I was looking forward to reading this for the Nature and Environment group—I’d heard good things about it and I love this kind of book—but although it was good in many ways, it was a bit of a dense slog and also hard going emotionally (early cancer treatments, OMG). The hubris and ego of early surgeons resulted in a lot of excessive suffering, needlessly for those patients, but some of it resulted in actual advances. It’s morally painful and ambiguous.
[Advocates of radical surgery] genuinely believed that they could relieve the dreaded symptoms of cancer. But they lacked formal proof, and as they went further up the isolated promontories of their own beliefs, proof became irrelevant and trials impossible to run. The more fervently surgeons believed in the inherent good of their operations, the more untenable it became to put these to a formal scientific trial. Radical surgery thus drew the blinds of circular logic around itself for nearly a century.
It was fascinating and disheartening also to see how the mistaken mental frames around cancer (one disease, on which a coordinated “war” can be waged) delayed understanding and treatment. That’s one of the simplistic ideas that have been a problem for medicine: the body is so so so much more complicated that the imagery of pumps/fluid mechanics/contamination allows for. And it makes sense that patients are quick to demand treatments that haven’t been fully tested, resenting what can seem like (and maybe it) foot-dragging, but then the opportunity to really test is lost.
It’s well written but sometimes a little purple. Mukherjee for example describes a person as “brackish”—I kind of like it but it’s on the edge of too showy. There’s a plates section which feels a bit arbitrary. Also, the framing autobiographical bit (his treatment of one particular patient) is very small in comparison with the dense mass of the rest.
- The modern-sounding clinical descriptions of Imhotep (2625 BC), under the description of breast cancer: treatment “There is none”
- Autopsy literally means “to see for oneself;” Vesalius vainly looking for Galen’s “black bile”
- Music and surgery: “The professions still often go hand in hand. Both push manual skill to its limit; both mature with practice and age; both depend on immediacy, precision, and opposable thumbs.”
- “Dogs, humans, and lions are the only animals known to develop prostate cancer”
- “Hefty Brunsviga calculators, the precursors of modern computers, clacked and chimed … ringing like clocks each time a long division was performed.”
- “The iconic Marlboro man, with his hypermasculine getup of lassos and tattoos, was an elaborate decoy set up to prove that there was nothing effeminate or sissy about smoking filter-tipped cigarettes.”
- “Normal cells are identically normal; malignant cells become unhappily malignant in unique ways.”
He’s widely read and has a great ear for quotes; a surprising number of the passages I flagged are from other writers:
- Howard Skipper: “A model is a lie that helps you see the truth.”
- Mukherjee names Bernard Fisher as the source for the fantastic “In God we trust. All others [must] have data;” the great Quote Investigator says it can’t be attributed to him, but I’m thrilled to have been introduced to it.
- Paul Brodeur: “Statistics are human beings with the tears wiped off”
- Richard Avedon: “All photographs are accurate. None of them is the truth.”
- David Rieff in his memoir of his mother Susan Sontag’s illness: “Like so many doctors, he spoke to us as if we were children but without the care that a sensible adult takes in choosing what words to use with a child.”
- Alfred Knudson saying he inferred the existence of anti-oncogenes “as one might infer the wind from the movement of the trees.”
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.
We are chemical apes: having discovered the capacity to extract, purify, and react molecules to produce new and wondrous molecules, we have begun to spin a new chemical universe around ourselves. Our bodies, our cells, our genes are thus being immersed and reimmersed in a changing flux of molecules—pesticides, pharmaceutical drugs, plastics, cosmetics, estrogens, food products, hormones, even novel forms of physical impulses, such as radiation and magnetism.