Editor ’ s Corner
Kindred Spirits
“ 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
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ESPITE 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
David P . Steensma , MD , is senior physician at the Dana- Farber Cancer Institute and associate professor of medicine at Harvard Medical School in Boston , Massachusetts .
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 travelling . 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 together 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 .
Have a comment about this editorial ? Let us know what you think ; we welcome your feedback . Email the editor at ACNEditor @ hematology . org .
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