I’m paying a bomb in overdue fines for this book, but it’s worth it. The book has been on my radar from a few years ago after a close friend recommended it, but it wasn’t available on the library’s otherwise fantastic e-book portal so it took a bit of a coincidence to finally get my hands on it.
i started reading it way back in June when I started my surgical oncology rotation. As I was doing a takeover of the patients before starting, one of my colleagues jokingly spoke of the field as being almost Halstedian (a reference that is easy to misconstrue). Halsted is famous for proposing the radical mastectomy, a major, disfiguring surgical procedure involving removal of the breast, the pecs, and lymph nodes in the arm pits. Surgeons of that era noticed a trend of breast cancer recurring in the margins of the previous surgery and this drove them into a frenzy of more and more invasive surgery (including removing lymph nodes around the collarbone, the chest and so on). This turned out to be a bad idea and looking at the data, it didn’t seem to improve life expectancy, yet the story goes that Halsted dogmatically persisted with aggressive surgery against consensus. Despite that Halsted is famous for a number of this as his wikipedia entry attests to.
Siddhartha Mukherjee really paints a lively, colourful picture of cancer’s history, and it looks like the secret to doing that well is to really flesh out the people who made that history. Mukherjee goes a step further to make the science accessible. Now I am clearly biased and I am reading this book as a medical professional and as the title of my blog suggests, always a student at heart. This paragraph, truly embodies how medicine should be taught. not as a bunch of dry facts but as a logical though process, with the appropriate historical context adding colour to the story.
“In 1982, a post doctoral scientist from Bombay, Lakshmi Charon Padhy, reported isolation of yet another such oncogene from a rat tumour called a neuroblastoma. Weinberg christened the gene neu, naming it after the type of cancer harbouring this gene.
The product of the neu gene in contrast, was a novel protein, not hidden deep inside the cell, but tethered to the cell membrane with a large fragment that hung outside, freely accessible to any drug. Lakshmi Charon Padhy even had a “drug” to test. In 1981, while isolating his gene, he hass created an antibody against the neu protein.
Weinberg had an oncogene and possibly an oncogene blocking drug but the twain had never met (in human cells or bodies). In the neuroblastoma cells dividing in his incubators, neu rampaged on monomaniacally, single mindedly, seemingly invincible. Yet its molecular foot still waved just outisde the surface of the plasma membrane, exposed and vulnerable, like Achilles’ famous heel”
I never imagined, during my cancer biology lectures back in med school that Cancer, something that we often see as depressing, morbid and sometimes hopeless, could have a story behind it that’s hopeful, inspiring and quite a scientific adventure.
It’s made me appreciate the training I’ve had and the value of good teachers.