the emperor of all maladies-siddhartha mukherjee

the ultimate elephant in the room-“a biography of cancer”.

damn, heavy reading material this year, right? but it’s truly a feat to pull of the sympathetic personification of one of the scariest entities out there…bigups to mukherjee for reals. it was amazing to hear him do the press for this, from the cbc rounds (the current, strombo) to the new york times-related events. to connect it back to george, though, i wonder about the incomplete shoutout to henrietta lacks on page 339:

“The cells, technically speaking, are immortal. The woman from whose body they were once taken has been dead for thirty years.”

what’s up with that? does oprah have a gag order?

“The answers to these questions are embedded in the biology of this incredible disease. Oncogenes arise from mutations in essential genes that regulate the growth of cells. Mutations accumulate in these genes when DNA is damaged by carcinogens, but also by seemingly random errors in copying genes when cells divide. The former might be preventable, but the latter is endogenous. Cancer is a flaw in our growth, but this flaw is deeply entrenched in ourselves. We can rid ourselves of cancer, then, only as much as we rid ourselves of the processes in our physiology that depend on growth-aging, regeneration, healing, reproduction.” (462)





4 thoughts on “the emperor of all maladies-siddhartha mukherjee

  1. in our own image:

    “This image-of cancer as our desperate, malevolent, contemporary doppelganger-is so haunting because it is at least partly true. A cancer cell is an astonishing perversion of the normal cell. Cancer is a phenomenally successful invader and colonizer in part because it exploits the very features that make /us/ successful as a species or as an organism.” (38)

    “This was a generation that no longer whispered about cancer.” (181)

    and just as this line made me think, “ours is a generation that no longer whispers about AIDS”….

    “When a disease insinuates itself so potently into the imagination of an era, it is often because it impinges on an anxiety latent within that imagination. AIDS loomed so large on the 1980s in part because this was a generation inherently haunted by its sexuality and freedom; SARS set off a panic about global spread and contagion at a time when globalism and social contagion were issues simmering nervously in the West. Every era casts illness in its own image. Society, like the ultimate psychosomatic patient, matches its medical afflictions to its psychological crises; when a disease touches such a visceral chord, it is often because that chord is already resonating.” (182)

    “The daughter was a physician, and she watched me with intense, hawklike eyes while I finished the exam. She was devoted to her mother, with the reversed-and twice and fierce-maternal instinct that marks the poignant moment of midlife when the roles of mother and daughter begin to switch.” (224)

    “Death (or at least the social meaning of death) could be counted and recounted with other gauges, often resulting in vastly different conclusions. The appraisal of diseases depends, Breslow argued, on our /self/-appraisal. Society and illness often encounter each other in parallel mirrors, each holding up a Rorschach test for the other.” (233)

    “In the end, a mammogram or a Pap smear is a portrait of cancer in its infancy. Like any portrait it is drawn in the hopes that it might capture something essential about the subject-its psyche, its inner being, its future, its /behavior/. “All photographs are accurate,” the artist Richard Avedon liked to say, “[but] none of them is the truth.” (303)

    “We have not slain our enemy, the cancer cell, or figuratively torn the limbs from his body,” Varmus said. “In our adventures, we have only seen our monster more clearly and described his scales and fangs in new ways-ways that reveal a cancer cell to be, like Grendel, a distorted version of our normal selves.” (363)

  2. thank you for smoking:

    “And when a risk factor for a disease becomes so highly prevalent in a population, it paradoxically begins to disappear into the white noise of the background. As the Oxford epidemiologist Richard Peto put it: “By the early 1940s, asking about a connection between tobacco and cancer was like asking about an association between sitting and cancer.” If nearly all men smoked, and only some of them developed cancer, then how might one tease apart the statistical link between one and the other?” (241)

    “A priest with terminal lung cancer swore that smoking was the only vice that he had never been able to overcome. Even as these patients were paying the ultimate price for their habit, the depth of denial in some of them remained astonishing; many of my patients continued to smoke, often furtively, during their treatment for cancer (I could smell the acrid whiff of tobacco on their clothes as they signed the consent forms for chemotherapy). A surgeon who practiced in Britain in the seventies-a time when lung cancer incidence was ascending to its macabre peak-recalled his first nights in the wards when patients awoke from their cancer operations and then walked like zombies through the corridors begging the nurses for cigarettes.” (275)

    “When English physicians tested these mill workers in the 1920s to study the effects of this chronic malnutrition, they discovered that many of them, particularly women after childbirth, were severely anemic. (This was yet another colonial fascination: to create the conditions of misery in a population, then subject it to social or medical experimentation.)” (28)

    and prisoners (of war), factory workers, mines-these are all ways to create captive audiences for cigarettes….

  3. tunnel vision (real and imagined):

    “Immersed in the day-to-day management of cancer, I could only see the lives and fates of my patients played out in color-saturated detail, like a television with the contrast turned too high. I could not pan back from the screen. I knew instinctively that these experiences were part of a much larger battle against cancer, but its contours lay far outside my reach. I had a novice’s hunger for history, but also a novice’s inability to envision it.” (5)

    “Farber’s paper, published on June 3, 1948, was seven pages long, jam-packed with tables, figures, microscope photographs, laboratory values, and blood counts. Its language was starched, formal, detached, and scientific. Yet, like all great medical papers, it was a page-turner. And like all good novels, it was timeless: to read it today is to be pitched behind the scenes into the tumultuous life of the Boston clinic, its patients hanging on for life as Farber and his assistants scrambled to find new drugs for a dreadful disease that kept flickering away and returning. It was a plot with a beginning, middle, and, unfortunately, an end.” (36)

    “The basement of the Hospital Dieu, where anatomy demonstrations were held, was a theatrically macabre space where instructors hacked their way through decaying cadavers while dogs gnawed on bones and drippings below. “Aside from the eight muscles in the abdomen, badly mangled and in the wrong order, no one had ever shown a muscle tome, nor any bone, much less the succession of nerves, veins, and arteries,” Vesalius wrote in a letter. Without a map of human organs to guide them, surgeons were left to hack their way through the body like sailors sent to sea without a map-the blind leading the ill.” (51)

    “The regimen would be known by a new acronym, with each letter standing for one of the drugs: VAMP.
    The name had many intended and unintended resonances. /Vamp/ is a word that means to improvise or patch up, to cobble something together from bits and pieces that might crumble apart any second. It can mean a seductress-one who promises but does not deliver. It also refers to the front of a boot, the part that carries the full brunt of force during a kick.” (142)

    /Doctors are men who prescribe medicines of which they know little, to cure diseases of which they know less, in human beings of whom they know nothing./
    -Voltaire (143)

    “But the fatal flaw in mammography lies in that these rates are not absolute: /they depend on age/. For women above fifty-five, the incidence of breast cancer is high enough that even a relatively poor screening tool can detect an early tumor and provide a survival benefit. For women between forty and fifty years, though, the incidence of breast cancer sinks to a point that a “mass” detected on a mammogram, more often than not, turns out to be a false positive. To use a visual analogy: a magnifying lens designed to make small script legible does perfectly well when the font size is ten or even six points. But then it hits a limit. At a certain size font, chances of reading a letter correctly become about the same as reading a letter incorrectly.” (302)

    “Cancer is not a concentration camp, but it shares the quality of annihilation: it negates the possibility of life outside and beyond itself; it subsumes all living…..The poet Jason Shinder wrote, “Cancer is a tremendous opportunity to have your face pressed right up against the glass of your mortality.” But what patients see through the glass is not a world outside cancer, but a world taken over by it-cancer reflected endlessly around them like a hall of mirrors.” (398)

  4. and the obligatory confirmation that 1979 was a year of special births:

    “In the summer of 1979, Chiaho Shih, a graduate student in Weinberg’s lab, began to barrel his way through fifteen different mouse cancer cells, trying to find a fragment of DNA that would produce foci out of normal cells. Shih was laconic and secretive, with a slippery, quicksilver temper, often paranoid about his experiments. He was also stubborn: when he disagreed with Weinberg, colleagues recalled him thickening his accent and pretending not to understand English, a language he spoke with ease and fluency under normal circumstances. But for all his quirks, Shih was also a born perfectionist. He had learned the DNA transfection technique from his predecessors in the lab, but even more important, he had an instinctive feel for his cells, almost a gardener’s instinct to discriminate normal versus abnormal growth.” (373)

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