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    The Emperor of All Maladies

    Page 72
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      mustard gas, see nitrogen mustard

      mutagens, mutagenesis, 278, 303, 347, 348, 362, 364, 406, 456

      mutation, genetic, 377

      in bacteria, 277–78

      Cancer Genome Atlas and, 450–54

      causes of, see mutagens, mutagenesis

      driver (active), 453

      frequency of, 451–52

      in fruit flies, 347

      functional vs. structural view of, 455

      as governing all aspects of cancer, 387–88, 462

      as mechanism of carcinogenesis, 6, 39, 176, 278, 357, 362, 370, 380–83, 384–88, 390–92, 403, 406, 449–50, 462, 464–65

      passenger (passive), 452–53

      see also oncogenes

      myc (c-myc) gene, 382–83, 384, 391, 410, 412, 453–54, 458

      mycobacteria, 84, 131

      myelodysplasia, 306, 309, 312

      myeloid cells, 16–17

      Myriad Genetics, 381

      Nathan, David, 140

      National Alliance of Breast Cancer Organizations (NABCO), 327

      National Breast Cancer Coalition (NBCC), 426, 429

      National Cancer Act (1971), 188, 189

      National Cancer Institute (NCI), 15, 114, 130, 158, 159, 166, 177, 188, 228, 231, 318, 325, 330, 339, 374, 393, 443

      chemotherapy protocols of, 132–42, 143–50, 164–66, 206–8, 219–20, 232, 310, 317

      Clinical Center of, 128–29, 139, 145, 162, 165, 260

      creation of, 25–26

      Institutional Board of, 137

      mammography project (BCDDP) of, 296–98, 302

      Pap smear trial of, 289–90

      preventative strategies neglected by, 233–34

      Special Virus Cancer Program of, 175–76, 280–81, 356, 357

      National Cancer Institute Act (1937), 25

      National Health Service, British, 294

      National Institutes of Health (NIH), 25n, 121, 187, 188, 202–3, 260, 319

      National Library of Medicine, 261

      National Program for the Conquest of Cancer, 184

      National Science Foundation (NSF), 121

      National Surgical Adjuvant Breast and Bowel Project (NSABP), 200–201

      National Tuberculosis Association, 259

      natural selection, 248

      Nature, 354, 379

      Nature Medicine, 435

      nausea, from chemotherapy, 165, 205–6, 209, 226, 305

      Nazis, 290

      Neely, Matthew, 25, 173

      negative statistical claims, 197–98

      Nelson, Marti, 424–25, 429

      “funeral procession” for, 425–26

      neoplasia, 16, 42, 385

      neu, 410–11, 412, 413, 420

      neuroblastomas, 410, 413

      New England Journal of Medicine, 35–36, 161, 229, 330, 385

      Newton, Isaac, 370

      New York, HIP in, 294–96, 297

      New York, N.Y., AIDS in, 316, 318

      New York Amsterdam News, 286

      New York Times, 24, 26–27, 105, 117, 119–20, 180–81, 183, 319, 327, 455

      Neyman, Jerzy, 197–98

      nicotine:

      addictive properties of, 270–71

      see also cigarettes; smoking; tobacco; tobacco industry

      Nisbet, Robert, 193

      nitrogen mustard, 207, 220, 257

      bone marrow affected by, 88, 90

      DNA damaged by, 163, 406

      hyperplasia as halted by, 163, 406

      as mustard gas, 87–88, 89–90, 162–63

      nitrosoguanidine derivatives, 278

      Nixon, Richard M., 180–81, 183, 184, 187–88

      Nobel Prize, 28, 87, 91, 176, 348, 363

      Norris Center, 323

      Norton, Larry, 327, 426

      Novartis, 436, 439

      Nowell, Peter, 365

      NSABP-04 trial, 200–201, 203, 220

      Nuland, Sherwin, 38

      Ochsner, Alton, 256–57

      Oedipus the King (Sophocles), 321

      Office of Scientific Research and Development (OSRD), 90, 119

      Oliver Twist (Dickens), 239

      oncogenes, 363, 366, 370–71, 380, 384, 402, 409–11, 412, 415, 431, 439, 443, 450, 453, 454, 462, 466

      amplification of, 416

      pathological hyperplasia induced by, 357–59, 372, 431

      proto-, see proto-oncogenes

      see also specific genes

      oncology, oncologists, 304, 433

      AIDS and, 316–17

      death and, 4, 306–8, 337–38

      fellowships in, 2–5, 168

      origin of term, 47

      overconfidence of, 223, 226, 231–32, 234, 308, 310

      palliative care and, 224–26, 307

      patients’ relationships with, 199, 202, 209, 306–8, 449

      radiation, see radiation therapy

      OncoMouse, 382–83, 384

      onkos, 47

      etymology of, 466–67

      “On Some Morbid Appearances of the Absorbent Glands and Spleen” (Hodgkin), 157

      opiates, 226

      Oregon Health and Science University (OHSU), 434

      Orman, Ben, 151–53, 155, 399–400

      Osler, William, 45

      osteosarcomas (bone tumors), 43

      ovarian cancer, 59, 162, 346, 381, 450, 451, 457

      ovaries, removal of, 214, 215

      Pacific yew tree, 206

      Pack, George, 70–71

      Padhy, Lakshmi Charon, 410–11

      Page, Irvine, 187

      paleopathology, 42

      palliative care, 223–26, 231, 307

      drug trials for, 226

      pancreas, 154, 414

      pancreatic cancer, 154, 158, 450, 451, 465

      Panel of Consultants, 184, 188

      Panzer, Fred, 270

      Papanicolaou, George, 286–90, 291, 384–85, 386, 401

      Papanicolaou, Maria, 287

      papillomavirus, 174, 349n, 381n

      Pap smears, 228, 286, 287–90, 296, 303, 331, 381, 385, 401

      Paré, Ambroise, 49

      Paris, University of, 51

      Park, Roswell, 24, 45

      Parliament cigarettes, 269

      Pasteur, Louis, 57

      pathology, pathologists, 11–12, 14

      Hodgkin’s approach to, 156–57

      Patterson, James, 183

      PCP (Pneumocystis carinii), 165, 315–16

      Pearson, Egon, 197–98

      pectoralis major, 64–65

      pectoralis minor, 64

      pellagra, 110

      penicillin, 21–22, 122, 129, 465–66

      Penicillium, 122

      Pepper, Claude, 26n

      peptic ulcers, 281–84

      Perkin, William, 81–82, 83

      pernicious anemia, 27–28, 31

      Peru, 42–43

      pesticides, 456–57

      Peters, Vera, 159–60

      Peters, William, 311–15, 319–20, 321, 325, 326, 329

      Peto, Richard, 241, 249, 273–74, 462

      pharmaceutical industry, 426

      see also specific companies

      Philadelphia chromosome, 365, 430–31

      Philip Morris, 251, 269–71, 273

      phlegm, 48

      phosphorylation, 358–59, 361, 380, 418, 431–32

      Piccolo, Brian, 181

      Pim, Isabella, 58

      Pinkel, Donald, 123, 167–68, 170, 178

      pitchblende, 74

      pituitary cells, 414

      placebos, in randomized trials, 131–32, 319

      placenta, 135, 219

      platelets, 18

      Plato, 370

      Pneumocystis carinii (PCP), 165, 315–16

      pneumonectomy, 242

      pneumonia, 45

      PCP, 165, 315–16

      Poet Physicians, 60

      polio, 22, 229, 342, 466

      national campaign against, 93–94, 175

      Popper, Karl, 370

      population, U.S., aging of, 230

      Postmortem Examination, The (Farber), 19

      Pott, Percival
    l, 173, 237–39, 241, 276, 447

      precancer, 286, 306, 455

      Auerbach’s research on, 258–59, 284, 289

      prednisone, 127, 140, 143, 149

      see also VAMP regimen

      Premarin, 213

      preventive medicine, 281

      epidemiology and, 290

      see also cancer prevention

      procarbazine, 162, 164

      product-liability lawsuits, 269–73, 401

      progesterone, 456

      “Progress Against Cancer?” (Bailar and Smith), 229, 231–32, 329–30

      Prohibition, 262

      promyelocytes, 407–8, 409

      prostate, 211–13, 215

      prostate cancer, 211, 443

      in dogs, 212–13

      hormonal therapy for, 213–14, 222

      remissions in, 214

      surgical removal of, 59, 71, 216

      prostatectomy, radical, 71

      prostatic fluid, 211–12

      protein drugs, 414

      proteins, 345–46, 442

      as molecular switches, 387

      phosphorylation of, 358–59, 361, 380, 418, 431–32

      signaling pathways of, 387, 388, 389, 402, 406, 432, 443, 453–54, 457, 458, 464–65

      structural view of, 432

      protocols (clinical trials):

      for ABMT, 325–26

      for breast cancer, 200–201, 294–302, 420–22, 423, 424, 426–29

      for choriocarcinoma, 135–38, 139

      conflicts of interest in, 198

      for, CML, 436–38

      for Hodgkin’s lymphoma, 163–66, 208

      for leukemia, 132–34, 135, 139, 140–42, 143–50

      of mammography, 294–302

      multi-institutional, 207–8

      for palliative care, 226

      randomization in, 131–32, 160, 243, 293, 298–300, 302, 314, 319, 321, 426

      proto-oncogenes, 361–63, 364, 369, 370, 380, 384, 412

      activation of, 386–87, 388, 406, 407

      pteroylaspartic acid (PAA), 33

      public health and hygiene, 22

      Public Health Service, U.S., 257, 259, 260

      purines, 92

      pus, 13, 14

      radiation, 74–75

      as carcinogen, 75, 77–78, 347, 364, 389

      radiation therapy, 23, 154, 158–59, 405

      for breast cancer, 75–76, 77, 158, 161, 195, 464

      chemotherapy in combination with, 123–24, 154, 168–70, 400

      extended field, 159–61

      for Hodgkin’s lymphoma, 159–61, 163

      involved field, 160

      local surgery combined with, 195–96, 197, 464

      for lung cancer, 158, 403

      for lymphomas, 77, 158

      radium in, 76, 195

      staging and, 160–61

      X-rays in, 75–76, 158–59

      radical surgery, 6, 59, 60, 304, 308, 406

      see also mastectomies, radical

      radio, see broadcast media

      radium:

      discovery of, 74–75, 76

      radiation poisoning from, 74–75, 77–78, 173, 347

      in radiation therapy, 76, 195

      Radium girls, 78, 278

      Ramazzini, Bernardino, 238

      Ramses V, King of Egypt, 41

      randomization of trials and studies, 131–32, 160, 243, 247, 293, 294, 302, 314, 319, 321, 426

      ras gene, 374–75, 376, 379–80, 383, 384, 385, 387, 388, 391, 410, 412, 431n, 453–54, 458

      Ras-Mek-Erk pathway, 387, 453–54

      Rauscher, Frank, 191, 223, 234

      Rb gene, 364, 367–69, 376, 377–80, 381, 391, 412, 453–54, 458

      Reader’s Digest, 112

      recall bias, 446

      receptors, 31

      in estrogen, 215, 216, 217, 464

      recombinant DNA, 413, 414

      red blood cells, 3, 18, 88

      Red Queen syndrome, cancer and, 443, 444, 446, 470

      Reed, Carla, 1–3, 7, 17–18, 126–27, 168–69, 190, 337, 338–39, 398, 400, 448–49, 459

      Reimann, Stanley, 121–22

      relapses, 59, 138, 443

      of breast cancer, 64, 66–69, 197, 208, 221, 329, 419

      of leukemia, 35, 91, 132, 133, 147, 165, 166, 170, 442

      remissions:

      of ALL, 127, 190, 338–39, 400

      of APL, 409–10

      of breast cancer, 217, 222, 314, 454, 456

      of Hodgkin’s lymphoma, 160–61, 171, 179

      of leukemia, 34, 35, 101, 127, 133, 145–46, 179, 190

      of, CML, 437–39, 441, 443, 444

      retinoblastoma, 366–68, 376, 377, 380, 391

      retinoic acid, 408–9

      retroviruses, 318, 352, 353, 354, 360, 361–62, 363, 380

      as carcinogens, 354, 355–56, 357, 415, 431n

      reverse transcriptase, 352–54, 371

      Revlimid, 443

      Rhoads, Cornelius “Dusty,” 92, 114

      Richards, A. N., 121

      Richardson, Dora, 216

      Rieff, David, 306

      risk factors, for disease, 444–45

      for cancer, 44, 276, 303, 445–46, 455–57

      in social networks, 445–46

      risky prediction, 370

      R. J. Reynolds, 273

      RNA (ribonucleic acid), 91, 345–46

      reverse transcription to DNA of, 352–54, 371

      transcription from DNA to, 352

      viral, 352–54

      Roe v. Wade, 199

      Rogers, Paul, 187–88

      Rollin, Betty, 200

      Rome, ancient, medical knowledge in, 48–49

      Romeo and Juliet (Shakespeare), 89

      Röntgen, Anna, 73

      Röntgen, Wilhelm, 73–74

      Roosevelt, Franklin D., 25, 94, 404

      Rosenberg, Barnett, 204

      Rosenberg, C. E., 46

      Rosenow, Fanny, 26–27

      Rosensohn, Etta, 286

      Roswell Park Cancer Institute, 133, 167n

      Rous, Peyton, 173, 174, 175, 176, 335, 342–43, 350, 355, 362, 382, 383

      Rous sarcoma virus (RSV), 174, 342, 349–50, 351, 358–59, 372, 466

      genome as modified by, 351–52

      as mutated src gene, 361–62

      as retrovirus, 353

      Rowley, Janet, 365–66, 376, 409–10, 430–31

      Rubin, Harry, 351

      Ruijin Hospital, 408, 409–10

      Sabin, Albert, 22, 94

      St. Bartholomew’s Hospital, 195

      St. Christopher’s hospice, 225

      St. Jude’s hospital, 167–68, 170

      Saint Louis Hospital (Paris), 408

      St. Luke’s Hospital, 64

      St. Thomas’ Hospital, 156, 157

      Salecl, Renata, 182

      Salk, Jonas, 22, 94

      Salmonella, 277, 278

      Salomon, Albert, 290

      Salvarsan (compound 606), 86

      Samuel, Book of, 305

      Sandler, Elliott, 33, 34

      Sandler, Robert, 32–34, 35

      San Francisco, Calif., AIDS in, 317–18

      San Francisco General Hospital, Ward 5B at, 317–18, 424

      sarcomas, 173, 174, 443, 467

      SARS, 182

      Saunders, Cecily, 225–26

      Sawyers, Charles, 436, 437, 438, 441–42

      Schabel, Frank, 312

      Scheele, Leonard, 235

      Schleiden, Matthias, 15

      Schmidt, Benno, 184–85, 187

      Schope, Richard, 174

      Schuman, Leonard, 261

      Schwann, Theodor, 15

      science:

      Apollo program and public perception of, 179

      goal-driven vs. basic research in, 119–22, 183

      measurement in, 19, 74, 197–98, 227

      technology vs., 462

      Science the Endless Frontier (Bush), 120

      Scientific American, 227–28, 350

      scientific revolutions, 196

      screening:

      for breast cancer, 457, 464; see also mammography


      colonoscopy, 331, 401

      molecular biology and, 457–58

      over- vs. underdiagnosis in, 291–92, 293, 302

      Pap smears, 288–90, 296, 303, 331, 401

      as prone to error, 302

      scrofula, 47

      scrotal cancer, 173, 237–39, 241, 276

      scurvy, 110

      sea urchins, 341, 348, 349

      secondhand smoke, 260

      Senate, U.S., 122, 185

      see also Congress, U.S.

      Shakespeare, William, 1, 89, 191

      Shapiro, Sam, 294–95, 296, 297, 299, 302

      Shelby County, Tenn., 289–90

      Shepard, Mike, 418, 420, 427

      Sheridan, Catherine Variety, 95, 96

      Shih, Chiaho, 373–74, 376

      Shimkin, Michael, 107

      Shinder, Jason, 398

      signaling pathways, 387, 388, 389, 402, 406, 432, 443, 453–54, 457, 458, 464–65

      Silent Spring (Carson), 456

      6-mp (6-mercaptopurine), 92, 127, 132–33, 140, 143, 338

      see also VAMP regimen

      Skipper, Howard, 139, 140–41, 143, 196, 206, 311–12

      Skolnick, Mark, 381

      Slamon, Dennis, 415–19, 433

      Herceptin trials of, 420–22, 423, 426–29

      sleeping sickness, 85, 245

      slime molds, 345, 346, 349

      smallpox, 24, 41, 175, 225, 343

      Smith, Anna Deavere, 305

      Smith, Edwin, 39

      Smith, Elaine, 229, 231–34

      Smith papyrus, 39–41

      smoking, 45, 250, 251, 267–68, 272, 273–74, 275, 445–46

      cancer and, see tobacco-cancer link

      decrease in, 401

      increase in, 240–42, 445

      social networks and, 445–46

      by women, 268, 445

      see also cigarettes; nicotine; tobacco; tobacco industry

      Smoking and Cancer (Graham), 257

      “Smoking and Carcinoma of the Lung” (Doll and Hill), 246

      snuff, 239–40

      social networks, as risk factors for disease, 445–46

      Solzhenitsyn, Aleksandr, 4, 181, 316, 461

      Sontag, Susan, vii, 37–38, 202, 306, 316, 388, 449

      soot, 173, 238, 239, 364

      Sophocles, 321

      Sorenson, Beatrice, 153–55

      Special Virus Cancer Program, 175–76, 280–81, 356, 357

      specificity, specific affinity, 80–81, 84–88, 90–92, 210, 222, 432, 433, 434, 439

      Spector, Deborah, 361

      Speyer, Maria, 17

      Spiegelman, Sol, 186, 355–56, 357, 360, 362

      spinal fluid:

      chemotherapy and, 167–68

      leukemia in, 146–47

      spinal taps, 127, 146

      spleen, leukemia and, 14

      src gene, 375, 418, 431, 433

      endogenous, 361–62, 364, 368, 371, 466

      viral, 358–60, 364, 368, 370, 372

      stages, staging, of cancers, 55, 67, 160–61, 163, 164–65, 218, 222, 289, 290, 385, 428, 463

      STAMP (Solid Tumor Autologous Marrow Program) protocol, 310, 311–15, 320, 325, 326, 328–29

      as adjuvant therapy, 320

      Statistical Unit, 245

     


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