The Emperor of All Maladies: A Biography of Cancer (91 page)

Harold Varmus, in particular, provided astonishingly detailed and insightful commentary and annotations—emblematic of the extraordinary generosity that I received from scientists, writers, and doctors.

David Scadden and Gary Gilliland provided a fostering laboratory environment at Harvard. Ed Gelmann, Riccardo Dalla-Favera, and Cory and Michael Shen gave me a new academic “home” at Columbia University, where this book was finished. Tony Judt’s Remarque Institute Forum (where I was a fellow) provided an inimitable environment for historical discussions; indeed, this book was conceived in its current form on a crystalline lake in Sweden during one such forum. Jason Rothauser, Paul Whitlatch, and Jaime Wolf read, edited, and checked the facts and figures in the manuscript. Alexandra Truitt and Jerry Marshall researched and cleared copyrights for the pictures.

vii
Susan Sontag,
Illness as Metaphor and AIDS and Its Metaphors
(New York: Picador, 1990), 3.

PROLOGUE

1
Diseases desperate grown:
William Shakespeare,
Hamlet
, Act IV, Scene III.

1
Cancer begins and ends with people:
June Goodfield,
The Siege of Cancer
(New York: Random House, 1975), 219.

4
In Aleksandr Solzhenitsyn’s novel:
Aleksandr Solzhenitsyn,
Cancer Ward
(New York: Farrar, Straus and Giroux, 1968).

5
Atossa, the Persian queen:
Herodotus,
The Histories
(Oxford: Oxford University Press, 1998), 223.

6
“The universe,” the twentieth-century biologist:
John Burdon Sanderson Haldane,
Possible Worlds and Other Papers
(New York: Harper & Brothers, 1928), 286.

PART ONE:
“OF BLACKE CHOLOR, WITHOUT BOYLING”

9
In solving a problem of this sort:
Arthur Conan Doyle,
A Study in Scarlet
(Whitefish, MT: Kessinger Publishing, 2004), 107.

“A suppuration of blood”

11
Physicians of the Utmost Fame:
Hilaire Belloc,
Cautionary Tales for Children
(New York: Alfred A. Knopf, 1922), 18–19.

11
Its palliation is a daily task:
William B. Castle, “Advances in Knowledge concerning Diseases of the Blood, 1949–1950,” in
The 1950 Year Book of Medicine: May 1949–May 1950
(Chicago: Year Book Publishers, 1950), 313–26.

11
In a damp:
Details concerning aminopterin and its arrival in Farber’s clinic are from several sources. Sidney Farber et al., “The Action of Pteroylglutamic Conjugates on Man,”
Science
, 106, no. 2764 (1947): 619–21; S. P. Gupta, interview with author, January 2006; and S. P. Gupta, “An Indian Scientist in America: The Story of Dr. Yellapragada Subbarao,”
Bulletin of the Institute of Medicine
(Hyderabad) 6, no. 2 (1976): 128–43; S. P. Gupta,
In Quest of Panacea
(New Delhi: Evelyn Publishers, 1987).

11
Farber’s specialty was pediatric pathology:
John Craig, “Sidney Farber (1903–1973),”
Journal of Pediatrics
128, no. 1 (1996): 160–62. Also see “Looking Back: Sidney Farber and the First Remission of Acute Pediatric Leukemia,” Children’s Hospital, Boston,
http://www.childrenshospital.org/gallery/index.cfm?G=49&page=2 (accessed January 4, 2010); H. R. Wiedemann, “Sidney Farber (1903–1973),”
European Journal of Pediatrics
, 153 (1994): 223.

12
“It gave physicians plenty to wrangle over”:
John Laszlo,
The Cure of Childhood Leukemia: Into the Age of Miracles
(New Brunswick, NJ: Rutgers University Press, 1995), 19.

12
“diagnosed, transfused—and sent home to die”:
Medical World News
, November 11, 1966.

13
“He is of dark complexion”:
John Hughes Bennett, “Case of Hypertrophy of the Spleen and Liver in Which Death Took Place from Suppuration of the Blood,”
Edinburgh Medical and Surgical Journal
64 (October 1, 1845): 413–23. Also see John Hughes Bennett,
Clinical Lectures on the Principles and Practice of Medicine
, 3rd ed. (New York: William Wood & Company, 1866), 620.

13
“A suppuration of blood”:
Bennett, “Case of Hypertrophy of the Spleen.” Also see Bennett,
Clinical Lectures
, 896.

13
Rudolf
Virchow, independently published:
Rudolf Ludwig Karl Virchow,
Cellular Pathology: As Based upon Physiological and Pathological Histology
, trans. Frank Chance (London: John Churchill, 1860), 169–71, 220. Also see Bennett,
Clinical Lectures
, 896.

14
s
eeking a name for this condition:
Charles J. Grant, “Weisses Blut,”
Radiologic Technology
73, no. 4 (2003): 373–76.

14
in the early 1980s, another change in name:
Randy Shilts,
And the Band Played On
(New York: St. Martin’s), 171.

14
Virchow’s approach to medicine:
“Virchow,”
British Medical Journal
, 2, no. 3171 (1921): 573–74. Also see Virchow,
Cellular Pathology
.

16
Bennett’s earlier fantasy:
William Seaman Bainbridge,
The Cancer Problem
(New York: Macmillan Company, 1914), 117.

17
Michael Anton Biermer, described:
Laszlo,
Cure of Childhood Leukemia
, 7–9, 15.

17
From its first symptom to diagnosis to death:
Biermer, “Ein Fall von Leukämie,”
Virchow’s Archives
, 1861, S. 552, cited in Suchannek, “Case of Leukaemia,” 255–69.

19
Farber completed his advanced training:
Denis R. Miller, “A Tribute to Sidney Farber—the Father of Modern Chemotherapy,”
British Journal of Haematology
134 (2006): 4, 20–26.

20
What is true for
E. coli: This remark, attributed to Monod (perhaps apocryphally), appears several times in the history of molecular biology, although its precise origins remain unknown. See, for instance, Theresa M. Wizemann and Mary-Lou Pardue, eds.,
Exploring the Biological Contributions to Human Health: Does Sex Matter?
(Washington, DC: National Academy Press, 2001), 32; Herbert Claus Friedmann, “From Butyribacterium to
E. coli
: An Essay on Unity in Biochemistry,”
Perspectives in Biology and Medicine
47, no. 1 (2004): 47–66.

“A monster more insatiable than the guillotine”

21
The medical importance of leukemia:
Jonathan B. Tucker,
Ellie: A Child’s Fight Against Leukemia
(New York: Holt, Rinehart, and Winston, 1982), 46.

21
There were few successes in the treatment:
John Laszlo,
The Cure of Childhood Leukemia: Into the Age of Miracles
(New Brunswick, NJ: Rutgers University Press, 1995), 162.

21
a cornucopia of pharmaceutical discoveries:
Michael B. Shimkin, “As Memory
Serves—an Informal History of the National Cancer Institute, 1937–57,”
Journal of the National Cancer Institute
59 (suppl. 2) (1977): 559–600.

21
the drug was reextracted:
Eric Lax,
The Mold in Dr. Florey’s Coat: The Story of the Penicillin Miracle
(New York: Henry Holt and Co., 2004), 67.

21
In 1942, when Merck had shipped:
“Milestone Moments in Merck History,” http://www.merck.com/about/feature_story/01062003_penicillin.html (site is no longer available but can be accessed through http://www.archive.org/web/web.php).

21
A decade later, penicillin:
E. K. Marshall, “Historical Perspectives in Chemotherapy,”
Advances in Chemotherapy
13 (1974): 1–8. Also see
Science News Letter
41 (1942).

22
chloramphenicol in 1947:
John Ehrlich et al., “Chloromycetin, a New Antibiotic from a Soil Actinomycete,”
Science
106, no. 2757 (1947): 417.

22
tetracycline in 1948:
B. M. Duggar, “Aureomycin: A Product of the Continuing Search for New Antibiotics,”
Annals of the New York Academy of Science
51 (1948): 177–81.

22
“The remedies are in our own backyard”:
Time
, November 7, 1949.

22
In a brick building on the far corner:
John F. Enders, Thomas H. Weller, and Frederick C. Robbins, “Cultivation of the Lansing Strain of Poliomyelitis Virus in Cultures of Various Human Embryonic Tissues,”
Science
49 (1949): 85–87; Fred S. Rosen, “Isolation of Poliovirus—John Enders and the Nobel Prize,”
New England Journal of Medicine
351 (2004): 1481–83.

22
by 1950, more than half the medicines:
A. N. Richards, “The Production of Penicillin in the United States: Extracts and Editorial Comment,”
Annals of Internal Medicine
, suppl. 8 (1969): 71–73. Also see Austin Smith and Arthur Herrick,
Drug Research and Development
(New York: Revere Publishing Co., 1948).

22
Typhoid fever:
Anand Karnad,
Intrinsic Factors: William Bosworth Castle and the Development of Hematology and Clinical Investigation at Boston City Hospital
(Boston: Harvard Medical School, 1997).

22
Even tuberculosis:
Edgar Sydenstricker, “Health in the New Deal,”
Annals of the American Academy of Political and Social Science
176, Social Welfare in the National Recovery Program (1934): 131–37.

22
The life expectancy of Americans:
Lester Breslow,
A Life in Public Health: An Insider’s Retrospective
(New York: Springer, 2004), 69. Also see Nicholas D. Kristof, “Access, Access, Access,”
New York Times
, March 17, 2010.

22
Hospitals proliferated:
Rosemary Stevens,
In Sickness and in Wealth
(New York: Basic Books, 1989), 204, 229.

22
As one student observed
: Temple Burling, Edith Lentz, and Robert N. Wilson,
The Give and Take in Hospitals
(New York: Putnum, 1956), 9.

22
Lulled by the idea of the durability:
From
Newsweek
and
Time
advertisements, 1946–48. Also see Ruth P. Mack, “Trends in American Consumption,”
American Economic Review
46, no. 2, (1956):55–68.

23
“illness” now ranked third:
Herbert J. Gans,
The Levittowners: Ways of Life and Politics in a New Suburban Community
(New York: Alfred A. Knopf), 234.

23
Fertility rose steadily:
Paul S. Boyer et al.,
The Enduring Vision: A History of the American People
(Florence, KY: Cengage Learning, 2008), 980.

23
The “affluent society”
: John Kenneth Galbraith,
The Affluent Society
(New York: Houghton Mifflin, 1958).

23
In May 1937:
“Cancer: The Great Darkness,”
Fortune
, May 1937.

24
In 1899, when Roswell Park:
Robert Proctor,
Cancer Wars: How Politics Shapes What We Know and Don’t Know About Cancer
(New York: Basic Books, 1995), 20.

24
Smallpox was on the decline:
K. A. Sepkowitz, “The 1947 Smallpox Vaccination Campaign in New York City, Revisited,”
Emerging Infectious Diseases
10, no. 5 (2004): 960–61. Also see D. E. Hammerschmidt, “Hands: The Last Great Smallpox Outbreak in Minnesota (1924–25),”
Journal of Laboratory and Clinical Medicine
142, no. 4 (2003): 278.

24
Between 1900 and 1916:
Lucius Duncan Bulkley,
Cancer and Its Non-Surgical Treatment
(New York: W. Wood & Co., 1921).

24
By 1926, cancer:
Proctor,
Cancer Wars
, 66.

24
In May that year
, Life: “U.S. Science Wars against an Unknown Enemy: Cancer,”
Life
, March 1, 1937.

24
When cancer appeared:
“Medicine: Millions for Cancer,”
Time
, July 5, 1937; “Medicine: After Syphilis, Cancer,”
Time
, July 19, 1937.

24
American Association for Cancer Research: “AACR: A Brief History,” http://www.aacr.org/home/about-us/centennial/aacr-history.aspx (accessed January 4, 2010).

25
from 70,000 men and women in 1911:
“A Cancer Commission,”
Los Angeles Times
, March 4, 1927.

25
Neely asked Congress:
69th Cong., 2nd sess.,
Congressional Record
, 68 (1927): p3 2922.

25
Within a few weeks:
Richard A. Rettig,
Cancer Crusade: The Story of the National Cancer Act of 1971
(Lincoln, NE: Author’s Choice Press, 1977), 44.

25
In June, a joint Senate-House conference:
“National Cancer Act of 1937,” Office of Government and Congressional Relations, Legislative History, http://legislative.cancer.gov/history/1937 (accessed November 8, 2009).

25
An advisory council of scientists:
Shimkin, “As Memory Serves,” 559–600.

26
“The nation is marshaling its forces”:
Congressional Record
, appendix 84:2991 (June 30, 1939); Margot J. Fromer, “How, After a Decade of Public & Private Wrangling, FDR Signed NCI into Law in 1937,”
Oncology Times
28 (19): 65–67.

26
The U.S. Marine Hospital:
Ora Marashino, “Administration of the National Cancer Institute Act, August 5, 1937, to June 30, 1943,”
Journal of the National Cancer Institute
4: 429–43.

26
“mostly silent”:
Shimkin, “As Memory Serves,” 599–600.

26
“programmatic response to cancer”:
Ibid.

26
“a nice quiet place out here in the country”:
Ibid.