1. Sledge, George W. Jr. MD

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(written on Dec. 31, 2013)

GEORGE W. SLEDGE JR.... - Click to enlarge in new windowGEORGE W. SLEDGE JR., MD. GEORGE W. SLEDGE JR., MD, is Chief of Oncology at Stanford University.His

There is something about the end of a year that renders one more thoughtful, makes one look back rather than forward. We see it in all the media. For every article about the coming year, there are 10 about what we just experienced: the year's best movies, the year's best books, the year's best (I kid thee not) reality TV series, the year's 10 most important news stories or sports events or whatever.


You get the idea. It is easier to review than to predict, and less embarrassing. Hindsight is 20/20. We are also reminded which important people died during the last year, or at least some person's idea of who was important. Whenever I read of these, I often say to myself, "I didn't know he was still alive to die" or "who?" or "darn, no more novels from her."


This year's consensus big departure was Nelson Mandela. Not a bad choice, I would say, though my own thoughts were captured by a number of other passings, some reasonably well known, some not. Let me share them with you:


1. Voyager leaves the solar system. This actually happened on August 15, 2012, though NASA didn't announce it until September of 2013. I have grown old with Voyager, which was launched the year I graduated from medical school. It is the first man-made object (other than radio waves) to leave the solar system. That it is still transmitting us data, decades after launch and some 18.2 billion kilometers away, is wonderful. In 40,000 years, it will come within shouting distance (1.6 light-years) of a star called AC+79 3888 in the Camelopardalis Constellation.


2. Carbon dioxide levels pass 400 ppm. Unlike Voyager, which in penetrating the heliosphere surrounding the solar system passed a real boundary, this boundary is artificial. There is nothing magical about it, any more than a highway sign that says "37 miles to Chicago." But global warming is real, and our inability to address it as a people (both inside and outside the United States) will be seen by future generations as an act of breathtaking irresponsibility. That a significant proportion of the population, and one of our two great political parties, reject the scientific reality of global warming is truly depressing.


3. Palo Alto outlaws dying. Well, not really, but something like it. In moving to Stanford I have had the opportunity to see Silicon Valley close up, and what an interesting sight it is. The local rag (the Daily Post) had a wonderful story late in October on the closure of the Roller & Hapgood & Tinney funeral home-Palo Alto's last-after 114 years of business. "The property value in Palo Alto is so great it can no longer justify use as a funeral home," said the funeral home's president. The property was sold to Yahoo CEO Marissa Mayer, who is rumored to want the land for residential development. There, in just a few sentences, is all you need to know about the Silicon Valley economy.


And, perhaps, our larger economy as well. Capitalism's acts of creative destruction, fueled by scientific discovery, have been the great engine of productivity and growth since the 19th century takeoff, and certainly have made possible the lifting of hundreds of millions from poverty around the globe. But does it have any limits, any real boundaries? And will its current iteration, the Internet economy, enrich any more than the few, at the expense of vital (or post-vital) services for the many? Will it really be possible to die in Palo Alto in the future?


4. The death of Gloria Bush. The answer is yes. I thought the funeral home story was funny, until a subsequent article in the Daily Post sobered me right up. A 72-year-old homeless woman was found dead in Palo Alto's Heritage Park. Bush, who was mentally ill, slept on the stairs of local churches and ate at local food pantry programs. A Palo Alto couple saw her wrapping her feet in plastic the night before her body was found. Her daughter had contacted local authorities, concerned that Gloria would stay outside during a recent cold snap, but they could not move her in against her will.


The world is full of small tragedies. Our care of the mentally ill is shameful, as any who have given the problem a minute's thought must know. You've never met Gloria Bush, and if I ever saw her I'm sure I ignored her, as one ignores embarrassing crazy people one passes on the street. But please take a moment to remember Gloria Bush.


The story in the Daily Post did not say where she would be buried.


5. Science passings: Len Herzenberg. There is some chance you have heard of Stanford's Len Herzenberg, who died at the age of 81 on October 27. Herzenberg, along with his wife Lee, created the first flow cytometry machine, which morphed into the modern FACS (fluorescence activated cell sorter) used in research and clinical laboratories around the globe.


The story is that one day Herzenberg was looking through a microscope, counting fluorescent cells until his eyes hurt. He wondered if there might be a better way, thinking, "There's got to be some kind of a machine that could do this." With the help of Stanford engineers, he modified a machine developed at the Los Alamos National Labs, creating what they called "The Whizzer," the parent to all modern FACS machines. Their first publication was in 1969, the first true FACS following in 1971.


We don't think much about where our scientific machinery comes from, nor do the makers of such machines win the Nobel Prizes: the closest the Herzenbergs came was the Kyoto Prize in 2006. Stockholm doesn't always get it right. One could easily argue that the impact of the FACS on modern biology and medicine was as great as just about any other biologic breakthrough one can point to in recent decades. Try to imagine AIDS or leukemia research (or treatment) without the FACS machine.


I'm reminded of one of my favorite Francis Bacon quotes, from the Novum Organum: "Neither the naked hand nor the understanding left to itself can effect much. It is by instruments and helps that the work is done, which are as much wanted for the understanding as for the hand."


Herzenberg was a famously happy man, loved by all who knew him: the Stanford obit refers to his "constitutive smiling," a very biologic description for a great biologist.


6. Scientific Passings: Janet Rowley. This is a name known to many in the oncology profession, though certainly not to all. Janet Rowley was a giant in the field of cancer genetics. I heard her speak on several occasions, and once met with her for an hour at the University of Chicago. She was gracious, polite, and razor-sharp, acting highly interested in a not very interesting visitor.


Rowley attended medical school at the University of Chicago. The first year she applied, she could not get in: the women's quota of three (in a class of 65) was filled, so she waited until the next year. Almost unimaginable today, but that was how it was done in 1944. For many years after graduation, she worked three days a week, while raising her family.


One day in 1972, while spreading chromosomal photomicrographs of Giemsa-stained cells on the family dinner table, she realized that CML was a disease of chromosomal rearrangement, with a translocation of chromosome 9. It was a true paradigm shift (a widely overused phrase, but appropriate for Rowley's epiphany), the first of many chromosomal translocations implicated in carcinogenesis, and a crucial step on the road to drugs such as imatinib and crizotinib.


She was showered with awards, all well deserved, but like Herzenberg her real achievement was the many people alive today because of her work. I doubt we will see her name on many year's end lists, and the nature of scientific achievement is that it is anonymous to the many and eventually forgotten even by the few who should remember.


So let me end with another quote, the beautiful ending to George Eliot's Middlemarch:


"The effect of her being on those around her was incalculably diffusive: for the growing good of the world is partly dependent on unhistoric acts; and that things are not so ill with you and me as they might have been, is half owing to the number who lived faithfully a hidden life, and rest in unvisited tombs."


Janet Rowley MD died of ovarian cancer at the age of 88. Until the last few months of her life, she continued to bicycle to work.


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