Books: From Bang to Whimper: A Heart Drug’s Story

On June 23, 2005, American medicine managed to take a small step forward and a giant step backward at precisely the same time, with government approval of the first medication to be earmarked for a specific racial group. It was BiDil, a drug designed to treat heart failure in blacks.

Enthusiasts hailed BiDil’s approval by the Food and Drug Administration as a landmark event in the nascent field of pharmacogenomics, which aims to create drugs tailored to fit an individual’s genetic makeup as precisely as a bespoke suit drapes its owner’s shoulders. Critics just winced and clocked one more misstep in medicine’s long history of race-related disasters.

You would think that the elucidation of the human genome would have cleared up most of the hoary untruths surrounding race and health. But as Jonathan Kahn makes clear in his worthy if convoluted review of the events surrounding the birth of BiDil, the genome has in many respects only made things worse.

It has been clear for decades that race has minimal relevance to the body’s inner workings. Research has repeatedly shown that the biologic variations among individuals of the same race are reliably great enough for race to retain little utility as a biologic predictor. You might as well sort people by height. Or, in the words of an editorial writer for Nature Biotechnology in 2005, “Pooling people in race silos is akin to zoologists grouping raccoons, tigers and okapis on the basis that they are all stripy.”

But old misconceptions die hard, particularly for entrepreneurs eagerly awaiting cash bonanzas from the genomic revolution.

Race may be irrelevant; it may be, as Dr. Francis Collins, the director of the National Institutes of Health, put it, “a weak and imperfect proxy” for genetic differences. But it is also a familiar concept — and asking people what race they are is substantially cheaper than genotyping them.

So in a peculiar paradox, race has come to serve in some circles as a crude surrogate for genetic analysis until actual genomic medicine comes along — a temporary bridge from now to later, known to be flawed but still a quasi-legitimate stand-in for the real thing.

Against this background unfolds the story of BiDil, a drama of greed and good intentions.

Several observations prompted the drug’s development. Among them was the common assertion from the last century that blacks with heart failure were more likely to die than whites. (Mr. Kahn does an impressive job of researching and debunking this statistic.) Then there was the belief that blacks often reacted badly to some of the newer drugs used for treating heart failure, and the results of a study dating from the 1980s suggesting that many black patients did well with two old standby drugs.

Those two drugs were (and are) on sale as generics, costing pennies a pill. But just suppose they were combined into a single pill that could be then specifically marketed to patients who just happened to be thought in particular need of effective medication? Now there was a pharmacologic and marketing plan that would extend a lucrative new patent for decades.

And so it came to pass that a collection of eager investors and some of the nation’s foremost cardiologists smiled on the results of an industry-sponsored trial performed on self-identified black subjects with heart failure: The two cheap drugs combined into the not-so-cheap BiDil reduced mortality by 40 percent compared with placebo. This figure was impressive enough to end the trial early and speed BiDil to market.

How did whites do on BiDil? Nobody bothered to check.

Mr. Kahn deserves credit for teasing out all the daunting complexities behind these events, including the details of genetic analysis, the perils of racial determinations and the minutiae of patent law. Unfortunately, though, he suffocates his powerful subject in a dry, repetitive, ponderous read.

A law professor with a doctorate in history and longstanding interest in race issues, Mr. Kahn trudges a partisan path through the drama in which he himself was a player. (He testified before an F.D.A. advisory committee that BiDil should be approved without racial qualifications.)

He heads bravely into many statistical thickets, but omits relevant clinical data; he repeatedly refers to the trial that led to BiDil’s approval, for instance, but I could find its numerical findings nowhere in the book and had to look them up. In a story that fairly drips with potential human interest, he offers the reader not one sip.

The issues raised on every page are so important and so thought-provoking that it would be irresponsible to warn interested readers away. Still, it would be almost as irresponsible to misrepresent the difficulty of the journey.

As it happens, BiDil itself has had a remarkably inglorious career. Despite its much-trumpeted release, patients did not request the medication, and practicing doctors did not prescribe it.

NitroMed, the company that developed it, sponsored no further studies and failed in 2009.

The drug still lingers on the market; Mr. Kahn writes that BiDil may be resurrected in sustained-release form — that other time-honored technique for wringing a few more years from a drug’s patent.

For a parable of early 21st-century medicine, as it treads water between past and future and never hesitates to reach for a buck, it doesn’t get much better than BiDil.

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Raging fire guts Kabul market

KABUL, Afghanistan -- Firefighters battled through the night to contain a raging fire that swept through a market in the Afghan capital.

No injuries were reported, but the blaze destroyed hundreds of stores and millions of dollars worth of merchandise, Afghan police and firefighters said at the scene. 

Dealers at the neighboring currency exchange, the city’s largest, said they evacuated cash, computer equipment and records from their shops as the flames approached during the night. But in the morning, the market was jammed with people haggling over thick stacks of notes as smoke billowed overhead.

Col. Mohammed Qasem, general director of the Kabul fire department, said he suspected an electrical short was to blame for the fire. 

Gas canisters used to heat the stores propelled the flames, along with the cloth and clothing sold by many of the vendors, Qasem said. “It made it very big in a short time.”

Firefighters from the Afghan defense department and NATO forces were sent to assist. But the city’s notorious traffic and the market’s narrow lanes made it difficult for responders to maneuver their vehicles, Qasem said.

Abdulrahman, who like many Afghans has only one name, squatted near a fire truck with his head in his hands  as responders aimed a hose at the blackened ruins of a building still smoldering at noon Sunday, more than 12 hours after the fire broke out.

He said the building had contained three shops that he owned and a warehouse full of glassware, crockery and kitchen utensils. 

“I lost everything,” he said.

Shirali Khan complained that police hadn't allowed him to remove the goods from his four clothing stores.

“They thought we were all robbers,” he said.  “There’s only ashes left.”

ALSO:

Pope pardons former butler convicted of theft

Bombing kills local official, 7 other people in Pakistan

Tensions high as vote on proposed Egyptian constitution continues

Special correspondent Hashmat Baktash contributed to this report.

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Wired Science Space Photo of the Day: Hourglass Nebula

This Hubble telescope snapshot of MyCn18, a young planetary nebula, reveals that the object has an hourglass shape with an intricate pattern of "etchings" in its walls. A planetary nebula is the glowing relic of a dying, Sun-like star.

The results are of great interest because they shed new light on the poorly understood ejection of stellar matter that accompanies the slow death of Sun-like stars. According to one theory on the formation of planetary nebulae, the hourglass shape is produced by the expansion of a fast stellar wind within a slowly expanding cloud, which is denser near its equator than near its poles.

Image: Raghvendra Sahai and John Trauger (JPL), the WFPC2 science team, and NASA [high-resolution]

Caption: Hubble Heritage site

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South Africa’s Mandela responding to treatment in hospital

JOHANNESBURG (Reuters) – Former South African president and anti-apartheid hero Nelson Mandela, who is 94, continues to respond to treatment two weeks after being taken to hospital, the government said on Saturday.

The Nobel Peace laureate, who has been treated for a lung infection and gallstones after being hospitalized on December 8, was visited by South African President Jacob Zuma, presidency spokesman Mac Maharaj said in a statement.

“Madiba has been in hospital since the 8th of December and continues to respond to treatment,” Maharaj said, referring to Mandela by his clan name.

“President Zuma assured him of the love and support of all South Africans, young and old, and the whole world.”

The country’s first black president was admitted to hospital in Pretoria earlier this month after being flown from his home village of Qunu in a remote part of the Eastern Cape province.

It seems likely that Mandela, admired at home and abroad as a global icon against injustice for his lifetime of struggle against minority white rule, will end up spending Christmas in the hospital.

On Thursday, following his re-election as leader of the ruling African National Congress (ANC), Zuma reported Mandela had “steadily improved”.

Zuma said then the former president was receiving “the best care possible” but recalled that Mandela was “at an age where medical challenges require extraordinary care”.

He praised Mandela as an “unparalleled fighter”.

In an interview broadcast on Saturday but recorded a day earlier, the ANC’s newly elected Deputy President Cyril Ramaphosa said he believed Mandela was “on the mend”.

Mandela spent 27 years in apartheid prisons, including 18 years on the windswept Robben Island off Cape Town. He was released in 1990 and went on to use his prestige to push for reconciliation between whites and blacks as the bedrock of the post-apartheid “Rainbow Nation”.

He stepped down in 1999 after one term in office and has been largely removed from public life for the last decade.

Mandela spent time in a Johannesburg hospital in 2011 with a respiratory condition, and again in February this year because of abdominal pains. He was released the following day after a keyhole examination showed there was nothing serious.

He has since spent most of his time in Qunu.

His fragile health prevents him from making any public appearances in South Africa, although he has continued to receive high-profile domestic and international visitors, including former U.S. president Bill Clinton in July.

(Reporting by David Dolan; Editing by Pascal Fletcher)

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News Analysis: The Perils of Yoga for Men

MEN are famous for ignoring aches and pains. It’s macho. Men get physical exams less often than women. They tend to remain silent if worried about their health. When hurt, their impulse is to shun doctors and rely on home remedies, like avoiding heavy lifting to ease backaches. Male athletes play through injuries. It’s all about virility and manliness.

The stereotype has exceptions, of course. But denial of injury and ill health — from the relatively inconsequential to the grave — is common enough that physicians seek ways to encourage men to be more forthcoming.

So it pays to listen carefully when guys start talking about intolerable pain and upended lives. Doing so led me to an unexpected finding that I have confirmed in a trove of federal data. It suggests that yoga can be remarkably dangerous — for men.

Guys who bend, stretch and contort their bodies are relatively few in number, perhaps one in five out of an estimated 20 million practitioners in the United States and 250 million around the globe. But proportionally, they are reporting damage more frequently than women, and their doctors are diagnosing more serious injuries — strokes and fractures, dead nerves and shattered backs. In comparison, women tell mainly of minor upsets.

Men who are breaking the code of silence are doing so with physicians in hospital emergency rooms, who in turn report their findings to the federal government.

Their outspokenness reveals much about modern yoga and suggests ways it can be made safer. As a practitioner since 1970, I know some of the guy hazards personally and have learned through painful experience how to live with my inflexible body.

The male disclosures help explain one of the central mysteries of modern yoga — why it is largely a feminine pursuit. As Yoga Journal, the field’s top magazine, put the question: “Where Are All the Men?”

Science has long viewed the female body as relatively elastic. Now the new disclosures suggest that women who tie themselves in knots also enjoy a lower risk of damage. It seems like common sense.

Surprisingly, evidence of the male danger has, to my knowledge, never before been made public. Nor has its flip side — that women seem less vulnerable. The subject of male risk merits discussion if only because the booming yoga industry has long targeted men as a smart way to expand its franchise.

Informal observations hint at possible explanations. Yoga experts say women tend to see classes as refuges while men see challenges — their goal at times to impress the opposite sex.

Women say men push themselves too far, too fast. Men admit to liking the intensity but say the problem is pushy teachers who force them into advanced poses while urging them to ignore pain.

I stumbled on the issue after my book, published in February, laid out a century and a half of science and, in its chapter on injuries, contradicted the usual image of yoga as completely safe. The yoga establishment makes billions of dollars by selling itself as a path to healthy perfection. Predictably, it responded with sharp denials.

I also received a surprising number of moving replies from injured yogis — male and female — including stroke victims.

A letter initiated my inquiry. In April, a man told how an agonizing back injury had turned his life into “a living hell.” Too many instructors, he wrote, are “pushing us too hard and having us do dangerous poses.”

The “us” resonated.

Suddenly, I realized his cry sounded familiar.

I raced through a correspondence file and saw that many of the letters about serious damage had come from men.

Tara Stiles, a yoga teacher who runs a popular studio in Manhattan, told me that guys have more muscle (one reason for their relative inflexibility) and can thus force themselves into challenging poses they might otherwise find impossible. It seemed a plausible explanation for blinding pain.

Other teachers echoed her analysis and cited supporting anecdotes.

Yoga poses are unisex. But in my research, I found a world of poorly known information on gender disparity.

“Science of Flexibility,” by Michael J. Alter, explained how the pelvic regions of women are shaped in a way that permits an unusually large range of motion and joint play. In yoga, the pelvis is the central pivot for extreme bending of the legs, spine and torso.

In June, I turned to the Consumer Product Safety Commission and its National Electronic Injury Surveillance System, which monitors hospital emergency rooms. In July, officials sent me 18 years of annual survey data that summarized the admission records for yoga practitioners hurt between 1994 and 2011, the maximum available span.

First, I needed a baseline that would let me compare the guy admissions to males doing yoga in the United States. Figures in the yoga literature described men as making up some 10 percent of practitioners at the beginning of the period and 23 percent at the end. So the middle ground seemed to be roughly 16 percent.

Then I dug into the medical data. The analysis took weeks, but the results spoke volumes.

William J. Broad is a science reporter for The New York Times and the author of “The Science of Yoga: The Risks and the Rewards.”

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This bus' next stop: doing good

Maybe you want to help others. Maybe you long to lend a hand. But you're not sure where and you're not sure how and you don't know who to call.

You could ask around. Or you could book a seat on the Do Good Bus.

You will pay $25. You will get a box lunch. You will put yourself in the hands of a stranger.

CITY BEAT: Life in the Southland

When the bus takes off, you will not know where you are going — only that when you get there, you will be put to work.

You find yourself on this weekday afternoon one of an eclectic group, gathered a little shyly on an East Hollywood curb.

There's a Yelp marketer, a grad student, an actor, a novelist, a Manhattan Beach mother with her son and daughter, who just got home from prep school and college.

You see a school bus pull up. You step on board. It feels nostalgic, like day camp or a field trip.

Rebecca Pontius welcomes you, wearing jeans and sneakers and a black fleece vest. She looks like the kind of person who would plunge her hands deep into dirt, who wouldn't be afraid of the worms, who could lead you boldly.

The bus takes off, and Pontius stands toward the front, sure-footed. She founded the Do Good Bus, she tells you, to 1) build awareness, 2) build community, 3) encourage continued engagement.

Oh, she says, and to 3a) have fun. Hence the element of mystery, the faux holly branches that decorate some of the rows of seats, the white felt reindeer antlers she's wearing on her head.

She smiles a wide, toothy smile that makes you automatically reciprocate.

So you go along when she asks you to play get-to-know-you games. Even though you're embarrassed, you don't object when she assigns you one of the 12 days of Christmas to sing and act out when it's your turn.

Everyone's singing and laughing as the bus fits-and-starts down the freeway.

Maids-a-milking, geese-a-laying, bus-a-exiting somewhere in South Los Angeles.

It stops outside a boxy blue building — the Challengers Boys and Girls Club — where, finally, Pontius tells you you'll be helping children in foster care build the bicycles that will be their Christmas gifts.

She did it last year, she says. It was great. And she's brought along some powder that turns into fake snow, which the kids will like.

You step inside a large gym, where nothing proceeds quite as expected.

It's the holiday season, so way too many volunteers have shown up. The singer Ne-Yo is coming to lead a toy giveaway. There's a whole roomful of presents the children can choose from, including pre-assembled bikes — which means no bikes will need to be built.

You stand and you sit and you wait. Then the kids come. You try to help where you can — making sure they get in the right lines, handing out raffle tickets.

You see their joy at getting gifts, which is nice. You're in a place you might not ordinarily be, which is interesting. And as the children head out, you offer them snow. You put the powder in their cupped hands. You add water. The white stuff grows and begins to look real. It's even cold.

It makes them go wide-eyed. It makes them laugh. And you feel such moments of simple happiness are something.

It's chilly as you wait to get back on the bus. You get in a group hug with your fellow bus riders, who seem like old friends.

On the trip back in the dark, Pontius plays Christmas music. She serves you eggnog in Mason jars.

And she says she's sorry your help wasn't more needed today.

She promises the January ride will be more hands-on.

Come or don't, she tells you. But whatever you do, find a way to do something.

nita.lelyveld@latimes.com

Follow City Beat @latimescitybeat on Twitter or at Los Angeles Times City Beat on Facebook.

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Maker Mom Builds Cookie-Cutter Empire With 3-D Printers

Athey Moravetz is doing some tasty work with her 3-D printers.

The video game designer has worked on PlayStation games like Resistance Retribution and Uncharted Golden Abyss. She's also a self-described "jack-of-all-trades," skilled with 3-D modeling tools like Maya, and knows how to design compelling characters with them.

After having two children she decided to work from home, and in addition to keeping active in the computer graphics industry, she also created a wildly successful Etsy shop, where she sells 3-D printed cookie cutters based on nerd culture favorites Pokemon, Dr. Who and Super Mario Brothers.

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Alan Ball’s ‘Banshee’ Screeches Onto Cinemax in January

LOS ANGELES (TheWrap.com) – “True Blood” creator Alan Ball‘s new television series “Banshee” will premiere January 11 at 10 p.m. on Cinemax, the network said Thursday.

The drama, which is executive-produced by Ball and “House M.D.” executive producer Greg Yaitanes, centers on ex-con and master thief Lucas Hood (played by “Rush” star Anthony Starr), who assumes the identity of the sheriff of Banshee, Pa., where he continues his criminal ways while being hunted by a team of gangsters from his past. Ivana Milicevic (“Charlie’s Angels”) and Ulrich Thomsen (“The Celebration”) also star.

Series writers Jonathan Tropper and David Schickler also executive-produce, along with Peter Macdissi.

The pilot episode will re-air at 11:05 p.m. and 12:10 a.m., with additional re-airings on January 12, 13, 14, 15, 16 and 30.

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Genetic Gamble : New Drugs Aim to Make Cells Destroy Cancer

C.J. Gunther for The New York Times

Dr. Donald Bergstrom is a cancer specialist at Sanofi, one of three companies working on a drug to restore a tendency of damaged cells to self-destruct.

For the first time ever, three pharmaceutical companies are poised to test whether new drugs can work against a wide range of cancers independently of where they originated — breast, prostate, liver, lung. The drugs go after an aberration involving a cancer gene fundamental to tumor growth. Many scientists see this as the beginning of a new genetic age in cancer research.

Great uncertainties remain, but such drugs could mean new treatments for rare, neglected cancers, as well as common ones. Merck, Roche and Sanofi are racing to develop their own versions of a drug they hope will restore a mechanism that normally makes badly damaged cells self-destruct and could potentially be used against half of all cancers.

No pharmaceutical company has ever conducted a major clinical trial of a drug in patients who have many different kinds of cancer, researchers and federal regulators say. “This is a taste of the future in cancer drug development,” said Dr. Otis Webb Brawley, the chief medical and scientific officer of the American Cancer Society. “I expect the organ from which the cancer came from will be less important in the future and the molecular target more important,” he added.

And this has major implications for cancer philanthropy, experts say. Advocacy groups should shift from fund-raising for particular cancers to pushing for research aimed at many kinds of cancer at once, Dr. Brawley said. John Walter, the chief executive officer of the Leukemia and Lymphoma Society, concurred, saying that by pooling forces “our strength can be leveraged.”

At the heart of this search for new cancer drugs are patients like Joe Bellino, who was a post office clerk until his cancer made him too sick to work. Seven years ago, he went into the hospital for hernia surgery, only to learn he had liposarcoma, a rare cancer of fat cells. A large tumor was wrapped around a cord that connects the testicle to the abdomen. “I was shocked,” he said in an interview this summer.

Companies have long ignored liposarcoma, seeing no market for drugs to treat a cancer that strikes so few. But it is ideal for testing Sanofi’s drug because the tumors nearly always have the exact genetic problem the drug was meant to attack — a fusion of two large proteins. If the drug works, it should bring these raging cancers to a halt. Then Sanofi would test the drug on a broad range of cancers with a similar genetic alteration. But if the drug fails against liposarcoma, Sanofi will reluctantly admit defeat.

“For us, this is a go/no-go situation,” said Laurent Debussche, a Sanofi scientist who leads the company’s research on the drug.

The genetic alteration the drug targets has tantalized researchers for decades. Normal healthy cells have a mechanism that tells them to die if their DNA is too badly damaged to repair. Cancer cells have grotesquely damaged DNA, so ordinarily they would self-destruct. A protein known as p53 that Dr. Gary Gilliland of Merck calls the cell’s angel of death normally sets things in motion. But cancer cells disable p53, either directly, with a mutation, or indirectly, by attaching the p53 protein to another cellular protein that blocks it. The dream of cancer researchers has long been to reanimate p53 in cancer cells so they will die on their own.

The p53 story began in earnest about 20 years ago. Excitement ran so high that, in 1993, Science magazine anointed it Molecule of the Year and put it on the cover. An editorial held out the possibility of “a cure of a terrible killer in the not too distant future.”

Companies began chasing a drug to restore p53 in cells where it was disabled by mutations. But while scientists know how to block genes, they have not figured out how to add or restore them. Researchers tried gene therapy, adding good copies of the p53 gene to cancer cells. That did not work.

Then, instead of going after mutated p53 genes, they went after half of cancers that used the alternative route to disable p53, blocking it by attaching it to a protein known as MDM2. When the two proteins stick together, the p53 protein no longer functions. Maybe, researchers thought, they could find a molecule to wedge itself between the two proteins and pry them apart.

The problem was that both proteins are huge and cling tightly to each other. Drug molecules are typically tiny. How could they find one that could separate these two bruisers, like a referee at a boxing match?

In 1996, researchers at Roche noticed a small pocket between the behemoths where a tiny molecule might slip in and pry them apart. It took six years, but Roche found such a molecule and named it Nutlin because the lab was in Nutley, N.J.

But Nutlins did not work as drugs because they were not absorbed into the body.

Roche, Merck and Sanofi persevered, testing thousands of molecules.

At Sanofi, the stubborn scientist leading the way, Dr. Debussche, maintained an obsession with p53 for two decades. Finally, in 2009, his team, together with Shaomeng Wang at the University of Michigan and a biotech company, Ascenta Therapeutics, found a promising compound.

The company tested the drug by pumping it each day into the stomachs of mice with sarcoma.

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Preoccupations: When Relocation Is a Way of Life

ON New Year’s Day, the company I work for, Four Seasons Hotels and Resorts, will move me from Washington to Paris, where I will become a regional vice president of the company and general manager of the Hotel George V, which it manages.

Daniel Rosenbaum for The New York Times

Gathering the frequent-mover miles: From left are Christian and Meg Clerc, and their daughters, Eleanor and Georgia, at home in Washington.

My wife, Meg, teaches at a Montessori school. She and our teenage daughters, Eleanor and Georgia, will reunite with me at the end of the school year. It’s the seventh move for Meg and me: about every three years for the last two decades, we’ve packed and unpacked, and left newfound schools, friends, cars, dry cleaners, banks and homes, and found newer ones.

If you want to advance in the hotel industry, you’d better be able to check “yes” next to the box that asks, “Willing to relocate?” Mobility must be in your DNA if you want to move up. Originally from Switzerland, I myself have moved eight times over 25 years of working in hotels, rising from hotel restaurant food runner to hotel general manager: from Gstaad to Lausanne, Switzerland; then to Washington, Rome, Paris and back to Washington, then to Puerto Vallarta, Mexico, and to Chicago and Washington once more. Eleanor, now 17, was born in Rome. Georgia, 14, joined the journey on our first assignment in Washington.

Meg knew the score — and welcomed the global lifestyle — when she married me. In fact, she chose a mobile career herself, knowing that there would be Montessori schools worldwide.

The company provides good logistical support when it moves its employees. And on the home front, we have grown increasingly adaptive, and the moves have become easier over the years. The process begins when I first realize that a move may be in the works. Meg and I go out for lunch or coffee and review our trusty to-do list to become move-ready. Then we take our daughters out to lunch or dinner and broach the subject, beginning with “How would you feel if we moved to X?”

The worst reaction was when we planned to move back to Washington from Chicago less than a year after arriving there from Mexico. We thought the girls would be thrilled to reunite with friends in a familiar place. We thought wrong. In unison, they broke out in tears; they had just made new friends and were starting to fit in again.

Meg, so skilled at working with children as a teacher, had them talk about the roots of their fears and sadness, which usually revolve around establishing new social networks. I, racked by guilt about upsetting their cart again, blurted that they could get the puppy they had been begging for. (I had been adamantly opposed until then.) The tears stopped. Needless to say, our pup, Snickers, will be moving to Paris, too.

To stay sane at relocation time, we keep the house we’re in as homey as possible until we move, then turn the new house into a home as fast as we can. That way, we don’t have to stare at cardboard boxes on both ends of the trip. We can pack in two weeks.

Moving makes you prioritize what’s important. You have to decide what’s crucial enough to bring, and what’s marginal enough to leave behind. With friends, you have to choose those to see before you go, and the ones you want to stay in touch with after the move.

Each of us has certain things we take along — our “transitional objects.” For example, I need the big wooden credenza that’s been in my family for generations, a great coffee machine, my A.S. Roma soccer-club shirt and my watch box — after all, I am Swiss. For Meg, it’s not about things, but about creating a cozy, well-lit new space. The girls still bring their favorite stuffed animals along with photos, but their most important transitional object is each other.

BUILDING a new network of friends can be as daunting for Meg and me as it is for the girls. We’ve found friends among new work colleagues and through tight-knit expat communities. But there’s a danger of getting stuck in a cultural bubble and never befriending local people.

Our moves have brought us a great appreciation of cultural differences. The ability to adapt quickly to change helps in all kinds of situations. The moves have also prepared our daughters to make new friends quickly. Still, we wonder and worry how it will affect their future relationships. Will they have trouble forming long-lasting bonds?

We find inspiration, meanwhile, in
the lyrics of “You’re My Home,” the Billy Joel song: “I never had a place that I could call my very own, but that’s
all right, my love, ’cause you’re my home.”

As told to Perry Garfinkel.

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