Gross Incompetence?

 NJ Transit is in my opinion and my experience one of the most incompetently run entities in the world! Warped tracks, broken equipment, filthy train stations (NY Penn especially), nasty employees, failed management. The list could go on. In the NY Times they note:

New Jersey train passengers could be in for a rough ride. NJ Transit, the state’s rail service, announced a number of delays and cancellations because of the extreme heat, and warned that the problems could persist through Saturday. High temperatures can cause overhead electrical equipment to sag and tracks to expand, potentially leading to long delays. The agency also warned that air conditioning systems on aging trains and buses, many of which are overdue for replacement, could be spotty. On Thursday morning, a number of NJ Transit trains traveling along the Northeast Corridor, which connects busy stations in New Jersey to Penn Station in Manhattan, were canceled because of mechanical issues and lack of available equipment, according to the agency. And delays and cancellations were announced on other trains, including some on the Morris & Essex Line, Pascack Valley Line and Main/Bergen County Line.

 Perhaps these are Acts of God, to keep people from going into NYC! 

 

MDS: Whack a Mole?

 I went to an interesting conference on microplastics syndrome (MDS), at Columbia Medical School, and had an interesting insight.

Namely, take prostate cancer. There are two schools of thought. The first is, "how does it occur?". This is the gene, mutation, etc question, generally occurring inside the cell. One may also consider external factors such as inflammation, but ultimately it results inside the cell. For simplicity I call this the "WHY" school. There are many silos that are focused upon, many relate to genes, RNAs proteins etc.

The second school is call  the "EXTERNAL", which focuses on how to kill the malignant cell. Thus HER2+ uses ADC, antibody drug conjugates, to target the malignant cell and kill it with a drug. This school cares less as to why the malignant cell arose. This school tries to uniquely identify the enemy and attack it. Many immunotherapies are part of this school as well.

The WHY school looks at the internal elements and perhaps if they can identify a targetable one such as imatinib in CML. The recent work on JAK inhibitors fall in the scheme. 

The WHY school in MDS seems to be quite expansive. Each time an internal target is found another appears. This is the "whack a mole" syndrome. Which of these targets are best. In hematological cancers the EXTERNAL school may not be effective since it may just destroy a whole line of blood cells. 

It is interesting to see this yin and yang approach from inside and outside.