Å·±¦ÓéÀÖ

Hi everyone! I've been a bit behind--something about traveling to about 15 cities in 7 weeks will do that to you!

The good news, I'm settling back in and CAN'T WAIT to read and discuss this great book together.

As we all start reading the first few chapters, let's do a few introductions again AND talk about what makes each of us want to pick up this book.

Would it be too personal to tell you the irony of us reading this book wasn't lost on me today as I went in for a diagnostic mammogram and exam? All is well (whew. whew). But the experience reminded me just how deeply personal this book is.

History is not something that we can keep at an arm's distance. History is about each and everyone of us. Our joys, our fears, our hopes, and everything in between. Studying history--the history of cancer, especially--provides a deep connection between us and those who have preceded us.

And if the first chapter of the EMPEROR OF ALL MALADIES is any indication, I have a feeling it is going to be a touching and intense read.

Your preliminary thoughts??

I started reading this over the weekend - so glad I picked it up! It looks like it's going to be very good. I wanted to read this mostly because I heard the author interviewed on NPR (probably Fresh Air, but don't remember). Looking forward to the discussion!

I started reading it this weekend and thought that this might be good for the class I'm revising heavily this summer, removing some of the more esoteric genetics and adding in cancer. So far the history, or what little they can find pre-20th century is very interesting.

I was able to acquire Emperor of all maladies from my library shortly after the decision to read it was made. That said I have completed it. Good read but it takes time. I was able to read other works with it (something I rarely do) to help it along.

Holly, your remarks on history are right on target. Cancer is prevalent in my family. While I was reading I was trying to place different family members within the context of the treatment timeline. I recall alot of anger ith the choices each faced but this helps translate that anger into somethng understandable. My grandfather died of leukemia in the 1940s. There were no choices for care. My greataunt died of breast cancer in the 60's after extensive mastectomy and some radiation. My mother had breast cancer X2 and it ended her life. First time she was treated with mastectomy, radiation and chemo. Second time she could only be offered radiation as a palliative measure. As you can see the treatment line paralllels my family history.

Interesting, my career as a nurse is also put into context with the treatments and advancement of knowledge. In the 70's as a new nurse I worked on an oncology floor where we delivered chemotherapy and did diagnostic workups. But chemo was not so developed and occured rarely. Most of the interventions were surgical. Things have evolved and chaged much. As part of my clinical rotation for my Master's degree I worked in bone marrow transplant.

I do not think you can remove history from any story. When we try to or ignore it I think the majority of the story's richness and meaning is lost. This is an intense read but not really touching to my mind. The author's intimacy with some of his patients is relayed in 3rd person or a distant manner more often than not.

I have found this book to be a fascinating read so far. We think of cancer as a modern disease, but it has a history nearly as long as human history. The ancient Egyptian and Greek physicians encountered cancer and left written records of it.

It is also very interesting to see how the treatment of cancer has evolved with the field of medicine as a whole. Every advance in medicine has seen as advance in the treatment of cancer. Anesthesia allowed for more extensive surgeries including tumor removals. X-rays led to radiation being used as a treatment for cancer. Chemical synthesis led to the beginnings of chemotherapy.

Christie wrote: "I have found this book to be a fascinating read so far. We think of cancer as a modern disease, but it has a history nearly as long as human history. The ancient Egyptian and Greek physicians encou..."

I was just reading about the X-rays last night. I was appalled by the guy who lost his cheeks. What the *HECK* does that look like?!!? Was it the bones???

Before I even saw the Emperor of Malady book, I was interested in it. I have MGUS (Monoclonal Gammopathy of an Uncertain Origin). It can sometimes be a precursor to Multiple Myeloma. So, currently, I am being monitored every three months with blood tests,and other test less often.

My family (I thought!) had no history of cancer on either side. About four years ago, one of my cousins died of breast cancer and a year ago another counsin was found to have stage 3a of invasive breast cancer. Since the beginning of monitoring of MGUS, I have learned a whole new vocabulary. I joined a support group for MGUS and for the first time, they are posting from around the world on Facebook. The many posts on Facebook and fatigue from going to a doctor's appointment kept me from posting yesterday.

I am just over a 100 pages into this fascinating book and excited about seeing Sidney Farber's name (I am familiar with the Dana-Farber Cancer Institute). It is very interesting to me how the researchers had get involved personally to raise funds to do the research. And to find out how different treatments came to being in so many surprising ways.

I also am finding this to be an interesting read. I appreciate the integration of case studies, both current and historical. As others have commented, this is a personal topic for most of us at some level. Even if we haven't experienced cancer ourself, it's virtually impossible to not know someone who has. The case studies put a human face to the scientific, medical aspect.

One of the first things I was struck by was the dedication: To Robert Sandler (1945-1948). There's a story there, I thought, and I wondered if he would tell it to us. Learning who Robert Sandler was made me further appreciate Mukherjee's compassion and sensitivity.

A couple of quotes that have stuck with me:

"Science begins with counting. To understand a phenomenon, a scientist must first describe it; to describe it objectively, he must first measure it." I think I'll use this one in the syllabi for my research classes next year.

Describing a breat cancer survivor meeting in the newspaper as "a meeting about disease of the chest wall". Crimeny!

I wonder what others think about the organization of the book. I'm still in Part 1, but I'm having a hard time getting a sense of the overall arc of the story. Maybe my frustration with this is partly because I'm reading The Ghost Map at the same time. It is clearly organized to me as a story and I look forward to seeing what will happen next. Emperor is interesting, but doesn't have the same forward push to me.

honestly Amanda, I'm having the same issues with the organization of Emperor. I like the material as we go but if has a feeling like the notes never quite gelled.

Amanda wrote: "I also am finding this to be an interesting read. I appreciate the integration of case studies, both current and historical. As others have commented, this is a personal topic for most of us at som..."

amanda-don't know why you are having such a time with Emperor--it's the most fascinationg book i have read in a long time-i never was interseted in cancer-why i don't know-but this story of the development of effective treatments of leukemia and Hodgkins is amazing-this all took place when i was young with young children-i am glad they didn't suffer from any of these problems.think of what might be going on today in the field of research.

Amanda wrote: "I also am finding this to be an interesting read. I appreciate the integration of case studies, both current and historical. As others have commented, this is a personal topic for most of us at som..."

I've had the same issue with the organization of the book and trying to figure out the common theme. The book has been incredibly fascinating and I do have trouble putting it down, but it does seem more like just a collection of anecdotes and not a cohesive book. I am still enjoying the book though.

I just got the book yesterday. Received it through inter-library loan - took forever! I have started reading and was I ever surprised! It is so good! I have already read the other selection for the month and it looks like this one will go quickly too. Thanks for such good book choices!

Hi everyone. I'm back in the saddle, so to speak, after a crazy travel schedule and trying to catch up on life post-book tour.

I'm really interested in what you guys are saying about the structure of the book. I feel it sometimes too. I'm wondering--and this is a question--is it possible to have a narrative (à la GHOST MAP) when an author is trying to cover the history of cancer from the earliest beginnings to now?

Are we wanting a linear narrative when it may not be possible?

So here's the philosophical question: Is history better described as unrelated moments or as a linear story, where all of the pieces click neatly (eventually) together? Or maybe it's a little of both.

Deep for an early morning...but would love to hear your thoughts...

Hi Holly,

I have thought about the structure problem but it is not preventing me from be interested in the book. So, to me it doesn't matter whether it is linear or not.

Right now, I just finished the chapter, 'The Emperor's Nylon Stockings'. It is common knowledge that the tabacco companies fought the recognition of tabacco use as being a cause of cancer. What I was amazed is that the research studies could not get funding from the government. The autopsies were showing tar stained bronicles and soot on the lungs but it was thought of as a correlation only and not proof of causing cancer. So this opinion had to be changed in order to get the research funded.

So, isn't Medicine fluid? So many times, something has been said that this has to be absolutely correct and later it turns out as in the practice of always doing radical mascetomies not always the best for the patient.

Popping in here from the other thread. It looks like these discussions are going to pull together on the question of the difficulty of changing the course of medical thinking. Synchronicity is so much fun!

Holly wrote: "Hi everyone! I've been a bit behind--something about traveling to about 15 cities in 7 weeks will do that to you!

The good news, I'm settling back in and CAN'T WAIT to read and discuss this gre..."

I'm not a history teacher, but I do know that history teachers regularly question the effectiveness of teaching history chronologically. Many argue for a thematic approach instead. Here, for example, is a post by educator Diana Laufenberg for the National History Education Clearinghouse that addresses this very question:

Since a book such as The Emperor of All Maladies is essentially a vehicle for teaching history to readers, the author also had to make decisions about the efficacy of chronological versus thematic organization. I think he opted for a blended approach.

I have not gotten into this book yet, but a while ago I read an article (I think it was in the the Atlantic), about how it is nearly impossible to publish anything that is not in narrative form any more. The present-day reader, or at least the present-day publisher, requires it. If you look at top-selling nonfiction, it is almost always narrative (perhaps Malcolm Gladwell is the poster child for turning absolutely any topic into an easy-to-read narrative). The author was suggesting this is a bad thing. I don't think it is such a bad thing so long as it is recognized for what it is: a means of popularizing information which may lack the depth that other more academic and less-read forms allow.

Thank you for posting the history teacher link- very interesting.

And I think this relates to the other question recently discussed in these parts of identifying a revolutionary way of interpreting information. If one expects everything to grow out of the previous event (history in general, or history of medicine) it is more and more difficult to have the revolutionary thought. And this is where too much narrative soaking into the brain may indeed be harmful and make one less capable of thinking outside the box than one may have otherwise been capable of.

Reading the old Emperor in parallel with The Coming Plague: Newly Emerging Diseases in a World Out of Balance. I tell you it's a powerful combo. A most interesting and frightening synergy. Mustard gas, drunken helicopter pilots, radical mastectomy, ebola...

The only drawback is that I'm not sleeping so well.

This is one of the most interesting books I have ever read. My copy didn't have a glossary, but I didn't miss it. It also didn't have an index, which I missed so much I started making one as I read, so I could refer back to the efforts of various researchers.

As far as the structure of the book is concerned, it would be impossible to write an account that made much sense WITHOUT working back and forth through time. The author speaks to this in the beginning of the book.

Holly wrote: "Hi everyone! I've been a bit behind--something about traveling to about 15 cities in 7 weeks will do that to you!

The good news, I'm settling back in and CAN'T WAIT to read and discuss this gre..."

Holly wrote: "Hi everyone. I'm back in the saddle, so to speak, after a crazy travel schedule and trying to catch up on life post-book tour.

I'm really interested in what you guys are saying about the structur..."

As I have continued to read the book, I have found that the way the book is organized easier to follow and am beginning to like it more. I can tell that the author is trying to group the different aspects of cancer history together instead of starting at the beginning of time and do more of a linear narrative which would get very confused very quickly. I see now that the organization makes more sense.

Christie wrote: "Holly wrote: "Hi everyone. I'm back in the saddle, so to speak, after a crazy travel schedule and trying to catch up on life post-book tour.

I'm really interested in what you guys are saying abou..."

I agree Christie. I am starting to settle into it a bit more now. I imagine it didn't help that I was reading three books at once! Narrative doesn't have to be linear or chronological, but I do feel the author needs to make the links clear. The more I read, the more I see it coming together. It's a complicated story and a good depiction of how messy scientific (or any?) progress is. It reminds me of something I read long long ago in college (Kuhn?) about how paradigm shifts happen - lots of slow, plodding work to build a foundation of knowledge and then, bam!, someone makes a connection that wasn't made before and there's a big leap forward. Then it's back to the slow, plodding work again for awhile. It makes it seem like the "mavericks" are the ones who make it all happen, but they couldn't do it if the solid foundation wasn't there to start with.

The intersection of scientific, social, and political forces is particularly interesting to me. Good science alone isn't enough to make change happen.

I also have realized that reading books like this on my Nook is hard. Normally I would be flipping back and forth to remind myself of something I read before, but it's harder to do that on an e-reader. I love my Nook, but it doesn't work equally well for all types of reading.

I am half way through this book and am really enjoying it.
I do have a question to people not in research. How is the science reading to you? It's a very watered down version of the actual science but knowing the background of the signal transduction and the jargon, the basic science sort of fades into the background for me.
Although I've always thought of the ras, myc, src as just a normal signaling molecules in a normally functioning cells, so to read them as oncogenes is a bit confusing.

sparkle--i am a retired nurse so all of the language is not a mystery to me--i am reading this book more slowly than others i think because i have to think about it-i have been writing down the pages for referance so i can go back and read again --later.but toward the end i am getting boggy in the brain with all the details about the lab work which i am not familiar with--i find it totally fascinating-- all the thinking and research these people have done to try to solve the puzzle of cancer --cause and cure. i wish i had a mind like they do--all i can do is read and appreciate the work.

It's very true about us in science not talking to each other. That would make the progress to clinical application that much easier and faster, but I guess that's not going to happen anytime soon.
For example Immunologists have CD names for all their proteins but the rest of the scientific community actually call them by names, as in Immunologist's CD13 would be Aminopeptidase N for others. There are 300+ CDs last time I checked and I have no idea what the actual names for most of those are. :(

SPARKLE-you are right about scientist not talking to each other-at least according to what i read--this habit is the same in other disciplines such as police work--i watch cop shows--they don't communicate with each other so the perps get away . they are more concerened with being the first -so their egos get in the way of good work--i always thougha central point with any effort is the key to solving problems.

Sparkle, I am not in research but have a bit of a background in biochemistry. This book is just about perfect for me in its presentation of the research, since the details of the research are not of interest to me. For someone with no background in biochemistry or genetics, I think it would be difficult going.

On your last post--I volunteer at a police department and my experience shows me the cop shows have it completely wrong. When there is ANYTHING going on--a new lead, etc.--nearly every detective puts aside his/her paperwork and offers whatever knowledge they have.

phylwil--i still love the book despite my lack of knowledge about specific lab work--i got the general idea about oncogenes and mutations. of course it would be much more interesting to a person educated in the field but even so i enjoyed it a lot. now i understand why the fight against cancer is so difficult.
i love cap shows but i know they are not always the way they are portrayed--that is artistic license.

Bunnie,
I think the author may have summarized his own ideas of why the fight against cancer is so difficult. It is the outgrowth of all the processes that make our cells work in the first place...another version of ourselves.

phylwil-the mystery is what is that outgrowth? mutations cause change -sometimes for the good but sometimes not so good. what is the mechanism by which mutations come about and cause change? i'm not sure i am asking the right questions--not sure i understand all of the facts presented-the researchers don't understand everything either. a great puzzle-- to be continued.

Hi Bunnie and phlwil,that is a great question! There are a lot of people who helped with the World Trade Tower disaster coming down with Sarcoidosis now. I am wondering if the exposure to all that is bad caused a gene mutation that caused Sarcoid, or how does that work.

Also, researchers are now finding out that glaucoma is due to a gene mutation not high eye pressure. I am wondering will that discovery led to more effective medicines than the eye drops now used?

carol,--another interesting question-quite a few years ago i developed a condition that went undiagnosed for quite awhile-my eyes bothered me-light bothered me and i had a squeezing of the lids-finally after going to a health fair-an optomotrist listed some of the things it could be-one of which was blephrospasm--i had taken Reglan at that time and told my doctor about it and he told me to stop. so years later they are now finding that reglan does indeed cause this problem--by what mechanism does this drug cause the lids to spasm and become light sensitive? what causes this reaction? mutation or what?the drug acting against what? CAN IT BE REVERSED ? where did you get the information on glaucoma?

Here is a link for one of articles about the glaucoma discoverhttp:
//
If you goggle for it, you find pages of sites.

I hadn't heard of blephrospasm before. My gastroenterologist put me on Reglan for a while because I had diverticulitis. But it didn't help, I quit it after taking it for a short period of time.
I don't know the answers to your last questions, you may want to goggle and see what you find. Also ask your opthmalogist if you knows the answer.

Since I have glaucoma, I set up what is know as a Google Alert and set it to report to every day. That is the way that I fisrt found out the news. You might also want to set up an alert for blephrospasm. It is very easy and you get a lot of information. Just search for Google Alerts and the prompts will take you through the steps. Good Luck, Carol

carol-thanks for the link--i never heard of blephrospasm before i got it- the treatment for it is botox- i started getting these shots several years ago and they definitely help-for some reason i only need the shots very infrequently -like once in every eight or twelve months-not sure this is normal- others need it much more frequently-the shots are made with what i think is an extremely fine needle around the eyes -above and below and to the side.
did your doctor recommend fiber for your diverticulitis? why did regaln affect me one way and not you?

Hi Bunnie, I am glad that the treatments are helping you. Yes, he did and I make sure to get extra fiber. It has been a while since I have had an attack so that's great. Don't know the answer.

Drugs affect people differently. I used to go to a neurologist who put me on Ritalin for ADD. I still don't think I have it because instead a flood of ideas,
sometimes I have blank moments. I tried Ritalin and woke up screaming at the top of my lungs with a terrible nightmare. I thought maybe that was a coincidence so I tried again. That night the same thing happened. I refused to try it any more. Even though it been several years I can still remember the terrible nightmare. A lot children and adults can take it and have nothing like I did.

carol--how do you cope with ADD? i think i may have that too-i am always thinking of something else when i am reading or watching a movie. my daughters get upset with me because i'm not listening when someone is speaking. i think our society is over medicated and some of the so called disorders we have are just normal for some people. how does it disturb your normal life?i see you are into handwork. i always loved crewel work but never got around to much-i am a quilter though i have done some crochet work.maybe you are just a creative thinker if you a flood of ideas.

Anyone have a favorite quote from EMPEROR OF MALADIES? Something that gave you an "Ah Ha!" thought, or that will stick with you for a long time?

"But the story of leukemia -- the story of cancer -- isn't the story of doctors who struggle and survive, moving from one institution to another. It's the story of patients who struggle and survive, moving from one embankment of illness to another. Resilience, inventiveness, and survivorship--qualities often ascribed to 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."
- Siddhartha Mukherjee

I liked this quote because it really shows that the author did not write this book to pat doctors on the back for all their accomplishments in the fields of cancer research and cancer treatment. Throughout the entire book, he has never lost sight of the cancer patients. This isn't just a story about scientific research and breakthroughs made by doctors, but the story of Robert Sandler and Carla Reed and countless other patients. I appreciate that the author covered their stories too and I think this quote really sums up why.

Bunnie wrote: "carol--how do you cope with ADD? i think i may have that too-i am always thinking of something else when i am reading or watching a movie. my daughters get upset with me because i'm not listening w..."

I really don't think that I have it. The neurologist gave me a test and my score was borderline. I read about it in some books to get more information. But they said that what happens to a person with ADD is that they get a rush of many ideas but instead of that my mind sometimes goes completely blank. There are no ideas! Also, sometimes I will be talking and the words come out jumbled, like letters get transposed when you type. This happened at work and it was so embarrassing, now I wonder if I could be having mini strokes. I don't know how that is checked for but I will talk to my doctor about it.

I have cut out several medications. I discussed their value or non value with my doctor and now I have other meds but I think they are so necessary, will discuss again with my new doctor. The one medical problem that disrupts my life the most is Restless Leg Syndrome. Somethimes the pill slipe throigh my fingers when I take it or it is not strong enough then I have little sleep, maybe two hours.

I find cross stitch and regular embriodery very relaxing. Not able to do crochet, I can do a double chain but then I get mixed-up. Think I just need someone to teach me more. Glad that you can do some crochet.

Christie wrote: ""But the story of leukemia -- the story of cancer -- isn't the story of doctors who struggle and survive, moving from one institution to another. It's the story of patients who struggle and survive..."

I like that quote too. I really liked that he put the stories of patients in the book. After all, all the discoveries are actually for them.

Carol wrote: "Bunnie wrote: "carol--how do you cope with ADD? i think i may have that too-i am always thinking of something else when i am reading or watching a movie. my daughters get upset with me because i'm ..."

carol,when i read about your lapse of words i thought you might be right about mini strokes-when i was pregnant over 50 years ago, the last month, i had an event like that-i could think the right words but they didn't come out right for awhile.you might want to check with your doctor about this if you haven't already.when it comes to ADD-i don't know-but i have a complete blank in my mind when it comes to a subject i don't like-i am absolutely blank when it comes to an idea for dinner-i mean blank-i don't like to cook-my biggest problem is thinking of what to eat.when you go blank is there a particular subject or is it at any time or about anything?that might be because of circulation problems.the pills slipping from your fingers does suggest circulation -i seem to have developed a numbness in my fingers and i think it is a circultaion problem--check for diabetes too.

Yes, I plan to get it all checked out. Have you been checked for it? With me, it doesn't matter what the subject is? I will be talking OK then the words come out jumbled. My dad died of a stroke at 63 and mother of a heart attack at 68. I was seeing a cardiologist but he left the group and the new one said that I don't need to see him! Also have had pre-diabetes since my 20's so will have everything checked out. I keep thinking that all of us are so fortunate to be born now than two hundred years ago because so much more is known.

carol, if the cardiologist said you didn't need to see him go see another and get a second opinion. the heart and circulation is nothing to ignore especially since you have a family history-yes i have had MRI's and ultra sounds and the works lately.you are right to think where we would be if this were fifty or one hundred years ago.my heros are the doctors and researchers that spent time looking for the answers to these problems.have you read Breakthrough by Thea Cooper and Arthur Ainsberg? it's about the discovery of insulin--sure glad i didn't have diabetes back then.

That's what I am going to do, first though I am lining up a Internal Medicine Specialist. Thank you for the book recommendaton. I just added that one to my wishlist. Are you Type II or I?

carol--yeah i sounds like i said i have diabetes --i don't yet--i'm watching my blood sugars though--my dad was type 11 so i am careful of what i eat.
specialist --good idea