stuff I read

The Emperor of All Maladies

Because I’m a research assistant in hospital epidemiology, people usually assume my Master’s degree is in something like health policy/administration or infectious diseases epidemiology.  It is neither (although my scores in ID epidemiology and hospital epidemiology got me my job).  My Master’s is in epidemiology and I wrote my thesis in cancer epidemiology; specifically, descriptive and analytic epidemiology of intraocular melanoma among Iowa residents using the SEER Cancer data from 1973- 2000.  I didn’t really choose that topic – it fell into my lap, more or less, as a thesis-ready project – but the history and epidemiology of cancer in general is fascinating so when I spied an advance copy of Siddhartha Mukherjee’s new book, The Emperor of All Maladies, on the breakroom table at the store I absolutely had to read it.

Mukherjee is an oncologist and researcher at Columbia University and teaches at the medical school.  He stands on the front line, straddling the line between clinician (treating the patient) and researcher (finding new treatments) but he started writing The Emperor of All Maladies while in his fellowship at the Dana-Farber Cancer Institute in Boston.  Several of his patients make appearances in the book, most notably Carla, a new leukemic whose story begins and ends Mukherjee’s history of cancer treatment.

Leukemia is the cancer that provided the puzzle that spurred pediatric pathologist Sidney Farber to start his cancer research in the 1940s.  Leukemia was first described – as we would recognize it today – by physician John Bennett in the mid-nineteenth century.  Prior to the advent of germ theory, cell theory, and an understanding of hematopoesis (the process by which blood cells are made and matured), Bennett concluded that a young male patient had died of a “suppuration of blood” – the patient’s blood had spontaneously turned to pus without any known cause (p 13).  Today, we recognize that as the final stage of leukemia where the deranged overgrowth of immature white blood cells has completely squeezed out all the red blood cells from the patient’s blood and bone marrow.  Soon other cases were described.  As advances in microscopy and pathology came along, physicians began to classify solid tumors (i.e. breast, colon, lung, etc.) and hematologic tumors (i.e. leukemia).  Mukherjee notes, by 1902 a new theory of cancer had emerged which focused on the hallmark of a cancer cell: uncontrolled cell growth (pathologic hyperplasia).  Cancers could now be classified according to the type of cell grown out of control, including cancers of the blood.

But it brought physicians no closer to creating a medical treatment for cancer.  Solid tumors near the surface of the body, like those of the breast or skin, could be removed by a surgeon, possibly effecting a “cure.”  Radical surgery and even more-radical surgery pioneered by William Stewart Halsted in turn-of-the-century Baltimore theorized that the more tissue or “tumor” removed during an operation, the more likely the patient is to have long-term survival.  At one point, a very radical mastectomy included not only removal of the affected breast (breasts) but the pectoralis major and minor muscles of the chest, the lymph nodes under the armpit, above the collarbone, and under the sternum, and possibly a rib or two.  Women were left disfigured and potentially disabled (without the chest muscles it is difficult to use the arms normally and the lack of lymph nodes causes severe swelling).  The discovery of radiation led to the use of radiation therapy in conjuction with radical surgery (in some cases).  But there was still little to no hope for patients with non-solid cancers or metastatic tumors (new tumors that have invaded the body at a site distant from the original tumor) that could not be cut out of the body by the scalpel.

Which brings the reader back to Farber.  Childhood leukemia was a death sentence; children came to his hospital to die of leukemia, not be treated for it.  Pediatricians felt no need to push for treatment so Faber gathered up all the available research and information about the function of normal blood cells and started applying that knowledge to childhood leukemias.  His first treatment trial using folate was a disaster because no one knew, at that time, how cells actually grow and divide.  Farber’s second trial using aminopterin, an anti-folate, had good initial responses but, sadly, the children relapsed within months and died.  More trials and new and different chemicals would come; Farber had started picking at the Gordian knot that was cancer and within a few decades the discoveries would come faster and faster.

This is the real meat of the book: the development of cancer research and cancer treatment, i.e. chemotherapy.  The current model for drug development – the multi-phase, randomly-assigned, placebo-controlled clinical trial – was never used initially to develop cancer treatment.  One therapy after another was tried on terminally ill patients to see if a remission could be elicited.  Only after some success were randomized trials initiated to measure response and relapse rates and it is only in the last thirty or forty years that the greatest strides in achieving and maintaining remission have been made.  Mukherjee follows the medical breakthroughs right into the twenty-first century with the advent of inhibitors like Gleevec and ruminates on the future of cancer treatment.

The Emperor of All Maladies is an extremely well-written and engaging book.  Mukherjee doesn’t dumb-down the science to the point of boringness but neither does he make it so full of medical jargon and regurgitated research results that it becomes unreadable.  This is very much a book for the everyman, for the general reading public because every person on this planet will, in his or her lifetime, either be personally diagnosed with cancer or have a family member or close friend diagnosed with cancer.  It provides so much needed information about the history of this disease.  Even medical professionals will enjoy The Emperor of All Maladies and it is a book that medical professionals need to read; Mukherjee treats his patients and subject with respect and compassion.  Even with my background, well-versed in cancer epidemiology and well-read in medical and scientific history, I found new bits and pieces of cancer history, and reminders of how quickly researchers can get out-of-hand (although I did find the third or fourth definition of “metastasis” too much repetition).

The Emperor of All Maladies is a Barnes and Noble Discover Great New Writers Holiday 2010 selection.  I really do urge everyone to visit their favorite bookstore and read this book.

Dear FTC: I read the advance copy received in my store from the publisher.

BNBC · stuff I read

3 Mini-reviews: Ponder-ing Much About Flops

Due to the insanity of moving house during the holidays, meaning I have even less free time than normal (into the negative numbers, if such a thing is possible) and I have packed nearly everything I own, I’m going to compress three reviews into one post and save what’s left of my sanity.

#1: The Ponder Heart by Eudora Welty

Read as the December pick for Literature by Women at BNBC, this was the first Eudora Welty book for me.  Compared to last December’s choice, The Complete Stories by Flannery O’Connor (masterful Southern Gothic but too much all at one time during the holidays), this is a chatty, gossipy family dramedy.  It’s a short novel – nearly a novella – and Miss Enda Earle Ponder will tell you all about her dotty Uncle Daniel and the Ponder heart.

#2: Don’t Know Much About History (audio) by Kenneth C. Davis

I was looking for a new audio book for my 10 minute commute every day (this is quite handy since network radio is the pits anymore these days and I can get about 20+ minutes of an audiobook listened to while driving) and thought I’d give one of the Don’t Know Much About books a try.  I quite liked this one – I learned or re-remembered things from history class (such as the Alger Hiss trial which was one where the name was familiar but couldn’t remember why).  I think I like this more because of the audio format – it was quite easy to digest – but I think I would have gotten bored while reading the book because of the repetition in format.  I also think that Davis was very balanced in his assessment of US History; I have read some reviews which called this a “liberal propaganda” piece, but I don’t think there’s anything conservative or liberal in reporting the facts as they are, particularly when the facts say the US government has behaved less than honorably at times.

#3: My Year of Flops by Nathan Rabin

Last year I read The Big Rewind and found Rabin’s AV Club posts so I was eager to read My Year of Flops when it came out in book form.  My Year of Flops takes its name from Rabin’s AV Club column and the nice thing, unlike other blog-inspired books, is that the book isn’t a simple repetition of the MYoF blog.  Instead, Rabin curated his blog posts, grouping his favorites/best posts by theme, and added some “book only” Flops and interviews.  I especially enjoyed the interview with Roberto Benigni about Pinocchio, a movie I’ve had the misfortune of seeing (I saw the subtitled original Italian, not the dubbed-in-English-by-Breckin-Meyer one, so I’m sure it was better than the theatrical dubbed release but it was still creepy with a 50-year-old Italian man-child playing a bratty wooden puppet). Some of the movies are, yes, bad movies that result from spectacularly poor judgement on the part of directors/stars/studios/writers/producers (like The Conqueror, The Scarlet Letter, and Exit to Eden not to mention Waterworld) but some of the movies Rabin reviews are secretly quite enjoyable (The Rocketeer is one, and I’m surprised that it was considered a flop because my little brothers watched it all the time).  At the end, there is a very, very funny minute-by-minute review of Waterworld, agreeably one of the worst flops in cinematic history, aside from being a terrible movie on its own.  My Year of Flops was a great distraction from the mess of moving and I very much enjoyed Rabin’s style.

Knitting goddess · secret knitting · Xmas knitting

Orchid Thief Shawlette (and other knitted things)

Knitting has occurred in copious amounts at my house.  Knitted gifts galore.

First, there’s the shawlette for my boss.

The Orchid Thief Shawlette by Ysolda Teague from Brave New Knits, knit from Malabrigo Sock in Primavera.  The boss has an enormous garden and is a knitter, too, so I think she’ll love this.

Then a hat for one of the secretaries – she helps me out a TON throughout the year.

A water bottle/coffee mug cozy for my Secret Santa at the office.

And last, but certainly not least because it was the first one done but last given, is my little niece Alexis’s Christmas Stocking.  All three girls’ stockings were laid out by the fireplace on Christmas Eve and they looked so sweet together, just like ours did when I was little (it’s the same pattern my Grandma used).

I’m still working on a sweater (for me), the DNA scarf (for whoever – maybe me), a pair of socks (half-done, for me), and a summer blouse (also, for me).  I need to knit faster!

stuff I read

The Mischief of the Mistletoe

Lauren Willig gave us a little surprise this year – not just one new Pink book but TWO.  The Betrayal of the Blood Lily debuted last January, and The Orchid Affair will drop on January 20, 2011, but Lauren has provided The Mischief of the Mistletoe, a little Christmastime spy mystery featuring the seemingly brainless Turnip Fitzhugh and new heroine Arabella Dempsey (if you’d like a peek at a Selwick Christmas check out Lauren’s website for Ivy and Intrigue: A Very Selwick Christmas).  Arabella has recently arrived in Bath due to the rather hasty marriage of her middle-aged-plus (and rich) aunt/guardian to a much younger (and non-rich) man (who had apparently been courting Arabella, too).  Arabella is determined to make her own way as a teacher at a ladies’ seminary in Bath but fate, in the guise of Turnip and a Christmas pudding, have other plans.

Lauren’s books are a breath of fresh air for me.  Nice and fun. Happy endings.  Just what I needed this December since I’m about to pull my hair out with this whole selling-my-house mess that’s going on. Turnip Fitzhugh gets a chance to be the hero for once, instead of the fop, although he’s still Turnip (and always will be), and Arabella makes a nice heroine in the Letty sense (Letty’s my favorite Willig heroine). Several characters from other Pink books make cameos – Mischief is set starting between Seduction of the Crimson Rose and Temptation of the Night Jasmine and ends with the Twelfth Night festivities at Girdings from Night Jasmine – so we meet up with the Vaughns, Pinchingdales, various characters’ little sisters, Hen, Charlotte, the Dowager Duchess of Dovedale, and that pack of aristocratic idiots from Night Jasmine and Blood Lily who all ought to be in jail.

Oh, and there’s Jane Austen, too.  Jane is Arabella’s cousin (?, or maybe just dear friend) and she appears in all her sharp-witted glory.  Jane appears to be collecting characters and stories…what could she be doing with them, I wonder? 


Gratuitous cat picture Friday!

Because I just downloaded more pictures from my camera!

 My Dante kitty.

My Chaucer kitty – who obviously is having his nap interrupted.

 Jeez, mom – go away.  I wants to sleeeeeeep.  I don’t want tummy rubs.

But you can pet me!!  I wants tummy rubs!

Seriously, mom, I’m not kidding.  I just want to take a nap under the nice, warm electric blankie!  Put the camera away.


Happy Birthday, Jane Austen! (PS: Free Sourcebooks ebooks today 12/16/10!)

In honor of Miss Jane Austen’s 235th birthday (Many happy returns!) Sourcebooks is offering TEN Austen-inspired titles as free ebooks (my nook is currently busy downloading):

Eliza’s Daughter by Joan Aiken
The Darcys & the Bingleys by Marsha Altman
Mr. Darcy Takes a Wife by Linda Berdoll
What Would Jane Austen Do? by Laurie Brown
The Pemberley Chronicles by Rebecca Ann Collins
The Other Mr. Darcy by Monica Fairview
Mr. Darcy’s Diary by Amanda Grange
Mr. & Mrs. Fitzwilliam Darcy: Two Shall Become One by Sharon Lathan
Lydia Bennet’s Story by Jane Odiwe
Mr. Fitzwilliam Darcy by Abigail Reynolds

Sourcebooks is also offering free downloads of their illustrated editions of Pride and Prejudice, Sense and Sensibility, Persuasion, Mansfield ParkNorthanger Abbey, and Emma.

Strike while the iron is hot!  I believe these titles are free for today ONLY so check your favorite ebook outlet.

I’ve been burned by Austen-world off-shoot novels before, so I never read any of these after my experience with Mr. Darcy’s Daughters, etc., but I’m not turning up my nose at free books!  I’ll have them on my nook and when the inclination strikes, I’ll be ready!
I found out about the sale via Laurel Ann’s Austenprose posting 🙂