Everything was worked out in the battle plan against my lymphoma. Or so I thought.

I was scheduled to start a combination of chemo and immunotherapy the coming Sunday morning. The chemo would zap the cancer cells that had grown mainly on the lymph nodes around the back of my abdomen, while the immunotherapy would recruit my body’s own defenses to target a specific B-cell protein gone rogue.

The remission rates were impressive with many people reporting up to 10 years of PFS – that’s “progression-free survival,” medical speak for the number of years without disease before the cancer returns.

My particular cancer is called “follicular lymphoma.” It’s not currently curable but is increasingly being seen as a chronic condition, like diabetes or high blood pressure. As long as you stick to your treatment and meds, you can live a relatively normal life.

“The chemo is not like you think from the movies,” a friend, who has the same kind of lymphoma as me, reassured me. “You don’t lose your hair. I barely had any side effects and they have these great pills that knock out the nausea in 10 minutes. That’s if you even get sick.”

All things considered, I was feeling pretty positive – raring to go and ready to beat the beast in my body.

Then I got a second opinion.

I met with one of the leading hematologists in the country, the kind of expert whose name, when you Google hematologists in Israel, is one of the first to pop up.

“You don’t need chemo,” he pronounced calmly in his Tel Aviv office, after reviewing my CT scans, blood tests and pathology results. “We can treat you with just immunotherapy.”

Now, despite everything I’d previously learned about how chemo’s not so terrible, it’s still, well, chemo, and if I could avoid taking on an unnecessary toxic burden, that seemed a better alternative.

“He says I don’t need chemo!” I excitedly told my main doctor back in Jerusalem.

“I’m not so sure,” she countered, and in her hesitation, my balloon burst into a thousand needles searching for a vein in vain. “Just doing immunotherapy usually results in a much shorter period of PFS. But it’s your decision.”

How do you decide something like that, with implications that go far beyond such pedestrian daily dilemmas as choosing a particular restaurant or deciding between buying an electric or gasoline-powered car?

My dilemma was one we all experience at times: How much risk and uncertainty can you handle?

In my case, was the toxicity of chemotherapy worth the likelihood (though without any kind of guarantee) of gaining more time until the lymphoma comes back?

Or was it smarter to buy just a few years today with the hope that one of the many newer immunotherapy treatments in clinical trial would be ready by the time I needed it?

Complicating the decision even further: There is no data that either direction makes a difference for overall life expectancy. And no one can say in advance how Brian’s body will react.

Back and forth I went, weighing this apple against that orange. I was suffering from Fear of Making a Decision – any decision, but particularly a wrong one.

Fear of Making a Decision (let’s call it FOMAD for short) is not exclusive to health, of course. It rears its indecisive head whenever any kind of really big choice is in play: choosing a partner, a school, a job, moving to a new country.

FOMAD is where its sister anxiety FOMO (the Fear of Missing Out) gets its Sliding Doors moment and nothing is the same after.

I felt paralyzed. How could I possibly decide?

“You’re so not paralyzed,” my therapist said to me. “You’re actively engaged in finding out as much as you can. You just haven’t come to a decision yet.”

My therapist was right (again). Since my diagnosis, I had met with some of the top experts in the field in Israel, including a third physician who’s been described as a “lymphomaniac.”

At the same time, I was doing my own intensive research, reading scientific papers and learning a litany of acronyms (GELF, PRIMA, FLIPI, R-CHOP, CAR-T and many more). I’d joined online support groups and talked at length with other follicular lymphoma patients about their experiences.

Investigating antibodies and treatment modalities had become a full-time job.

It was my wife Jody who helped me grapple with my decision-making fear.

“Given that neither option is going to kill you, can you be comfortable in whatever decision you come to, knowing that you’ll be making it with imperfect information?” she asked.

Jody, I realized, was essentially making a religious argument: Can you have faith, even where some things are as yet (and possibly will always be) unknowable?

The irony was not lost on me: I’ve spent much of the last decade moving away from religion thinking. And now the way to balance the risks ahead was to … have faith?

“Either choice is a risk,” my main doctor said after another one of our marathon “debating” sessions. “But it’s a calculated one. There really is no right or wrong answer.”

At this point, I know as much as I can about my disease and how to treat it. Whichever direction I opt for in the end, ultimately I’m choosing faith – in science and modern medicine and the wisdom of my caring physicians.

That’s a religion I can get behind.

I first wrote about decision-making with imperfect information at The Jerusalem Post.

Image from Bill Branson (Photographer) via Wikimedia Commons.


Lessons from lymphoma

by Brian on February 25, 2018

in Cancer,Health

To her great credit, my doctor never used the word cancer. “You have a growth on your lymph nodes,” she said at the start of a 45-minute conversation. “It’s indolent” – linguistically idle or, in medical terms, slow growing.” “It’s the lowest grade of the least aggressive form of lymphoma.”

Yet, no matter how she sugarcoated it, my life still changed on that rainy afternoon in the hematology ward at Jerusalem’s Hadassah Medical Center. I am now a person with cancer and I will be for the rest of my life.

I’m lucky: My particular lymphoma was caught early and my treatment will be relatively mild. (How that actually plays out I can’t say yet as I don’t begin until next week.) The bad news: the cancer will almost certainly come back, although it could be another 10 years “by which time our medications should be that much better,” my doctor reassured me.

In that way, a cancer diagnosis like mine is like finding out you have an incurable, chronic but usually treatable illness. It’s similar to HIV in that way. In the 1980s, if you were diagnosed with the virus that causes AIDS, it was almost certainly a death sentence. Today, you can live a nearly unimpaired life with the right medical cocktail.

In the first few days after my diagnosis (which came after several months of stomach pain, 3 ultrasounds, 2 CT scans and finally a biopsy), my mood cycled through repeated rounds of depression and despair followed by cognitive resolve.

I would beat it, of course. I’d maintain a positive attitude throughout, no matter how sick I might feel. I’d embrace the toxic chemicals as they cleansed my blood of the tumors that had arrived unbidden in my abdomen. I’d transform this misfortune into meaning, a learning experience worthy of a TED Talk.

And then I would break down again and scream in the shower: “It’s not supposed to be this way. This shouldn’t be my life!”

“Who said so?” my therapist challenged me. “Who said life is ‘supposed’ to be easy, that you ‘should’ be healthy and that everything will just go great until you drop dead someday, painlessly from old age?”

She was right. I have a long history with “shoulds.” My often unrealistic expectations – of myself, of others, of how the world should work – are my personal anti-mindful bugaboo.

My therapist and I explored where this message might come from. Perhaps it’s from my own history with illness. This is, after all, not my first dance with a long-term, debilitating condition.

When I was 12-years-old, I was diagnosed with Crohn’s disease. In a tweenage flash, my dreams for the life I “expected” blew up – at least in my imagination. I would be in constant pain from the inflammation, I wouldn’t be able to travel, no one would ever love someone disabled like me.

It’s not supposed to be this way. This shouldn’t be my life.

For a while it was pretty tough. I was on a ton of medication, including one phase where I had to take a steroid enema every night. The picture in my mind: backpacking through Europe after finishing college lugging a suitcase full of enemas. Thankfully there was no TSA back then; I’m sure I would have been over the carry-on liquid limit.

I was fortunate then as I am now: my Crohn’s disease went into remission for nearly 30 years. Still I worried. I interpreted every upset stomach over the decades as a sign the Crohn’s was back, even as my doctor explained that everyone gets a tummy ache now and then. Sometimes I would whisper, “Is this cancer?”

Ironically, it was my vigilance and refusal to accept the pains that would eventually send me to the ER last year as my new normal that led to the ultrasound that first detected something amiss.

I “shouldn’t” have gotten Crohn’s disease then, and I “shouldn’t” have to live with lymphoma now. But I do and I will.

My life, post-Crohn’s diagnosis, turned out all right. I found someone who loves me and whom I love dearly. We raised three wonderful children – in Israel to boot. I have meaningful work, a well-received book and have traveled the world (and I never had to pack a suitcase full of enemas).

I debated whether to write about my lymphoma publicly – I wasn’t seeking any extra attention on a topic that was, until just a few weeks ago, far from my main area of interest and expertise. (I’m “supposed” to be the electric car guy.) But I figured I write about everything else – religion, relationships, cannabis and sex; how could I not share that which is most pressing in my life?

I’m not sure how I’ll feel in the coming months. But if there’s anything I’ve learned so far in the short time I’ve sat with this unexpected diagnosis, it’s that with cancer, as with life, there are no shoulds.

I “broke” the story on my cancer at The Jerusalem Post.


Secrets of the Startup Nation

by Brian on February 5, 2018

in Only in Israel,Technology

As thousands of high-tech executives and investors gathered in Jerusalem for this year’s OurCrowd crowdfunding summit, the question of how Israel became the Startup Nation was never far from discussion.

How did Israel, a tiny nation, with no natural resources of its own and surrounded by enemies, come to have more companies on Nasdaq than India, Japan and Korea combined? How did we become no. 1 in the world in both R&D spending and venture capital investment per capita?

Why does every major technology company – Apple, Facebook, Microsoft, Google, Intel, General Electric and more – have an office here, developing some of the most cutting-edge technologies in artificial intelligence, cybersecurity, autonomous driving and medical devices?

There’s no shortage of answers – heck, there’s even an entire book (Saul Singer and Dan Senor’s bestselling “Start-up Nation”) dedicated to the subject.

I’d like to offer 5 reasons of my own.

1. Innovation army. This is probably the most cited way that Israel is “different” than other countries, and for good reason. Israel’s mandatory conscription gives 18-year-olds incomparable responsibility.

Critical decisions that have changed the direction of wars can – and have – been decided by soldiers in the field. Hierarchy in the IDF can be surprisingly informal and privates who speak up are often rewarded not punished.

That’s something Ilan Regenbaum wants to see more of. The 27-year-old immigrant from Atlanta is serving in the Israeli Air Force’s “Innovation Unit,” which has as its goal transforming the army from a bureaucratic machine to something more Google-like.

Regenbaum’s unit runs an in-house “accelerator” (the first internal army accelerator anywhere). Think Y Combinator or MassChallenge but for military entrepreneurship. While it’s just Air Force for now, the aim is to eventually change the culture of the IDF as a whole.

2. Immig-tech. From its very start, Israel has been a nation of immigrants and that has contributed immeasurably to the proliferation of new ideas, increased economic demand, and brought an infusion of tech talent looking for a home.

Immigrants have played an especially strong role in Jerusalem, my hometown. According to Startup Genome’s 2017 Global Startup Ecosystem Report, Jerusalem startups have the 7th highest rate of immigrant founders in the world, at 34 percent. That’s double the percentage in Tel Aviv. It makes sense: Immigrants don’t fit neatly into Sabra-led organizations, so they create their own.

3. Chutzpah. When you live in a neighborhood like the Middle East, and especially when you’re young and idealistic, nothing seems impossible and Israeli entrepreneurs will try just about anything, fail and try again. Sometimes this leads to great success. But chutzpah can be a double-edged sword.

Israeli electric car startup Better Place, the subject of my recent book TOTALED, is a perfect example. The company’s CEO, Shai Agassi, was truly motivated by a desire to wean the world off oil. His often brash behavior helped the company raise nearly a billion dollars. But Agassi’s audacious style also alienated many of the partners Better Place would eventually need to succeed.

Still, even though the company has now gone to a better place, Yaron Samid, who founded the TechAviv Founder’s Club, told me when I spoke to the group in December that we need more people like Shai Agassi, not less, and now more than ever. “Only people who dream so big can truly change the world and inspire others to do the same,” he said.

4. Argue like an Israeli. Roey Tzezana is a futurist and author of the Israeli bestseller “Guide to the Future.” To solve the world’s biggest problems, tech leaders and entrepreneurs need to “argue more like Israelis,” Tzezana says.

“We need to create a culture and a society where people aren’t afraid to disagree” like they are in much of the overly polite West, Tzezana told me; “where they aren’t afraid to fight over intellectual dominance, and will really shout at each other – and later get up, shake hands and give each other a hug.”

5. People of the fix. Jewish sources are full of apparent contradictions, where it says one thing and then later another thing entirely. Sometimes that’s a story that doesn’t make sense. (Did the Flood described in the book of Genesis last for 150 days or for 40 days and 40 nights?) Other times it’s a minuscule interpretation of Jewish Law. (When can one eat from the new harvest? From the height of the day or only after a sacrifice is brought?)

The rabbis in the Talmud can’t stand cognitive dissonance. And so much of their back and forth bickering is really working over areas in dispute, until they come to some type of harmonic resolution.

Our tradition – and our thinking today – is filled with this type of “fixing.” Indeed, the Jewish brain seems hardwired towards Tikkun Olam (“fixing the world”) from the very act of studying our foundational texts.

Do high-tech entrepreneurs think about this when they’re researching a cure for cancer or building an Iron Dome? Some do.

Prof. Zvi Bentwich founded NALA, an NGO that addresses “neglected tropical diseases” like schistosomiasis (snail fever) in Africa. “Tikkun Olam was very much a mission in our family,” he told me in a recent interview. “I volunteered early on as a student. So I feel that it’s kind of an obligation.”

Gal Salomon, the CEO of CLEW Medical, perhaps says it best. “The Jewish mind is always coming up with new ideas.” Israelis, he adds, “just won’t take no for an answer.”

I presented my 5 reasons Israel is the Startup Nation first at The Jerusalem Post.


“I heard Ben broke up with his girlfriend. I’m sorry.”

“Don’t be.”

“Why not?”

“They weren’t good together. They were always fighting.”

“Well, that’s a relief, I guess.”

“Not really. He’s got a new girlfriend. She’s even worse.”

“What’s wrong this time?”

“She’s not Jewish.”

“But do they get along?”

“Oh yes, they are very compatible. I’ve never seen Ben happier in fact. They want to get married.”

“So what’s the problem?”

“I told you already. She’s not Jewish.

“But do you like her?”

“Of course. But I’d rather he was unhappy with someone Jewish than happy with someone who’s not.”

This is a composite of a real conversation I’ve heard many times over the years in the Jewish world. It’s always struck me as wrong-headed. If you were to substitute a different ethnic or religious descriptor for “Jewish,” you would be immediately (and rightly) called out for prejudice.

Just think of the 2017 hit movie “The Big Sick” where Kamil, a Pakistani Muslim, falls for Emily, who is white. Kamil’s parents, who spend much of the film trying in vain to arrange a marriage for their son, don’t approve. It’s not hard to guess which side we’re supposed to root for.

But in the Jewish world (and for other groups where tribal continuity is a key religious or national value), combatting intermarriage is so important we check the moral outrage we’d have for other groups at the door.

There’s a word for this: endogamy. Merriam-Webster defines endogamy as “marriage within a specific group as required by custom or law” and adds that the practice is “characteristic of aristocracies and religious and ethnic minorities in industrialized societies but also of the caste system in India and of class-conscious non-literate societies such as the Masai of eastern Africa.”

How is it, then, that highly-educated Jews in the 21st century still advocate for endogamy?

It makes sense when you’re in the thick of it. If you believe that Jewish tradition is beautiful and valuable, then sticking to “one’s own kind” may be the best way to ensure that continuity. And certainly, over the years, it’s been a highly successful ethnic strategy.

It’s less of an issue in Israel with its Jewish majority, but it’s not entirely absent either. An interfaith candle lighting at the First Station in Jerusalem for Hanukah last year was repeatedly disrupted by protests from Lehava, an extremist group whose name is a Hebrew acronym for “Prevention of Assimilation in the Holy Land.”

Most Jews would agree that support for endogamy sounds outrageous when applied to other groups. Moreover, it’s totally out of sync with today’s Millennials where endogamy is an absolute no-go.

That includes Millennial Jews in the Diaspora where dating someone who’s of a different faith is not just a demographic reality but a politically-correct imperative.

Anti-endogamous Millennials can argue that, now that we know more than our ancestors did about genetics, in-marrying is a biological mistake, leading to a greater chance of propagating DNA mutations and depleting genetic diversity.

Endogamy conflicts with the liberal American values I grew up with. And yet, I’m conflicted. I love being Jewish so I married a Jewish woman.

But that muddled message is increasingly falling on deaf ears. You want to win the intermarriage battle among Millennials? You can’t – at least not without promoting what comes across as racism masquerading as religion.

Move to Israel like we did as a solution, where our children have a much more likely chance of marrying another Jew? That might work for some, although these days, most Jews making aliyah from Western countries are those already supporting endogamy.

Embrace both patrilineal and matrilineal descent where a child is considered Jewish if either the child’s father or mother is? That increases the pool of Jews but still doesn’t address the core liberalism vs. endogamy dilemma.

My colleague Dan Libenson has been thinking about this too. Dan co-hosts the podcast “Judaism Unbound,” which tries to imagine what the future of Judaism, particularly in North America, will look like.

Judaism’s deep-seated cultural attachment to endogamy has made Jews “who marry non-Jews feel ‘less than’ in the Jewish community and it makes them less likely to get involved,” Libenson says. It’s a self-fulfilling feedback loop that works against the Jewish community’s objective of increasing meaningful Jewish engagement.

If Judaism is defined around an idea “that intermarried Jews and their families cannot by definition achieve, they are going to be more likely to see it as something that is not for them,” he adds.

Libenson imagines that if Judaism adopted an anti-endogamous position, that message would eventually fall by the wayside. “It might take a few generations and we may see decreased Jewish practice in the children of intermarried couples in the meantime, but that doesn’t necessarily mean it will stay that way.”

More than that, Libenson doesn’t think the communal aim “should be ‘easy continuity.’ I don’t see ‘some Jewish practice continuing through the generations’ as a worthy goal. Endogamy is basically a way to avoid the hard work.”

The argument against endogamy is, for the Jewish Diaspora, much like the case I’ve made in previous columns for a Jewish future in Israel driven by datlashim (formerly religious Jews). Both involve extraordinary struggles for the soul of our people and will require intense creativity. But we can’t avoid either.

Can we wish Ben and his partner a happy life together? Can we afford not to?

I first put into words the case against endogamy in The Jerusalem Post.


What’s fueling the growing phenomenon in Israel of datlashim – the Hebrew acronym for formerly religious Jews? And how big is it in real numbers?

Based on surveys conducted by the Central Bureau of Statistics, the Chotam religious lobbying organization found that, among the national religious public, only 46 percent of those who defined themselves as religious in 2002 remained so ten years later.

Jewish educator Aryeh Ben David has been trying to make sense of the numbers – both on a personal and professional level. The director of Ayeka, a Jerusalem-based institute that offers training in “soulful education,” Ben David says that too often religious parents blame themselves. That includes Ben David, whose own sons have left the religious path.

“If only we had sung different songs, practiced different rituals, or followed different halachic opinions, maybe things would have turned out differently,” he writes in a recent soul-baring column.

But what is happening now among religious teens and twentysomethings “is way beyond any individual tweaks we think we should or should not have done,” he continues. “The issue is systemic. Traditional Judaism is not working for this next generation.”

Ben David says we are in the midst of a “radical disruption” prompted by the establishment of the State of Israel itself. Growing up as a ‘powerful majority,” he says, has been transformative. “For this generation, Jewish continuity has never been in doubt. Jewish existence is simply a fact. Individual Jews may slip away but the fear of the Jewish People not continuing is a worry of the past.”

That creates a new reality where “obedience is no longer a prized value.” Strict adherence to Jewish Law is all about sustaining, Ben David emphasizes. “This generation does not know from obedience.”

Aryeh Ben David is a friend; a deep and honest thinker and that rare religious educator who dares to confront his and his community’s core assumptions without having already defined a path to a future that gives him comfort. His analysis is precise and insightful. But it also misses the elephant in the room.

It’s not just that living as a Jewish majority gives young religious Israelis an “out” from following the traditions of their parents. It’s that Jewish Law hasn’t been speaking to Jews for a long while.

Indeed, as soon as the gates of the shtetl opened to the outside world, Jews rushed to drop observance. They set up secular Yiddish-speaking societies, opened theaters and made art. Some immigrated to Israel and became kibbutzniks and soldiers. Those who moved to America gravitated towards frameworks with less stringent forms of Jewish expression.

And while some did remain observant, it’s their turn now to drop out. In that sense, the modern datlash phenomenon is not unique. It is simply the second wave.

But there’s a fundamental difference between today’s datlashim 2.0 and their historical counterparts. Datlashim in 2017 are seeking to create their own forms of spirituality, just not those centered on “obedience.”

They may spend a decade smoking pot and eating treife, but eventually, as they have children of their own, they consider ways to fuse their pasts and presents in a way that looks foreign to their parents but may very well be the future of the Jewish people.

For example, Trybe is a new age Jewish group in Los Angeles and New York that sponsors lavish Friday night “parties” that mix challah and blessings with haute cuisine (think honey-roasted kabocha squash dolloped with ricotta, braised short ribs and cauliflower rice). Its Yom Kippur services are pitched less as prayer and more as “spiritual restoration and communal vibes followed by a superfoods menu.”

My initial thought when I read about Trybe was: “How is this Jewish?” Or as Mattie Kahn, who wrote about Trybe in BuzzFeed News, asks, “Is ‘Shabbat Shalom’ the new ‘Namaste?’”

But that was the old religious me talking. My datlash self could imagine that if I were a Millennial in America, I might really dig a Trybe Shabbat.

Closer to home, the “Shalom al Lechem” project of the Jerusalem Village organization describes itself as a “social concierge and strategic matchmaker,” placing young Jews of differing practices at the same Shabbat table. Don’t know how to cook? No worries. Shalom al Lechem provides its own gourmet chef and a portable kosher kitchen, all expenses paid.

Yet, there’s another elephant in the room, and it’s one that threatens to spoil the post-denominational party. That same Chotam survey also found that the number of pupils in ultra-Orthodox schools had tripled in the last decade, seemingly offsetting any gains for datlashim.

Do the haredim hold the key to the future of religious Judaism? I ask Ben David.

The comparison isn’t fair, he replies.

“It’s hard to survey the haredi world because no one there is honest,” he tells me. “I personally know families who have exiled their children from their homes when they became non-religious. It’s ironic: Judaism was the first religion to get rid of child sacrifice. Now we are bringing it back. Families are sacrificing their children in the name of religion.”

Ben David isn’t haredi and he would never dream of kicking out his non-observant kids. Still, “I thought that God wanted my sons to be a continuation of myself,” he writes.

For Ben David, his family’s new reality is a painful realization. For me (and for my own datlash children), it’s the energizing start to a transformative, authentically Millennial and radically Israeli dialogue.

I wrote about the future of datlashim first at The Jerusalem Post.

Picture in article from a Jerusalem Village event.


Searching for cannabis in California

January 8, 2018

On my recent trip to California, I go in search of medical cannabis. Here’s what I discovered – from online “doctors” to medical dispensaries.

Read the full article →

A night in an Israeli hospital

December 7, 2017

I spent the night in the Emergency Room recently. I was expecting a nightmare. When it was all over, my verdict from my experience in the ER: surprisingly not bad.

Read the full article →

Judaism’s epistemic crisis

November 22, 2017

Are we on the verge of an “epistemic crisis?” Vox Magazine’s David Roberts seems to think so. And it has implications for battles we’re seeing in the Jewish world, from the Western Wall to the army induction office.

Read the full article →

The price of memory

November 9, 2017

“We found Mom. She’s safe.” That was the text message I received from my brother in California. It came out of the blue.

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High hopes for medical cannabis from Israel

October 13, 2017

Israel may have finally figured out a way to stop BDS. We’ll get the BDS leaders so stoned they won’t be able to demonize us anymore.

Read the full article →