The Emperor of All Maladies: A Biography of Cancer (99 page)

213
Premarin, natural estrogen purified:
Barbara Seaman,
The Greatest Experiment Ever Performed on Women: Exploding the Estrogen Myth
(New York: Hyperion, 2004), 20–21.

213
he could inject them to “feminize” the male body:
Huggins, “Endocrine-Induced Regression”; Charles Huggins et al., “Studies on Prostatic Cancer: II. The Effects of Castration on Advanced Carcinoma of the Prostate Gland,”
Archives of Surgery
43 (1941): 209–23.

214
George Beatson and breast cancer: George Thomas Beatson, “On the Treatment of Inoperable Cases of Carcinoma of the Mamma: Suggestions for a New Method of Treatment, with Illustrative Cases,”
Lancet
2 (1896): 104–7; Serena Stockwell, “George Thomas Beatson, M.D. (1848–1933),”
CA: A Cancer Journal for Clinicians
33 (1983): 105–7.

214
only about two-thirds of all women:
Alexis Thomson, “Analysis of Cases in Which Oophorectomy was Performed for Inoperable Carcinoma of the Breast,”
British Medical Journal
2, no. 2184 (1902): 1538–41.

214
“It is impossible to tell beforehand”:
Ibid.

215
a young chemist in Chicago:
E. R. DeSombre, “Estrogens, Receptors and Cancer: The Scientific Contributions of Elwood Jensen,”
Progress in Clinical and Biological Research
322 (1990): 17–29; E. V. Jensen and V. C. Jordan, “The Estrogen Receptor: A Model for Molecular Medicine,”
Clinical Cancer Research
9, no. 6 (2003): 1980–89.

215
Ovarian removal produced many other severe side effects:
R. Sainsbury, “Ovarian Ablation as a Treatment for Breast Cancer,”
Surgical Oncology
12, no. 4 (2003): 241–50.

216
“there was little enthusiasm”:
Jensen and Jordan, “The Estrogen Receptor.”

216
Tamoxifen: Walter Sneader,
Drug Discovery: A History
(New York: John Wiley and Sons, 2005), 198–99; G. R. Bedford and D. N. Richardson, “Preparation and Identification of
cis
and
trans
Isomers of a Substituted Triarylethylene,”
Nature
212 (1966): 733–34.

216
Originally invented as a birth control pill:
M. J. Harper and A. L. Walpole, “Mode of Action of I.C.I. 46,474 in Preventing Implantation in Rats,”
Journal of Endocrinology
37, no. 1 (1967): 83–92.

216
tamoxifen had turned out to have exactly the opposite effect:
A. Klopper and M. Hall, “New Synthetic Agent for Induction of Ovulation: Preliminary Trials in Women,”
British Medical Journal
1, no. 5741 (1971): 152–54.

216
Arthur Walpole and breast cancer: V. C. Jordan, “The Development of Tamoxifen for Breast Cancer Therapy: A Tribute to the Late Arthur L. Walpole,”
Breast Cancer Research and Treatment
11, no. 3 (1988): 197–209.

216
Mary Cole’s tamoxifen trial: M. P. Cole et al., “A New Anti-oestrogenic Agent in Late Breast Cancer: An Early Clinical Appraisal of ICI46474,”
British Journal of Cancer
25, no. 2 (1971): 270–75; Sneader,
Drug Discovery
, 199.

217
In 1973, V. Craig Jordan:
See V. C. Jordan,
Tamoxifen: A Guide for Clinicians and Patients
(Huntington, NY: PRR, 1996). Also see V. C. Jordan, “Effects of Tamoxifen in Relation to Breast Cancer,”
British Medical Journal
6075 (June 11, 1977): 1534–35.

Halsted’s Ashes

218
I would rather be ashes:
Jack London,
Tales of Adventure
(Fayetteville, AR: Hannover House, 1956), vii.

218
Will you turn me out:
Cicely Saunders,
Selected Writings, 1958–2004
, 1
^st
ed. (Oxford: Oxford University Press, 2006), 71.

219
at the NCI, Paul Carbone, had launched a trial:
Vincent T. DeVita, “Paul Carbone: 1931–2002,”
Oncologist
7, no. 2 (2002): 92–93.

219
“Except for an occasional woman”:
Paul Carbone, “Adjuvant Therapy of Breast Cancer 1971–1981,”
Breast Cancer Research and Treatment
2 (1985): 75–84.

220
With his own trial, the NSABP-04:
B. Fisher et al., “Comparison of Radical Mastectomy with Alternative Treatments for Primary Breast Cancer. A First Report of Results from a Prospective Randomized Clinical Trial,”
Cancer
39 (1977): 2827–39.

220
In 1972, as the NCI was scouring the nation:
G. Bonadonna et al., “Combination Chemotherapy as an Adjuvant Treatment in Operable Breast Cancer,”
New England Journal of Medicine
294, no. 8 (1976): 405–10; Vincent T. DeVita Jr. and Edward Chu, “A History of Cancer Chemotherapy,”
Cancer Research
68, no. 21 (2008): 8643–53.

220
“The surgeons were not just skeptical”:
Springer,
European Oncology Leaders
(Berlin, 2005), 159–65.

221
Fisher’s tamoxifen trial: B. Fisher et al., “Adjuvant Chemotherapy with and without Tamoxifen in the Treatment of Primary Breast Cancer: 5-Year Results from the National Surgical Adjuvant Breast and Bowel Project Trial,”
Journal of Clinical Oncology
4, no. 4 (1986): 459–71.

223
“We were all more naive a decade ago”:
“Some Chemotherapy Fails against Cancer,”
New York Times
, August 6, 1985.

223
“We shall so poison the atmosphere of the first act”:
James Watson,
New York Times
, May 6, 1975.

225
“If there is persistent pain”:
J. C. White, “Neurosurgical Treatment of Persistent Pain,”
Lancet
2, no. 5 (1950): 161–64.

225
“a window in [her] home”:
Saunders,
Selected Writings
, xiv.

225
care,
she wrote, “is a soft word”:
ibid., 255.

225
“The resistance to providing palliative care to patients”:
Nurse J. N. (name withheld), interview with author, June 2007.

226
“The provision of . . . terminal care:
Saunders,
Selected Writings
, 71.

Counting Cancer

227
We must learn to count the living:
Audre Lourde,
The Cancer Journals
, 2nd ed. (San Francisco: Aunt Lute, 1980), 54.

227
Counting is the religion of this generation:
Gertrude Stein,
Everybody’s Autobiography
(New York: Random House, 1937), 120.

227
“These registries,” Cairns wrote in an article:
John Cairns, “Treatment of Diseases and the War against Cancer,”
Scientific American
253, no. 5 (1985): 51–59.

229
John Bailar and Elaine Smith’s analysis: J. C. Bailar III and E. M. Smith, “Progress against Cancer?”
New England Journal of Medicine
314, no. 19 (1986): 1226–32.

231
cancer mortality was not declining:
This was not unique to the United States; the statistics were similarly grim across Europe. In 1985, a separate analysis of age-adjusted cancer mortality across twenty-eight developed countries revealed an increase in cancer mortality of about 15 percent.

231
There is “no evidence”:
Bailar and Smith, “Progress against Cancer?”

231
“a thorn in the side of the National Cancer Institute”:
Gina Kolata, “Cancer Progress Data Challenged,”
Science
232, no. 4753 (1986): 932–33.

232
As evidence, they pointed to a survey:
See E. M. Greenspan, “Commentary on September 1985 NIH Consensus Development Conference on Adjuvant Chemotherapy for Breast Cancer,”
Cancer Investigation
4, no. 5 (1986): 471–75. Also see Ezra M. Greenspan, letter to the editor,
New England Journal of Medicine
315, no. 15 (1986): 964.

232
“The problem with reliance on a single measure”:
Lester Breslow and William G. Cumberland, “Progress and Objectives in Cancer Control,”
Journal of the American Medical Association
259, no. 11 (1988): 1690–94.

233
“Our purpose in making these calculations”:
Ibid. The order of the quotation has been inverted for the purpose of this narrative.

234
prevention research received:
John Bailar interviewed by Elizabeth Farnsworth, “Treatment versus Prevention” (transcript),
NewsHour with Jim Leher
, PBS, May 29, 1997; Richard M. Scheffler and Lynn Paringer, “A Review of the Economic Evidence on Prevention,”
Medical Care
18, no. 5 (1980): 473–84.

234
By 1992, this number had increased:
Samuel S. Epstein,
Cancer-Gate: How to Win the Losing Cancer War
(Amityville, NY: Baywood Publishing Company, 2005), 59.

234
In 1974, describing to Mary Lasker:
Letter from Frank Rauscher to Mary Lasker, March 18, 1974, Mary Lasker Papers, Box 118, Columbia University.

234
At Memorial Sloan-Kettering in New York:
Ralph W. Moss,
The Cancer Syndrome
(New York: Grove Press, 1980), 221.

234
“not one” was able to suggest an “idea”:
Edmund Cowdry,
Etiology and Prevention of Cancer in Man
(New York: Appleton-Century, 1968), xvii.

234
Prevention, he noted drily:
Moss,
The Cancer Syndrome
, 221.

234
“A shift in research emphasis”:
Bailar and Smith, “Progress against Cancer?”

PART FOUR:
PREVENTION IS THE CURE

235
It should first be noted:
David Cantor, “Introduction: Cancer Control and Prevention in the Twentieth Century,”
Bulletin of the History of Medicine
81 (2007): 1–38.

235
The idea of preventive medicine:
“False Front in War on Cancer,”
Chicago Tribune
, February 13, 1975.

235
The same correlation could be drawn:
Ernest L. Wynder letter to Evarts A. Graham, June 20, 1950, Evarts Graham papers.

“Coffins of black”

237
When my mother died I was very young:
“The Chimney Sweeper,” William Blake,
The Complete Poetry and Prose of William Blake
, ed. David V. Erdman (New York: Random House, 1982), 10.

237
It is a disease, he wrote:
Percivall Pott and James Earles,
The Chirurgical Works of Percivall Pott, F.R.S. Surgeon to St. Bartholomew’s Hospital, a New Edition, with His Last Corrections, to Which Are Added, a Short Account of the Life of the Author, a Method of Curing the Hydrocele by Injection, and Occasional Notes and Observations, by Sir James Earle, F.R.S. Surgeon Extraordinary to the King
(London: Wood and Innes, 1808), 3: 177.

238
“Syphilis,” as the saying ran:
Michael J. O’Dowd and Elliot E. Philipp,
The History of Obstetrics & Gynaecology
(New York: Parthenon Publishing Group, 2000), 228.

238
In 1713, Ramazzini had published:
Bernardino Ramazzini,
De Morbis Artificum Diatriba
(Apud Josephum Corona, 1743).

238
“All this makes it (at first) a very different case”:
Pott and Earles,
Chirurgical Works
, 3: 177.

239
Eighteenth-century England:
See Peter Kirby,
Child Labor in Britain, 1750–1870
(Hampshire, UK: Palgrave Macmillan, 2003). For details on chimney sweeps, see ibid., 9; and
Parliamentary Papers
1852–52, 88, pt. 1, tables 25, 26.

239
“I wants a ’prentis”:
Charles Dickens,
Oliver Twist, or The Parish Boy’s Progress
(London: J. M. Dent & Sons, 1920), 16.

239
In 1788, the Chimney Sweepers Act:
Joel H. Wiener,
Great Britain: The Lion at Home: A Documentary History of Domestic Policy, 1689–1973
(New York: Chelsea House Publishers, 1974), 800.

239
In 1761, more than a decade before
: John Hill,
Cautions against the Immoderate Use of Snuff
(London: R. Baldwin and J. Jackson, 1761).

240
a self-professed “Bottanist, apothecary, poet”:
G. S. Rousseau, ed.
The Letters and Papers of Sir John Hill, 1714–1775
(New York: AMS Press, 1982), 4.

240
“close, clouded, hot, narcotic rooms”:
George Crabbe,
The Poetical Works of the Rev.
George Crabbe: With his Letters and Journals, and His Life
(London: John Murray, 1834), 3: 180.

240
By the mid-1700s, the state of Virginia:
See Paul G. E. Clemens, “From Tobacco to Grain,”
Journal of Economic History
35, no. 1: 256–59.

240
In England the import of tobacco:
Kenneth Morgan,
Bristol and the Atlantic Trade in the Eighteenth Century
(Cambridge University Press, 1993), 152.

240
In 1855, legend runs, a Turkish soldier:
See Richard Klein,
Cigarettes Are Sublime
(Durham, NC: Duke University Press, 1993), 134–35.

240
In 1870, the per capita consumption in America:
Jack Gottsegen,
Tobacco: A Study of Its Consumption in the United States
(New York: Pittman, 1940).

241
A mere thirty years later, Americans:
Ibid.

241
On average, an adult American smoked ten cigarettes:
Harold F. Dorn, “The Relationship of Cancer of the Lung and the Use of Tobacco,”
American Statistician
8, no. 5 (1954): 7–13.

241
By the early twentieth century, four out of five:
Richard Peto, interview with author, September 2008.

241
“By the early 1940s, asking about a connection”:
Ibid.

242
“So has the use of nylon stockings”:
John Wilds and Ira Harkey,
Alton Ochsner, Surgeon of the South
(Baton Rouge: Louisiana State University Press, 1990), 180.