Authors: George Johnson
THIS IS A BORZOI BOOK
PUBLISHED BY ALFRED A. KNOPF
Copyright © 2013 by George Johnson
All rights reserved. Published in the United States by Alfred A. Knopf, a division of Random House LLC, New York, a Penguin Random House Company, and in Canada by Random House of Canada Limited, Toronto.
eBook ISBN: 978-0-385-34971-0
Hard Cover ISBN: 978-0-307-59514-0
Knopf, Borzoi Books, and the colophon are registered trademarks of Random House LLC.
Library of Congress Cataloging-in-Publication Data
Johnson, George, 1952 Jan. 20-
The cancer chronicles : unlocking medicine’s deepest mystery / by George Johnson. —First edition.
Includes bibliographical references and index.
1. Cancer—Etiology—Popular works. I. Title.
Jacket design by Jason Booher
For Joe’s girls,
Jennifer, Joanna, Jessica, and Emmy
and for his wife, Mary Ann
We must never feel disarmed: nature is immense and complex, but it is not impermeable to intelligence; we must circle around it, pierce and probe it, looking for the opening or making it.
The Periodic Table
A strange fossil from Colorado … Pathology of dinosaur bones … Monster tumors … The epidemiology of extinction … Cancer in ancient beasts … Tumors in sunflowers … Fish, reptiles, and amphibians…“Why Don’t All Whales Have Cancer?”…A curious law of nature … Contemplating the odds
Food pyramidology … Pascal’s wager … Folates, antioxidants, and Finnish smokers … Fruits, vegetables, and giant steaks … Carcinogenic estrogen … The real risks of cigarettes … Emanations from the earth … Cancer clusters … A worrisome lump … Nancy’s cancer
In the boneyards of Kenya … Face-to-face with Kanam man…
…Hippocrates and the crabs … The wild beast of cancer … Metastasis in a Scythian king … Skeletons and mummies … Visions of an ancient paradise … Counting up the dead
“Large and beautifully pellucid cells”…Morbid juices … Seeds and soil … The mysteries of metastasis … A horrifying precision … The ebb and flow of lymph … The surgeon’s diagnosis … Weeds from outer space
Man-made mutations … Funny-looking chromosomes…“A new kind of cell”…Matter that comes alive … The Radium Girls … Coal tar and tumors … Viral invaders … Oncogenes and tumor suppressors … Cellular suicide … Intimations of immortality … A conspiracy of cells
Embryos and tumors … Snail, slug, and twist … Sonic hedgehog … the Pokémon gene … Cyclopean sheep … Holoprosencephaly … 1 + 1 = 3 … Prayers of an agnostic … An endless day at the hospital
The surprising aftermath of Love Canal … What “environment” really means…“The Causes of Cancer”…An environmental turncoat … The carcinogens in coffee … Mitogenesis and mutagenesis … Making sense of the cancer statistics … A maverick presidential report
Cancer cells and magnets … The penicillin of cancer … A rare kind of malignancy … Disheartening statistics…“The Median Isn’t the Message”…Flying farolitos … A visit to MD Anderson … Rothko’s brooding chapel
A physics of cancer … Epigenetic software … The stem cell conundrum … An enormous meeting in Orlando … Espresso and angiogenesis … The news from Oz.…Communing with the microbiome … Beyond the double helix … Dancing at the Cancer Ball
Chimney sweeps and nuns … A “mysterious sympathy”…The case of the missing carcinogens … The rise and fall of vegetables … A mammoth investigation … The insulin-obesity connection…“Wounds that do not heal”…A hundred pounds of sugar … Skewing the energy equation
Flunking the radon test … A ubiquitous carcinogen … Down in the uranium mines … Tourism at Chernobyl … Hiroshima and Nagasaki … Exhuming Curie’s grave … A pocketful of radium … Robot oncologists … Relay for Life
A flight to Boston … Stand Up to Cancer … A tale of two cousins … The return of the hedgehog … Where weird drug names come from … Waiting for super trastuzumab … Orphaned cancers … Biological game theory … Contagious cancer
On Microwave Mountain … Cell phones and brain waves … Is cancer here “on purpose”?…Physicists and oncologists … Snapshots of a proteome … Five crazy ideas … Mitochondria and farandolae … Maxwell’s triumphant demon
Several years ago, for reasons that will become clear in these pages, I was driven to learn everything I could about the science of cancer. How much could I as an outsider, a longtime science writer more com- fortable with the sharp edges of cosmology and physics, grasp of this wet, amorphous, and ever-changing terrain? I imagined the expanse before me as a boundless rain forest whose breadth and diversity could never be captured within a single book or even a single mind. I would find an opening at one of the borders and enter, cutting my own path, exploring where my curiosity led—until I emerged years later at the other side, with a better understanding of what we know and don’t know about cancer. I was in for some remarkable surprises.
Many people helped along the way. First I thank the scientists who devoted so much time—sitting for interviews, answering e-mails, reviewing parts or all of the manuscript: David Agus, Arthur Aufderheide, Robert Austin, John Baron, José Baselga, Ron Blakey, Timothy Bromage, Dan Chure, Tom Curran, Paul Davies, Amanda Nickles Fader, William Field, Andy Futreal, Rebecca Goldin, Anne Grauer, Mel Greaves, Seymour Grufferman, Brian Henderson, Richard Hill, Daniel Hillis, Elizabeth Jacobs, Scott Kern, Robert Kruszinsky, Mitchell Lazar, Jay Lubin, David Lyden, Franziska Michor, Jeremy Nicholson, Elio Riboli, Kenneth Rothman, Bruce Rothschild, Chris Stringer, Bert Vogelstein, Robert Weinberg, Tim White, and Michael Zimmerman. In addition I consulted more than five hundred papers and books about cancer and sat in on dozens of
lectures. Most of these sources are listed as references in my endnotes along with interesting information that didn’t make it into the main text. George Demetri and Margaret Foti kindly allowed me to sit in on a private workshop in Boston organized by the American Association for Cancer Research. Thanks to them and the staff of AACR, including Mark Mendenhall and Jeremy Moore, who welcomed me to the organization’s fascinating annual meeting in Florida. I am also grateful to the Keystone Symposia and the Society for Developmental Biology for accommodating me at some of their events.
Just as I was getting my boots wet, David Corcoran at
The New York Times
enthusiastically commissioned and published two of my early reports. Thanks to him and other colleagues—Christie Aschwanden, Siri Carpenter, Jennie Dusheck, Jeanne Erdmann, Dan Fagin, Louisa Gilder, Amy Harmon, Erika Check Hayden, Kendall Powell, Julie Rehmeyer, Lara Santoro, Gary Taubes, and Margaret Wertheim—for their reactions and advice on the manuscript.
Several recent alumni of the Santa Fe Science Writing Workshop read early versions, offering their good sense and expertise: April Gocha, Cristina Russo, Natalie Webb, Shannon Weiman, and Celerino Abad-Zapatero. Bonnie Lee La Madeleine and Mara Vatz helped with library research and the endless checking of facts. The manuscript was in constant flux and any errors that survive are my own. This will be the seventh book I have done with Jon Segal, my editor at Knopf, and the fourth with Will Sulkin of Jonathan Cape and Bodley Head in London. Thanks to them and their colleagues—including Victoria Pearson, Joey McGarvey, Meghan Houser, and Amy Ryan, a superb copyeditor—and to Esther Newberg, my agent almost from the start.
Special thanks to Cormac McCarthy, who read an early version of the book, and to Jessica Reed, whose literary sensibility and encouragement were an inspiration. More than once my friend Lisa Chong read through the book sentence by sentence, page by page, helping to apply the finishing touch.
Finally my deep thanks to Nancy Maret and the family of my brother, Joe Johnson, who allowed me to tell their stories.
I wonder now, though, if the steady presence of music around me didn’t contribute importantly to my sense of the cancer as a thing with its own rights. Now it sounds a little cracked to describe, but then I often felt that the tumor was as much a part of me as my liver or lungs and could call for its needs of space and food. I only hoped that it wouldn’t need all of me.
Whole New Life
Tuberculosis used to be called “consumption” because it consumes. It dissolved a lung or bone. But cancer produces. It is a monster of productivity.
Death Be Not Proud
As I crossed a dry, lonesome stretch of
Prehistoric Highway, I tried to picture what western
Colorado—a wilderness of sage-covered mesas and rocky canyons—looked like 150 million years ago, in Late Jurassic time. North America was breaking away from Europe and Asia—all three had formed a primordial supercontinent called
Laurasia. The huge land mass, flatter than it is today, was drifting northward a few centimeters per year and was passing like a ship through the waters of what geographers would come to call the Tropic of Cancer. Mile-high Denver was near sea level and lay about as far south as where the Bahamas are today. Though the climate was fairly dry, webs of rivulets connecting shallow lakes and swamps covered part of the land, and vegetation abounded. There were no grasses or flowers—they had yet to evolve—just a weird mix of conifers commingling with ginkgos, tree ferns, cycads, and horsetails.
Giant termite nests soared as much as thirty feet high. Splashing and stomping through this Seuss-like world were
—their bones buried far below me as I made my way from Grand Junction to a town called Dinosaur.
Occasionally one can glimpse outcroppings of the Jurassic past, exposed by erosion, seismological uplift, or a highway department road cut—colorful bands of sediment that form a paleontological treasure house called the
Morrison Formation. I knew what to look for from photographs: crumbling layers of reddish, grayish, purplish, sometimes greenish sediment—geological debris piled up over some 7 million years.
Just south of the town of Fruita on the Colorado River, I hiked to the top of
Dinosaur Hill, stopping for a moment to pick up a pinch of purplish Morrison mudstone that had fallen near the trail. As I rolled it in my fingers it crumbled like dry cookie dough. On the far side of the hill, I came to a shaft where in 1901 a paleontologist named
Elmer Riggs extracted 6 tons of bones that had belonged to an
(the proper name for what most of us call a
). Alive and fully hydrated, the 70-foot-long reptile would have weighed 30 tons. Riggs encased the bones in plaster of paris for protection, ferried them across the Colorado on a flat-bottom boat, and then shipped them by train to the Field Museum in Chicago, where they were reassembled and put on display.