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I had a novice’s hunger for history, but also a novice’s inability to envision it.
The secret to battling cancer, then, is to find means to prevent these mutations from occurring in susceptible cells, or to find means to eliminate the mutated cells without compromising normal growth. The conciseness of that statement belies the enormity of the task. Malignant growth and normal growth are so genetically intertwined that unbraiding the two might be one of the most significant scientific challenges faced by our species.
(mutations in cancer genes accumulate with aging; cancer is thus intrinsically related to age).
Virchow called these two modes hyperplasia and hypertrophy. In hypertrophy, the number of cells did not change; instead, each individual cell merely grew in size—like a balloon being blown up. Hyperplasia, in contrast, was growth by virtue of cells increasing in number.
Lymphoid cells are thus produced in vast excess, but, unable to mature, they cannot fulfill their normal function in fighting microbes. Carla had immunological poverty in the face of plenty.
Science begins with counting. To understand a phenomenon, a scientist must first describe it; to describe it objectively, he must first measure it.
In fact, rearing children was becoming a national preoccupation at an unprecedented level.
(This was yet another colonial fascination: to create the conditions of misery in a population, then subject it to social or medical experimentation.)
Cancer is an expansionist disease; it invades through tissues, sets up colonies in hostile landscapes, seeking “sanctuary” in one organ and then immigrating to another. It lives desperately, inventively, fiercely, territorially, cannily, and defensively—at times, as if teaching us how to survive.
Nearly every known cancer originates from one ancestral cell that, having acquired the capacity of limitless cell division and survival, gives rise to limitless numbers of descendants—Virchow’s omnis cellula e cellula e cellula repeated ad infinitum.
Every generation of cancer cells creates a small number of cells that is genetically different from its parents. When a chemotherapeutic drug or the immune system attacks cancer, mutant clones that can resist the attack grow out. The fittest cancer cell survives.
Cancer thus exploits the fundamental logic of evolution unlike any other illness. If we, as a species, are the ultimate product of Darwinian selection, then so, too, is this incredible disease that lurks inside us.
Cancer is an age-related disease—sometimes exponentially so. The risk of breast cancer113, for instance, is about 1 in 400 for a thirty-year-old woman and increases to 1 in 9 for a seventy-year-old.
The gibbet and the graveyard—the convenience stores for the medieval anatomist
Antisepsis and anesthesia were twin technological breakthroughs that released surgery from its constraining medieval chrysalis.
With the world around him erased and silenced by this routine and rhythm, Halsted now attacked breast cancer with relentless energy.
Halsted’s mastectomy is thus a peculiar misfit in both cases; it underestimates its target in the first case and overestimates it in the second. In both cases, women are forced to undergo indiscriminate, disfiguring, and morbid operations—too much, too early for the woman with local breast cancer, and too little, too late, for the woman with metastatic cancer.
That a chemical produced by natural organisms could be derived so easily in a flask threatened to overturn the entire conception of living organisms: for centuries, the chemistry of living organisms was thought to be imbued with some mystical property, a vital essence that could not be duplicated in a laboratory—a theory called vitalism. Wöhler’s experiment demolished vitalism.
It was Disney World fused with Cancerland.
The Laskers were professional socialites, in the same way that one can be a professional scientist or a professional athlete; they were extraordinary networkers, lobbyists, minglers, conversers, persuaders, letter writers, cocktail party–throwers, negotiators, name-droppers, deal makers. Fund-raising—and, more important, friend-raising—was instilled in their blood, and the depth and breadth of their social connections allowed them to reach deeply into the minds—and pockets—of private donors and of the government.
Lasker grasped an even more essential truth: that the fight had to begin in the lab before being brought to Congress. She needed yet another ally—someone from the world of science to initiate a fight for science funding. The War on Cancer needed a bona fide scientific sponsor among all the advertisers and lobbyists—a real doctor to legitimize the spin doctors. The person in question would need to understand the Laskerites’ political priorities almost instinctually, then back them up with unquestionable and unimpeachable scientific authority.
Li had stumbled on a deep and fundamental principle of oncology: cancer needed to be systemically treated long after every visible sign of it had vanished.
In science, ideology tends to corrupt479; absolute ideology, [corrupts] absolutely.
Between 1891 and 1981, in the nearly one hundred years of the radical mastectomy, an estimated five hundred thousand women underwent the procedure to “extirpate” cancer.
In nursing slang, the drug came to be known as “cisflatten.”
Tired of memorizing books and journals in an empty, drafty waiting room, Huggins changed tracks and set up a laboratory to study urological diseases while waiting for patients to come to his clinic.
Galen’s black bile.
(“Syphilis,” as the saying ran603, “was one night with Venus, followed by a thousand nights with mercury.”)
Even Doll, who had personally favored road-tar exposure as the cause of lung cancer, could no longer argue with his own data. In the middle of the survey, sufficiently alarmed, he gave up smoking.
Their choice, as if to close the circle of ironies, was Clarence Cook Little, the ambitious contrarian that the Laskerites had once deposed as president of the American Society for the Control of Cancer (ASCC).
Faced with the prospect of a prolonged court battle, Banzhaf approached the American Cancer Society, the American Lung Association, and several other public health organizations for support. In all cases, he was rebuffed. Banzhaf chose to go to trial anyway. Dragged into court in 1968, he squared off against “a squadron of the best-paid lawyers in the country,680 row after row of them in pinstripe suits and cuff links”—and, to the utter shock of the tobacco industry, won his case.
And this was to save rats, right? Or mice? You spent all this money to save mice the problem of developing tumors?
No intervention had single-handedly decimated tobacco, but the cumulative force of scientific evidence, political pressure, and legal inventiveness had worn the industry down over a decade.
old sins have long shadows,
The list of cancer-causing agents seemed to get—as another swallower of unknown potions might have put it—“curiouser and curiouser.”
Alice In Wonderland :)
Women had been timing their periods—without Papanicolaou’s cytological help—for centuries.
Then, for nearly two decades, having produced two perfectly useless inventions over twenty years, he virtually disappeared from the scientific limelight.
Salomon had detected stigmata of cancer in his X-rays—microscopic sprinkles of calcium lodged in cancer tissue (“grains of salt,” as later radiologists would call them) or thin crustacean fingerlings of malignant cells reminiscent of the root of the word cancer.
“If a man die,”784 William Carlos Williams once wrote, “it is because death / has first possessed his imagination.
Montagnier soon deduced that this was an RNA virus that could convert its genes into DNA and lodge into the human genome—a retrovirus.
Bailar had set out to prove that the War on Cancer had reached terminal stagnancy. Instead, he had chronicled a dynamic, moving battle in midpitch against a dynamic, moving target.
Avery separated heat-killed bacteria into their chemical components. And by testing each chemical component for its capacity to transmit genes, Avery and his colleagues reported in 1944 that genes were carried by one chemical, deoxyribonucleic acid, or DNA. What scientists had formerly disregarded as a form of cellular stuffing with no real function—a “stupid molecule,” as the biologist Max Delbruck once called it dismissively—turned out to be the central conveyor of genetic information between cells, the least stupid of all molecules in the chemical world.
Rous sarcoma virus was no ordinary virus. It could write genetic information backward: it was a retrovirus.*
Weinberg felt as if he was stuck in a perpetual penumbra, surrounded by fame but never famous himself.
“The chair of the department,”908 he said, “considered me quite a fool. A good fool. A hardworking fool, but still a fool.”
The cancer cell was a broken, deranged machine. Oncogenes were its jammed accelerators and inactivated tumor suppressors its missing brakes.*
Cancer is not merely a lump in the body; it is a disease that migrates, evolves, invades organs, destroys tissues, and resists drugs.
In genetic terms, our cells were not sitting on the edge of the abyss of cancer. They were dragged toward that abyss in graded, discrete steps.
But although dysregulated cell division is the pathological hallmark of cancer, cancer cells do not merely divide; they migrate through the body, destroy other tissues, invade organs, and colonize distant sites.
At Children’s Hospital in Boston in the 1990s, the surgeon-scientist Judah Folkman demonstrated that certain activated signaling pathways within cancer cells, ras among them, could also induce neighboring blood vessels to grow. A tumor could thus “acquire” its own blood supply932 by insidiously inciting a network of blood vessels around itself and then growing, in grapelike clusters, around those vessels, a phenomenon that Folkman called tumor angiogenesis.
