Siddhartha Mukherjee Quotes

Genetic tests," as Eric Topol, the medical geneticist described it, "are also moral tests. When you decide to test for 'future risk,' you are also, inevitably, asking yourself, what kind of future am I willing to risk?" Three case studies illustrate the power and the peril of using genes to predict "future risk.

Could your medicine be a cell, not a pill? Could your medicine be an organ that's created outside the body? Could your medicine be an environment?

In Ersilia, to establish the relationships that sustain the city's life, inhabitants stretch strings from the corners of the houses, white or black or gray or black-and-white according to whether they mark a relationship of blood, of trade, authority, agency. When the strings become so numerous that you can no longer pass among them, the inhabitants leave: the houses are dismantled. - Italo Calvino

The dinosaurs who studied dinosaurs would soon become extinct in their own right. Watson

The approach required more persistence than imagination, but it produced remarkable results.

This was yet another colonial fascination: to create the conditions of misery in a population, then subject it to social or medical experimentation.

Sandeep Jauhar's Doctored is a passionate and necessary book that asks difficult questions about the future of medicine. The narrative is gripping, and the writing is marvelous. But it was the gravity of the problem - so movingly told - that grabbed and kept my attention throughout this remarkable work.

Mutants are necessary to maintain the essence of our selves. Our genomes has negotiated a fragile balance between counterpoised forces, pairing strand with opposite strand, mixing past and future, pitting memory against desire. It is the most human of all things that we possess. Its stewardship may be the ultimate test of knowledge and discernment of our species.

A Pap smear would give a woman a chance to receive preventive care [and] greatly decrease the likelihood of her ever developing cancer.

In 2004, a rash of early scientific reports suggested that cell phones, which produce radio frequency energy, might cause a fatal form of brain cancer called a glioma.

What if - poring through Graham's bank in some future era - the selected "genius specimens" were found to possess the very genes that, in alternative situations, might be identified as disease enabling (or vice versa: What if "disease-causing" gene variants were also genius enabling?)?

Bailey had profoundly changed the conversation around sexual identity away from the 1960s rhetoric of "choice" and "personal preference" toward biology, genetics, and inheritance. If we did not think of variations in height or the development of dyslexia or type 1 diabetes as choices, then we could not think of sexual identity as a choice. But

The moral and medical lessons from this story are even more relevant today. Medicine is in the midst of a vast reorganization of fundamental principles. Most of our models of illness are hybrid models; past knowledge is mishmashed with present knowledge. These hybrid models produce the illusion of a systematic understanding of a disease - but the understanding is, in fact, incomplete. Everything seems to work spectacularly, until one planet begins to move backward on the horizon. We have invented many rules to understand normalcy - but we still lack a deeper, more unified understanding of physiology and pathology.

I could write a thesis on the physiology of vision. But I had no way to look through the fabric of confabulation spun by a man with severe lung disease who was prescribed 'home oxygen', but gave a false address out of embarrassment because he had no 'home.'

Nineteenth-century doctors often linked cancer to civilization: cancer, they imagined, was caused by the rush and whirl of modern life, which somehow incited pathological growth in the body. The link was correct, but the causality was not: civilization did not cause cancer, but by extending human life spans - civilization unveiled it.

It is an old complaint about the practice of medicine that it inures you to the idea of death. But when medicine inures you to the idea of life, to survival, then it has failed utterly.

Most days, I go home and I feel rejuvenated. I feel ebullient.

It is difficult to describe what happened next-except to say that it is a moment that occurs uniquely in the history of refugees. Q tiny bolt of understanding passed between them. The woman recognized my father- not the actual man, whom she had never met, but the form of the man : a boy returning home. In Calcutta- in Berlin, Peshawar, Delhi, Dhaka- men like this seem to turn up everyday, appearing out of nowhere off the streets and walking unannounced into houses, stepping casually over thresholds into their past.

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.

History repeats, but science reverberates.

Pierre and Marie (then Maria Sklodowska, a penniless Polish immigrant living in a garret in Paris) had met at the Sorbonne and been drawn to each other because of a common interest in magnetism.

It is encrusted with history. Embedded within it are peculiar fragments of DNA-some derived from ancient viruses-that were inserted into the genome in the distant past and have been carried passively for millennia since then. Some of these fragments were once capable of actively "jumping" between genes and organisms, but they have now been largely inactivated and silenced. Like decommissioned traveling salesmen, these pieces are permanently tethered to our genome, unable to move or get out. These fragments are vastly more common than genes, resulting in yet another major idiosyncrasy of our genome: much of the human genome is not particularly human.

I began wondering, can one really write a biography of an illness? But I found myself thinking of cancer as this character that has lived for 4,000 years, and I wanted to know what was its birth, what is its mind, its personality, its psyche?

One swallow is a coincidence, but two swallows make summer.

It was a Rube Goldberg disease. A change in the sequence of a gene caused the change in the sequence of a protein; that warped its shape; that shrank a cell; that clogged a vein; that jammed the flow; that racked the body (that genes built).

is, in truth, a variety of diseases

Is there something I can do to kill the cancer germ? Can the rooms be fumigated ... ? Should I give up my lease and move out?

But the story of leukemia
the story of cancer
isn't the story of doctors who struggle and survive, moving from institution to another. It is the story of patients who struggle and survive, moving from on embankment of illness to another. Resilience, inventiveness, and survivorship
qualities often ascribed to great physicians
are reflected qualities, emanating first from those who struggle with illness and only then mirrored by those who treat them. If the history of medicine is told through the stories of doctors, it is because their contributions stand in place of the more substantive heroism of their patients.

God is in no hurry, so why should I be?"), Griffith

Leukemia was a malignant proliferation of white cells in the blood. It was cancer in a molten, liquid form.

The biological universe was full of molecules picking out their partners like clever locks designed to fit a key: toxins clinging inseparably to antitoxins, dyes that highlighted only particular parts of cells, chemical stains that could nimbly pick out one class of germs from a mixture of microbes. If biology was an elaborate mix-and-match game of chemicals, Ehrlich reasoned, what if some chemical could discriminate bacterial cells from animal cells--and kill the former without touching the host?

Normalcy is the antithesis of evolution.

Children with cancer, as one surgeon noted, were typically "tucked in the farthest recesses of the hospital wards." They were on their deathbeds anyway, the pediatricians argued; wouldn't it be kinder and gentler, some insisted, to just "let them die in peace"?

If you prefer an "academic life" as a retreat from reality, do not go into biology. This field is for a man or woman who wishes to get even closer to life. - Hermann Muller We

In 2010, about six hundred thousand Americans, and more than 7 million humans around the world, will die of cancer. In the United States, one in three women and one in two men will develop cancer during their lifetime. A quarter of all American deaths, and about 15 percent of all deaths worldwide, will be attributed to cancer. In some nations, cancer will surpass heart disease to become the most common cause of death.

The proteins create a gradient within the egg. Like sugar diffusing out of a cube in a cup of coffee, they are present at high concentration on one end of the egg, and low concentration on the other. The diffusion of a chemical through a matrix of protein can even create distinct, three-dimensional patterns-like a pool of syrup ribboning into oatmeal. Specific genes are activated at the high-concentration end versus at the low-concentration end, thereby allowing the head-tail axis to be defined, or other patterns to be formed.

History repeats itself, in part because the genome repeats itself. And the genome repeats itself, in part because history does. The impulses, ambitions, fantasies, and desires that drive human history are, at least in part, encoded in the human genome. And human history has, in turn, selected genomes that carry these impulses, ambitions, fantasies, and desires. This self-fulfilling circle of logic is responsible for some of the most magnificent and evocative qualities in our species, but also some of the most reprehensible. It is far too much to ask ourselves to escape the orbit of this logic, but recognizing its inherent circularity, and being skeptical of its overreach, might protect the week from the will of the strong, and the 'mutant' from being annihilated by the 'normal'.

A major hindrance to cancer effort has been a chronic, severe shortage of funds - a situation that is not generally recognized.

If the history of the last century taught us the dangers of empowering governments to determine genetic "fitness" (i.e., which person fits within the triangle, and who lives outside it), then the question that confronts our current era is what happens when this power devolves to the individual. It is a question that requires us to balance the desires of the individual - to carve out a life of happiness and achievement, without undue suffering - with the desires of a society that, in the short term, may be interested only in driving down the burden of disease and the expense of disability. And operating silently in the background is a third set of actors: our genes themselves, which reproduce and create new variants oblivious of our desires and compulsions - but, either directly or indirectly, acutely or obliquely, influence our desires and compulsions. Speaking at the Sorbonne in 1975, the cultural historian Michel Foucault once proposed that "a technology of abnormal individuals appears precisely when a regular network of knowledge and power has been established." Foucault was thinking about a "regular network" of humans. But it could just as easily be a network of genes.

The daughter of Lithuanian immigrants, born with a precocious scientific intellect and a thirst for chemical knowledge, Elion had completed a master's degree in chemistry from New York University in 1941 while teaching high school science during the day and preforming her research for her thesis at night and on the weekends. Although highly qualified, talented, and driven, she had been unable to find a job in an academic laboratory. Frustrated by repeated rejections, she had found a position as a supermarket product supervisor. When Hitchings found Trudy Elion, who would soon become on of the most innovative synthetic chemists of her generation (and a future Nobel laureate), she was working for a food lab in New York, testing the acidity of pickles and the color of egg yolk going into mayonnaise. Rescued from a life of pickles and mayonnaise ...

Scientists often study the past as obsessively as historians because few other professions depend so acutely on it. Every experiment is a conversation with a prior experiment, every new theory a refutation of the old.

The very effect of X-rays killing rapidly dividing cells - DNA damage - also created cancer-causing mutations in genes.

The most intriguing correlations obtained by the Minnesota study were also among the most unexpected. Social and political attitudes between twins reared apart were just as concordant as those between twins reared together: liberals clustered with liberals, and orthodoxy was twinned with orthodoxy. Religiosity and faith were also strikingly concordant: twins were either both faithful or both nonreligious. Traditionalism, or "willingness to yield to authority," was significantly correlated. So were characteristics such as "assertiveness, drive for leadership, and a taste for attention." Other

It is said that if you know your enemies and know yourself, you will not be imperiled in a hundred battles; if you do not know your enemies but do know yourself, you will win one and lose one; if you do not know your enemies nor yourself, you will be imperiled in every single battle. - Sun Tzu

The cure of even one solid cancer in adults, Farber knew, would singularly revolutionize oncology. It would provide the most concrete proof that this was a winnable war.

The secret to battling cancer, then, is to find means to prevent these mutations from occurring in susceptible cells, or to find means to eliminate the mutated cells without compromising normal growth. The conciseness of that statement belies the enormity of the task. Malignant growth and normal growth are so genetically intertwined that unbraiding the two might be one of the most significant scientific challenges faced by our species. Cancer is built into our genomes: the genes that unmoor normal cell division are not foreign to our bodies, but rather mutated, distorted versions of the very genes that perform vital cellular functions. And cancer is imprinted in our society: as we extend our life span as a species, we inevitably unleash malignant growth (mutations in cancer genes accumulate with aging; cancer is thus intrinsically related to age). If we seek immortality, then so, too, in a rather perverse sense, does the cancer cell.

It was, I suspected, not the first time that a patient had consoled a doctor about the ineffectuality of his discipline.

How can one capture genes that behave like ghosts," Weinberg wrote, "influencing cells from behind some dark curtain?

Introns are not the exception in human genes; they are the rule. Human introns are often enormous-spanning several hundreds of thousands of bases of DNA. And genes themselves are separated from each other by long stretches of intervening DNA, called intergenic DNA. Intergenic DNA and introns-spaces between genes and stuffers within genes-are though to have sequences that allow genes to be regulated in context. To return to our analogy; these regions might be described as long ellipses scattered with occasional punctuation marks. The human genome can thus be visualized as:

This......is............the......(...)...s...truc...ture......of......your......gen...om...e;

The words represent genes. The long ellipses between the words represent the stretches of intergenic DNA. The shorter ellipses within the words (gen...ome...e) are introns. The parentheses and semicolons-punctuation marks-are regions of DNA that regulate genes.

The discipline of medicine concerns the manipulation of knowledge under uncertainty.

There is a very moving and ancient connection between cancer and depression.

Three profoundly destabilizing scientific ideas ricochet through the twentieth century, trisecting it into three unequal parts: the atom, the byte, the gene.

Hodgkin had just returned from his second visit to Paris, where he had learned to prepare and dissect cadaveric specimens. He was promptly recruited to collect specimens for Guy's new museum. The job's most inventive academic perk, perhaps, was his new title: the Curator of the Museum and the Inspector of the Dead. Hodgkin

Gliomas appeared on the same side of the brain that the phone was predominantly held, further tightening the link. An avalanche of panic ensued in the media.

It was Disney World fused with Cancerland.

Doctors are men who prescribe medicines of which they know little, to cure diseases of which they know less, in human beings of whom they know nothing. - Voltaire

Cancer is not a concentration camp, but it shares the quality of annihilation: it negates the possibility of life outside and beyond itself; it subsumes all living.

It is one thing to try to understand how genes influence human identity or sexuality or temperament. It is quite another thing to imagine altering identity or sexuality or behavior by altering genes.

Cancer is a tremendous opportunity to have your face pressed right up against the glass of your mortality. But what patients see through the glass is not a world outside cancer, but a world taken over by it - cancer reflected endlessly around them like a hall of mirrors.

It turns out that the very genes that turn on in cancer cells perform vital functions in normal cells. In other words, the very genes that allow our embryos to grow or our brains to grow, our bodies to grow, if you mutate them, if you distort them, then you unleash cancer.

Cancer is not one disease but many diseases.

Even an ancient monster needs a name. To name an illness is to describe a certain condition of suffering - a literary act before it becomes a medical one. A patient, long before he becomes the subject of medical scrutiny, is, at first, simply a storyteller, a narrator of suffering - a traveler who has visited the kingdom of the ill. To relieve an illness, one must begin, then, by unburdening its story. The

In New York in the 1910s, William B. Coley, James Ewing, and Ernest Codman had treated bone sarcomas with a mixture of bacterial toxins - the so-called Coley's toxin.

I am a scientist and I am a physician. So I write papers.

Labs, too, can become machines. In science, it is more often a pejorative description than a complimentary one: an efficient, thrumming, technically accomplished laboratory is like a robot orchestra that produces perfectly pitched tunes but no music.

Second, proto-oncogenes and tumor suppressor genes typically lie at the hubs of cellular signaling pathways.

Nécessité absolue trouver origine de cet emmerdement [It is absolutely necessary to find the origin of this pain in the ass]. - Jacques Monod

Nearly every one of the genes that turns out to be a key player in cancer has a vital role in the normal physiology of an organism. The genes that enable our brains and blood cells to develop are implicated in cancer.

Science is often described as an iterative and cumulative process, a puzzle solved piece by piece, with each piece contributing a few hazy pixels of a much larger picture. But the arrival of a truly powerful new theory in science often feels far from iterative. Rather than explain one observation or phenomenon in a single, pixelated step, an entire field of observations suddenly seems to crystallize into a perfect whole. The effect is almost like watching a puzzle solve itself.

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

Postwar U.S. was the world's leader in science and technology. The investment in science research was staggering.

If we, as a species, are the ultimate product of Darwinian selection, then so, too, is this incredible disease that lurks inside us.

Seek simplicity, but distrust it," Alfred North Whitehead, the mathematician and philosopher, once advised his students. Dobzhansky

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

In Lewis Carroll's poem, when the hunters finally capture the deceptive Snark, it reveals itself not to be a foreign beast, but one of the human hunters sent to trap it. And so it had turned out with cancer. Cancer genes came from within the human genome. Indeed the Greeks had been peculiarly prescient yet again in their use of the term oncos. Cancer was intrinsically "loaded" in our genome.

In 1788, the Chimney Sweepers Act was passed in Parliament, preventing master sweeps from employing children under eight (children over eight were allowed to be apprenticed).

Most of the selected essays share a common thread: They describe how science happens.

The chances in some cases are infinitesimal, but the potential is still there. This is about all that patients need to know and it is about all that patients want to know.

The trial designed to bring the most rigorous statistical analysis to the cause of lung cancer barely required elementary mathematics to prove its point.

Cancer, perhaps, is an ultimate perversion of genetics - a genome that becomes pathologically obsessed with replicating itself. The

You spent all this money to save mice the problem of developing tumors? Exchanges

Robert Sandler is a child who died when he was three years old, and he is a child who was the first child that we know of to be treated with chemotherapy.

I think the way we think about cancer, the way we treat cancer, has dramatically changed in the last century. There is an enormous amount of options that a physician can provide today, right down from curing patients, treating patients or providing patients with psychic solace or pain relief.

It is the impulse of science to try to understand nature, and the impulse of technology to try to manipulate it.

I think you would have to be a nihilist to say that we are not making progress on cancer, just like you'd have to be hubristically optimistic to say that we have conquered cancer.

The search for a way to eradicate this scourge ... is left to incidental dabbling and uncoordinated research. - The Washington Post, 1946

We of the craft are all crazy," Lord Byron, the high priest of crazies, wrote. "Some are affected by gaiety, others by melancholy, but all are more or less touched.

The history is important because science is a discipline deeply immersed in history. In other words, every time you perform an experiment in science or in medicine, what you're actually doing is you're answering someone, answering a question raised by someone in the past.

There's a rising cancer trend and, as I said, one of the major contributors is the overall ageing of the population - we aren't dying of other things, so we're dying of cancer.

Is medicine a science?

I think the cardinal rule of learning to write is learning to read first. I learned to write by learning to read.

There is a duality in recognising what an incredible disease it is - in terms of its origin, that it emerges out of a normal cell. It's a reminder of what a wonderful thing a normal cell is. In a very cold, scientific sense, I think a cancer cell is a kind of biological marvel.

But the pigs--seventy pounds of porcine weight that did not take kindly to weekly endoscopies--did not sprout any ulcers. And testing the theory on humans was ethically impossible: how could one justify infecting a human with a new, uncharacterized species of bacteria to prove that it caused gastritis and predisposed to cancer?
In July 1984, with his experiments stalled and his grant applications in jeopardy, Marshall performed the ultimate experiment: "On the morning of the experiment, I omitted my breakfast….Two hours later, Neil Noakes scraped a heavily inoculated 4 day culture plate of Helicobacter and dispersed the bacteria in alkaline peptone water (a kind of meat broth used to keep bacteria alive). I fasted until 10 am when Neil handed me a 200 ml beaker about one quarter full of the cloudy brown liquid. I drank it down in one gulp then fasted for the rest of the day. A few stomach gurgles occurred. Was it the bacteria or was I just hungry?

Ehrlich hedged. The cancer cell, he explained, was a fundamentally different target from a bacterial cell. Specific affinity relied, paradoxically, not on "affinity," but on its opposite - on difference. Ehrlich's chemicals had successfully targeted bacteria because bacterial enzymes were so radically dissimilar to human enzymes. With cancer, it was the similarity of the cancer cell to the normal human cell that made it nearly impossible to target.

Technology, I said before, is most powerful when it enables transitions - between linear and circular motion (the wheel), or between real and virtual space (the Internet). Science, in contrast, is most powerful when it elucidates rules of organization - laws - that act as lenses through which to view and organize the world. Technologists

Many of my patients continued to smoke, often furtively, during their treatment for cancer (I could smell the acrid whiff of tobacco on their clothes as they signed the consent forms for chemotherapy).

Most discoveries even today are a combination of serendipity and of searching.

in BRCA-1 has a 50 to 80 percent chance of developing breast cancer in her lifetime (the gene also increases the risk for ovarian cancer), about three to five times the normal risk.

Our ability to read out this sequence of our own genome has the makings of a philosophical paradox. Can an intelligent being comprehend the instructions to make itself? - John Sulston Scholars

In an age of increasingly mechanized production, the genesis of scientific knowledge remains an unyieldingly, obstreperously hand-hewn process. It is among the most human of our activities. Far from being subsumed by the dehumanizing effects of technology, science remains our last stand against it.