‘Our ability to reach unity in diversity will be the beauty and the test of our Civilization’.

Mahatma Gandhi (1869–1948). Indian lawyer and humanitarian anti-colonialist Fig. 1.

Diversity has been in the air in areas of race, religion and gender for some time. Mahatma Gandhi certainly believed in diversity in India yet did not want differences between racial groups or Muslim and Hindu communities to cause problems. Although American President, Lyndon Johnson, signed an executive order (11246) on Diversity, Equity, Inclusion and Accessibility in the Federal Workforce Fig. 2 in 1965, it is debatable whether equity has been achieved.

Smithsonian Magazine. Zahary Clary, January 23, 2023. Source Wikipedia. Smithsonian@smithsonianService.com.

The question of equity and diversity also extends to other areas of life, including wine. Many of us are probably used to consuming wines from France, Germany and the United States of America but recently many wine shops and even supermarkets stock wines from many more countries around the world. Alice Lascelles, writing in the Financial Times, HSTI, for example, waxes eloquently about the red grape Xinomavro used in Greek wine [1] which I have not heard of before, but I have sampled Greek wines made from the Assyrtiko Fig. 3 white grape which are excellent. Both grapes are widely planted in Greece. A further example of increasing diversity in the wine trade is, I suppose, the most radical departure from historical French dominance, with the production of sparkling wines in England [2] which can often be superior to French Champagne [3]. Although not inexpensive, these wines make an excellent aperitif.

Widely planted and makes excellent white wines. Source Wikipedia.

It would be an impossible task to try to mention every country now making wine, but it suffices to say that countries you probably would never have associated with wine-making such as India, China, Eastern European and many South American countries, are now all on the map and in some cases their wines are excellent. Seth Sherwood writing in the New York Times [4] claims that the Chinese village of Jiahu might have produced the world’s first wine, several millennia before Christ! Unfortunately, lack of knowledge together with snobbery (it abounds in the wine-drinking clientele) means that several people are afraid to experiment with wines from countries with which they are not familiar. The best advice is to consult your local wine-shop owner or take a chance in a supermarket. Remember taste the wine before you read about it and of course price should never be your guide. When drinking wine, the context is most important, as has been said many times. Congenial company, a pleasant environment and good quality wine glasses should add to the overall pleasure of your experience.

What about diversity in wine labels? Well, there has been a revolution from the more traditional label and many are spectacularly brash, and not to my liking. However, the days when wine labels carried illustrations of medieval castles or knights in shining armour are rapidly becoming scarce. Yet wine-labels help to sell wine, as a local wine merchant confirmed to me recently. Of course, which label appeals to you, is a very personal matter.

Is there diversity in haematology? The molecular revolution and the unravelling of the human genome has opened new avenues in our understanding of human and plant diseases and helped to provide a greater diversity of novel treatments. In other areas of medicine, happily, things are changing for the better. In countries where historically female medical students were in a minority, the ratio of males to females is now almost 50/50. In Trinity College Dublin there are now 70% females in the first year. Academic promotion is probably still easier for males than females in most countries, but parity of remuneration in not usually a problem. I understand that in some countries a bizarre practice continues in which paediatricians receive less remuneration than adult physicians! Very young children who cannot speak and therefore don’t present with symptoms, surely present an additional diagnostic challenge!

I attended the American Society of Haematology (ASH) annual meeting almost every year since my fellowship days at the University of Minnesota in the early 1970s until the outbreak of Covid. I was always struck by the lack of diversity in the audience in terms of both gender and race. However, happily, I understand that things have improved in recent decades. Another reflection of the issue, however, was the apparent lack of interest in Sickle Cell Disease (SCD). This was evident in the lack of scientific papers presented about this very important disorder. In a recent conversation with Professor Michael DeBaun from Vanderbilt University it seems that things have improved, at least in certain areas. He tells me (personal communication) that the situation, at least for children has improved. Stroke has been virtually eliminated in this population with appropriate blood transfusion, frequent doppler examination of the middle cerebral artery and the use of Hydroxyurea. The situation is not as good in the adult population, however, and life expectancy remains at approximately 50 years. Specialist care for adolescents also remains a problem which may reflect the paucity of paediatric haematologists and the poor remuneration they receive in North America.

Things are taking a major turn for the better in terms of the increasing diversity of treatments available for haematological malignancies. The use of immunotherapy often combined with chemotherapy has altered the landscape for many patients. Morbidity is certainly reduced and long-term remission seems achievable. In terms of stem Cell Transplantation (HSCT) the future is looking brighter. The introduction of haplo-identical HSCT with chemotherapy, given after the graft, looks very promising but unfortunately is not a practical proposition for patients in many jurisdictions where haemoglobinopathies are prevalent. The introduction of CAR-T therapy has increased remission rates and may become an adjunct to HSCT, haploidentical or allogeneic HSCT. Haploidentical transplant with thiotepa and post-transplant cyclophosphamide is now a readily available option for adults with SCD living in middle-high income countries with overall survival at least as equivalent to gene therapy [5]. Immunotherapy may also have a place in the treatment of benign haematological disorders, reducing the toxicity of current treatments and making life more ‘normal’ for patients.

Is there diversity in haematological practise? Yes, including treatment of benign and malignant haematological conditions and problems in coagulation but this can be a double-edged sword. Transfusion medicine has been a separate entity within haematology for as long as I remember but, when in practise, I was regularly asked to see patients with bleeding problems in the ICU and throughout the hospital. Now these problems are the ‘territory’ of specialists in coagulation medicine and no longer within the realm of the general haematologist. Many will say that this is a welcome development but it may result in doctors becoming ‘over-specialised’ and failing to treat the patient rather than the illness!

Whatever your preferences in wine please keep a wide perspective which will help to improve your palate. Regarding haematology the situation, I’m afraid, is irreversible and sub-specialisation is here to stay, certainly, in large teaching hospitals,