T HE

E MP E R OR

OF ALL

M AL ADIES

CAST OF CHARACATERS
Sidney Farber (19031973)
A pioneer of modern chemotherapy, Sidney Farber was among the first to use chemicals to kill cancer cells, focusing initially on leukemia in children. His cancer clinic at the Childrens Hospital in Boston was one of the first of its kind. In the mid-1970s, Farber joined forces with Mary Lasker to spearhead a national War on Cancer.

Joseph Lister (18271912)

A Scottish surgeon who pioneered the use of antiseptics in modern medicine. His discoveries allowed for more advanced surgical procedures.

Theodor Billroth (18291894)

A Viennese surgeon who meticulously explored techniques for removing a wide variety of tumors, focusing particularly on abdominal tumors.

Rudolf Virchow (18211902)

A German physician who coined the term leukemia, he played an important early role in characterizing cancer as a disease caused by uncontrolled growth of the bodys own cells.

William Stewart Halsted (18521922)

Pioneer and early proponent of the radical mastectomy. With this method, not only the tumor was removed, but a large amount of the surrounding and underlying tissue as well.

Yellapragada Subbarao (18951948)

A pioneering biochemist who synthesized the folic acid for Sidney Farbers first antifolate clinical trials.

Paul Ehrlich (18541915)

A German biologist and chemist who proposed the notion of specific affinitythat biological molecules work by virtue of binding other molecules with specificity. Ehrlich synthesized chemicals with specific affinities for certain microbes, including those that cause sleeping sickness and syphilis. This discovery opened the door for later advances in chemotherapy. Ehrlich also coined the phrase magic bullet to describe specific cancer therapy.

Claudius Galen (ad 129199)

A Greek physician and philosopher who practiced among the Romans theorized that diseases were caused by an imbalance in the bodys four humors. Cancer and depression were due to excesses of black bile. Galens ideas influenced medical thought, rightly or wrongly, for centuries after his death.

Andreas Vesalius (15141564)

An anatomist whose detailed maps of the human body advanced medical understanding and challenged the Galenic theory that cancer was caused by black bile.

Alfred Gilman (19081984)

American chemist who, working with Louis Goodman at Yale University, used a variant of mustard gas to treat lymphomas. Gilman and Goodmans work was kept secret for several years because it was performed under contract with the wartime Office of Scientific Research and Development.

Matthew Baillie (17611823)

An anatomist who published a text cataloging and depicting in detail various diseases and tumors.

Louis Goodman (19062000)

Chemist who, working with Alfred Gilman at Yale University, used a variant of mustard gas to treat lymphomas in the early 1940s.

Gordon Zubrod (19141999)

Director of the National Cancer Institutes Clinical Center. He helped direct important early research for childhood leukemia.

Jimmy (Einar Gustafson) (19352001)

A young patient of Sydney Farbers, he became the face behind the Jimmy Fund and helped create a new public interest in the fight against cancer.

Austin Bradford Hill (18971991)

An influential English statistician who devised the randomized clinical trial, whereby patients were assigned to either the placebo or study group at random. Along with Richard Doll, Hill also devised a seminal study linking smoking and lung cancer.

Mary Lasker (19001994)

An influential fundraiser and activist. Together with Sidney Farber, she helped launch the War on Cancer by providing crucial energy, direction, and funding.

Min Chiu Li
An NCI researcher who treated choriocarcinoma with the antifolates and documented striking response rates. Li used a hormonal fingerprint in the blood to direct chemo.

Clarence Cook Little (18881971)

A one-time president of the American Society for the Control of Cancer, Little eventually headed the Tobacco Industry Research Committee and became a prominent tobacco apologist.

Howard Skipper (19152006)

The self-professed mouse doctor who provided the animal model of combination chemotherapy that would lead to the work of Frei and Freireich.

Vannevar Bush (18901974)

Director of the Office of Scientific Research and Development and author of the influential report Science the Endless Frontier. He helped to transition American scientific research from a wartime footing to a focus on less-targeted general research investigating fundamental questions.

Thomas Hodgkin (17981866)

A British pathologist and anatomist who discovered and characterized Hodgkins lymphoma.

Henry Kaplan (19181984)

An American radiologist who pioneered the use of extended field radiation to treat Hodgkins disease. Kaplan launched serial and comprehensive clinical trials using X-rays, resulting in the cure of localized Hodgkins disease by the mid-1960s.

Emil Frei
A researcher at the National Cancer Institute who, along with Emil Freireich and Gordon Zubrod, performed trials of combination chemotherapy for childhood acute lymphoblastic leukemia.

Vincent DeVita (1935 )

A colleague of Frei, Freireich, and Zubrod at the National Cancer Institute, he led intensive combination chemotherapy trials for advanced Hodgkins disease. DeVita, working with Canellos, also pioneered the use of combination chemotherapy for breast cancer.

Emil Freireich
A researcher at the National Cancer Institute who, along with Emil Frei and Gordon Zubrod, performed some of the first combination chemotherapy trials on children with lymphoblastic leukemia.

Donald Pinkel (1926 )

An oncologist and protg of Sidney Farber, Pinkel advanced leukemia chemotherapy by using combinations of drugs, X-ray therapy, and direct injection of chemotherapy into the spinal fluid to obtain striking response rates and cures in children.

George Beatson (18481943)

Scottish surgeon who surgically removed ovaries in a cohort of women with breast cancer and observed striking remissions. Beatson was inspired by tales from Scottish highland farmers who had shown that ovarian removal in cows caused changes in breast tissue.

Peyton Rous (18791970)

A researcher at the Rockefeller Institute who discovered the first cancer-causing virus. His work laid part of the foundation for the modern genetic understanding of cancer.

Mary (Moya) Cole (19182004)

A British oncologist and radiotherapist at Christie Hospital in Manchester who launched the first tamoxifen trial for breast cancer, with great success.

Geoffrey Keynes (18871982)

A British surgeon (and the brother of John Maynard Keynes), Keynes doubted Halsteds method of radical mastectomy. Keynes used a combination of local surgery and radiation to treat breast cancer.

Paul Carbone
An oncologist who worked with colleagues at the NCI to develop adjuvant chemotherapy, where the patient is treated with chemotherapy after tumors had been successfully removed via surgery.

George Barney Crile (19071992)

A surgeon who, with the help of data from Geoffrey Keynes, cast doubt on Halsteds theory of radical surgery. Crile found that local surgery, even without radiation, was just as effective as radical surgery.

Gianni Bonadonna (1934 )

An Italian oncologist who carried out the first large-scale trial for adjuvant chemotherapy for breast cancer. The treatment greatly reduced the prevalence of relapse.

Cecily Saunders (19182005)

A former nurse and physician who launched the palliative care movement, emphasizing the role of palliative medicine for terminally ill cancer patients.

Bernard Fisher (1927 )

A surgeon who launched a comprehensive clinical trial to investigate the efficacy of various treatments for breast cancer. He found that the radical mastectomy provided no benefits at all with regard to survival rates, recurrence, or mortality.

John Cairns (1922 )

A Harvard biologist who penned an influential article for Scientific American quantifying cancer-related deaths in the United States. He found that while modern treatment had made some advances, treatment still could only benefit about one in twenty cancer patients.

Charles Huggins (19011997)

A urological surgeon who established the link between prostate cancer and testosterone. This laid the groundwork for hormonal therapy for breast and prostate cancer.

John Bailar
A Harvard statistician who, along with Elaine Smith, undertook a comprehensive mathematical analysis of cancer mortality over three decades.

Elwood Jensen (1920 )

A chemist and colleague of Charles Huggins, he discovered the estrogen receptor. Jensens work provided the scientific basis for the use of tamoxifen in breast cancer.

Lester Breslow
An epidemiologist who critiqued the Bailer-Smith analysis of cancer mortality. He found that while mortality remained high, treatment was still creating gains in terms of years of life saved.

John Banzhaf (1940 )

An American attorney who used the so-called fairness doctrine of broadcast media to battle cigarette ads on television. Cigarette manufacturers responded by voluntarily eliminating all cigarette ads from broadcast media in 1970.

Percivall Pott (17141788)

An English surgeon who deduced the link between the prolonged exposure to chimney soot and scrotal cancer. He was one of the first to tie cancer to an environmental cause.

Rose Cipollone (19261984)

A lifelong smoker whose death from lung cancer spurred a Supreme Court case over the liability of cigarette manufacturers. While her widower gained only a small settlement, the case opened the door for other lawsuits.

Ernst Wynder (19231999)

An American epidemiologist who, along with Evarts Graham, produced one of the first studies finding a correlation between smoking and lung cancer.

Marc Edell
The New Jersey attorney who plead Rose Cipollones Supreme Court case. Though he won only a relatively small damage settlement, the case opened the door to similar lawsuits and a settlement agreement between the cigarette manufacturers and forty-seven states.

Richard Doll (19122005)

A British epidemiologist who, along with Bradford Hill, produced an influential study linking smoking and lung cancer. Doll and Hill devised the prospective study, in which a control and test population (e.g., smokers versus non smokers) is studied forward in time.

Bruce Ames (1928 )

A bacteriologist who developed a method to test chemicals for the mutation rate they induced in bacteria. Substances that induced a high rate of mutations proved frequently to be carcinogens as well.

Evarts Graham (18831957)

Coauthor with Ernst Wynder of an important early study linking lung cancer and smoking. A long-time smoker, he died of lung cancer himself.

Baruch Blumberg (1925 )

A biologist who discovered the hepatitis B virus, which proved to be a cause of liver cancer. This was one of the viral carcinogens that the NCI had fruitlessly searched for.

Oscar Auerbach (19051997)

An American lung pathologist who studied the progression of lung cancer through its various stages. Auerbachs results suggested that cancer develops through multiple stages in a step-wise progression.

Barry Marshall (1951 )

An Australian physician who proved that peptic ulcers were caused by the bacterium Helicobacter pylori by intentionally infecting himself. The bacterium also proved to be a preventable cause of stomach cancer.

Luther Terry (19111985)

The Surgeon General of the United States, Terry appointed an advisory committee to study the links between lung cancer and cigarette smoking. After a long and broad survey, the committee produced a definitive 1964 Surgeon Generals Report that clearly identified smoking as the major cause of lung cancer.

George Papanicolaou (18831962)

Inventor of the Pap smear, one of the first tests able to detect cancer in its earliest stages, where it could be excised with relatively simple surgery.

William Peters
A New York doctor who, under the guidance of Emil Frei, created the STAMP regimen, where chemotherapy was combined with bone marrow transplantation.

David Baltimore (1938 )

An American virologist who, with Temin, independently discovered reverse transcription, the mechanism by which some RNA viruses can convert their genetic material from RNA into a DNA copy and integrate this copy into the DNA of host organisms.

Nelene Fox (19531993)

A schoolteacher with advanced breast cancer, she was refused a bone marrow transplant treatment by her insurance provider because it was not yet clinically proven. She raised money to pay for the procedure herself but still died less than a year later. Her case led to litigation in the California courts, where her family was awarded $89 million in damages.

Sol Spiegelman (19141983)

An American virologist who, inspired by Temins and Baltimores discovery of reverse transcription, launched an effort to find cancer-causing viruses in the 1970s.

J. Michael Bishop (1936 )

A virologist who, working with Harold Varmus at UCSF, discovered that homologues of the src gene were present in all cells. Bishop would thus advance the hypothesis that viral cancer-causing genes (viral oncogenes) were, in fact, derived from precursor genes (proto-oncogenes) present in all cells.

Werner Bezwoda
A South African physician who reported amazing success with megadose chemotherapy treatment. His trial turned out to be a fraud.

Maggie Keswick Jencks ( 1995)

An artist stricken with breast cancer, she underwent high-dose chemotherapy coupled with bone marrow transplantation that failed to save her life. She wrote the essay A View from the Front Line to describe her experiences.

Harold Varmus (1939 )

A virologist who, working with Michael Bishop at UCSF, discovered that homologues of the src gene were present in all cells. Bishop and Varmus would thus advance the hypothesis that viral cancer-causing genes (viral oncogenes) were, in fact, derived from precursor genes (proto-oncogenes) present in all cells.

Theodor Boveri (18621915)

A scientist and former assistant of Rudolf Virchow, he put forth a chromosomal theory of cancer, whereby abnormalities in chromosomes caused normal cells to become malignant.

Janet Rowley (1925 )

An American hematologist who used chromosome staining techniques to discover that cancer cells often contain translocated chromosomes.

Howard Temin (19341994)

A virologist who discovered reverse transcription, the mechanism by which some RNA viruses can convert their genetic material from RNA into a DNA copy and integrate this copy into the DNA of host organisms.

Alfred Knudson (1922 )

A geneticist who proposed the two-hit model of tumor suppressor genes. Since tumor suppressors need to be inactivated and since two copies of each such gene exist in every cell, two independent mutations are required for the development of cancer.

Robert Weinberg (1942 )

A cancer biologist who was one of the first to isolate oncogenes directly out of tumor cells.

Marti Nelson
A breast cancer patient who was denied treatment with Herceptin because of its experimental status. After her death, her cause became a rallying cry for activist groups such as the National Breast Cancer Coalition.

Thad Dryja
An ophthalmologist-turned-geneticist who discovered the Rb gene with the help of researchers in Robert Weinbergs lab.

Brian Druker (1958 )

A researcher who was crucial in the creation of Gleevec, a kinase inhibitor extremely effective in the treatment of chronic myelogenous leukemia.

Philip Leder
An American geneticist who created genetically modified mice to demonstrate that defined genetic alterations in mouse genes could cause cancer development.

Mary Claire-King
American geneticist who analyzed breast-cancer-linked families to suggest the existence of distinct breast cancer linked genes, later found to be BRCA-1 and BRCA-2.

Bert Vogelstein (1949 )

A cancer researcher, currently at Johns Hopkins Medical School, who characterized the step-wise progression of genetic mutations that are present in each stage of colon cancer. This was a first step toward understanding how cancer was caused by mutations in key biological pathways.

Atossa (550475 BC)

Persian/Achaemenid queen, wife of Darius, who is briefly mentioned in Herodotus Histories. Atossa develops a mysterious mass in her breast that might have been inflammatory breast cancer.

Zhen Yi Wang (1924 )

A Chinese researcher who led a leukemia trial combining chemotherapy with treatment with trans-retinoic acid (which specifically targets the mutation responsible for the cancer). Three-fourths of patients proved to be relapse-free.

Imhotep (26552600 BC)

Egyptian scribe and royal physician who is the purported author of the Edwin Smith papyrus. Imhotep wrote a description of a disease that may have been breast cancer. Under Therapy, he solemnly noted: There is none.

Axel Ullrich (1943 )

A researcher at Genentech whose work led to the development of Herceptin, an antibody that targets the breast cancerpromoting Her-2 gene.

Rose Kushner (19291990)

Prominent and outspoken journalist and breast cancer activist who challenged the radical mastectomy.

Dennis Slamon (1946 )

A UCLA oncologist who worked with Axel Ullrich to develop Herceptin, an antibody that targets the breast cancerinducing Her-2 gene. The drug was one of the first instances of targeted therapy in cancer.

THE

EMP E ROR

OF A L L

MA LAD I ES

SIDDHARTHA MUKHERJEE