I haven't ever written on here before about books, but twoI finished recently were truly both excellent reads. After reading medical textbooks for years, you would think I'd be sick of reading about medicine and science. But you would be wrong! We never stop learning. Especially in this day and age.
I had heard that 'The Emperor of All Maladies: A Biography of Cancer' by Dr. Siddhartha Mukherjee was a great book. The author, an Oncologist (Cancer Doctor), was awarded a Pulitzer Prize for this particular work. I purchased it months ago, but in the midst of interview season I did not have time to read it. I will say that some sections are fairly dense as it is a biography of sorts that begins when, as far as we know, humans first acknowledged the presence of cancer. What truly amazed me was the story telling aspect that depicted how the detection, research, and treatment of cancer have rapidly progressed in the past few hundred years.
I learned so much of the science featured in this book during my early years in medical school. I studied tumor oncogenes, tumor suppressor genes, and certain treatments without realizing at the time just how short a period of time these particulars have been a fact. Much of this knowledge became known during my lifetime. This pretty much blew me away.
I learned about Rb, the tumor suppressor gene, during my very first year of medical school. It is a tumor suppressor gene that is mutated in many cancers, the most famous of which is Retinoblastoma, after which it was named. Retinoblastoma, I learned, is a very important type of cancer to be familiar with, because it runs in families in an Autosomal Dominant fashion. This means if only one copy of the mutated Rb gene from one parent is passed on to a child, the child will one day present with Retinoblastoma (a type of cancer of the retina). The child inherits only one mutated Rb gene, and the loss of one Rb tumor suppressor gene is not enough to lead to cancer. The second Rb gene must be affected, which is part of the "two hit hypothesis". I'm sure I'm just rambling at this point and I do not wish to concern anyone reading this as it is an extremely rare tumor. It is, however, one of the reasons physicians are comforted when we see a good red eye reflex in a photograph of a child. Children with Retinoblastoma will lack this red eye reflex in the affected eye.
What I've written above is common knowledge to all medical students training today. The Rb gene was first identified in Retinoblastoma patients through research performed in 1985. The very first publication of this knowledge was in 1986, the year I was born. In an age where our healthcare system often fails to truly take care of each and every patient adequately, it is heartwarming to realize how far we have come regarding our knowledge base for treating many illnesses.
Another section of the book discusses the development of the drug Gleevec (Imatinib) a cancer drug that after it was discovered remained in limbo for some time. Gleevec works by stopping the activating signal, through a tyrosine kinase inhibiting mechanism, and was identified by a research lab for use of treating a specific key component of Chronic Myelogenous Leukemia, CML. It works specifically on the Philadelphia Chromosome product, the BCR-ABL gene that results from a traslocation of chromosomes 9 and 22. This is classically seen in CML. It is one of the first very specific, tailored cancer drugs that did not have the severe systemic effects often experienced with typical chemotherapy medications. The particular drug company, Novartis, that considered manufacturing it almost never started a clinical trial. This was due to the fact that at the time, CML had an incidence of only "a few thousand patients every year in America," but the "animal studies and clinical trials would cost $100 to $200 million." Today nearly a quarter of a million people live with CML as long as they remain on Gleevec therapy.
To put things in perspective an Oncologist Dr. Hagop Kantarjian at the MD Anderson Cancer Center in Texas summarized:
"Before the year 2000, when we saw patients with CML, we told them they had a very bad disease, that their course was fatal, their prognosis was poor with a median survival of maybe three to six years, frontline therapy was allogenic transplant... and there was no second-line treatment... Today when I see a patient with CML, I tell them that the disease is an indolent leukemia with an excellent prognosis, that they will usually live their functional life span provided they take an oral medicine, Gleevec, for the rest of their lives."
For a much lighter, hilarious read I would really recommend 'Medicine Men: Extreme Appalachian Doctoring' by Carolyn Jourdan. Ryan gave this to me for my birthday, and I could not put it down! Several of the short stories from the Appalachian Doctors in the book will make you laugh until you cry.
I am thankful that Fourth year has allowed for this additional leisure reading time! I know this free time I am enjoying now will not last much longer.
.JPG)
