Rebecca Skloot – The Immortal Life of Henrietta Lacks

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Biography, Book Review, Henrietta Lacks, History of Medicine, Rebecca Skloot, The Immortal Life of Henrietta Lacks

Henrietta Lacks may have saved my life although I never knew her

In 1951 human tissue culture was in its infancy, with researchers struggling to keep cells alive beyond a few cellular generations; normal cells are subject to apoptosis (programmed cellular lifespan/death)

Henrietta Lacks, a poor young black woman, was admitted to hospital in Baltimore in 1951 with an exceptionally invasive and aggressive cancer.

A standard biopsy was taken of her cancerous cells. She did not know that the biopsy would not be used purely for diagnostic purposes, but also tissues would be used for research. No consent was sought for this. In 1951 and indeed still today samples of tissue taken for diagnostic purposes can be used for other purposes – we do not own our tissues once they are no longer part of us.

Cancer cells are not subject to apoptosis. The particular aggressiveness of Henrietta Lacks’ cancer yielded astonishing results for tissue culture, and within a short space of time the `HeLa’ cell line was being used for a wide number of medical research studies world wide, whether testing the actions of many pharmaceutical drugs or as part of the human genome project, and more.

`HeLa’ has had profound, beneficial effects on probably most of us who benefit from modern medicine. HeLa has earned millions of dollars and much prestige for many predominantly white male scientists, as patents have been taken out on advances only possible through tissue culture using the HeLa line

However, Henrietta’s family were unaware of the rich legacy she left the world – or the rich financial legacy reaped by institutions and individuals. In fact, they remained poor and unable to afford healthcare.

Rebecca Skloot has written an angering, compassionate and educative book, looking not only at the science made possible by HeLa – but also exposing the arrogance, hypocrisy and callousness of some individuals and establishments within scientific research. She also tells the story of Henrietta and the Lacks family – indeed, formed strong relationships with that family. Inevitably, given time and place the book is also a shameful expose of how America used its poor in unethical `research’ very little different from the `research’ which Mengele and others were using in concentration camps a decade or so earlier

This book pulls no punches, and may not be for those sensitive to medical issues – there are graphic descriptions of medical procedures and the ravages of terminal illness. It is, however, extraordinary.

The Immortal Life of Henrietta Lacks Amazon UK
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Barbara Griggs – The Green Pharmacy: The History and Evolution of Western Herbal Medicine

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Barbara Griggs, Book Review, Green Pharmacy, Herbalism, History of Medicine, Phytotherapy

Fascinating account of our history with medicinal plants

Anyone who has an interest in the development of medicine, philosophy of healing, or the politics of who is allowed to heal and why, cannot help but be uplifted and angered by this book.

Barbara Griggs is an excellent writer, and she has given a clear and sobering account of mankind’s relationship with medicinal plants from pre-history. She looks at developments of a philosophy of healing, and charts the unfortunate history of conflicts between those who sought to empower their patients, and to demystify healing (often a female tradition) and those who sought to make a lot of money out of ‘healing’. This latter group had a vested interest in making ‘healing’ something which only they could ‘do’ for someone else, and therefore the methods of healing had to be difficult, rare, costly – and often downright dangerous.

Culpeper WikiCommons

She contrasts the philosophy of herbalists such as Nicholas Culpeper, and his use of ‘simples’ with apothecaries who were using a whole range of far flung exotic substances, often engaged in ‘heroic’ practices such as bleeding, purging, cupping etc.

There is a sobering account of the outlawing of herbal treatment in the UK during part of the twentieth century – and of course many many parallels to be drawn between the earlier conflicts between ‘wise women/’witch’ herbal practitioners and ‘educated’ professionals with often some pretty newfangled, untried remedies – and the modern conflicts between herbal medicines and the big pharmaceutical giants.
Parallels suggested themselves between the vilifying of herbal practitioners by the ‘professionals’ with their new ‘mainstream’ use of mercury and arsenic in large (not homeopathic doses) in the 17th/18th century which often killed the patient, and, today’s big pharma.touting heroic, similarly ‘newfangled’ medicine which is often without the long term in the field use herbals have had.

For example, unopposed oestrogen being put on the market as the absolute to be desired for menopausal women – and 10-15 years down the line, the link between ORT and endometrial cancer becomes evident. And then a replay with HRT and the years and years before a truly large scale longitudinal study verified what various complementary practitioners – and indeed some medics – had been saying about long term use, and breast cancer. Drugs coming onto the market and being withdrawn from the market whilst a gentler medicine is often mocked if not deliberately hounded out, is a history which has been replayed.
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Siddhartha Mukherjee – The Emperor of All Maladies

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Book Review, History of Medicine, Science and nature, Siddhartha Mukherjee, The Emperor of All Maladies

Abnormal Distortions of our Normal Selves

This is a tremendous piece of research and writing by a doctor, for the lay reader. To say that a book about cancer, that most dread of diseases, is deeply thought provoking, instructive and very entertaining indeed may seem a weird combination of experiences, but so it is. I’m not surprised that this book was a Pulitzer Prize Winner. It is quite brilliant.

Mukherjee examines this disease and its treatment historically from the first evidence of its appearance. It is a malady which appears to have been known and feared for at least as long as we have had any sort of written records – the ancient Egyptian physician Imhotep describes its aetiology in the Smith papyrus, thought to date from around 2,500 B.C, defining with precision what seems to be the presentation of breast cancer, with the dread advice to fellow physicians on treatment – There Is None.

Mukherjee intersperses the long and fascinating history of the search for initially, A Cure For Cancer, to more modern methods which look at multifactorial treatments, and specific treatments for individual cancers, with the narrative of specific patients. The historical journey weaves in, as it must, much fascinating information about changes in medical philosophies, ethics, the relationship between clinician and patient, the move away from a holistic view of disease inhabiting a person to views which see the clinician completely focused on the condition and ignoring the person with the condition. Stories about the extreme radicalism of surgical procedures for breast cancer `The Halstead approach’ in the latter part of the 19th and early 20th century make for shocking reading, and one can’t help but feel it was more about the glorious and theatrical daring of the surgeon than the benefit of the poor sufferer. This was medicine without the evidence to support it, happening none the less.

Even I (well aware that often `gold standard ` trials in medicine DON’T happen) was shocked to discover that the preferred treatment for breast cancer, – increasingly radical mastectomy, in use in America for nearly 100 years, – was not brought to the table for a proper trial. It was not until 1981 that  the results were shown that survival rates following `extirpation’ (removal of the breast, axillary and sometimes even cervical lymph nodes) were no better a treatment than either simple mastectomy, or the even more conservative lumpectomy with radiotherapy. In fact, the name `lumpectomy’ was coined as a dismissive, by the radicals, to describe the early, effective and more conservative treatment initially pioneered, as early as 1924, by an English doctor, Geoffrey Keynes. It was a struggle for those trying less invasive treatments to get the orthodox radicalists to listen.

Interestingly, Mukherjee links the eventual move towards less disfiguring, yet equally effective treatments, with the rise of patient power, and, in the case of breast cancer, feminism’s challenge to a generally masculine medical model.

deviant art, commons

The development of radiotherapy and chemotherapy make fascinating reading. Synthesised chemistry initially grew out of the desire to find dyes for cloth in the 1850s, natural dyes being costly and not so effective, and was then further exploited by the war industry, most notably in the production of Mustard Gas in the trenches of the First World War.

Treatment of survivors of mustard gas showed they had severe anaemia – in fact, mustard gas depleted the blood-forming cells in bone marrow. Eventually this led to interesting conclusions which could be utilised in the search of a cure for leukaemia, abnormal and aggressive proliferation of white blood cells. An unlikely combination of the fashion industry and the war industry as the mother and father of chemotherapy, where chemical molecules are designed and developed for specific purposes.

There is a long and absorbing section on the woefully late entrance of funding, ideology and will, to the idea of Cancer Prevention, rather than the starrier and more dramatic search for a cure or cures. The section begins with a telling quote from 1975, published in the Chicago Tribune:

The idea of preventative medicine is faintly Un-American. It means, first, recognising that the enemy is us

He enters into the shocking and political story of the known links between tobacco and lung-cancer, and the length of time it took for anything meaningful to be done with the explosive information. Two studies done in 1948, one in the UK and one in the USA, were published in medical journals, already demonstrating the evidence. A later landmark study, as far as methodology is concerned, published in 1954, by the British team, in theory put the evidence clearly in the market place. Cover-ups and skilful manipulation by an extremely powerful lobby, the tobacco industry, kept the death toll caused by smoking-related lung cancer steadily rising. When America finally took action, and the health of its population became more important than the vested interests of the tobacco industry, that industry shifted its focus to emerging markets.

Future death-by-lung-cancer for citizens of the developing world awaits. Mukherjee pulls no punches on this, describing the condition from his observations of his patients afflicted with the condition.

There are fascinating stories about `public taste’ – an early campaigner seeking to set up support groups for breast cancer survivors in the 1950s tried to take out an ad addressed to such women in the New York Times. She was told that neither the word `breast’ nor indeed the word `cancer’ could possibly be mentioned. The suggested wording was `diseases of the chest wall’ . Mukherjee examines the history of advertising campaigns, and how that too had its part to play in changing public awareness of the unmentionable condition and, more importantly, generating the cash which would fund research into cures.

There is also an interesting fleeting look at how cancer – a condition after all of `immortality and excess’ – normal cells have `programmed death’ – apoptosis which cancerous cells over-ride, mutating into fast proliferating immaturity – may be a disease which could, to some degree, be symbolic of our times – in the same way that `consumption’ – TB, symbolised Victorian romanticism.

Movingly, the book is dedicated to a little 3 year old, Robert Sandler, 1947-1950, who was one of the earliest beneficiaries, if only for a very short time, of treatment with an early, chemical isolate, which was trialled (without patient consent) for experimentation on his leukaemia.

Mukherjee is a poetical scientist, a scientific poet, in his writing. His use of metaphor illuminates the hard science. The subtitle of the book, `A Biography of Cancer’ is also particularly well chosen – this disease is as complex, contradictory and multi-faceted as any person.

Particularly of interest to me was the long section detailing the struggle for some of the newer, more specific cancer drugs to be brought into treatments, and this section encapsulated a lot of the real, problematic ethics behind classic medical trials, and the often worrying split between `hard-science’ (or, indeed `hard profits’) and real-life living (and dying) patients. .

My only disappointment with the book is that he has only focused on mainstream approaches to cure or management of the condition. Mock though some will, there have been other, often combination treatments – mainstream WITH complementary, and there is evidence out there. I would have liked to have seen some information for example about the work of the  Simontons, Getting Well Again: The Bestselling Classic about the Simontons’ Revolutionary Lifesaving Self-Awareness Techniques, about results with the now outlawed laetrile, and some mention of dietary approaches. There are oncologists and oncology units who routinely suggest patients have CAM treatments – NOT to treat the cancer itself, but to support the person who has the cancer. Understanding more about the interface between body and mind – Psychoneuroendoimmunology – gives credence to holism.

For once, the `puff’ about the book from published reviewers seems in no way an oversell. Impossible to praise highly enough! This book and the equally profound and moving The Immortal Life of Henrietta Lacks, both about cancer, cancer research and medical history, are unforgettable, meaningful books about much more than a disease which fills us with dread.

Apologies, if you made it, for the length of this review. Nearly as long as the book itself!

The Emperor of All Maladies Amazon UK
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