Wielding Genomes in the Fight Against Cancer

The warm-up act was a video of ?brightly colored cells, ropes of DNA and other mystery blobs — gorgeous and ominous — floating to solemn, New-Agey music with lots of strings and poignant piano notes. Slides broke in bearing scary statistics — cancer kills more than half a million Americans a year, for example — and quotes from researchers: “Cancer is always genetic.” Cancer cells are “more perfect versions of ourselves.”

The panelists were Eric Lander, an expert in genome sequencing; Mary Claire King, the first scientist to identify genes that can cause breast cancer; Olufunmilayo Olopade, a medical oncologist and breast cancer researcher; and Siddhartha Mukherjee, an oncologist and researcher, and author of the Pulitzer prize-winning book "The Emperor of All Maladies: A Biography of Cancer." The moderator was Dr. Richard Besser, a physician who is chief health and medical editor for ABC News. ?

Dr. Besser wore a sharp suit and tie, Dr. Mukherjee had artfully tousled hair and close-fitting white pants over boots, and the other three went business casual. Dr. Lander and Dr. King tried to high-five each other, missed once and then connected.

One major theme that emerged from the 90-minute discussion was that although genetic research has already helped in the diagnosis, treatment and prevention of some cancers, it may be decades before the science produces new treatments that come anywhere near the dream of curing cancer or at least making it a chronic disease.

Why try to sequence cancer genomes? Dr. Besser asked.

Dr. Lander said that cancer was caused by mutations and that it was “nuts” to think the disease could ever be cured without understanding what had gone wrong genetically. But the first step was to sequence the normal human genome; then, cancer genomes could be tackled. Cracking the normal genome cost a few billion dollars, but since then, he said, the cost of sequencing had dropped to $10,000 or less per genome, and so it made sense to apply the technology to cancer. Samples are needed from many patients with each type of cancer, he said. Sequencing a cancer from one person will reveal many mutations, but not all of them will be involved with the disease.

But with samples from many patients, researchers can hunt for culprit genes that are mutated in, say, half the cases, or maybe even all of them.

“Let the cancer tell you what’s important,” Dr. Lander said.

Genetic information is already being put to use to help women from families with mutations that cause breast cancer. Researchers can offer them options, Dr. King said, though she acknowledged that the options are “not pretty,” because they require removing the ovaries or breasts to avoid the disease. But the surgery can prevent 10,000 cases of breast cancer a year in the United States, she said.

Genetic findings have also led to some very focused treatments for cancer: drugs like Herceptin, for women with a certain type of breast cancer, and Gleevec, which is used for some blood cancers and gastrointestinal stromal tumors with specific mutations.

But Dr. Lander cautioned that individual targeted treatments were not cures. He cited a drug that can make tumors “melt away” in patients with melanoma, a deadly type of skin cancer. But they melt away for only eight months, he said. Then, the tumors “come roaring back,” because the cancer develops a new mutation and becomes resistant to the drug. He said cancer treatment needed what he called the “Colin Powell approach” — overwhelming force, which will probably turn out to be a cocktail of targeted drugs like the combination of antiretrovirals that can now keep H.I.V. in check for most patients.

Dr. Mukherjee said that in “Let Me Down Easy,” a play by Anna Deavere Smith, a character observes that giving chemotherapy is like hitting a dog with a stick to get rid of fleas. Flea ointment would work better, he said — but you might need six types of ointment.

Dr. Olopade said that as a medical oncologist, she had to defend chemotherapy, because it has cured many childhood leukemias.

Why not try to sequence as many cancer genomes as possible in the next five years? Dr. Lander asked. But he warned that the information would not lead to new treatments right away. He said that could take decades, and he accused the news media of “overpromising” and misleading the public into expecting cures within a few years.??

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A Grass-Roots Fight to Save a ‘Supertree’

But can it survive a development-hungry Chinese Communist Party? In Nanjing, a southeastern city of eight million people, the answer seems — for now — to be yes.

In a nation where homes and farmland are routinely chewed up for the sake of high rises and factories, a grass-roots campaign by Nanjing residents this spring to save hundreds of the trees, known here as the wutong, from a subway expansion might seem like a nonstarter. But the effort, organized mostly online, has led to a surprising compromise from local government officials.

It was not a shining example of democracy in action. But neither were ordinary citizens left fuming about power-drunk bureaucrats deaf to anyone below.

Maybe that is because some Nanjing officials consider the Communist Party’s credo of “supervision by the people” to be more than mere words. Or maybe it is because trees, in the scheme of development, provide an easy compromise.

Giants in the arboreal world, the wutongs were introduced in China by the French in the late 1800s or early 1900s to adorn their settlement in Shanghai, Nanjing officials say. In 1928 and 1929, Nanjing planted more than 20,000 saplings along Zhongshan Avenue, a road leading to the mausoleum of the anti-imperialist leader Sun Yat-sen, revered as the father of modern China.

Many more were reportedly planted after the Communists took power in 1949. The trees grew fast and provided shade during Nanjing’s scorching summers. And they became not just a symbol of Nanjing’s graceful beauty, but of its civic philosophy. China’s capital through multiple dynasties, Nanjing regards itself as a cultural haven. Its urban plan touts the city’s integration with mountains, rivers and trees.

Liu Hengzhen, a former military employee, planted wutongs in the 1950s. “They keep the whole city cool,” Mr. Liu, now 80, said as he played mah-jongg at a street cafe, its roof pierced by a massive wutong branch.

“The people of Nanjing grew up together with these trees,” said He Jinxue, the daily operations director for the city’s urban construction commission. “There is so much emotional attachment to them.”

That did not shield them from the onslaught of development. In 1993, more than 3,000 were felled virtually overnight to make way for the Shanghai-Nanjing Expressway. Nearly 200 more were removed to build Nanjing Subway Line Two in 2006.

Then, this year, came Subway Line Three, calling for more than 1,000 trees — mostly wutongs — to be beheaded, uprooted and plunked down elsewhere to make space for six above-ground stations in the city center.

Nanjing’s two existing subway lines, each carrying a million commuters a day, are not nearly enough, said Mr. He, the urban commission director. More than 10 new lines are planned, he said.

But once workers had reduced a first batch of 49 wutongs to trunks and a few feet of branches, the Chinese equivalents of Twitter rustled with more than 10,000 outraged messages. A schoolteacher organized students to tie green ribbons around some untouched trees.

Several celebrities weighed in, including Huang Jianxiang, a freelance television host and sports commentator whose Sina Weibo microblog is followed by more than five million people. So did a Taiwan legislator with the Kuomintang Party, which made Nanjing its headquarters until it was vanquished by the Communists in 1949.

Zhu Fulin, an enterprising reporter for the government-owned Nanjing Morning Post, traced the fate of 190 trees that had been moved elsewhere five years ago to construct Line Two. Despite the government’s pledge to protect and replant them, he found 80 of the wutongs languishing in a trash-strewn city field.

Mia Li contributed research from Beijing, and Barclay Walsh from Washington.

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Albertina Sisulu, Who Helped Lead Apartheid Fight, Dies at 92

The African National Congress confirmed her death.

Mrs. Sisulu’s passing extinguishes another light of a generation that fought one of the great moral battles of the 20th century. Since her death, virtually every one of this nation’s leaders have come to her home to offer condolences. Only Nelson Mandela has been conspicuously absent. He is increasingly frail, and members of the Sisulu family visited him instead.

A humble but forceful woman, Mrs. Sisulu was the widow of Walter Sisulu, one of Mr. Mandela’s earliest political mentors, who died in 2003. She kept her dignity through decades of government harassment. Mr. Sisulu was imprisoned for 26 years, and she herself was repeatedly jailed, held incommunicado and “banned,” a restriction limiting where she could go and how many people she could see.

“But try as they might, they could not break her spirit, they could not make her bitter, they could not defeat her love,” Archbishop Emeritus Desmond Tutu said in one of the many tributes offered after her death.

Nontsikelelo Thethiwe was born into a poor farming family in the Transkei, a former British protectorate that is now part of Eastern Cape Province. When she enrolled in a school run by missionaries, she was given a list of Christian names to chose from and selected Albertina.

Her father died when she was 11, and poverty might have kept her from finishing her education had she not won a scholarship to a Roman Catholic secondary school. After graduation, she accepted the advice of an admired priest and moved to Johannesburg to study nursing, a career that offered a small salary as she apprenticed.

In 1941, she was training at the Non-European General Hospital when she met Mr. Sisulu, a political activist with the African National Congress. Their courtship would be her political awakening. They married three years later. Nelson Mandela was best man at the ceremony.

In his autobiography, Mr. Mandela describes Albertina as a “wise and wonderful presence.” At the Sisulus’ wedding reception, he wrote, an A.N.C. stalwart warned the bride, “Albertina, you have married a married man: Walter married politics before he met you.”

She, in turn, was marrying the liberation movement. The Sisulus’ home in the Orlando area of Soweto became a central meeting place for the robust discussions that shaped the direction of the A.N.C. She combined her work as a visiting nurse with the distribution of political pamphlets.

On Aug. 9, 1956, Mrs. Sisulu was a leader of a historic march by 20,000 women against the nation’s pass laws, which restricted the movements of blacks. One slogan from the protest was, “You strike a woman, you strike a rock.” Aug. 9 is now celebrated in South Africa as Women’s Day.

Walter Sisulu would go on to head the A.N.C., and later, along with Mr. Mandela and others, create an armed wing of the organization. The Sisulus’ relationship has been celebrated in South Africa as a great love story, but during the first 20 years of their marriage, he was so often in jail or on the run that the couple barely spent 9 years together.

Once, in 1963, when the police failed to locate her husband, they seized Mrs. Sisulu instead, arresting her while she was treating patients. She was placed in solitary confinement under a notorious law that allowed detention for 90 days without charges.

“There was nothing to read, nothing to do, nothing to occupy my mind—nothing except to think of what was happening to my children at home,” she recalled in a 2002 biography written by her daughter-in-law, Elinor Sisulu.

The couple had five children and raised three more who belonged to Mrs. Sisulu’s deceased sister. Unknown to Mrs. Sisulu, after she was jailed, her 17-year-old son Max was arrested and held under the same law.

In 1964, Mr. Sisulu was sentenced to life imprisonment, serving most of his time, like Mr. Mandela, on Robben Island. Mrs. Sisulu was banned for 10 years. Her children either went into exile or entered boarding school.

As the decades passed, MaSisulu, as she was affectionately called, was frequently arrested, locked up for infractions as slight as attending the funeral of a friend. Her children faced similar harassment.

“I did not mind going to jail myself, and I had to learn to cope without Walter,” Mrs. Sisulu once said. “But when my children went to jail, I felt that the Boers were breaking me at the knees.”

Nevertheless, her political activities continued. In 1983, she became one of the founders of the United Democratic Front, a powerful antiapartheid coalition that brought together religious, labor and student groups.

In July 1989, she led a delegation on an overseas mission, arguing for sanctions against the apartheid government. She met with President George H. W. Bush and former President Jimmy Carter. She dined with Jacqueline Kennedy Onassis.

The days of racist oppression were drawing to a close. That October, Mr. Sisulu was set free; Mr. Mandela would be released four months later.

In 1994, with multiracial democracy finally having replaced white domination, Mrs. Sisulu was elected to Parliament. She served for four years, retiring from politics though remaining active in social causes.

The Sisulu family, for so long badgered and humiliated, is now a political dynasty. Her daughter Lindiwe Sisulu is the nation’s defense minister. Her son Max is speaker of the National Assembly. Another daughter, Beryl Sisulu, is South Africa’s ambassador to Norway. She is also survived by her son Zwelakhe Sisulu and daughter Nkuli Sisulu.

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A Grass-Roots Fight to Save a ‘Supertree’

But can it survive a development-hungry Chinese Communist Party? In Nanjing, a southeastern city of eight million people, the answer seems — for now — to be yes.

In a nation where homes and farmland are routinely chewed up for the sake of high rises and factories, a grass-roots campaign by Nanjing residents this spring to save hundreds of the trees, known here as the wutong, from a subway expansion might seem like a nonstarter. But the effort, organized mostly online, has led to a surprising compromise from local government officials.

It was not a shining example of democracy in action. But neither were ordinary citizens left fuming about power-drunk bureaucrats deaf to anyone below.

Maybe that is because some Nanjing officials consider the Communist Party’s credo of “supervision by the people” to be more than mere words. Or maybe it is because trees, in the scheme of development, provide an easy compromise.

Giants in the arboreal world, the wutongs were introduced in China by the French in the late 1800s or early 1900s to adorn their settlement in Shanghai, Nanjing officials say. In 1928 and 1929, Nanjing planted more than 20,000 saplings along Zhongshan Avenue, a road leading to the mausoleum of the anti-imperialist leader Sun Yat-sen, revered as the father of modern China.

Many more were reportedly planted after the Communists took power in 1949. The trees grew fast and provided shade during Nanjing’s scorching summers. And they became not just a symbol of Nanjing’s graceful beauty, but of its civic philosophy. China’s capital through multiple dynasties, Nanjing regards itself as a cultural haven. Its urban plan touts the city’s integration with mountains, rivers and trees.

Liu Hengzhen, a former military employee, planted wutongs in the 1950s. “They keep the whole city cool,” Mr. Liu, now 80, said as he played mah-jongg at a street cafe, its roof pierced by a massive wutong branch.

“The people of Nanjing grew up together with these trees,” said He Jinxue, the daily operations director for the city’s urban construction commission. “There is so much emotional attachment to them.”

That did not shield them from the onslaught of development. In 1993, more than 3,000 were felled virtually overnight to make way for the Shanghai-Nanjing Expressway. Nearly 200 more were removed to build Nanjing Subway Line Two in 2006.

Then, this year, came Subway Line Three, calling for more than 1,000 trees — mostly wutongs — to be beheaded, uprooted and plunked down elsewhere to make space for six above-ground stations in the city center.

Nanjing’s two existing subway lines, each carrying a million commuters a day, are not nearly enough, said Mr. He, the urban commission director. More than 10 new lines are planned, he said.

But once workers had reduced a first batch of 49 wutongs to trunks and a few feet of branches, the Chinese equivalents of Twitter rustled with more than 10,000 outraged messages. A schoolteacher organized students to tie green ribbons around some untouched trees.

Several celebrities weighed in, including Huang Jianxiang, a freelance television host and sports commentator whose Sina Weibo microblog is followed by more than five million people. So did a Taiwan legislator with the Kuomintang Party, which made Nanjing its headquarters until it was vanquished by the Communists in 1949.

Zhu Fulin, an enterprising reporter for the government-owned Nanjing Morning Post, traced the fate of 190 trees that had been moved elsewhere five years ago to construct Line Two. Despite the government’s pledge to protect and replant them, he found 80 of the wutongs languishing in a trash-strewn city field.

Mia Li contributed research from Beijing, and Barclay Walsh from Washington.

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Syrian Elite to Fight Protests to ‘the End’

The frank comments by Rami Makhlouf, a tycoon who has emerged in the two-month uprising as a magnet for anger at the privilege that power brings, offered an exceedingly rare insight into the thinking of an opaque government, the prism through which it sees Syria, and the way it reaches decisions.

Troubled by the greatest threat to its four decades of rule, the ruling family, he suggested, has conflated its survival with the existence of the minority sect that views the protests not as legitimate demands for change but rather as the seeds of civil war.?

“If there is no stability here, there’s no way there will be stability in Israel,” he said in an interview Monday that lasted more than three hours. “No way, and nobody can guarantee what will happen after, God forbid, anything happens to this regime.”

Asked if it was a warning or a threat, Mr. Makhlouf demurred. “I didn’t say war,” he said. “What I’m saying is don’t let us suffer, don’t put a lot of pressure on the president, don’t push Syria to do anything it is not happy to do.”

His words cast into the starkest terms a sentiment the government has sought to cultivate — us or chaos — and it underlined the tactics of a ruling elite that has manipulated the ups and downs of a tumultuous region to sustain an overriding goal: its own survival.

Though the uprising has yet to spread to Syria’s two largest cities — Damascus, the capital, seemingly tranquil, and Aleppo, a key conservative bastion, has been relatively quiet — the protests have unfurled in Damascus’s suburbs and across much of the rest of the country, building on longstanding neglect of the countryside and anger at corrupt and unaccountable security forces. While the government offered tentative concessions early on, it has since carried out a ferocious crackdown, killing hundreds, arresting thousands and besieging four cities.

“The decision of the government now is that they decided to fight,” Mr. Makhlouf said.

But even if it prevails, the uprising has demonstrated the weakness of a dictatorial government that once sought to draw legitimacy from a notion of Arab nationalism, a sprawling public sector that created the semblance of a middle class and services that delivered electricity to the smallest towns.

The government of Mr. Assad, though, is far different than that of his father, who seized power in 1970. A beleaguered state, shorn of ideology, can no longer deliver essential services or basic livelihood. Mr. Makhlouf’s warnings of instability and sectarian strife like Iraq’s have emerged as the government’s rallying cry, as it deals with a degree of dissent that its officials admit caught them by surprise.

Mr. Makhlouf, a childhood friend and first cousin of Mr. Assad, whose brother is the intelligence chief in Damascus, suggested that the ruling elite — staffed by Mr. Assad’s relatives and contemporaries — had grown even closer during the crisis. Though Mr. Assad has the final say, he said, policies were formulated as “a joint decision.”

“We believe there is no continuity without unity,” he said. “As a person, each one of us knows we cannot continue without staying united together.”

He echoed an Arabic proverb, which translated loosely, means that it will not go down alone.

“We will not go out, leave on our boat, go gambling, you know,” he said at his plush, wood-paneled headquarters in Damascus. “We will sit here. We call it a fight until the end.” He added later, “They should know when we suffer, we will not suffer alone.”

Mr. Makhlouf, just 41 and leery of the limelight, stands as both a strength and liability of Mr. Assad’s rule, and in the interview he was a study in contrasts — a feared and reviled businessmen who went to lengths to be hospitable and mild-mannered. To the government’s detractors, his unpopularity rivals perhaps only that of Mr. Assad’s brother, Maher, who commands the Republican Guard and the elite Fourth Division that has played a crucial role in the crackdown.