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livlillies 's review for:
The Emperor of All Maladies: A Biography of Cancer
by Siddhartha Mukherjee
challenging
informative
inspiring
slow-paced
Learned a lot:
- Hippocrates named the disease “cancer” because he believed it looked like a crab the way the tumour had spread out with “legs”.
- Cancer was originally thought to have been linked with a black pus that needed to be released (but no one could find).
- Penicillin was so precious during WWII that it was red reacted from the urine of patients who had been treated with it.
- The concept of starving cancer cells was conceived in 1946 when folate supplements were found to accelerate cancer progression. As such, anti-folates were theorised.
- December 28, 1947: the first “chemotherapy” was used. An anti-folate that could plateau leukaemia cell proliferation.
- Radical mastectomies were common as early as the 1890s. And surgeons were competing to be the most radical. They would regularly cut out the pectoralis major and lymph nodes. An approach that was too aggressive for the early stages and not aggressive enough for those that had already metastasised.
- In contrast to the radical mastectomy, radical prostatectomies were much more meticulous (1904).
- Mustard gas’ propensity to completely eviscerate bone marrow led to its use as a cancer treatment. IV mustard was administered in 1942. Demonstrating that “all treatments are a poison in disguise”.
- Government expenditure shows where our priorities were: $231,000 USD on the Jimmy Fund (children’s cancer research). $100 million USD every month on the Manhattan Project.
- The concept of using multiple chemotherapy drugs was slammed for years for being barbaric. It wasn’t until 1959 that it was first trialled. It still took many more years before doctors would realise treatment was still required after symptoms were gone.
- Cancer staging didn’t get developed until the 1950s which is when doctors realised not all cancers were the same.
- Chemotherapy works well on cancer cells because it ceases proliferation. Because cancer cells proliferate faster than most normal cells, it affects them most.
- Identifying smoking as a powerful carcinogen was easy. It took years to convince the public, marking a significant argument between the medical community and marketing.
- Antifolates, such as Farber’s aminopterin, interrupt the metabolism of folic acid and starve all cells of a crucial nutrient required for cell division. Nitrogen mustard and cisplatin chemically react with DNA, and DNA-damaged cells cannot duplicate their genes and thus cannot divide. Vincristine, the periwinkle poison, thwarts the ability of a cell to construct the molecular “scaffold” required for all cells to divide.
Favourite quotes:
Dying, even more than death, defines the illness.
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.
If we seek immortality, then so, too, in a rather perverse sense, does the cancer
For 3,000 years and more, this disease has been known to the medical profession. And for 3,000 years and more, humanity has been knocking at the door of the medical profession for a “cure.”
“When a doctor has to tell a patient that there is no specific remedy for his condition, [the patient] is apt to feel affronted, or to wonder whether the doctor is keeping abreast of the times.”
A patient, long before he becomes the subject of medical scrutiny, is, at first, simply a storyteller, a narrator of suffering—a traveler who has visited the kingdom of the ill.
Patients tell stories to describe illness; doctors tell stories to understand it.
- Hippocrates named the disease “cancer” because he believed it looked like a crab the way the tumour had spread out with “legs”.
- Cancer was originally thought to have been linked with a black pus that needed to be released (but no one could find).
- Penicillin was so precious during WWII that it was red reacted from the urine of patients who had been treated with it.
- The concept of starving cancer cells was conceived in 1946 when folate supplements were found to accelerate cancer progression. As such, anti-folates were theorised.
- December 28, 1947: the first “chemotherapy” was used. An anti-folate that could plateau leukaemia cell proliferation.
- Radical mastectomies were common as early as the 1890s. And surgeons were competing to be the most radical. They would regularly cut out the pectoralis major and lymph nodes. An approach that was too aggressive for the early stages and not aggressive enough for those that had already metastasised.
- In contrast to the radical mastectomy, radical prostatectomies were much more meticulous (1904).
- Mustard gas’ propensity to completely eviscerate bone marrow led to its use as a cancer treatment. IV mustard was administered in 1942. Demonstrating that “all treatments are a poison in disguise”.
- Government expenditure shows where our priorities were: $231,000 USD on the Jimmy Fund (children’s cancer research). $100 million USD every month on the Manhattan Project.
- The concept of using multiple chemotherapy drugs was slammed for years for being barbaric. It wasn’t until 1959 that it was first trialled. It still took many more years before doctors would realise treatment was still required after symptoms were gone.
- Cancer staging didn’t get developed until the 1950s which is when doctors realised not all cancers were the same.
- Chemotherapy works well on cancer cells because it ceases proliferation. Because cancer cells proliferate faster than most normal cells, it affects them most.
- Identifying smoking as a powerful carcinogen was easy. It took years to convince the public, marking a significant argument between the medical community and marketing.
- Antifolates, such as Farber’s aminopterin, interrupt the metabolism of folic acid and starve all cells of a crucial nutrient required for cell division. Nitrogen mustard and cisplatin chemically react with DNA, and DNA-damaged cells cannot duplicate their genes and thus cannot divide. Vincristine, the periwinkle poison, thwarts the ability of a cell to construct the molecular “scaffold” required for all cells to divide.
Favourite quotes:
Dying, even more than death, defines the illness.
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.
If we seek immortality, then so, too, in a rather perverse sense, does the cancer
For 3,000 years and more, this disease has been known to the medical profession. And for 3,000 years and more, humanity has been knocking at the door of the medical profession for a “cure.”
“When a doctor has to tell a patient that there is no specific remedy for his condition, [the patient] is apt to feel affronted, or to wonder whether the doctor is keeping abreast of the times.”
A patient, long before he becomes the subject of medical scrutiny, is, at first, simply a storyteller, a narrator of suffering—a traveler who has visited the kingdom of the ill.
Patients tell stories to describe illness; doctors tell stories to understand it.