Why a Bear Market Is an Investor’s Best Friend

In the USA, both the S&P 500 and the Nasdaq are in bear market territory. A bear market is often taken to mean a 20% fall. That’s either from a recent peak, or over a set period of time.But generally, investors tend to think of any sustained upwards run as a bull market. And any significant downwards spell is a bear market. Typically, the average bull market has lasted around five years. The average bear, meanwhile, continues for a little more than a year.

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Might long-term investors be better of if that was the other way round, with more falls than rises? Wouldn’t we have more opportunities to buy cheap shares? To answer that, I can’t think of anything better than looking at how the billionaire boss of Berkshire Hathaway, Warren Buffett, deals with stock market falls.

In the few weeks after the Covid-19 pandemic struck, the S&P 500 fell 30%. The recovery was surprisingly fast, with the index regaining its ground by August. The FTSE 100 took quite a bit longer, mind. What happened the next year, in 2021? The S&P 500 gained 28.7%, while Buffett’s Berkshire Hathaway slightly bettered it with 29.6%. Buying shares while they were depressed by the pandemic was clearly a good plan.

Major bear market
But that’s nothing compared to the carnage resulting from the the financial crash, which kicked off in 2007. Between a high point in October that year, and the beginning of March 2009, the S&P 500 crashed by a whopping 56%.

Berkshire Hathaway suffered too, albeit with a softer fall of 32%. Now what do we see if we wind forward a decade? From the depths of the banking crash in 2009, the S&P 500 had gained 280% by the same point in 2019. Buffett’s shareholders did a bit better on 290%, and they’d started from a significantly lower initial fall.

Just like the Covid market slump, the financial crash provided investors with a great time to buy. And those who were panicking and selling while shares were down? Well, we can see what they missed.

Fear and greed

Buffett is famed for buying heavily when he sees great companies unfairly marked down. In his 1986 letter to Berkshire Hathaway shareholders, he explained how he avoids trying to time the market bottoms. Instead, he said: “Our goal is more modest: we simply attempt to be fearful when others are greedy and to be greedy only when others are fearful.

That approach to bear markets has served Buffett, and his shareholders, well.From Buffett taking control of Berkshire Hathaway in 1965 up to the end of 2021, the S&P 500 managed a total return (including dividends) of more than 30,000%. Berkshire, meanwhile, soared by a total of 3.6 million percent!

We’re not all going to be as good as Buffett. But even investors who make regular purchases in an index tracker will benefit from bear markets over the long term. The simple truth is that when markets are down, we can buy more shares for the same money.

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by Alan Oscroft

Source: Why a bear market is an investor’s best friend – The Motley Fool UK

Critics by: principal.com

If you have reviewed these basics and you still have money at the end of the month, here’s a quick look at further investment options to consider.

1. Increase your deferral to your 401(k) or other workplace retirement plan.

The maximum amount you can contribute each year through elective salary deferrals is $19,500.1 And if you’re 50 or older, you can also make a “catch up” contribution of up to $6,500.2

“Bumping up your deferral, even by 1 or 2%, may not seem like much. But with the power of compounding earnings, it can make a big difference over 20 or 30 years,” says Heather Winston, CFP®, assistant director of financial advice and planning for Principal®. Also, weigh the difference between saving in a tax-deferred account vs. a taxable one.

Winston says if your account has taken a dip, increasing your contributions may help you reach your retirement goal sooner. If the markets have dropped, the money you defer to your retirement plan may go further by allowing you to buy more shares.

To get started: If you have a retirement account from your employer with services by Principal, you can log in to increase your contribution. First time logging in? Here’s how you create an account.

2. Add to your traditional or Roth Individual Retirement Account (IRA).

Good news: You have until July 15, 2020, to make a 2019 contribution to an IRA, thanks to recent legislation. (And you can always make a 2020 contribution now, too.)

The maximum annual contribution to a traditional IRA is $6,000. If you’re 50 or older, the IRA catch-up contribution limit is $1,000. (Read the basics of IRAs.)

Depending how much money you make and if you’re not covered by a retirement plan at work, you may be able to deduct all or a portion of your traditional IRA contributions from your taxes (details are on the IRS website). The more you save today, the more you’ll likely have years down the road.

With a Roth IRA, you can contribute up to $6,000 per year using after-tax money. If you’re 50 or older, you can add an extra $1,000 per year. To contribute the full amount to a Roth IRA, you need to make less than:

  • $124,000 if you’re single or file as head of household.
  • $196,000 if you’re married filing jointly.

You can withdraw your annual Roth IRA contributions without taxes or penalties at any time. If you have earnings, you can withdraw them tax-free in retirement.3

To get started: Review our IRA solutions to see what may be best for you.

Tip: Monitor and rebalance. If you’re investing in the market through a retirement plan, IRA, stocks, or mutual funds, consider putting this on your to-do list annually: Rebalance your portfolio (PDF) and make sure you have a diverse mix of investment options within various asset classes. A financial professional can help you learn how to do that.

3. Open a brokerage account, if you don’t already have one.

If you’ve never invested in stocks and mutual funds outside of your workplace retirement plan or IRAs, you could start by opening a brokerage account. (Not sure if you’re ready? Read “Four signs you’re ready to start investing.”)

You’ll need to know your risk tolerance. A risk profile (PDF) places you on a scale somewhere between conservative (more averse to risk) and aggressive (more tolerant of risk). Your profile can help you select investments and build a portfolio at a level of risk you’re comfortable with, while continuing to work toward your goals.

This year is a good test of investors’ tolerance for risk. If you find yourself worrying about whether your portfolio is gaining or losing day-to-day, or certainly if you’re losing sleep, you may need to adjust your risk profile. When your risk tolerance matches your investment portfolio, volatile times can be less concerning for you.

To get started: Connect with a financial professional to discuss your options.

Asset classes you might consider

If you invest, consider diversifying—spreading your money across multiple types of investments—to help reduce the risk of losing money.

  • Large companies and technology stocks will likely continue to perform well.
  • Look at small companies and sectors like energy, materials, consumer discretionary (non-essential goods and services), and financials to improve.
  • Stocks in emerging countries may perform better than those in developed countries outside the United States.
  • For bonds, go for higher yields on high quality corporate and municipal bonds at short-intermediate maturities.
4. Set aside money in a 529 savings plan for a child or grandchild.

A 529 savings plan allows you to invest your money to be used for qualified education expenses such as college, apprenticeship programs, and K-12. This includes tuition, room and board, mandatory fees, and textbooks. You designate how and where it’s spent.

Before opening an account, get a full understanding of the plan, including its tax benefits, fees, expenses, and investment options. You can open a 529 plan offered by any state, so shop around for the one that best suits your needs.

To get started: If you’re interested in learning about our 529 plan, visit scholarsedge529.com.

5. Contribute more to a Health Savings Account (HSA).

If you’re enrolled in a High Deductible Health Plan (HDHP), you can add a total of $3,550 a year for single coverage or a max of $7,100 for family coverage in 2020. If you’re over age 55 but under 65, you can also make “catch-up” contributions to your HSA, to the tune of $1,000 more per year.

An HSA offers a triple advantage on federal income taxes: Money put in isn’t taxed, it grows tax-free, and you’re not taxed when you take money out for medical expenses. Plus you decide how the funds are invested, and how you’ll use the money for health care expenses.

To get started: Talk to your employer’s human resources department about how to contribute more to an HSA associated with your HDHP.

Just How Valuable Is Tax-Loss Harvesting?

1

Investors looking to improve their overall portfolio returns often turn to tax-loss harvesting at the end of the year. This amounts to selling some stocks or assets that have fallen in value and using the losses to help offset capital-gains tax liability, reducing one’s overall tax bill.

But how much can you actually add to your returns by tax-loss harvesting?

My research assistant Kanwal Ahmad and I decided to tackle this question by running simulations over different tax regimens, portfolio sizes and holding periods. We found that on average an investor facing a capital-gains tax rate of 25% can juice an equity portfolio’s annual return by 1.10 percentage points to 1.42 percentage points with tax-loss harvesting.

The value that can be added is even greater when markets are more volatile, thus producing a bigger number of loser stocks, or when capital-gains tax rates are high, either because the federal government raised rates or an investor is selling short-term holdings.

To explore this issue, we pulled data on all publicly traded stocks on the New York Stock Exchange, Nasdaq and the old American Stock Exchange (which was acquired by the NYSE) going back to 1930. We then created value-weighted portfolios to mimic how most people invest, and ran extensive simulations of each portfolio on how to best tax-loss-harvest. 

Each simulation we ran sold off particular positions that had incurred losses according to various cutoffs. If a losing position was harvested, we added a similar asset to maintain the portfolio’s asset-allocation mix and risk level — though any position that was tax-loss-harvested wasn’t allowed to re-enter the portfolio until a month later in line with the IRS’s wash-sale rule, which says if an investment is sold at a loss and then repurchased within 30 days, the initial loss cannot be claimed for tax purposes.

We then calculated the value of tax-loss harvesting to an investor on a yearly basis as the capital-gains tax rate multiplied by the return of the stock that was cut from the portfolio, adding this up over all stocks that were harvested that year. Averaging this over all simulations and over all years, we were able to come to a maximum estimate for the value of tax-loss harvesting.

To make it a bit more realistic, we put in a condition that no more than half the portfolio could be harvested in a particular year — this we defined as our “conservative” estimate of tax-loss harvesting benefits.

Our first interesting finding is that conservatively, investors can juice their returns 1.10 percentage points a year on average, assuming a 25% tax rate. If investors are pushing it in terms of taking advantage of every tax-loss harvesting opportunity, they can add as much as 1.42 percentage points a year to their portfolio’s return.

Fund investors often debate: Should I entrust my money to an experienced fund manager with a record over many different market cycles, or should I go with an upstart manager who might have fresh ideas on how to generate gains?

My research suggests that if you want a fund that will track an index better and provide superior posttax returns, the more-seasoned fund manager is likely your best bet. If, on the other hand, you are looking for outsize bets and potential home runs, a short-tenure manager may be the way to go.

To examine the relationship between fund-manager tenure and performance, my research assistant, Ioana Baranga, and I collected data on all actively managed mutual funds between 2010 and 2020. We then partitioned all fund managers by their tenure at the fund, using a range of zero to three years to define “short tenure” managers, and six years and greater to define the “long tenure” managers. If there were multiple fund managers within the same fund, we opted to use the oldest fund manager’s tenure to define our partition.genesis3-2-1-1-1-1-1-2-1-1-2-2-1-1

Next, we explored how these fund managers differ in their returns and investment decisions. The results associated with managers in the large-cap U.S.-stock category highlight the results well. On a pretax basis, the average long-tenure manager underperforms the average short-tenure manager by 0.03 percentage point a year (12.39% average annual return for long-tenure managers versus 12.42% average annual return for short-tenure managers).

Yet this result flips when we examine posttax returns — it is actually long-tenure managers outperforming short-tenure managers by 0.14 percentage point a year, on average (9.15% average posttax annual return for long-tenure managers versus 9.01% average posttax annual return for short tenure managers).

Research Shorts

By: Derek Horstmeyer

Read more : https://www.wsj.com/

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The 10 Commandments of Salary Negotiation

The largest salary increase I’ve helped get was for a female FAANG executive: I helped her get $5.4M more on her offer. Through the process, it struck me that even though she was a senior leader everyone admired (you’d 100% know of her if I told you her name), she had very little knowledge of how to negotiate. Don’t get me wrong — she knew how to ask and be assertive, but she was much less comfortable “playing the game.”

And she’s not alone.

Regardless of how senior or junior you are, most tech folks struggle with negotiation. Partially this is because compensation is set up to be intentionally misleading. Partially it’s because sticking up for yourself is nerve-racking AF.

Here are the 10 commandments to negotiation I wish everyone knew:

1. Negotiation starts earlier than you think

Every recruiter worth their salt will ask about your salary expectations when you first start interviewing. Do not — I repeat, do not — give them a number.

What to do instead: Ask for the range they’re budgeted for the role.

How to say it: “Can you tell me the salary band for this level? Happy to let you know if it’s within my range, and we can discuss specific numbers later when I’ve met the team.”

Bonus points: If you’re junior/mid, time all your interviews so you get offers around the same time. If you’re senior, get some press before you start meeting folks.

2. Mine for intel during interviews

Go into the interview ready not just to answer questions but to ask some of your own. You will use this as ammunition to negotiate later. Here are a few examples of what you should ask:

  • What’s the biggest priority for the team right now?
  • Why is this role open?
  • What’s the biggest challenge for someone stepping into this role?
  • How does the org structure on the team work?

3. Don’t give in to the pressure

Once you’ve been offered the role, the recruiter’s job shifts from evaluating you to closing you. Most experienced recruiters will ask you again to put up a number for your salary. Clever recruiters may even tell you that they “will go to bat for you.” Yeah, no thanks.

What recruiters say: “If you give me your number, I will make it happen for you.”

What they mean: “I’ll get you something lower, but kinda close to what you asked for.”

4. At FAANG, your recruiter may have no say at all

At FAANG-size companies (i.e. over 5K employees), compensation is heavily formulaic. In fact, there is often a separate team — the “compensation committee” — who sets your salary. They take into account your background, interview performance, and level. They give the recruiter a number to go with. The recruiter then gives you the number, and every time you negotiate they have to go back to that committee to ask for a re-evaluation.

What do clever recruiters do? They get your number up-front to save some legwork.

Unfortunately, this may hurt your chances of getting more on your offer later. It also deprives you of some valuable data — where you fall in the level/salary band. If you get caught in this loop, quickly turn the tables: most companies will consider “new information,” like another offer, to reopen a negotiation. Don’t forget, an offer to stay from your existing company also counts!

5. Read between the lines

Your initial offer speaks volumes, if you know how to interpret the data. Here are a few scenarios you should consider:

Let’s say you’re applying for an L6 role at a big company.

Initial offer comes in low: The team may have felt that you have a lot of “room for growth.” In this case, my advice is to dig deeper and ask the interviewer to share feedback from folks who met you to fix any misconceptions before you ever negotiate. Telling someone you want more money because you’re “the greatest PM ever” while the team felt you were “meh” is not going to fly.

Middle of the road: You got “the number” (the medium opening number that’s basically a template recruiters use). It’s the most common opening offer — companies do this to reduce risk of lawsuits. Over 80% of people get it. It likely means you don’t have a strong advocate on the interview loop. Do not negotiate until you match with a team and you have a manager batting for you.

Initial offer comes in top-of-band: There was likely a discussion about giving you a higher level. Many times in this case, you can push for an “out-of-band” offer — essentially getting paid for an L7 while you’re an L6.

6. At a startup, the playbook is different 

You may be dealing with the founder directly. It’s very likely there is no range for the role, as smaller companies have much less access to salary data. The goal at the initial offer conversation is to understand three things:

That last one can be tricky because you need data the recruiter may be reluctant to give — the option strike price, preferred price, number of outstanding shares — and you need to understand how options work. At last, get ready to ask:

“What is the valuation based on?”

And get ready to not get a straight answer until you’ve asked five times (yes, this is normal).

TL;DR: Ask the questions an investor would ask because, *news flash*, you are now an investor — but instead of cash, you’re staking your time and earning trajectory on the company’s success. You can meet with the investors too; it’s 100% OK to ask for that when the company is early-stage.

Lastly, 2021 has been a weird year for startup compensation, so much of the data from previous years is unreliable. Remote work, abundant access to capital, and greater trust in international talent have skewed things quite a bit. Still, I find the Holloway Guide ranges to be a good starting point.

7. Your job is to win hearts and minds

It can be tempting to think you need to negotiate now that you have data. Nope, not yet. The next step, instead, is to upsell your worth before you come back with any kind of counteroffer. This is especially important if you’re going for a senior role.

What to do next: Ask for follow-up meetings with decision makers. If you’re a Director or higher, you can usually ask to meet with any VP and possibly C-level execs. VPs can often meet with the CEO and even board members. Take your time; this is important if you want your salary to reflect your value. If everyone wants you, you’ll be calling the shots later.

How to run these effectively: Come prepared with three things, tailored to who you’re meeting:

  • Questions about how you can create meaningful impact
  • Ideas based on your interviews so far
  • Bonus points: discussing obstacles to your taking the role and making them sell you on it

8. OK, now get some good data

Did you know that women make only 47 cents in equity for every dollar a man makes? A HUGE reason for that is that many women don’t fully evaluate their offer before negotiating. Let’s change that. Particularly if you are a woman, ask yourself these questions:

9. Comparing offers

Not all offers are made equal — in fact, they are intentionally confusing. At Google, you may get a front-loaded vesting schedule on your stock; at Amazon, sizable cash bonuses the first two years. It seems obvious that you should look at the comp, but that’s not everything:

  • Which company has a better trajectory?
  • How do promotions work?
  • Is your manager influential enough to pull for you when needed?
  • Is your product or team visible enough to get good resourcing?
  • What’s the company brand worth to your earnings trajectory?

TL;DR: Getting paid more up-front doesn’t always mean you’ll make the most overall. Plan carefully.

10. Time to make an ask

It can be awkward to ask for more money, but trust me, everyone expects you to do it. On top of that, it doesn’t help that so much of the advice out there is conflicting. Let’s set the record straight:

“I need a competing offer.”

MYTH: You absolutely do not need multiple offers. Just being able to say you’re speaking to other companies is sufficient — you can quote the expected salaries for other roles if needed.

“I need to provide copies of my other offers.”

MYTH: Nope, nope, nope (even though Google in particular loves to ask for them). You signed an NDA before every interview, so you can always use that as a reason.

“I should send the recruiter an email with my ask and justification.”

MYTH: Negotiating via email = MAJOR CRINGE and definitely a worse outcome. I know there are folks selling fill-in-the-blank templates out there. My advice if you want a meaningful/large increase is to have the conversation over the phone.

“If I find a number online, I can quote it as a reason to get more.”

MYTH: Nothing boils a recruiter’s blood more than “It says X on Glassdoor.” Compensation is an exact science — have arguments prepared that are specific to your situation.

“The best way to get more is to reiterate how qualified I am.

MYTH: You already got interviewed and everyone’s read your resume. That’s how you got your initial offer; now you need to build additional arguments. Use the information you collected during the interview about what challenges the team is facing — maybe that increases the scope of the role? Discuss why leaving your current role will be hard — are you critical to your current team? In other words: instead of asking for money, make them give you more money by bringing in obstacles the recruiter needs to overcome to close you.

“I need to be aggressive and threaten to walk if they don’t match.”

MYTH: LOL, let me know how that goes for you. My guess is you’ll get a mediocre increase worded as a “final offer.” If you want big moves, I’m talking $100K+ more, you need to collaborate with your recruiter, not make them an enemy.

As a final word of wisdom: Start with negotiating your overall compensation, not individual components. For example, ask for “500K” and then the next round ask “Can I have X more equity?” Then, when you’ve exhausted all other avenues, ask for a signing bonus. If you still need more help, you can always read our guide.

Now that you’ve got all these RSUs in your compensation…

If your new RSUs are more than 10% of your liquid net worth, you should make a plan to diversify ASAP. Holding a concentrated position can translate into greater portfolio volatility, which has been shown to reduce compounded growth rates and future wealth. At Candor we help you automate RSU diversification by converting your stock weekly, even during blackout periods. You can find us here.

Thanks, Niya!

Till next week, and have a fulfilling and productive week 🙏


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Browse more open roles, or add your own, at Lenny’s Job Board.

 

By: Lenny Rachitsky

Guest post by Niya Dragova, co-founder of Candor

Source: The 10 commandments of salary negotiation – by Lenny Rachitsky – Lenny’s Newsletter

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Cancer Without Chemotherapy A Totally Different World

Dr. Seema Doshi was shocked and terrified when she found a lump in her breast that was eventually confirmed to be cancerous. “That rocked my world,” said Dr. Doshi, a dermatologist in private practice in the Boston suburb of Franklin who was 46 at the time of her diagnosis. “I thought, ‘That’s it. I will have to do chemotherapy.’”

She was wrong.

Dr. Doshi was the beneficiary of a quiet revolution in breast cancer treatment, a slow chipping away at the number of people for whom chemotherapy is recommended. Chemotherapy for decades was considered “the rule, the dogma,” for treating breast cancer and other cancers, said Dr. Gabriel Hortobagyi, a breast cancer specialist at MD Anderson Cancer Center in Houston. But data from a variety of sources offers some confirmation of what many oncologists say anecdotally — the method is on the wane for many cancer patients.

Genetic tests can now reveal whether chemotherapy would be beneficial. For many there are better options with an ever-expanding array of drugs, including estrogen blockers and drugs that destroy cancers by attacking specific proteins on the surface of tumors. And there is a growing willingness among oncologists to scale back unhelpful treatments.

The result spares thousands each year from the dreaded chemotherapy treatment, with its accompanying hair loss, nausea, fatigue, and potential to cause permanent damage to the heart and to nerves in the hands and feet.

The diminution of chemotherapy treatment is happening for some other cancers, too, including lung cancer, the most common cause of cancer deaths among men and women in the United States, killing about 132,000 Americans each year. Breast cancer is the second leading cause of cancer deaths among women, killing 43,000.

Still, the opportunity to avoid chemotherapy is not evenly distributed, and is often dependent on where the person is treated and by whom.

But for some patients who are lucky enough to visit certain cancer treatment centers, the course of therapy has changed. Now, even when chemotherapy is indicated, doctors often give fewer drugs for less time.

“It’s a totally different world,” said Dr. Lisa Carey, a breast cancer specialist at the University of North Carolina.

Dr. Robert Vonderheide, a lung cancer specialist who heads the University of Pennsylvania’s Abramson Cancer Center, remembers his early days on the job, about 20 years ago.

“The big discussion was, Do you give patients two different types of chemotherapy or three?” he said. There was even a clinical trial to see whether four types of chemotherapy would be better.

“Now we are walking in to see even patients with advanced lung cancer and telling them, ‘No chemo,’” Dr. Vonderheide said.

The breast cancer treatment guidelines issued by the National Cancer Institute 30 years ago were harsh: chemotherapy for about 95 percent of patients with breast cancer.

The change began 15 years ago, when the first targeted drug for breast cancer, Herceptin, was approved as an initial treatment for about 30 percent of patients who have a particular protein on their tumor surface. It was given with chemotherapy and reduced the chance of a recurrence by half and the risk of dying from breast cancer by a third, “almost regardless of how much and what type of chemotherapy was used,” Dr. Hortobagyi said.

In a few studies, Herceptin and another targeted drug were even given without chemotherapy, and provided substantial benefit, he added.

That, Dr. Hortobagyi said, “started to break the dogma” that chemotherapy was essential. But changing cancer therapies was not easy. “It is very scary,” to give fewer drugs, Dr. Hortobagyi said.

“It is so much easier to pile on treatment on top of treatment,” he continued, “with the promise that ‘if we add this it might improve your outcome.’”

But as years went by, more and more oncologists came around, encouraged by new research and new drugs.

The change in chemotherapy use is reflected in a variety of data collected over the years. A study of nearly 3,000 women treated from 2013 to 2015 found that in those years, chemotherapy use in early-stage breast cancer declined to 14 percent, from 26 percent. For those with evidence of cancer in their lymph nodes, chemotherapy was used in 64 percent of patients, down from 81 percent.

More recent data, compiled by Dr. Jeanne Mandelblatt, a professor of medicine and oncology at Georgetown, and her colleagues, but not yet published, included 572 women who were 60 or older and enrolled in a federal study at 13 medical centers. Overall, 35 percent of older women received chemotherapy in 2012. That number fell to 19 percent by the end of 2019.

Cheaper and faster genetic sequencing has played an important role in this change. The technology made it easier for doctors to test tumors to see if they would respond to targeted drugs. Genetic tests that looked at arrays of proteins on cancer cells accurately predicted who would benefit from chemotherapy and who would not.

There are now at least 14 new targeted breast cancer drugs on the market — three were approved just last year — with dozens more in clinical trials and hundreds in initial development.

Some patients have reaped benefits beyond avoiding chemotherapy. The median survival for women with metastatic breast cancer who are eligible for Herceptin went from 20 months in the early 1990s, to about 57 months now, with further improvements expected as new drugs become available. For women with tumors that are fed by estrogen, the median survival increased from about 24 months in the 1970s to almost 64 months today.

Now some are in remission 10 or even 15 years after their initial treatment, Dr. Hortobagyi said.

“At breast cancer meetings, a light bulb went off. ‘Hey, maybe we are curing these patients,’” Dr. Hortobagyi said.

Dr. Doshi’s oncologist, Dr. Eric Winer of the Dana-Farber Cancer Institute, gave her good news: A genetic test of her tumor indicated she would not get any significant benefit from chemotherapy. Hormonal therapy to deprive her cancer of the estrogen that fed it would suffice.

But as much as Dr. Doshi dreaded chemotherapy, she worried about forgoing it. What if her cancer recurred? Would chemotherapy, awful as it is, improve her outcome?

She got a second opinion.

The doctor she consulted advised a “very aggressive” treatment, Dr. Doshi said — a full lymph node dissection followed by chemotherapy.

She had multiple conversations with Dr. Winer, who ended up discussing her case with four other specialists, all of whom recommended against chemotherapy.

Finally, Dr. Doshi said, “my husband said I should just pick a horse and run with it.” She trusted Dr. Winer.

Her struggles mirror what oncologists themselves go through. It can take courage to back off from chemotherapy.

One of the most difficult situations, Dr. Winer said, is when a patient has far more advanced disease than Dr. Doshi did — hers had spread to three lymph nodes but no further — and is not a candidate for one of the targeted treatments. If such a patient has already had several types of chemotherapy, more is unlikely to help. That means there is no treatment.

It falls to Dr. Winer to tell the patient the devastating news.

Dr. Susan Domchek, a breast cancer specialist at the University of Pennsylvania, can relate to those struggles.

“It is the nature of being an oncologist to be perpetually worried that you are either overtreating or undertreating a patient,” she said.

“Some cases keep me up at night,” she said, “specifically the cases where the risks and benefits of chemotherapy are close, yet the stakes still feel so high.”

When Dr. Roy Herbst of Yale started in oncology about 25 years ago, nearly every lung cancer patient with advanced disease got chemotherapy.

With chemotherapy, he said, “patients would be sure to have one thing: side effects.” Yet despite treatment, most tumors continued to grow and spread. Less than half his patients would be alive a year later. The five-year survival rate was just 5 to 10 percent.

Those dismal statistics barely budged until 2010, when targeted therapies began to emerge. There are now nine such drugs for lung cancer patients, three of which were approved since May of this year. About a quarter of lung cancer patients can be treated with these drugs alone, and more than half who began treatment with a targeted drug five years ago are still alive. The five-year survival rate for patients with advanced lung cancer is now approaching 30 percent.

But the drugs eventually stop working for most, said Dr. Bruce Johnson, a lung cancer specialist at Dana-Farber. At that point many start on chemotherapy, the only option left.

Another type of lung cancer treatment was developed about five years ago — immunotherapy, which uses drugs to help the immune system attack cancer. Two-thirds of patients from an unpublished study at Dana-Farber were not eligible for targeted therapies but half of them were eligible for immunotherapy alone, and others get it along with chemotherapy.

Immunotherapy is given for two years. With it, life expectancy has almost doubled, said Dr. Charu Aggarwal, a lung cancer specialist at the University of Pennsylvania.

Now, said Dr. David Jackman of Dana-Farber, chemotherapy as the sole initial treatment for lung cancer, is shrinking, at least at that cancer treatment center, which is at the forefront of research. When he examined data from his medical center he found that, since 2019, only about 12 percent of patients at Dana-Farber got chemotherapy alone, Dr. Jackman said. Another 21 percent had a targeted therapy as their initial treatment, and among the remaining patients, 85 percent received immunotherapy alone or with chemotherapy.

In contrast, in 2015, only 39 out of 239 patients received a targeted therapy as their initial treatment. The rest got chemotherapy.

Dr. Aggarwal said she was starting to witness something surprising — some who had received immunotherapy are still alive, doing well, and have no sign of cancer five years or more after their initial treatment.

She said: “I started out saying to patients, ‘I will treat you with palliative intent. This is not curative.’”

Now some of those same patients are sitting in her clinic wondering if their disease is gone for good.

Chong H. Hammond’s symptoms were ambiguous — a loss of appetite and her weight had dropped to 92 pounds.

“I did not want to look at myself in the mirror,” she said.

It took from October 2020 until this March before doctors figured it out. She had metastatic lung cancer.

Then Dr. Timothy Burns, a lung cancer specialist at the University of Pittsburgh, discovered that Mrs. Hammond, who is 71 and lives in Gibsonia, Pa., had a tumor with two unusual mutations.

Although a drug for patients with Mrs. Hammond’s mutations has not been tested, Dr. Burns is an investigator in a clinical trial involving patients like her.

He offered her the drug osimertinib, which is given as a pill. This allowed her to avoid chemotherapy.

Ten days later she began feeling better and started eating again. She had energy to take walks. She was no longer out of breath.

Dr. Burns said her lung tumors are mostly gone and tumors elsewhere have shrunk.

If Mrs. Hammond had gotten chemotherapy, her life expectancy would be a year or a little more, Dr. Burns said. Now, with the drug, it is 38.6 months.

Dr. Burns is amazed by how lung cancer treatment has changed.

“It’s been remarkable,” he said. “We still quote the one-year survival but now we are talking about survival for two, three, four or even five years. I even have patients on the first targeted drugs that are on them for six or even seven years.”

Mark Catlin, who is being treated at Dana-Farber, is one of those patients.

On March 8, 2014, Mr. Catlin, who has never smoked, noticed a baseball-size lump under his arm. “The doctors told me to hope for anything but lung,” he said.

But lung it was. It had already spread under his arm and elsewhere.

Oncologists in Appleton, Wis., where he lives, wanted to start chemotherapy.

“I was not a fan,” Mr. Catlin said. His son, who lives in the Boston area, suggested he go to Dana-Farber.

There, he was told he could take a targeted therapy but that it would most likely stop working after a couple of years. He is 70 now, and still taking the therapy seven years later — two pills a day, with no side effects.

He rides a bike 15 to 25 miles every day or runs four to five miles. His drug, crizotinib, made by Pfizer, has a list price of $20,000 a month. Mr. Catlin’s co-payment is $1,000 a month. But, he says, “it’s keeping me alive.” “It’s almost surreal,” Mr. Catlin said.

Gina Kolata

By:

Source: Cancer Without Chemotherapy: ‘A Totally Different World’ – The New York Times

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Related Contents:

SEC Signs Deal To Investigate DeFi Transactions

Blockchain analytics firm AnChain.AI has signed a deal with the U.S. Securities and Exchange Commission (SEC) to help monitor and regulate the turbulent decentralized finance (DeFi) industry, according to a company spokesperson. The initial value of the contract is $125,000, with five separate one-year $125,000 option years for a total of $625,000.

According to CEO and co-founder Victor Fang, “The SEC is very keen on understanding what is happening in the world of smart contract-based digital assets…so we are providing them with technology to analyze and trace smart contracts.”

AnChain.AI is a San Jose-based artificial intelligence and machine learning blockchain startup that focuses on tracking illicit activity across crypto exchanges, DeFi protocols, and traditional financial institutions. In revealing the SEC contract, which started in May 2021, the company also announced today a $10 million Series A round of funding led by an affiliate of Susquehanna Group, SIG Asia Investments LLP, at an undisclosed valuation.

The deal comes on the heels of the SEC taking further interest in DeFi as it rapidly matures and grows in size. The industry currently manages more than $82 billion, and the largest decentralized exchange, Uniswap, processed over $1.8 billion worth of transactions in the last 24 hours, many of which included tokens that could be determined to be securities by the SEC.

Additionally, these platforms are becoming increasingly complex. Fang noted that the Uniswap platform is actually an amalgam of 30,000 separate smart contracts that execute the actual exchange of tokens.

The SEC’s first major action against the DeFi space came in 2018, when it shut down EtherDelta, a ‘DeFi’ exchange that it deemed to be operating illegally.

In an August interview with The Wall Street Journal, SEC Chairman Gary Gensler warned that DeFi operations are not immune from oversight because they use the word decentralized, and that “There’s still a core group of folks that are not only writing the software, like the open source software, but they often have governance and fees…There’s some incentive structure for those promoters and sponsors in the middle of this.”

SEC Commissioner Hester Peirce echoed this sentiment in a March interview with Forbes, but perhaps in an acknowledgement of the potential in DeFi asked these projects to come forward and be pro-active with the regulator, “When you start to look at the tokens themselves and try to figure out whether they’re securities, it does get kind of confusing.

In particular, it’s so hard in the DeFi landscape because there’s such variety. This is why I encourage individual projects to come in and talk to the SEC because it really does require a look at the very particular facts and circumstances.”

In addition to cataloguing and monitoring known wallets tied to illicit actors, AnChain.AI has built a predictive engine that can be used to identify unknown addresses and transactions that could be suspicious. This is all part of Fang’s goal to move beyond doing “post-incident investigations” to move the “defense all the way up to the upstream” and make it “preventive”.

Aside from government clients, AnChain.AI’s technology is also being used by centralized cryptocurrency exchanges and traditional financial institutions. In a press release, Ye Li, Investment Manager at SIG said of the investment, “AnChain.AI has made great progress in developing its market-leading crypto security technology to meet its customers’ broad demand in regulatory compliance and transaction intelligence.”

The SEC declined to comment.

Follow me on Twitter or LinkedIn. Check out my website. Send me a secure tip.

I am director of research for digital assets at Forbes. I was recently the Social Media/Copy Lead at Kraken, a cryptocurrency exchange based in the United States.

Source: SEC Signs Deal To Investigate DeFi Transactions

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DeFiance: billion dollar finance, million dollar hacks, and very little value

fidentiaX: The Tradable Insurance Marketplace on Blockchain

Digital Assets and Blockchain Technology: US Law and Regulation

Why ‘DeFi’ Utopia Would Be Finance Without Financiers: QuickTake

Coders Flock Back to Crypto Projects With Prices Surging Again

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