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Thursday, January 10, 2013

Emperor of All Maladies

I am reading a fascinating book, "The Emperor of All Maladies" (2010), by Siddhartha Mukherjee, a Pulitzer Prize winning "biography" of cancer.  I'm only part way through the book, but I am coming to realize how important Dr. Sidney Farber was in the fight against cancer.  In the 1940's he pioneered the concept of chemotherapy to fight blood cancers, such as leukemia.  He was instrumental in founding the wildly-successful Jimmy Fund, which changed the landscape as to how money is raised in the fight against cancer.  He almost single-handedly not only transformed the way cancer would be treated in the future, but how both public and private financial resources could be brought to bear in cancer research.

One passage in the book I found interesting.  In 1956, despite many failures, Farber was resolute:

"The possibilities thrown open by these (chemotherapy drug) discoveries were enormous:  permutations and combinations of medicines, variations in doses and schedules, trials containing two-, three-, and four-drug regimens.  There was, at least in principle, the capacity to re-treat cancer with one drug if another had failed, or to try one combination followed by another.  This, Farber kept telling himself with hypnotic conviction was not the "finish".  This was just the beginning of an all-out attack."

Does that sound familiar?  Doesn't that summarize what just went on at the recent ASH Meeting?  I find myself both awed by Farber's prescience over half a century ago and also mildly disturbed that the words in the above passage are almost equally applicable today in the fight against many cancers as they were then.  The approach that Farber pioneered then is almost exactly the same approach being used today against Multiple Myeloma.  Yes, there have been a number of wonderful drug combinations now being used against MM, but a cure has been elusive, and the methodology being used today really hasn't changed much in 50 some years.  I guess it just goes to show what an implacable foe this cancer is.

Of course there are now promising approaches to develop vaccines to marshal the body's own defenses against the cancer, as well as individualized targeted therapies based on specific cytogenetic characteristics.  These may transform the landscape over the next couple of years.  Let's hope so.

I came across another quote in the book that stopped me in my tracks.  This is from the "Annals of Internal Medicine" (1993) by Michael LaCombe:

"The best (doctors) seem to have a sixth sense about disease.  They feel its presence, know it to be there, perceive its gravity before any intellectual process can define, catalog, and put it into words.  Patients sense this about such a physician as well:  that he is attentive, alert, ready; that he cares.  No student of medicine should miss observing such an encounter.  Of all the moments in medicine, this one is most filled with drama, with feeling, with history."

When I read that passage, I felt that I was reliving my first visit with Dr. Richardson.  It certainly was dramatic and historic for Gretchen and me.  Dr. Richardson embodies everything in that quote; his intuition, attentiveness, alertness, and no less important, his caring.  How fortunate I am to be under his care, at the great institution founded by Dr. Sidney Farber, as he, Dr. Anderson, and the others at DFCI continue to relentlessly pursue a cure for MM.  I feel like am a part of history unfolding.  I am optimistic that I will benefit from the fruits of their tireless labors, along with those of many others around the world, to conquer this malady.

Enough said!


  1. I'll bet that this is not how you wished to go down in history. 8*)

    Steve R

  2. Hi Bill,

    Great to read that you are doing so well. I am a Giants fan, so it is OK if the Pats win the Super Bowl this year!

    Sounds like an interesting read. The book got great reviews on Amazon. Any discussion of E. Donnall Thomas in the book so far? He is considered the "Father of Allogeneic transplantation." He won the Noble Prize for Medicine in 1990. I had read quite a few articles about him after he passed away late last year. Dr. Thomas was not even a myeloma Doctor, but his method is the closest thing we have to a cure in myeloma, even in 2013. My allo in 2011 has been a success (so far anyway!) Everything done at that transplant was based on work originally done by Dr. Thomas (ex. how they prevented me from getting GVHD). We could certsinly use a Dr. Thomas type specializing in myeloma!


    1. Mark, I apologize for taking so long to respond to your comment. I checked forward in the book and yes, Donnall Thomas is prominently mentioned for his pioneering work in transplantation. I still haven't gotten to that point in the book yet.

      I'm delighted for you that your allo has been so successful. I hope that someday you can look back and say that you are one of ones actually "cured" of MM. Good luck!!


  3. I'm reading The Emperor of All Maladies too. I'm not too far into it but it's really interesting so far - plus all the Dana-Farber & Boston area references are pretty cool! I think, "Ha, I've been there!"


    1. Elizabeth, I agree. As I learn more about the history of Dana Farber, I am even more in awe. It's truly the Mecca of cancer research. We're both fortunate to have it available to us.

  4. Hi,

    I have a quick question about your blog, would you mind emailing me when you get a chance?



    1. Cameron, send your question to my email address,, and I will be glad to discuss my blog with you. I don't know how to contact you otherwise.