Jerry Spivak, MD, Johns Hopkins University School of Medicine, Baltimore, MD, shares some insights into the challenges of treating and managing essential thrombocythemia (ET), and further discusses the biology behind ET and polycythemia vera (PV). Prof. Spivak also shares some thoughts on how to approach the treatment of these diseases. This interview took place at the third annual Texas MPN Workshop (TMW) 2022, held in San Antonio, TX.