Siddhartha Mukherjee


American Physician, Biological Scientist and Author, Awarded Pulitzer Prize for his book, The Emperor Of All Maladies: A Biography of Cancer

Author Quotes

And despite its many idiosyncrasies, leukemia possessed a singularly attractive feature: it could be measured. Science begins with counting. To understand a phenomenon, a scientist must first describe it; to describe it objectively, he must first measure it.

But the last part of the answer lies, surely, in how we imagine cancer and screening. We are a visual species. Seeing is believing, and to see cancer in its early, incipient form, we believe, must be the best way to prevent it. As the writer Malcolm Gladwell once described it, ?This is a textbook example of how the battle against cancer is supposed to work. Use a powerful camera. Take a detailed picture. Spot the tumor as early as possible. Treat it immediately and aggressively?. The danger posed by a tumor is represented visually. Large is bad; small is better.? But powerful as the camera might be, cancer confounds this simple rule. Since metastasis is what kills patients with breast cancer, it is, of course, generally true that the ability to detect and remove pre-metastatic tumors saves women?s lives. But it is also true that just because a tumor is small does not mean it is pre-metastatic. Even relatively small tumors barely detectable by mammography can carry genetic programs that make them vastly more likely to metastasize early. Conversely, large tumors may inherently be designed to be genetically benign?unlikely to invade and metastasize. Size matters, in other words?but only to a point. The difference in the behavior of tumors is not just a consequence of quantitative growth, but of qualitative growth.

Cancer begins and ends with people. In the midst of scientific abstraction, it is sometimes possible to forget this one basic fact.?

Cancer, we now know, is a disease caused by the uncontrolled growth of a single cell.

Even if he desired it, a surgeon could not extirpate the entire organ.

Halsted?s cancer storehouse grew far beyond its original walls at Hopkins. His ideas entered oncology, then permeated its vocabulary, then its psychology, its ethos, and its self-image. When radical surgery fell, an entire culture of surgery thus collapsed with it. The radical mastectomy is rarely, if ever, performed by surgeons today.

I don?t know why I deserved the illness in the first place, but then I don?t know why I deserved to be cured. Leukemia is like that. It mystifies you. It changes your life.

In 1847, he changed the name to the more academic-sounding leukemia?from leukos, the Greek word for white.

In China, lung cancer is already a leading cause of death attributable to smoking in men.

In the late 1970s, Varmus, Bishop, and Knudson could begin to describe the core molecular aberration of the cancer cell, stitching together the coordinated actions of oncogenes and anti-oncogenes. Cancer genes, Knudson proposed, came in two flavors. ?Positive? genes, such as src or ras, are mutant activated versions of normal cellular genes. In normal cells, these genes accelerate cell division, but only under appropriate circumstances, such as when the cell receives a growth signal. In their mutant form, these genes are driven into perpetual hyperactivity, unleashing cell division beyond control. an activated proto-oncogene, to use Bishop?s analogy, is ?a jammed accelerator? in a car. A cell with such a jammed accelerator careens down the path of cell division, unable to cease mitosis, dividing and dividing again relentlessly.

It is tempting to write the history of technology through products: the wheel; the microscope; the airplane; the Internet. But it is more illuminating to write the history of technology through transitions: linear motion to circular motion; visual space to sub-visual space; motion on land to motion on air; physical connectivity to virtual connectivity.

Long before becoming the object of medical scrutiny, a patient is first and foremost simply a chronicler, a narrator of suffering, a traveler who has visited the kingdom of the sick.

Natures and features last until the grave.

Our encounter with cancer has rounded us off; it has smoothed and polished us like river rocks.

Scientists divide. We discriminate. It is the inevitable occupational hazard of our profession that we must break the world into its constituent parts -- genes, atoms, bytes -- before making it whole again. We know of no other mechanism to understand the world: to create the sum of its parts, we must begin by dividing it into the parts of the sum.

The (cancer) cells, technically speaking, are immortals. The woman from whose body they were once taken has been dead for thirty years

The greatest clinicians who I know seem to have a sixth sense for biases. They understand, almost instinctively, when prior bits of scattered knowledge apply to their patients?but, more important, when they don?t apply to their patients.

The point is this: if you cannot separate the phenotype of mental illness from creative impulses, then you cannot separate the genotype of mental illness and creative impulse.

There was no detectable association between gliomas and cell phone use overall. Prevention experts, and phone-addicted teenagers, may have rejoiced?but only briefly.

Turned into a horrific mistake. Lucy Willis had observed that folic acid, if administered to nutrient-deprived patients, could restore the normal genesis of blood. Farber wondered whether administering folic acid to children with leukemia might also restore normalcy to their blood. Following that tenuous trail, he obtained some synthetic folic acid, recruited a cohort of leukemic children, and started injecting folic acid into them. In the months that passed, Farber found that folic acid, far from stopping the progression of leukemia, actually accelerated it. In one patient, the white cell count nearly doubled. In another, the leukemia cells exploded into the bloodstream and sent fingerlings of malignant cells to infiltrate the skin. Farber stopped the experiment in a hurry.

Yet, old sins have long shadows, and carcinogenic sins especially so. The lag time between tobacco exposure and lung cancer is nearly three decades, and the lung cancer epidemic in America will have an afterlife long after smoking incidence has dropped. Among men, the age-adjusted incidence of lung adenocarcinoma, having peaked at 102 per 100,000 in 1984, dropped to 77 in 2002. Among women, though, the epidemic still runs unabated. The stratospheric rise of smoking among women in Rose Cipollone?s generation is still playing itself out in the killing fields of lung cancer.

And this was to save rats, right? Or mice? You spent all this money to save mice the problem of developing tumors?

But the MSA has not signaled the death of the industry in a more global sense; beleaguered in America, the Marlboro Man has simply sought out new Marlboro countries. With their markets and profits dwindling and their legal costs mounting, cigarette manufacturers have increasingly targeted developing countries as new markets, and the number of smokers in many of these nations has risen accordingly. Tobacco smoking is now a major preventable cause of death in both India and China. Richard peto, an epidemiologist at Oxford and a close collaborator of Richard Doll?s (until Doll?s death in 2005), recently estimated that the number of smoking-related deaths among adults in India would rise to 1 million per year in the 2010s and continue to rise in the next decade. In China, lung cancer is already the leading cause of death, attributable to smoking in men.

Cancer changes your life, a patient wrote after her mastectomy. It alters your habits.? Everything becomes magnified.

Cancer's life is a recapitulation of the body's life, its existence a pathological mirror of our own. Susan Sontag warned against overburdening an illness with metaphors. But this is not a metaphor. Down to their innate molecular core, cancer cells are hyperactive, survival-endowed, scrappy, fecund, inventive copies of ourselves.

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American Physician, Biological Scientist and Author, Awarded Pulitzer Prize for his book, The Emperor Of All Maladies: A Biography of Cancer