drive vast numbers of voters to the polls, thereby resoundingly putting us on a new path and bringing Senate and House candidates along with them. I welcome your views on this matter in the comments section below.

What am I looking for in the Democrat’s eventual nominee—and, if you’re interested in a change from the current administration–what are you looking for?

As I watch and listen to these candidates, I try to picture each one in the Oval Office, in the Situation Room, and in meetings with allies and adversaries. I am trying to gauge their judgment and temperament.

Will they surround themselves with the best people they can find? Then will they listen, truly listen, to the advice they’re given, ask well-informed questions about that advice, and insist upon factual backup before making important decisions? Will they keep their cool in scary and potentially dangerous situations?

Do they demonstrate some innate wisdom in dealing with other people? Will they be careful and measured in their stewardship of the still most powerful nation in the world—and be able to undo the damage to our standing that’s been done over the past few years?

Do they possess the empathy that will enable them to understand the diverse problems that Americans are grappling with right now—so they can seek solutions that help people feel that the government is working—and is on their side?

Will they explain to us what their overall vision is on where they want to take this country, and how they’ll forge common ground on the often divisive issues we face so that they can work with Congress to move us forward?

Can they inspire us to be our best selves and advance us toward the national ideals we’ve long expounded?

I hope the debates that are held between now and the Iowa caucuses reveal more about these important aspects of the Democratic candidates. I’ve seen glimmers of what I’m seeking here and there, but I’d like to see a lot more.

Please let me know your reactions—to the candidates, the debate, my “wish list,” what you’re looking for, and anything else that comes to mind.

Annie

Beyond Music to Ritual: The Impact of Four Songs on America’s Psyche

When Colin Kaepernick, the former NFL football quarterback, took a knee (knelt) during The Star-Spangled Banner at the start of the games, he created quite the uproar.

I have written that I felt his using his visibility to call attention to the injustices against African-Americans and other minorities was in the best tradition of nonviolent protest. He paid a heavy price for his actions: though he reached a settlement with the National Football League and is now a free agent, to date no team has been willing to sign him.

Anna Celenza, Professor of Music at Georgetown University, discusses Kaepernick’s protest in her introduction to a One Day University lecture titled: “Four Musical Masterpieces That Changed America.”

I found her talk, which I watched on video, so enlightening that I’d like to provide you with some highlights. I’ve also added a bit of research from other sources.

Celenza first explained that Georgetown, known for politics, social justice, public policy, and law, had designed a major in American Musical Culture to explore “how music functions in culture.”

She also teaches American Studies, so it was natural for her to design and lead a freshman class on “Music and Politics.” To determine which songs to cover, she visited the Library of Congress and found a number of musical pieces that had evoked Congressional debate. The four songs highlighted in this lecture were culled from that syllabus.

“The Flag Was Still There”

She began with our national anthem, The Star-Spangled Banner. In defying the customary stance when the song is played—that is, the ritual, an important aspect of music—Kaepernick, she observed, was calling attention to the fact that the song is saying we’re all unified and free.

In essence, he was asking what the ritual means—and how can we make it true? A worthy question, I believe, now being raised in many aspects of American life.

The Star-Spangled Banner, that symbol of American culture, actually got its start as something called a “parody song.” The melody originated previously in a different context: the words to that melody had described “the pleasures of women and wine.”

But writer Francis Scott Key was a more serious type. He first used the words “Star-Spangled” to refer to the American flag in 1805 when he wrote a song for his friend Stephen Decatur, Jr., which described the “olive branch of peace and the laurel wreath of honor.”

What eventually became the national anthem appeared in 1814. The War of 1812 was still raging, and the British had just bombed Washington, DC. They were on their way to Baltimore, where a defeat, many feared, would mean the end of American independence. To prevent the Brits from reaching Baltimore’s Inner Harbor, the Americans had sunk ships so that the masts would block access.

Enter Francis Scott Key, a lawyer and sometime poet who had, I read elsewhere, been opposed to the war from the beginning. But now he’d been asked to try to stop the onslaught and negotiate a prisoner exchange.

When he met with the British, they wouldn’t let him leave: he was coerced to stay with them to watch the bombing.

From that vantage point, however, instead of witnessing defeat, he saw “the bombs bursting in air,” and, at the end of the battle, “the flag was still there.” The rest you know, right? He originally titled the song “In Defense of Fort McHenry.”

The song’s ascent to anthem status was a bit circuitous. While it was gaining popularity, some faulted it because it just doesn’t work as a marching song. (Try it; you’ll see.)

“My Country ’Tis of Thee” was considered a possible anthem, but ruled out because of its origins: this wasn’t the time for a song based on “God Save the King.” And “America the Beautiful” (O Beautiful for Spacious Skies…) didn’t make the cut because after the first stanza, it actually critiques America for not living up to its ideals. Hmmmm.

The Star-Spangled Banner finally became the National Anthem in 1931—two years after Congress proposed it as a way to bring together opposing factions who were blaming each other for the Great Depression. The feeling was that everyone singing together would be a unifying ritual.

And why the hand over heart? Initially, the song was sung accompanied by a straight-arm salute, ostensibly pointing to the American flag. But with images of Hitler and Mussolini in mind, people said, essentially, “No way!” We should, I think, be grateful for that!

Confronting Our National Horror

images-49 — Billie Holiday Courtesy of flickr.com

Abel Meeropol was a Jewish schoolteacher-turned-poet and songwriter, and a member of the American Communist Party in the 1930s. As Celenza pointed out, in those days, the Communist Party was not viewed as it was subsequently: its supporters were idealists who were attracted by its emphasis on peace, freedom, progress, and gender and racial equality. (Meeropol subsequently quit.)

Meeropol happened to see a postcard that shocked him to his core: it was a photograph of a lynching, showing two bodies hanging from trees while a group festively gathers below. In 1937, using a pseudonym, he wrote a poem about it called “Strange Fruit,” which was printed in a teachers union publication. He set it to music, and he and his wife would perform it at Communist Party rallies.

But Meeropol wanted more people to hear it. The following year, he connected with a man named Barney Josephson, who had started the first social club whose patrons were racially integrated. The house singer there just happened to be a woman named Billie Holiday. Meeropol told her: “You should sing this.”

She agreed, but only under certain conditions: no drinks were to be served before her performance; the only light in the room would be a spotlight on her; and it had to be the final song of the night. This was not an ego trip: Holiday knew how to elicit the greatest power from a very important song.

The song, and Holiday’s rendition of it, became famous. People said they “witnessed” her singing it because they were so moved. She recorded it, though her usual record label wouldn’t touch it due to its sensitive subject, so she went to a startup label in 1939. And it awakened people’s consciences: they signed petitions to their members of Congress to make lynching a federal crime. Celenza believes it actually marked the beginning of the Civil Rights Movement.

During the McCarthy era, Meeropol was attacked, and Strange Fruit wasn’t sung for a while. Nina Simone brought it back.

In 1999, Time Magazine called it “the song of the century.” It is listed in the National Recording Registry of the Library of Congress.

But a law still wasn’t passed, although there were 200 separate attempts to enact such legislation over the decades. In 2005, Senators Mary Landrieu (D) and George Allen (R) apologized for the failure to pass anti-lynching legislation.

Finally, in December, 2018, Senators Kamala Harris and Cory Booker asked for—and received—unanimous consent of the Senate to pass the bipartisan Justice for Victims of Lynching Act of 2018, which would, at long last, criminalize lynching, attempts to lynch, and conspiracy to lynch.

Booker said at the time that the legislation is intended to acknowledge the wrongs of the past and leave a legacy for future generations that Congress finally did the right thing. Senator Tim Scott was also a sponsor. The bill passed the Senate in February, 2019.

In March, 2019, the Senate bill was referred to the House Judiciary Committee’s Subcommittee on Crime, Terrorism, and Homeland Security. As far as I could tell, it’s still there.

I saw Audra McDonald portray Billie Holiday several years ago, and the last song she sang was Strange Fruit. I believe that once you hear it, you never forget it. It was/is emotionally wrenching to imagine such gross inhumanity from seemingly ordinary looking people.

Here is the opening verse:

Southern trees bear a strange fruit
Blood on the leaves and blood at the root
Black bodies swinging in the southern breeze
Strange fruit hanging from the poplar trees

If you’d like to hear Billie Holiday singing Strange Fruit, google Billie Holiday–Strange fruit-HD-YouTube.

Paul Simon Defies a Boycott

images-48 — Paul Simon, Graceland Courtesy of flickr.com

When South Africa was ruled by apartheid from 1948 to 1993, the US remained neutral. The African National Congress (ANC) supported 1930s communism, and the Soviet Union was a prime supporter of the ANC. With the Cold War in effect, the US would not side with the anti-apartheid group.

Then, in the 1980s, the United Nations forced the issue by passing a resolution that called for a cultural boycott of South Africa. American performers, such as Steve Van Zandt, said they wouldn’t play in South Africa. Van Zandt wrote a protest song, Sun City, which was recorded by Artists United Against Apartheid. (Sun City was a resort where the South African government had forcibly removed black people.)

But Paul Simon disagreed. He’d been given a tape of music by black South Africans, and—ignoring the boycott—he traveled to South Africa to record an album with the musicians who lived there, including Ladysmith Black Mambazo, the group whose harmonies among tenor, alto, and bass are so distinctive. That album became Graceland, which Rolling Stone has said “remains one of the most beloved albums in pop history.”

In 1987, Simon and his group staged a huge concert in neighboring Zimbabwe featuring the renowned singer Miriam Makeba, who had left South Africa in exile. They sang “Under African Skies.” Says Celenza: “The lyrics tell the story of how a song changes points of view.” And she quotes “the roots of rhythm remain…This is the story of how we begin to remember…”

There was a furor over Simon’s actions, and some still question his judgment—and even his motives. Simon brought all the musicians to the US; to him this issue wasn’t about politics; it was about the music.

The musicians he played with said he opened up opportunities for them that they would never otherwise have had. One year after Graceland, Simon produced Ladysmith Black Mambazo’s Shaka Zulu, which received a Grammy Award in 1988 for best folk recording, the first of four Grammys they’ve received.

But Dali Tambo, who founded Artists Against Apartheid, was deeply critical of Simon. “We were fighting for our land, for our identity,” he told a New York Times reporter. “And we saw Paul Simon coming as a threat because it was not sanctioned…by the liberation movement.”

Yet it had such an impact that the US government stopped doing cultural boycotts. Celenza spoke of an Irish Times headline not long ago that asked: “Who wins when artists stage a cultural boycott?” And she gave her answer: “No one. Music brings us together.”

And Then There’s Hamilton…

In July, 2008, Lin-Manuel Miranda was reading a book he’d bought at an airport bookstore prior to a vacation in Puerto Rico. In Alexander Hamilton, the biography by Ron Chernow, Miranda has said he recognized himself and the ideals of his friends and family.

Miranda gave a surprise early introduction to one of the songs as a work-in-progress to the Obamas at a White House Poetry Jam in 2009. If you haven’t seen the tape of that performance, you can do so here, complete with subtitles beneath the rap words. The play Hamilton: An American Musical premiered in August, 2015.

Unknown-26 — Lin-Manuel Miranda in Hamilton Courtesy of Commons.wikimedia.org

Hamilton is, of course, a huge sensation, and the touring companies seem to be everywhere. In a combination of rap, rhythm and blues, show tunes, and other styles, the music sets forth the ideas the founding fathers had that are still important, while also capturing what America looks like now, Celenza observes. (The founding fathers and other historical figures are primarily played by people of color.)

She recalls the evening when Vice President Mike Pence attended a performance. At the curtain call, the actors acknowledged him but, very politely, suggested that they hoped he wasn’t simply entertained–that he’ll remember the ideas and ideals he’d just heard.

What they did with that speech was a break in ritual, Celenza notes, “and people got upset. When you break ritual, it makes people think…about what our ideals are.”

She concluded with the hope that we all try to capture the best ideas we can from musical experiences such as the ones she’d presented.

What do you think?

UPDATE: My virtual friend and fellow blogger Joseph Urban (aka: The Old Liberal) noted in his comment the song that speaks to him personally the most strongly, and he asked me what song was mine. (You can see both our selections in his response below.) I thought this was a terrific question, and as I always enjoy your stories, I am posing it to you: When you think of songs that have had a lasting impact on you, which one(s) come to mind–and why?

Annie