The Immortal Life of Henrietta Lacks

by Rebecca Skloot

Diagnosis and Treatment

Like many doctors of his era, TeLinde often used patients from the public wards for research, usually without their knowledge. Many scientists believed that since patients were treated for free in the public wards, it was fair to use them as research subjects as a form of payment. And as Howard Jones once wrote, “Hopkins, with its large indigent black population, had no dearth of clinical material.”

told him about the Tuskegee syphilis study like I was giving an oral report in history class: It started in the thirties, when U.S. Public Health Service researchers at the Tuskegee Institute decided to study how syphilis killed, from infection to death. They recruited hundreds of African-American men with syphilis, then watched them die slow, painful, and preventable deaths, even after they realized penicillin could cure them. The research subjects didn’t ask questions. They were poor and uneducated, and the researchers offered incentives: free physical exams, hot meals, and rides into town on clinic days, plus fifty-dollar burial stipends for their families when the men died. The researchers chose black subjects because they, like many whites at the time, believed black people were “a notoriously syphilis-soaked race.” The public didn’t learn about the Tuskegee study until the seventies, after hundreds of men enrolled in it had already died. The news spread like pox through black communities: doctors were doing research on black people, lying to them, and watching them die. Rumors started circulating that the doctors had actually injected the men with syphilis in order to study them. “What else?” Pattillo grumbled. I told him I’d heard about so-called Mississippi Appendectomies, unnecessary hysterectomies performed on poor black women to stop them from reproducing, and to give young doctors a chance to practice the procedure. I’d also read about the lack of funding for r...

But Carrel wasn’t interested in immortality for the masses. He was a eugenicist: organ transplantation and life extension were ways to preserve what he saw as the superior white race, which he believed was being polluted by less intelligent and inferior stock, namely the poor, uneducated, and nonwhite. He dreamed of never-ending life for those he deemed worthy, and death or forced sterilization for everyone else. He’d later praise Hitler for the “energetic measures” he took in that direction.

Reader’s Digest ran articles by Carrel advising women that a “husband should not be induced by an oversexed wife to perform a sexual act,” since sex drained the mind. In his best-selling book, Man, the Unknown, he proposed fixing what he believed was “an error” in the U.S. Constitution that promised equality for all people. “The feebleminded and the man of genius should not be equal before the law,” he wrote. “The stupid, the unintelligent, those who are dispersed, incapable of attention, of effort, have no right to a higher education.”

This was a time when “benevolent deception” was a common practice—doctors often withheld even the most fundamental information from their patients, sometimes not giving them any diagnosis at all. They believed it was best not to confuse or upset patients with frightening terms they might not understand, like cancer. Doctors knew best, and most patients didn’t question that. Especially black patients in public wards. This was 1951 in Baltimore, segregation was law, and it was understood that black people didn’t question white people’s professional judgment. Many black patients were just glad to be getting treatment, since discrimination in hospitals was widespread.

According to Howard Jones, Henrietta got the same care any white patient would have; the biopsy, the radium treatment, and radiation were all standard for the day. But several studies have shown that black patients were treated and hospitalized at later stages of their illnesses than white patients. And once hospitalized, they got fewer pain medications, and had higher mortality rates.

Her doctors tried in vain to ease her suffering. “Demerol does not seem to touch the pain,” one wrote, so he tried morphine. “This doesn’t help too much either.” He gave her Dromoran. “This stuff works,” he wrote. But not for long. Eventually one of her doctors tried injecting pure alcohol straight into her spine. “Alcohol injections ended in failure,” he wrote.

“In 1951 a woman died in Baltimore in America,” he said, pausing for effect. “She was called Henrietta Lacks.” The music grew louder and more sinister as he told the story of her cells: “These cells have transformed modern medicine. … They shaped the policies of countries and of presidents. They even became involved in the Cold War. Because scientists were

convinced that in her cells lay the secret of how to conquer death….”

Though no law or code of ethics required doctors to ask permission before taking tissue from a living patient, the law made it very clear that performing an autopsy or removing tissue from the dead without permission was illegal.

The official cause of Henrietta’s death was terminal uremia: blood poisoning from the buildup of toxins normally flushed out of the body in urine. The tumors had completely blocked her urethra, leaving her doctors unable to pass a catheter into her bladder to empty it. Tumors the size of baseballs had nearly replaced her kidneys, bladder, ovaries, and uterus. And her other organs were so covered in small white tumors it looked as if someone had filled her with pearls.

Not long after Henrietta’s death, planning began for a HeLa factory—a massive operation that would grow to produce trillions of HeLa cells each week. It was built for one reason: to help stop polio. By the end of 1951 the world was in the midst of the biggest polio epidemic in history.

The trouble was, at that point, the cells used in neutralization tests came from monkeys, which were killed in the process. This was a problem, not because of concern for animal welfare—which wasn’t the issue then that it is today—but because monkeys were expensive. Doing millions of neutralization tests using monkey cells would cost millions of dollars. So the NFIP went into overdrive looking for a cultured cell that could grow on a massive scale and would be cheaper than using monkeys. The NFIP turned to Gey and a few other cell culture experts for help, and Gey recognized the opportunity as a gold mine for the field. The NFIP’s March of Dimes was bringing in an average of $ 50 million in donations each year, and its director wanted to give much of that money

to cell culturists so they could find a way to mass-produce cells, which they’d been wanting to do for years anyway.

The NFIP chose the Tuskegee Institute for the project because of Charles Bynum, director of “Negro Activities” for the foundation.

Bynum—a science teacher and civil rights activist who was the first black foundation executive in the country—wanted the center to be located at Tuskegee because it would provide hundreds of thousands of dollars in funding, many jobs, and training opportunities for young black scientists.

In just a few months, a staff of six black scientists and technicians built a factory at Tuskegee unlike any seen before. Its walls were lined with industrial steel autoclaves for steam sterilizing; row upon row of enormous, mechanically stirred vats of culture medium; incubators; glass culturing bottles stacked on their sides; and automatic cell dispensers—tall contraptions with long, thin metal arms that squirted HeLa cells into one test tube after another. The Tuskegee t...

students, soldiers, and cotton farmers who responded to ads in the local paper seeking bl...

Eventually, the Tuskegee staff grew to thirty-five scientists and technicians, who produced twenty thousand tubes of HeLa—about 6 trillion cells—every week.

It was the first-ever cell production factory, and it started with a single vial of HeLa that Gey had sent Scherer in their first shipping experiment, not long after Henrietta’s death.

With those cells, scientists helped prove the Salk vaccine effective. Soon the New York Times...

Black scientists and technicians, many of them women, used cells from a black woman to help save the lives of millions of Americans, most of them white. And they did so on the same campus—and at the very same time—that state officials were conducting the infamous Tuskegee syphilis studies.

At first the Tuskegee Center supplied HeLa cells only to polio testing labs. But when it became clear that there was no risk of a HeLa shortage, they began sending the cells to any scientist interested

buying them, for ten dollars plus Air Express fees.

HeLa cells grew much faster than normal cells, and therefore produced results faster. HeLa was a workhorse: it was hardy, it was inexpensive, and it was everywhere. And the timing was perfect. In the early fifties, scientists were just beginning to understand viruses, so as Henrietta’s cells arrived in labs around the country, researchers began exposing them to viruses of all kinds—herpes, measles, mumps, fowl pox, equine encephalitis—to study how each one entered cells, reproduced, and spread.

Henrietta’s cells helped launch the fledgling field of virology, but that was just the beginning. In the years following Henrietta’s death, using some of the first tubes of her cells, researchers around the world made several important scientific

advances in quick su...

To understand why cellular cloning was important, you need to know two things: First, HeLa didn’t grow from one of Henrietta’s cells. It grew from a sliver of her tumor, which was a cluster of cells. Second, cells often behave differently, even if they’re all from the same sample, which means some grow faster than others, some produce more poliovirus, and some are resistant to certain antibiotics. Scientists wanted to grow cellular clones—lines of cells descended from individual cells—so they could harness those unique traits. With HeLa, a group of scientists in Colorado succeeded, and soon the world of science had not only HeLa but also its hundreds, then thousands, of clones.

Researchers had long believed that human cells contained forty-eight chromosomes, the threads of DNA inside cells that contain all of our genetic information. But chromosomes clumped together, making it impossible to get an accurate count. Then, in 1953, a geneticist in Texas accidentally mixed the wrong liquid with HeLa and a few other cells, and it turned out to be a fortunate mistake. The chromosomes inside the cells swelled and spread out, and for the first time, scientists could see each of them clearly. That accidental discovery was the first of several developments that would allow two researchers from Spain and

Sweden to discover that normal human cells have forty-six chromosomes. Once scientists knew how many chromosomes people were supposed to have, they could tell when a person had too many or too few, which made it possible to diagnose genetic diseases. Researchers worldwide would soon begin identifying chromosomal disorders, discovering that patients with Down syndrome had an extra chromosome number 21, patients with Klinefelter syndrome had an extra sex chromosome, and those with Turner syndrome lacked all or part of one.

In February 1954, Southam loaded a syringe with saline solution mixed with HeLa. He slid the needle into the forearm of a woman who’d recently been hospitalized for leukemia, then pushed the plunger, injecting about five million of Henrietta’s cells into her arm. Using a second needle, Southam tattooed a tiny speck of India ink next to the small bump that formed at the HeLa injection site. That way, he’d know where to look when he reexamined the woman days, weeks, and months later, to see if Henrietta’s cancer was growing on her arm. He repeated this process with about a dozen other cancer patients. He told them he was testing their immune systems; he said nothing about injecting them with someone else’s malignant cells. Within hours, the patients’ forearms grew red and swollen. Five to ten days later, hard nodules began growing at the injection sites. Southam removed some

the nodules to verify that they were cancerous, but he left several to see if the patients’ immune systems would reject them or the cancer would spread. Within two weeks, some of the nodules had grown to two centimeters—about the size of Henrietta’s tumor when she went in for her radium treatments.

Southam eventually removed most of the HeLa tumors, and those he didn’t remove vanished on their own in a few months. But in four patients, the nodules grew back. He removed them, but they returned again and again. In one patie...

Since those patients had all had cancer to begin with, Southam wanted to see how healthy people reacted to the injections, for comparison’s sake. So, in May 1956, he placed an ad in the Ohio State Penitentiary newsle...

days later he had ninety-six volunteers, which quickly increased to 150. He chose the Ohio prison because its inmates had cooperated in several other studies without resistance, including one in which they’d been infected with a potentially deadly disease called tularemia. Research on inmates would come under scrutiny and start being heavily regulated about fifteen years later, because they’d be considered a vulnerable population unable to give informed consent. But at the time, prisoners nationwide were b...

Southam began injecting prisoners in June 1956 using HeLa cells that his colleague, Alice Moore, carried from New York to Ohio in a handbag. Sixty-five prisoners—murderers, emb...

benches for their injections. Some wore white hospital garb; others came off work gangs wearing blue dungarees. Soon tumors grew on the prisoners’ arms just as they’d grown in the cancer patients. The press ran story after story about the brave men at the Ohio Penitentiary, praising them as “the first healthy human beings ever to agree to such rigorous cancer experiments.” They quoted one man sayin...

July 5, 1963, with Emanuel Mandel, director of medicine at the Jewish Chronic Disease Hospital in Brooklyn, to use the hospital’s patients for his research. The plan was that Mandel would have doctors on his staff inject twenty-two JCDH patients with cancer cells for Southam. But when he instructed his staff to give the injections without telling

patients they contained cancer cells, three young Jewish doctors refused, saying they wouldn’t conduct research on patients without their consent. All three knew about the research Nazis had done on Jewish prisoners. They also knew about the famous Nuremberg Trials.

Sixteen years earlier, on August 20, 1947, a U.S.-led war tribunal in Nuremberg, Germany, had sentenced seven Nazi doctors to death by hanging. Their crime was conducting unthinkable research on Jews without consent—sewing siblings together to create Siamese twins, dissecting people alive to study organ function. The tribunal set forth a ten-point code of ethics now known as the Nuremberg Code, which was to govern all human experimentation worldwide. The first line in that code says, “The voluntary consent of the human

subject is absolutely essential.”

The idea was revolutionary. The Hippocratic Oath, written in the fourth century BC, didn’t require patient consent. And though the American Medical Association had issued rules protecting laboratory animals in...

But the Nuremberg Code—like other codes that would come after it—wasn’t law. It was, essentially, a list of recommendations. It wasn’t routinely taught in medical schools, and many American researchers—including Southam—claimed not to know it existed. Those who did know about it often thought of it as “the Nazi ...

By the 1960s, scientists joked that HeLa cells were so robust that they could probably survive in sink drains or on doorknobs. They were everywhere. The general public could grow HeLa at home using instructions from a Scientific American do-it-yourself article, and both Russian and American scientists had managed to grow HeLa in space.

What they found was disturbing: in mission after mission, noncancerous cells grew normally in orbit,

HeLa became more powerful, dividing faster with each trip.

The next morning, Joe went into Deborah’s kitchen and took her good carving knife with

Gartler leaned into the microphone and told the audience that, in the process of looking for new genetic markers for his research, he’d found that eighteen of the most commonly used cell cultures had one thing in common: they all contained a rare genetic marker called glucose-6-phosphate dehydrogenase-A (G6PD-A), which was present almost exclusively in black Americans. And even among them it was fairly rare. “I have not been able to ascertain the supposed racial origin of all eighteen lines,” Gartler told the audience. “It is known, however, that at least some of these are from Caucasians, and that at least one, HeLa, is from a Negro.” He knew this, because a few months earlier, he’d written George Gey: I am interested in the racial origin of the person from whom your HeLa cell line was initiated. I have checked a number of the early papers describing the development of the HeLa cell line but have not been able to find any information pertaining to the race of the donor. When Gey responded that HeLa cells had come from “a colored woman,” Gartler knew he’d found the source of the problem. “It seems to me the simplest explanation,” he told the audience, “is that they are all HeLa cell contaminants.”

Scientists knew they had to keep their cultures free from bacterial and viral contamination, and they knew it was possible for cells to contaminate one another if they got mixed up in culture. But when it came to HeLa, they had no idea what they were up against. It turned out Henrietta’s cells could float through the air on dust particles. They could travel from one culture to the next on unwashed hands or used pipettes; they could ride from lab to lab on researchers’ coats and shoes, or through ventilation systems. And they were strong: if just one HeLa cell landed in a culture dish, it took over, consuming all the media and filling all the space. Gartler’s findings did not go over well. In the fifteen years since George Gey had first grown HeLa, the number of published articles involving cell culture had more than tripled each year. Scientists had spent millions of dollars conducting research on those cells to study the behavior of each tissue type, comparing one to another, testing the unique responses of different cell types to specific drugs, chemicals, or environments. If all those cells were in fact HeLa, it would mean that millions of dollars had been wasted, and researchers who’d found that various cells behaved differently in culture could have some explaining to do. Years later, Robert Stevenson, who became president of the American Type Culture Collection, described Gartler’s talk to me this way: “He showed up at that meeting with no background or anything else...