Review: Emperor of all maladies, part 8: author commentary

Author Commentary

• “cancer, far from being a ‘modern’ disease, is one of the oldest diseases found in a human specimen—quite possibly the oldest.”
• Halstead’s ultra-radical mastectomy only provided a 50% 3 year survival rate
• 1944: Manhattan project spent $100 million each month; 1948: Americans spent over $126 million on Coca-Cola; 1948: Jimmy Fund raises a record $231,000 for the Farber institute, which will become the world’s best children’s leukemia hospital
• Quote from Farber: “[It is not] necessary, in order to make great progress in the cure of cancer, for us to have the full solution of all the problems of basic research…the history of Medicine is replete with examples of cures obtained years, decades, and even centuries before the mechanism of action was understood for these cures… Patients with cancer who are going to die this year cannot wait.”
• Min Chiu Li is axed from his position for continuing to treat patients with chemotherapy even when they seemed cured. He is vilified and black listed, but in the future is proven to be exactly right, and this becomes the standard practice.
• Success of multiple chemo drugs in mice and in leukemia patients in the 1950s starts a trend, much like Halstead’s drive to ultra-radical surgery, for ultra-radical chemotherapy, that will rage until the 80s. Worst point: new ultra chemo trials started in the 1970s that are killing patients, until in 1985 there have been 6,000 articles published without a single new thought in the last century. It takes until 1999 and the discovery of a false clinical trial in South Africa to kill megadose chemotherapy (which by that time was paired with autologous bone marrow transplants so that ever higher doses of chemo could be administered).
• The blood brain barrier, meant to protect the brain from poisons, ends up creating a heaven for cancer cells to metastasize to, which makes sense considering that chemotherapy is a poison
• Author compares modern chemotherapy regimens to Sisyphus, the figure in Greek myth doomed to push a boulder up a hill in Hades, and each time he gets to the top it rolls back down. Why? Because each time somebody just starts recovering from the last dose of chemo, they receive the next one
• Hodgkins lymphoma is unique in that it spreads locally and systematically (conquering one lymph node, then the next adjacent one, and so on), instead of jumping randomly in the body like solid tumors
• Nausea created by multiple chemotherapy drug “cocktails” kills people in the 20^th century because no anti-nausea drug is strong enough
• Viral theory throws off basic cancer biology research for almost a century: for example, in the 1960s, the NCI put 10% of its total budget into viral investigations, while research into the role of diet in cancer receives ~ 0.5% of their research funding; additionally, Rous, who discovered the cancer virus in chickens, in his Nobel prize speech, derides the theory of oncogenes
• Ultraradical mastectomies as gold standard spanned 90 years and over 500,000 women
• Despite Cairn’s report, the NCI did not even consider prevention as worthwhile of mentioning amongst their aims in a 1974
• Smoking is so prevalent in society, it’s hard to discern its effect in epidemiological analyses
• Master Settlement Agreement, while curbing tobacco in some ways, will protect them in the future from further attacks and may end up hurting public health