Inside the plane the Walter was behind Susan as they went to their seats. Susan had evidently checked her bag. As she put her valise in the overhead compartment Walter did the same with his backpack at the aisle seat opposite, and they came into momentary brushing contact once or twice. Susan removed the file folder, a device and headphones. Both took their seats, exchanging glances. Susan quickly looked forward, opening her seat tray, while Walter’s glance lingered a moment.
Walter removed his device and poked at it. The bustle on the plane was neutral, although rather loud. Susan had her headphones on and was holding papers and pen. Walter glanced furtively, repeatedly at the striking woman. She was working on a form, the kind with questions and multiple answers, where one or more answer is to be checked off or circled. She was working busily, methodically. Walter, pretending not to look, shifted as far as possible into the aisle so that, when the moment came, he could more easily look.
Mixed with the bustle of the plane and announcements that takeoff was imminent, faint music could be heard, tinny, as if coming from earphones across an aisle. Walter poked at his device, glanced across the aisle, poked and glanced again. A last minute passenger or two bustling by interrupted his discreet look at Susan and her form.
Now, as she shifted in her seat and moved the papers closer to him he could read some of the questions: “Would you recommend Folding Wings to your friends?” “On a scale of one to five (one least effective in treating addiction/alcoholism , five most effective) how would you rate Folding Wings?)”. Faint pop music was now a little more audible as the door was closed and the plane began to taxi.
Walter had a few minutes before he would be instructed to power down his device. Google quickly led him to the site of Folding Wings Rehabilitation Centers, with a location not far from the airport.
He quickly navigated the site. It was alcohol – oriented, but would accept addicts. It had more than twenty locations in the U. S. It emphasized recovery through the Twelve Steps – and, he discovered with a moment of joy, Folding Wings was seeking volunteers to work with recently discharged patients. There was a form. A smile came to his face. Walter quickly filled it out:
Q. How long have you been in recovery? A. 15 years.
Q. Are you available to meet with recent Folding Wings patients and go with them to meetings? A. Yes.
Q. What is your email address; etc, etc.
The engines were revving up. We saw Susan raise her tray and place her papers in her bag, placing the bag under the seat ahead of her. The plane was taking off. Walter turned off the wide area network on his device and put it in the pouch on the back of the seat ahead of him. Susan kept her headphones on and we could hear, in spite of the increased noise, pop music coming from the direction of her head, faint and tinny.
Now the flight attendants were serving drinks and refreshments from carts in the aisle, and as Walter’s view was obstructed while Susan was ordering he was momentarily relieved by not having to hide his continual glances at her.
They served him coffee, and as he looked over at Susan the pop music suddenly changed and became crystal clear. She was drinking the first of two small bottles of wine she had ordered.
Within five minutes she had downed both bottles and was asleep, or passed out, headphones still on, slumped toward the aisle, tray table holding the empties. The high fidelity music continued, without content, pop, fast, inexorable…
Copyright (c) 2016, William J. Spurlin, all rights reserved.
It would be impossible to identify the building. A black rectangle was superimposed over most of the sign in front, revealing only the word “clubhouse.” The people emerging from it had black rectangles hiding their faces, or the top part of the face. Two of the women coming out paused for a moment and embraced, and close up it could be seen that one had tears streaming from beneath her black rectangle.
From inside the car we could see one of the women approaching. She slid into the driver’s side. We could see in the back seat that her bag was packed. Her shoulder bag, half open on the front seat contained a couple of devices and a manila file folder with papers. She drove. We could see her black rectangle and the periphery of her face in the rear view mirror.
For a few seconds we saw her returning the rental car. The attendant didn’t seem to be disturbed by the black rectangle. Indeed, he appeared to be happily looking her in the eye; a courteous, motivated employee.
In the terminal building the woman, tall, determined, advanced, bag on wheels behind, shoulder bag closed and held at her side by an elbow. Suddenly she stopped and we saw the terminal building interior wheel slowly around her and stop in front of a bar. Happy people sat at the bar drinking and talking. We saw the woman’s face. We saw the black rectangle disappear, revealing Susan.
Copyright (c) 2016, William J. Spurlin, all rights reserved.
On the occasion of the investigation published by Le Monde on Tuesday, October 25, regarding the figures concerning cancer in France, Christopher Wild, director of the International Agency for Research on Cancer [IARC, the cancer agency of the World Health Organization headquartered in Lyon] , explains the overall patterns of the evolution of malignant tumors in the world…
What are the overall tendencies in the global evolution of the incidence of cancer?
We do not currently have solid data on the long term evolution of the incidence of cancer for all countries. This information, obtained from nationally registered data, remains scarce in numerous developing countries. Starting from the database of the IARC, we observe changes linked to development: the level of occurrence of certain major cancers (lung, breast, colorectal) is increasing in many poor or emerging countries, while several others, more associated with poverty or infectious diseases (uterus, stomach, liver) seem, rather, to be on the decline.
Overall, an understanding of those incidences which are increasing in countries in transition has to do with changes in the risks undertaken, which are approaching those of the rich countries: tobacco consumption, overweight, sedentary, increase in the age of child bearing and breast feeding… For several cancers a divergence in global tendencies can be observed: among men, lung cancer tends to decline in wealthier countries but is stable or still increasing among women.
These tendencies reflect the “maturity” of the epidemic of tobacco use, and the fact that women have taken up cigarettes more recently than men. Globally, in lower income countries the smoking habit has arrived later and we may be able to observe in decades to come a rapid increase in cancer in certain countries, particularly among men. Other cancers are increasing as well: a sub-type of cancer of the esophagus strongly linked to obesity is increasing in several western countries.
How is the sharp increase in the incidence of thyroid cancer to be interpreted?
These increases are linked to the development of new diagnostic tools (tomography, magnetic resonance imaging, etc.) which have led to a considerable augmentation in the detection of small papillary tumors, which would not have been evident before.
In spite of a decline at the world wide level, cancer of the cervix is still increasing in certain countries of East Africa, Eastern Europe and in the former Soviet countries.
The incidence of a good number of cancer types is at the same time reasonably constant. The mortality rate of pancreatic cancer is relatively stable, for example. But because of the poor prognosis of these tumors and advances in the treatment of other major forms of cancer (breast, prostate, colorectal), this illness [pancreatic cancer] has become one of the leading causes of death in the EU countries.
Beyond the big, known causes – tobacco, alcohol – what are the major determining factors observed?
We now have considerable knowledge of certain risk factors, that can explain part of the developments under observation: First of all, the impact of chronic infections is often neglected as a risk factor, but accounts for perhaps 15% of cancer at a global level, especially for liver cancer (viral hepatitis), cervical cancer (papillomavirus) and stomach cancer (Helicobacter pilori).
However, this varies considerably country by country: in Africa more than 40% of cancers are linked to such infections, against 1% to 3% in North America or Australia, for example… Certain viral or bacterial infections decrease along with the level of development.
It is also interesting to see, in certain wealthy countries, the increase in the number of cancers in the oropharyngeal (mouth, lips, pharynx, etc.) and ano-genital areas associated with sexual transmission of human papillomavirus (HPV). This development is a supplementary argument for the introduction of the HPV vaccine, the benefits of which will extend beyond the prevention of cervical cancer.
What are the consequences of the increase in tobacco use?
Tobacco use continues to increase in numerous countries, which leads naturally to a rise in the incidence of lung and other cancers, including a pronounced increase among women as well as men, as well as other health effects (cardiovascular illness, chronic respiratory trouble, etc.)
Overweight, obesity and lack of physical activity are increasing in a dramatic manner in numerous regions of the world and these life style changes are associated with accumulated risk of several cancers, among which are breast, esophagus, colorectal, kidney…
To what are these life style changes connected?
They are often linked to urbanization, diet, sugary drinks and to the consumption of red meat and processed meats. At the same time, the tendency for women to have children later in life, to have fewer children and to breast feed only for short periods of time is associated with the increase in the incidence of breast cancer in numerous countries.
Has not classic oncology, founded before all else on the concept of mutation, been overtaken by the emergence of new toxicological paradigms?
I would certainly not say that the concept of mutation [of a cell – LeM] has been, one way or another, made obsolete by recent advances in the understanding of molecular mechanisms facilitating cancer. Cancers are to the contrary characterized by a large number of mutations.
I would further say that the discovery of new “events” at the molecular or cellular level which lead to the development of a cancer come with and complement the fundamental work undertaken on mutations and offer fantastic opportunities to study the prevention, the early detection and treatment of this illness.
It is very stimulating to witness the arrival of new tools for the investigation of different “events” – as for example epigenetic modifications [certain changes in DNA or in the genetic environment – LeM] which may be produced among populations.
One of the critical challenges with which we are confronted is to understand how, beyond the induction of mutations, environmental or behavioral factors have an impact on the risk of developing cancer. This information is fundamental for prevention and early detection and has been until the present time largely neglected, compared to other domains of cancer research.
Has not the epidemiology of cancer arrived at a limit, in fact, at the current time, on the effects of environmental factors – as, for example, exposure to toxic chemicals – during critical periods of development such as fetal, perinatal, adolescence – which may, in the majority of cases, be accounted for?
Take care: it would be a mistake to believe that exposure during adult life might be without importance or necessarily less important than exposure during the perinatal period. However, epidemiology must certainly consider life taken as a whole and must measure exposure during all periods of life, as accurately as possible, while using the most feasible instruments, such as questionnaires, environmental measurements or biological markers, for example.
I do not think that exposure during adolescence or in the period around birth cannot be measured, but I recognize that to obtain accurate measurements is certainly a challenge to the extent that the exposure occurred in the past. The encouraging news is that new scientific developments will permit meeting this challenge.
What are they?
I will cite two: The first is that certain environmental exposures leave a molecular “tattoo” in DNA – in the blood cells, or in the tumor itself, for example – that can be detected many years after expression. This allows the beginning of an opening of a window into the past.
The second is that there are in the world a large number of recruited individuals from mother-father-children cohorts, who provide biological samples. In these studies it is possible to link exposures in the perinatal period with changes in the biology of the child.
One might then interpret these observations in connection with abnormalities of cellular or molecular function observed later in life. There again, this will allow the establishment of a bridge between an event that occurred early in life and its consequences much later.
This is Bill Spurlin’s translation of an interview given by Dr Christopher Wild to Le Monde, published here without objection from the IARC.
I punched Holden Caulfield in the face, and he fell heavily
On the ground, ideology oozing out of him
But that did not save Jack.
I went on my way for years and came back to that spot.
Holden was gone, having climbed back into his book,
Where he lives on, dead like Jack.
When in a hotel room near San Marcos in 2010
I heard about Salinger’s death, I cried.
(Not Jack’s Salinger; J. D.)
Wept a lot, broke down actually
for several hours. They were all really dead now,
Franny, Zooey, Holden and Jack.
It wasn’t that the people I met in my brief visit to Radio Mountain were
Uninterested in sex; they seemed to consider it more of a distraction –
Something unnecessarily complicated, like stereophonic sound.
Full of joy, they showed me the radio console they had built themselves:
Monaural, with built in limiting and several sides so that colleagues
Could sit down together and broadcast programs at the same time.
We took a run through the heavenly fields outside the studio, with the dogs.
My arthritis vanished, and the dogs enjoyed the run as much as I did.
Reversing direction suddenly one of them, a large furry bowling ball,
Came in collision with me and we all ended up in a laughing heap.
Over there the transmitting towers pointed, not skywards
Because we were already there, but everywhere, exciting the ether
With celestial bop. So fast. Can you imagine dancing to that?
There is sadness aplenty there too, remembering friends lost.
I actually cried when I saw snow, not knowing it snows
In every month there, a little bit, not like the tragic winter
That sometimes occurs in other parts of New England.
But, being near Connecticut, Heaven could hardly be without snow.
The road to it is easy, about nineteen miles west by south of Hartford.
There is a brook called Sodom near a medical center off I-691.
Take the first exit and follow the brook north to Rte. 71.
Go right, and you will soon see the entrance to Hubbard Park and the Peaks.