Zhenya Senyak on new work in molecular biology lifting the curtain on the complex processes involved in the creation of an MPN. This emerging view of the interplay of chance and heredity — using the MPN  23andMe patient database —  is shaping our understanding of MPN realities. Whether or not it can lead us out of the dead-end wasteland of JAK2 inhibition trials into gene therapy pathways remains to be seen.