The question came at dinner toward the end of June.

Anesthesiologist Nick Mondek, 48, was dying of acute myeloid leukemia, a cancer that affects blood-forming cells in the bone marrow. It was a serious topic to tackle with his then-9-year-old son, Stephen, as they ate bowls of pasta.

But Mondek needed a stem cell donor — and fast. So he asked his son to save his life.

The youngster agreed to be tested at Cedars-Sinai Medical Center to see if he could donate stem cells to his father.

The Rolling Hills Country Day fourth-grader, who dreams of becoming a doctor for a Major League Baseball team, had his own question first: “When do we go?”

In July, Stephen became what Cedars-Sinai Medical Center believes is its youngest known stem cell donor.

“I just wanted to help,” Stephen said.

His donation doesn’t just buy his father time but offers hope that Stephen’s stem cells will build a newer, stronger immune system that will help his father fight off blood cancer.

“I wanted him to do this as his own decision,” Mondek said. “I didn’t want him to feel forced. I didn’t want him to feel like he had to do it.”

Mondek’s journey from doctor to patient began in April 2022.

The then-45-year-old, an employee at the Martin Luther King Jr. Ambulatory Surgery Center, felt constantly fatigued with little appetite. Then one day he couldn’t turn his head. His resting heart rate jumped from a standard 60 beats per minute to a concerning, racing 100 bpm.

“Being a typical stubborn physician, I just kept writing it off,” he said. “I would take antibiotics, I would take ibuprofen, thinking it’s this, thinking it’s that, not even entertaining the fact that it could be cancer or even leukemia.”

Weeks of unrelenting symptoms led Mondek to take a simple Complete Blood Count, or CBC, test. He was hospitalized within hours of receiving the results.

Mondek first found aid in his brother, whose stem cell donation sent Mondek’s blood cancer into remission.

In April, however, the leukemia returned.

“We followed every clinical protocol, but the disease still managed to come back, so we had a new problem on our hands,” Dr. Ronald Paquette, clinical director of the Stem Cell and Bone Marrow Transplant Program at Cedars-Sinai Cancer, said in a news release. “How could we treat his cancer a second time around and have a better chance that it doesn’t return?”

Paquette and Mondek searched for genetic matches but found none in his family or in the National Bone Marrow Registry.

Stephen Montek with his dad, Nick; mom, Danielle Boyer, and brother, John.

(Courtesy of Cedars-Sinai)

That’s when Mondek opted for a curveball.

He recalled a friend successfully fought lymphoma after receiving a stem cell transplant from his 18-year-old son.

Paquette confirmed that Stephen, who turned 10 last month, was a possibility. Stephen was automatically a partial match since children receive half their DNA from each of their parents.

Further testing revealed that Stephen’s immune system was compatible with his father’s.

Mondek’s next conversation with his son was even more challenging than the initial lifesaving ask. He had to explain the ins and outs of the taxing preparation and procedure.

A bandage covers Stephen Mondek’s neck where a central line catheter was inserted for the stem cell donation.

(Courtesy of Cedars-Sinai)

“Every day, I tell patients about the risks and benefits before their procedures,” Mondek said. “And obviously they’re over 18 and they’re adults, so they can understand the pros and cons. So it’s like, how do I talk to a 9-year-old?”

Mondek explained to his son that there would be several weeks of pre-donation prep that included shots and blood exams. Although his son had reservations, he wasn’t concerned about anesthesia or procedures. He did have one worry.

“I didn’t want to miss any time playing baseball,” said Stephen, a Chicago Cubs fan and a catcher on the Rolling Hills Little League baseball team.

There were, however, special considerations because of Stephen’s age. A normal stem cell donation, for instance, is generally a non-surgical procedure in which blood is extracted from an arm through an IV.

Since Stephen’s veins are significantly smaller than an adult’s, doctors had to find another entry point.

Stephen arrived the day of his procedure at 7 a.m. He was placed at Cedars-Sinai Guerin Children’s pediatric ICU, given general anesthesia, intubated and put on a ventilator before a central line (catheter) was inserted into his neck, according to his father.

Stephen was then extubated and woken up, and then he rested for an hour before his blood was drained and spun through a centrifuge for six hours to separate out the stem cells.

“A donation from a child this young is very rare,” critical care pediatrician Dr. Hoyoung Chung said. “Stephen was very brave, and our team made sure everything went perfectly so that this young boy could help his father.”

Stephen went home that same day to his father, mother Danielle Boyer, and his younger brother, John.

His father’s recovery was not nearly as quick.

Mondek was admitted on July 23 and spent six days at Cedars receiving chemotherapy to suppress his immune system, making it less likely to reject Stephen’s cells.

Mondek passed an additional two weeks in the hospital to protect his fledgling and vulnerable immune system.

Paquette told Mondek that although the surgery was successful, it could take more than a year to determine if his new immune system, powered by his son’s cells, could defeat the leukemia. For now, he’d just have to wait.

On Aug. 16, Mondek was finally discharged from the hospital.

He drove straight to Stephen’s baseball game to catch his son’s final inning.

After a contentious discussion that at times referenced discredited theories, low-quality data and desperate pleas from physicians and patients to rely upon sound science, a key CDC committee opted Friday to weaken its existing recommendations on COVID-19 shots, while punting other vaccine decisions to a later date.

The Advisory Committee on Immunization Practices voted unanimously to pull back its current unequivocal recommendation that all adults get vaccinated against COVID-19 in favor of a process of “shared clinical decision making,” in which patients are encouraged to speak to a doctor, nurse or pharmacist first.

The group came extremely close to recommending that the COVID-19 vaccine be available by prescription only, with a 6-6 vote broken by chair Martin Kulldorff’s “no” vote. The group also postponed a vote on hepatitis B vaccination indefinitely, with some members arguing that a proposal to delay the first dose did not go far enough.

The two-day meeting’s chaotic atmosphere left even many close observers confused about what decisions the group actually made.

“What we’re seeing is what happens when individuals who don’t have a basic understanding about how vaccines are delivered are making these crucial policy decisions for the American public. They don’t know what they’re doing,” Dr. Sean O’Leary, chair of American Academy of Pediatrics’ Committee on Infectious Diseases, said Friday during a news conference over Zoom. “What we are getting from ACIP is confusion.”

On Thursday, the committee voted that children under the age of four receive the measles, mumps and rubella (MMR) vaccine and the varicella, or chickenpox, vaccine in two separate shots given at the same time, instead of a single dose.

It was a relatively minor change. Many pediatricians already do this in order to reduce the risk of febrile seizures.

But the meeting’s tone and the decisions the committee appeared poised to make profoundly worried many physicians and public health officials.

“The damage isn’t just in today’s specific votes, it’s in legitimizing this framework where these laboratory-based studies and theories based on misrepresented findings are given equal standing with robust population-level safety data,” Dr. Jake Scott, an infectious disease specialist at Stanford University School of Medicine, said Friday. “Now every anti-vax group knows that they can package their claims and scientific-looking slides and cite some weird paper out of context, and then potentially get their concerns mandated into official medical documents.”

The COVID-19 discussion was led by Retsef Levi, a professor of operations management at MIT Sloan and the lone member of the committee with no biomedical or clinical degree.

He began the discussion by making clear that the committee would take into account anecdotal evidence and unpublished reports in its decision making, together with rigorously researched data.

“We need to leverage all the relevant published and unpublished scientific, clinical and public health data, information and knowledge, including experiences from the field. We are going to focus on personalized risk benefit analysis, and we’re going to very much stay away from the narratives or the statements about ‘safe and effective,’” said Levi, who has stated that mRNA vaccines are deadly and should be pulled from the market. “We don’t believe that these are appropriate or scientific language to talk about the issues related to vaccination.”

At one point, a microphone caught someone in the meeting muttering “idiot” as Levi was talking. It was not clear who the speaker was.

The group voted unanimously to postpone any changes to hepatitis B vaccination. Vaccine skeptics appointed to the committee said that a proposal to delay the first dose by a month didn’t go far enough.

ACIP member Vicky Pebsworth, a nurse who serves as research director for the National Vaccine Information Center, an organization long criticized for promoting inaccurate information, criticized the CDC for glossing over side effects of hepatitis B vaccine such as fever, sleepiness and fussiness.

“These are not trivial reactions,” Pebsworth said. “I personally think we should be erring on the side of caution and adopt a more prudent vaccination policy.”

Hepatitis B has been nearly eliminated since the vaccine was introduced in 1991.

Up to 85% of babies born to infected mothers become infected themselves, and the risk of long-term effects from the disease is higher the earlier the infection is acquired.

Infants infected in the first year of life have a 90% chance of developing chronic hepatitis B and 25% of those who do will die from complications such as liver cancer and cirrhosis, according to the American Academy of Pediatrics.

Side effects from the vaccine are extremely rare, CDC scientists told the committee Thursday, and those that do occur tend to be mild.

Several committee members indicated they were unconvinced.

“There are gaps in what we know and understand about the effects of hepatitis B [vaccine], particularly on very young infants, and the conclusion that we know that it is safe is perhaps premature,” Pebsworth said.

At one point, she asked whether the irritability and fussing some babies showed at the time of the shot could be early symptoms of neurological problems stemming from the vaccine that hadn’t been studied.

At this, committee member Dr. Joseph Hibbeln pushed back.

“We have to vote on where there’s data of concrete harm or concrete benefit,” said Hibbeln, a psychiatrist who previously served as a section chief at the National Institutes of Health. “We’re going beyond data, and we’re turning into a discussion of speculation and possible clinical outcomes for which we have no data.”

The American Academy of Pediatrics said in a news conference Thursday that it would continue to recommend that infants receive their first hepatitis B shot at birth.

America’s Health Insurance Plans, an association that includes major U.S. insurers such as Aetna, Humana, Kaiser Permanente, Cigna and several Blue Cross and Blue Shield groups, announced this week that its members would continue to cover all vaccines recommended by the CDC as of Sept. 1 through the end of 2026.

For most of its 61-year history, ACIP meetings have been dry, technical affairs in which committees of experienced physicians, public health officials and research scientists get deep into the weeds of vaccine and disease data.

The committee’s role in vaccine insurance coverage and availability in the U.S. is paramount. Insurers are only required to cover vaccines the CDC endorses, though they can choose to cover others as well. The committee’s recommendation has typically set the vaccine schedule followed by schools and physicians. It also determines what vaccines are covered by the CDC’s Vaccines for Children Program, which pays to immunize nearly half the nation’s children.

Previously, the committee collaborated year-round with expert working groups like the American Medical Assn., the American Academy of Pediatrics and the Infectious Diseases Society of America to craft its recommendations and guidelines. Members also served staggered terms, so that new people coming on always joined colleagues with previous experience, and often went through more than a year of vetting.

But Kennedy fired the entire 17-member committee in June, and then informed medical groups they were no longer invited to review scientific evidence and advise the committee in advance of the meeting.

With the exception of Dr. Cody Meissner, who served on ACIP under presidents George W. Bush and Barack Obama, all of the members are new.

The lack of experience showed.

The group started the day by redoing a vote they’d hurriedly cast the previous afternoon on whether public funding would continue to cover the combined MMRV shot, as several members confessed to not fully understanding the text of the measure they’d voted on. In the new vote, they determined that it would not.

In August, Kennedy fired CDC Director Susan Monarez, who was appointed to the position by President Trump. On Wednesday, Monarez told a Senate committee that Kennedy fired her in part because she refused to sign off in advance on changes he planned to make to the vaccine schedule this month, without seeing scientific evidence for them.

The ACIP’s recommendations become official only after the CDC director approves them. With Monarez out, that responsibility now goes to Health and Human Services Deputy Secretary Jim O’Neill, who is serving as the CDC’s acting director.

“This committee has focused on poorly done research that supports their preconceived anti-vaccine notions, rather than trying to truly weigh risks and benefits to get to the best decisions for American kids,” said Dr. Adam Ratner, a New York City pediatric infectious disease specialist. “This ACIP meeting demonstrates a sad deterioration of our public health systems, and real families and children will suffer as a result.”

In one of the most comprehensive pictures yet of the growing health risks associated with wildfire smoke, new research suggests ash and soot from burning wildlands has caused more than 41,000 excess deaths annually from 2011 to 2020.

By 2050, as global warming makes large swaths of North America hotter and drier, the annual death toll from smoke could reach between 68,000 and 71,000, without stronger preventive and public health measures.

“The numbers are very big, and it definitely surprised us,” said Minghao Qiu, lead author and assistant professor at Stony Brook University. “We find that wildfire smoke is already killing a lot of people.”

During the 2020 wildfire season, the worst in California’s modern history, wildfires scorched more than 4.2 million acres statewide.

Many Californians, locked down during the COVID-19 pandemic, encountered choking air when they ventured outside. Bay Area residents remember the sickly orange sky they woke up to five years ago this month. The jet streams carried pollution thousands of miles east to the Atlantic Coast.

In the span studied, millions of people were exposed to unhealthful levels of air pollution. When inhaled, this microscopic pollution not only aggravates people’s lungs, it also enters the bloodstream, provoking inflammation that can induce heart attacks and stroke.

For years, researchers have struggled to quantify the danger the smoke poses. In the paper published in Nature, they report it’s far greater than public health officials may have recognized.

Yet most climate assessments “don’t often include wildfire smoke as a part of the climate-related damages. And it turns out, by our calculation, this is one of the most important climate impacts in the U.S.”

California, in particular, is projected to see the largest increase in smoke-related mortality, with over 5,000 excess deaths annually. The state’s vast forests and perennially dry climate make it the most fire-prone state in the nation. With 39 million residents, many Californians find themselves downwind.

The study also estimates a higher number of deaths than previous work in part because it projected mortality up to three years after a person has been exposed to wildfire smoke.

It also illustrates the dangers of smoke drifting from fire-prone regions into wetter parts of the country, a recent phenomenon that has garnered more attention with large Canadian wildfires contributing to hazy skies in the Midwest and East Coast in the last several years.

“Everybody is impacted across the U.S.,” Qui said. “Certainly the Western U.S. is more impacted. But the Eastern U.S. is by no means isolated from this problem.”

Elected officials and climate experts have called for reducing carbon emissions from burning fossils to prevent worsening effects from climate change. But because the concentration of greenhouse gases continues to climb each year and emissions are rising, not falling, some degree of warming is now unavoidable. Much of the carbon dioxide from a diesel tailpipe today, for example, will stay in the atmosphere for more than a century.

“Because of the inertia of the Earth’s [climate], even if we reduce the CO2 tomorrow, we are still going to see a considerable level of temperature increase,” Qiu said.

But that’s not to say nothing can be done. Qiu said it highlights the importance of adapting for a warmer planet, while working to reduce planet-warming emission.

Studies have shown air purifiers can drastically improve indoor air quality during wildfires. And states with a high fire risk, like California, should continue to fund prescribed burns, fires intentionally set by forestry professionals to clear away flammable vegetation and avoid larger wildfires.

“The tricky thing is, prescribed fires also generate smoke,” Qiu said. “So it’s going to be a trade-off. We are going to have some smoke, but the hope is it can reduce a much larger smoke burden due to [an actual] wildfire.”