206 could irreversibly damage the heart: C. A. J. Brouwer et al., “Long-Term Cardiac Follow-Up in Survivors of a Malignant Bone Tumor,” Annals of Oncology 17, no. 10 (2006): 1586–91.

206 Etoposide came from the fruit: A. M. Arnold and J. M. A. Whitehouse, “Etoposide: A New Anti-cancer Agent,” Lancet 318, no. 8252 (1981): 912–15.

206 Bleomycin, which could scar lungs without warning: H. Umezawa et al., “New Antibiotics, Bleomycin A and B,” Journal of Antibiotics (Tokyo) 19, no. 5 (1966): 200–209; Nuno R. Grande et al., “Lung Fibrosis Induced by Bleomycin: Structural Changes and Overview of Recent Advances,” Scanning Microscopy 12, no. 3 (1996): 487–94; R. S Thrall et al., “The Development of Bleomycin-Induced Pulmonary Fibrosis in Neutrophil-Depleted and Complement-Depleted Rats,” American Journal of Pathology 105 (1981): 76–81.

207 “Did we believe we were going to cure cancer”: George Canellos, interview with author.

207 In the mid-1970s: J. Ziegler, I. T. McGrath, and C. L. Olweny, “Cure of Burkitt’s Lymphoma—Ten-Year Follow-Up of 157 Ugandan Patients,” Lancet 3, no. 2 (8149) (1979): 936–38. Also see Ziegler et al., “Combined Modality Treatment of Burkitt’s Lymphoma,” Cancer Treatment Report 62, no. 12 (1978): 2031–34.

207 “Our applications skyrocketed”: Ibid.

207 “There is no cancer that is not potentially curable”: “Cancer: The Chill Is Still There,” Los Angeles Times, March 20, 1979.

208 the eight-in-one study: J. Russel Geyer et al., “Eight Drugs in One Day Chemotherapy in Children with Brain Tumors: A Critical Toxicity Appraisal,” Journal of Clinical Oncology 6, no. 6 (1988): 996–1000.

209 “When doctors say that the side effects are tolerable”: “Some Chemotherapy Fails against Cancer,” New York Times, August 6, 1985.

209 “The smiling oncologist”: Rose Kushner, “Is Aggressive Adjuvant Chemotherapy the Halsted Radical of the ’80s?” 1984, draft 9, Rose Kushner papers. The phrase was deleted in the final text that appeared in 1984.

209 “Hexamethophosphacil with Vinplatin to potentiate”: Edson, Wit, 31.

Knowing the Enemy

210 It is said that if you know your enemies: Sun Tzu, The Art of War (Boston: Shambhala, 1988), 82.

210 a urological surgeon, Charles Huggins: Luis H. Toledo-Pereyra, “Discovery in Surgical Investigation: The Essence of Charles Brenton Huggins,” Journal of Investigative Surgery 14 (2001): 251–52; Robert E. Forster II, “Charles Brenton Huggins (22 September 1901–12 January 1997),” Proceedings of the American Philosophical Society 143, no. 2 (1999): 327–31.

211 Huggins’s studies of prostatic fluid: C. Huggins et al., “Quantitative Studies of Prostatic Secretion: I. Characteristics of the Normal Secretion; the Influence of Thyroid, Suprarenal, and Testis Extirpation and Androgen Substitution on the Prostatic Output,” Journal of Experimental Medicine 70, no. 6 (1939): 543–56; Charles Huggins, “Endocrine-Induced Regression of Cancers.” Science 156, no. 3778 (1967): 1050–54; Tonse N. K. Raju, “The Nobel Chronicles. 1966: Francis Peyton Rous (1879–1970) and Charles Brenton Huggins (1901–1997), Lancet 354, no. 9177 (1999): 520.

212 “It was vexatious to encounter a dog”: Huggins, “Endocrine-Induced Regression.”

213 “Cancer is not necessarily autonomous”: Ibid.

213 “Its growth can be sustained and propagated”: Ibid.

213 In 1929, Edward Doisy, a biochemist: Edward A. Doisy, “An Autobiography,” Annual Review of Biochemistry 45 (1976): 1–12.

213 diethylstilbestrol (or DES): E. C. Dodds et al., “Synthetic Oestrogenic Compounds Related to Stilbene and Diphenylethane. Part I,” Proceedings of the Royal Society of London, Series B, Biological Sciences 127, no. 847 (1939): 140–67; E. C. Dodds et al., “Estrogenic Activity of Certain Synthetic Compounds,” Nature 141, no. 3562 (1938): 247–48; Edward Charles Dodds, Biochemical Contributions to Endocrinology: Experiments in Hormonal Research (Palo Alto, CA: Stanford University Press, 1957); Robert Meyers, D.E.S., the Bitter Pill (New York: Seaview/Putnam, 1983).

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.

242 “the cigarette century”: Allan M. Brandt, The Cigarette Century: The Rise, Fall, and Deadly Persistence of the Product That Defined America (New York: Basic Books, 2007).

The Emperor’s Nylon Stockings

243 Whether epidemiology alone can: Sir Richard Doll, “Proof of Causality: Deduction from Epidemiological Observation,” Perspectives in Biology and Medicine 45 (2002): 499–515.

243 lung cancer morbidity had risen nearly fifteenfold: Richard Doll and A. Bradford Hill, “Smoking and Carcinoma of the Lung,” British Medical Journal 2, no. 4682 (1950): 739–48.

243 “matter that ought to be studied”: Richard Peto, “Smoking and Death: The Past 40 Years and the Next 40,” British Medical Journal 309 (1994): 937–39.

243 In February 1947, in the midst of a bitterly cold: Ibid.

243 One expert, having noted parenthetically: British Public Records Office, file FD. 1, 1989, as quoted by David Pollock, Denial and Delay (Washington, DC: Action on Smoking and Health, 1989); full text available through Action on Smoking and Health, www.ash.org.

243 Yet the resources committed for the study: Medical Research Council 1947/366 and Ibid.

244 In the summer of 1948: Pollock, Denial and Delay, prologue. Also see Sir Richard Doll, “The First Report on Smoking and Lung Cancer,” in Ashes to Ashes: The History of Smoking and Health, Stephen Lock, Lois A. Reynolds, and E. M. Tansey, eds. (Amsterdam: Editions Rodopi B.V., 1998), 129–37.

244 “The same correlation could be drawn to the intake of milk”: Ernst L. Wynder, letter to Evarts A. Graham, June 20, 1950, Evarts Graham papers.

245 Wynder and Graham’s trial: Ernst L. Wynder and Evarts A. Graham, “Tobacco Smoking as a Possible Etiologic Factor in Bronchiogenic Carcinoma: A Study of Six Hundred and Eighty-Four Proved Cases,” Journal of the American Medical Association 143 (1950): 329–38.

245 When Wynder presented his preliminary ideas: Ernst L. Wynder, “Tobacco as a Cause of Lung Cancer: Some Reflections,” American Journal of Epidemiology 146 (1997), 687–94. Also see Jon Harkness, “The U.S. Public Health Service and Smoking in the 1950s: The Tale of Two More Statements,” Journal of the History of Medicine and Allied Sciences 62, no. 2 (2007): 171–212.

245 Doll and Hill’s study: Doll and Hill, “Smoking and Carcinoma of the Lung.”

246 When the price of cigarettes was increased: Richard Peto, personal interview. Also see Virginia Berridge, Marketing Health: Smoking and the Discourse of Public Health in Britain (Oxford: Oxford University Press, 2007), 45.

246 By May 1, 1948, 156 interviews: David Pollock, “Denial and Delay,” collections from the public record office files deposited in the Action on Smoking and Health archives, UK. Also see the Action on Smoking and Health Tobacco Chronology, http://www .ash.org.uk/ash_669pax88_archive.htm (accessed January 21, 2010).

247 In the early 1940s, a similar notion had gripped: R. A. Fisher and E. B. Ford, “The Spread of a Gene in Natural Conditions in a Colony of the Moth Panaxia diminula L.,” Heredity 1 (1947): 143–74.

248 And the notion of using a similar cohort: Stephen Lock, Lois A. Reynolds, and E. M. Tansey, eds., Ashes to Ashes (Amsterdam: Editions Rodopi B.V., 1998), 137.

249 Doll and Hill’s study of smoking habits and lung cancer in doctors: Richard Doll and A. Bradford Hill, “The Mortality of Doctors in Relation to Their Smoking Habits: A Preliminary Report,” British Medical Journal 1, no. 4877 (1954): 1451–55.

“A thief in the night”

250 By the way, [my cancer]: Evarts Graham, letter to Ernst Wynder, February 6, 1957, Evarts Graham papers.

250 We believe the products that we make: “A Frank Statement to Cigarette Smokers,” New York Times, January 4, 1954.

250 Cigarette sales had climbed: See, for instance, Richard Kluger, Ashes to Ashes (New York: Vintage Books, 1997), 104–6, 123, 125. Also see Verner Grise, U.S. Cigarette Consumption: Past, Present and Future, conference paper, 30th Tobacco Workers Conference, Williamsburg, VA, 1983 (archived at http://tobaccodocuments.org).

250 cigarette industry poured tens, then hundreds: For a succinct history of postwar advertising campaigns of cigarette makers see Kluger, Ashes to Ashes, 80–298.

251 “More doctors smoke Camels”: See, for example, Life, October 6, 1952, back cover.

251 At the annual conferences of the American Medical Association: See Martha N. Gardner and Allan M. Brandt, “‘The Doctors’ Choice Is America’s Choice’: The Physician in US Cigarette Advertisements, 1930–1953,” American Journal of Public Health 96, no. 2 (2006): 222–32.

251 In 1955, when Philip Morris: Katherine M. West, “The Marlboro Man: The Making of an American Image,” American Studies at the University of Virginia website, http://xroads.virginia.edu/~CLASS/marlboro/mman.html (accessed December 23, 2009).

251 “Man-sized taste of honest tobacco”: Ibid.

251 By the early 1960s, the gross annual sale: Estimated from U.S. Surgeon General’s report on per capita consumption rates for 1960–1970.

251 On average, Americans were consuming: Jeffrey E. Harris, “Patterns of Cigarette Smoking,” The Health Consequences of Smoking for Women: A Report of the Surgeon General (Washington, DC: U.S. Department of Health and Human Services, 1980), 15–342. Also see Allan Brandt, The Cigarette Century, 97.

251 On December 28, 1953, three years before: “Notes on Minutes of the Tobacco Industry Research Committee Meeting—December 28, 1953,” John W. Hill papers, “Selected and Related Documents on the Topic of the Hill & Knowlton Public Relations Campaign Formulated on Behalf of the Tobacco Industry Research Committee,” State Historical Society of Wisconsin, http://www.ttlaonline.com/HKWIS/12307.pdf (accessed December 23, 2009).

252 The centerpiece of that counterattack: “Frank Statement,” New York Times.

253 In January 1954, after a protracted search: Brandt, Cigarette Century, 178.

254 In a guest editorial written for the journal: C. C. Little, “Smoking and Lung Cancer,” Cancer Research 16, no. 3 (1956): 183–84.

254 In a stinging rebuttal written to the editor: Evarts A. Graham, “To the Editor of Cancer Research,” Cancer Research 16 (1956): 816–17.

254 “We may subject mice, or other laboratory animals”: Sir Austin Bradford Hill, Statistical Methods in Clinical and Preventative Medicine (London: Livingstone, 1962), 378.

254 Graham had invented a “smoking machine”: Ernst L. Wynder, Evarts A. Graham, and Adele B. Croninger, “Experimental Production of Carcinoma with Cigarette Tar,” Cancer Research 13 (1953): 855–64.

255 Forbes magazine had famously spoofed the research: Forbes 72 (1953): 20.

255 Bradford Hill’s nine criteria for epidemiology: Sir Austin Bradford Hill, “The Environment and Disease: Association or Causation?” Proceedings of the Royal Society of Medicine 58, no. 5 (1965): 295–300.

256 “Perhaps you have heard that”: Letter from Evarts Graham to Alton Ochsner, February 14, 1957, Evarts Graham papers.

257 In the winter of 1954, three years before: Alton Ochsner, Smoking and Cancer: A Doctor’s Report (New York: J. Messner, 1954).

“A statement of warning”

258 Our credulity would indeed be strained: Eva Cooper v. R. J. Reynolds Tobacco Company, 256 F.2d 464 (1st Cir., 1958).

258 Certainly, living in America in the last half: Burson Marsteller (PR firm) internal document, January 1, 1988. Cipollone postverdict document available at the UCSF Legacy Tobacco Documents Library.

258 In the summer of 1963, seven years after: See Richard Kluger, Ashes to Ashes, 254–55.

258 Auerbach’s paper describing the lesions: O. Auerbach and A. P. Stout, “The Role of Carcinogens, Especially Those in Cigarette Smoke, in the Production of Precancerous Lesions,” Proceedings of the National Cancer Conference 4 (1960): 297–304.

259 Auerbach’s three visitors that morning: See Kluger, Ashes to Ashes, 254.

259 In 1961, the American Cancer Society: “The 1964 Report on Smoking and Health,” Reports of the Surgeon General, Profiles in Science: National Library of Medicine, http://profiles.nlm.nih.gov/NN/Views/Exhibit/narrative/smoking.html (accessed December 26, 2009); U.S. Surgeon General. “Smoking and Health,” Report of the Advisory Committee to the Surgeon General of the Public Health Service, Public Health Service publication no. 1103 (Washington, DC: U.S. Department of Health, Education, and Welfare, Public Health Service, 1964).

260 “a reluctant dragon”: Lester Breslow, A History of Cancer Control in the United States, 1946–1971 (Bethesda, MD: U.S. National Cancer Institute, 1979), 4: 24.

260 he announced that he would appoint an advisory committee: U.S. Surgeon General’s report: Smoking and Health, 1964.

261 Data, interviews, opinions, and testimonies: Ibid.

261 Each member of the committee: Ibid. Also see Kluger, Ashes to Ashes, 243–45.

262 “The word ‘cause,’” the report read: U.S. Surgeon General’s report: Smoking and Health.

262 Luther Terry’s report, a leatherbound, 387-page: “1964 Report on Smoking and Health.”

262 “While the propaganda blast was tremendous”: George Weissman memo to Joseph Cullman III, January 11, 1964, Tobacco Documents Online, http://tobaccodocuments.org/landman/1005038559–8561.html (accessed December 26, 2009).

263 the commission’s shining piece of lawmaking: Annual Report of the Federal Trade Commission (Washington DC: United States Printing Office, 1950), 65.

263 In 1957, John Blatnik, a Minnesota chemistry teacher: “Making Cigarette Ads Tell the Truth,” Harper’s, August 1958.

263 The FTC had been revamped: “Government: The Old Lady’s New Look,” Time, April 16, 1965.

264 A week later, in January 1964: Federal Trade Commission, “Advertising and Labeling of Cigarettes. Notice of Rule-Making Proceeding for Establishment of Trade Regulation Rules,” Federal Register, January 22, 1964, 29:530–32.

264 they voluntarily requested regulation by Congress: “The Quiet Victory of the Cigarette Lobby: How It Found the Best Filter Yet—Congress,” Atlantic, September 1965.

264 Entitled the Federal Cigarette Labeling and Advertising Act: Cigarette Labeling and Advertising Act, Title 15, chap. 36, 1965; “Quiet Victory of the Cigarette Lobby.”

265 In the early summer of 1967, Banzhaf: John F. Banzhaf III v. Federal Communications Commission et al., 405 F.2d 1082 (D.C. Cir. 1968).

266 “The advertisements in question”: Ibid.

266 “a squadron of the best-paid lawyers in the country”: John Banzhaf, interview with author, June 2008.

266 “Doubt is our product”: “Smoking and Health Proposal,” 1969, Brown & Williamson Collection, Legacy Tobacco Documents Library, University of California, San Francisco.

266 In 1968, a worn and skeletal-looking William Talman: A video of the ad is available at http://www.classictvads.com/smoke_1.shtml (accessed December 26, 2009).

267 The last cigarette commercial: See Brandt, Cigarette Century, 271.

267 He had already died: “William Hopper, Actor, Dies; Detective in ‘Perry Mason,’ 54,” New York Times, March 7, 1970.

267 cigarette consumption in America plateaued: U.S. Department of Agriculture, Tobacco Situation and Outlook Report, publication no. TBS-226 (Washington, DC: U.S. Department of Agriculture, Economic Research Service, Commodity Economics Division, April 1994) table 2; G. A. Glovino, “Surveillance for Selected Tobacco-Use Behaviors—United States, 1900–1994,” Morbidity and Mortality Weekly Report CDC Surveillance Summaries 43, no. 3 (1994): 1–43.

267 “Statistics,” the journalist Paul Brodeur once wrote: Paul Brodeur, Outrageous Misconduct: The Asbestos Industry on Trial (New York: Pantheon Books, 1985).

267 She represented the midpoint: See “Women and Smoking,” Report of the U.S. Surgeon General 2001, and prior report from 1980.

268 “[It’s] a game only for steady nerves”: See, for example, Popular Mechanics, November 1942, back cover.

268 “never twittery, nervous or jittery”: Redd Evans and John Jacob Loeb, “Rosie the Riveter” (New York: Paramount Music Corp., 1942).

269 Marc Edell, a New Jersey attorney: For details of Cipollone’s case see Cipollone v. Liggett Group, Inc., 505 U.S. 504 (1992).

269 “deaf, dumb and blind”: Ibid.

269 In the three decades between 1954 and 1984: Burson Marsteller (PR firm), Position Paper, History of Tobacco Litigation Third Draft, May 10, 1988.

270 “Plaintiff attorneys can read the writing”: Burson Marsteller (PR firm), internal document, Cipollone postverdict communication plan, January 1, 1988.

270 In one letter, Fred Panzer: David Michaels, Doubt Is Their Product: How Industry’s Assault on Science Threatens Your Health (Oxford: Oxford University Press, 2008), 11. Also see Brown and Williamson (B & W), “Smoking and Health Proposal,” B & W document no. 680561778-1786, 1969, available at http://legacy.library.ucsf.edu/tid/nvs40f00.

270 “In a sense, the tobacco industry may be thought”: “Research Planning Memorandum on the Nature of the Tobacco Business and the Crucial Role of Nicotine Therein,” April 14, 1972, Anne Landman’s Collection, Tobacco Documents Online, http://tobaccodocuments.org/landman/501877121–7129.html (accessed December 26, 2009).

271 “Think of the cigarette pack as a storage container”: “Motives and Incentives in Cigarette Smoking,” 1972, Anne Landman’s Collection, Tobacco Documents Online, http://tobaccodocuments.org/landman/2024273959–3975.html (accessed December 26, 2009).

271 Edell quizzed Liggett’s president: Cipollone v. Liggett Group, Inc., et al., transcript of proceedings [excerpt], Tobacco Products Litigation Reporter 3, no. 3 (1988): 3.2261–3.268.

271 the Cipollone cancer trial appeared before the court in 1987: See Cipollone v. Liggett Group, Inc., et al., 893 F.2d 541 (1990); Cipollone v. Liggett Group, Inc., et al., 505 U.S. 504 (1992).

272 By 1994, the per capita consumption of cigarettes in America: “Trends in Tobacco Use,” American Lung Association Research and Program Services Epidemiology and Statistics Unit, July 2008, http://www.lungusa.org/finding-cures/for-professionals/epidemiology-and-statistics-rpts.html (accessed December 27, 2009).

272 Among men, the age-adjusted incidence: “Trends in Lung Cancer Morbidity and Mortality,” American Lung Association Epidemiology and Statistics Unit, Research and Program Services Division, September 2008, http://www.lungusa.org/finding-cures/for-professionals/epidemiology-and-statistics-rpts.html (accessed December 27, 2009).

272 In 1994, in yet another landmark case: “Mississippi Seeks Damages from Tobacco Companies,” New York Times, May 24, 1994.

272 “You caused the health crisis”: Ibid.

273 Several other states then followed: “Tobacco Settlement Nets Florida $11.3B,” USA Today, August 25, 1997; “Texas Tobacco Deal Is Approved,” New York Times, January 17, 1998.

273 In June 1997, facing a barrage: The Master Settlement Agreement is available online from the Office of the Attorney General of California, http://www.ag.ca.gov/tobacco/msa.php (accessed December 27, 2009).

273 Tobacco smoking is now a major preventable cause: Gu et al., “Mortality Attributable to Smoking in China,” New England Journal of Medicine 360, no. 2 (2009): 150–59; P. Jha et al., “A Nationally Representative Case-Control Study of Smoking and Death in India,” New England Journal of Medicine 358, no. 11 (2008): 1137–47.

273 Richard Peto, an epidemiologist at Oxford: Ibid.

274 In China, lung cancer is already: Gu et al., “Mortality Attributable to Smoking in China.”

274 In 2004, tobacco companies signed: Samet et al., “Mexico and the Tobacco Industry,” BMJ 3 (2006): 353–55.

274 In the early 1990s, a study noted, British American Tobacco: Gilmore et al., “American Tobacco’s Erosion of Health Legislation in Uzbekistan,” BMJ 332 (2006): 355–58.

274 Cigarette smoking grew by about 8 percent: Ibid.

274 In a recent editorial in the British Medical Journal: Ernesto Sebrié and Stanton A. Glantz, “The Tobacco Industry in Developing Countries,” British Medical Journal 332, no. 7537 (2006): 313–14.

“Curiouser and curiouser”

276 You’re under a lot of stress: Transcript of interview with Barry Marshall and an anonymous interviewer, National Health and Medical Research Council archives, Australia.

276 In the early 1970s, for instance, a series of studies: J. S. Harrington, “Asbestos and Mesothelioma in Man,” Nature 232, no. 5305 (1971): 54–55; P. Enterline, P. DeCoufle, and V. Henderson, “Mortality in Relation to Occupational Exposure in the Asbestos Industry,” Journal of Occupational Medicine 14, no. 12 (1972): 897–903; “Asbestos, the Saver of Lives, Has a Deadly Side,” New York Times, January 21, 1973; “New Rules Urged For Asbestos Risk,” New York Times, October 5, 1975.

277 In 1971, yet another such study identified: Arthur L. Herbst, Howard Ulfelder, and David C. Poskanzer, New England Journal of Medicine 284, no. 15 (1971): 878–81.

277 In the late 1960s, a bacteriologist named Bruce Ames: Bruce N. Ames et al., “Carcinogens Are Mutagens: A Simple Test System Combining Liver Homogenates for Activation and Bacteria for Detection,” Proceedings of the National Academy of Sciences of the United States of America 70, no. 8 (1973): 2281–85; Bruce N. Ames, “An Improved Bacterial Test System for the Detection and Classification of Mutagens and Carcinogens,” Proceedings of the National Academy of Sciences of the United States of America 70, no. 3 (1973): 82–786.

278 So did X-rays, benzene compounds, and nitrosoguanidine: “Carcinogens as Frameshift Mutagens: Metabolites and Derivatives of 2-Acetylaminofluorene and Other Aromatic Amine Carcinogens,” Proceedings of the National Academy of Sciences of the United States of America 69, no. 11 (1972): 3128–32.

278 Not every known carcinogen scored on the test: For DES, see Ishikawa et al., “Lack of Mutagenicity of Diethylstilbestrol Metabolite and Analog, (±)-Indenestrols A and B, in Bacterial Assays,” Mutation Research/Genetic Toxicology 368, nos. 3–4 (1996): 261–65; for asbestos, see K. Szyba and A. Lange, “Presentation of Benzo(a)pyrene to Microsomal Enzymes by Asbestos Fibers in the Salmonella/Mammalian Microsome Mutagenicity Test,” Environmental Health Perspectives 51 (1983): 337–41.

278 A biochemistry student at Oxford: Marc A. Shampo and Robert A. Kyle, “Baruch Blumberg—Work on Hepatitis B Virus,” Mayo Clinic Proceedings 78, no. 9 (2003): 1186.

279 The work of Baruch Blumberg: Baruch S. Blumberg, “Australia Antigen and the Biology of Hepatitis B,” Science 197, no. 4298 (1977): 17–25; Rolf Zetterstöm, “Nobel Prize to Baruch Blumberg for the Discovery of the Aetiology of Hepatitis B,” Acta Paediatrica 97, no. 3 (2008): 384–87; Shampo and Kyle, “Baruch Blumberg,” 1186.

279 Blumberg began to scour far-flung places: A. C. Allison et al., “Haptoglobin Types in British, Spanish, Basque and Nigerian African Populations,” Nature 181 (1958): 824–25.

279 In 1964, after a brief tenure at the NIH: Zetterstöm, “Nobel Prize to Baruch Blumberg.”

279 One blood antigen that intrigued him: Baruch S. Blumberg, Harvey J. Alter, and Sam Visnich, “A ‘New’ Antigen in Leukemia Sera,” Journal of the American Medical Association 191, no. 7 (1965): 541–46.

279 In 1966, Blumberg’s lab set out to characterize: Baruch S. Blumberg et al., “A Serum Antigen (Australia Antigen) in Down’s Syndrome, Leukemia, and Hepatitis,” Annals of Internal Medicine 66, no. 5 (1967): 924–31.

279 Au and hepatitis: Blumberg, “Australia Antigen and the Biology of Hepatitis B.”

280 “roughly circular . . . about forty-two nanometers”: Baruch Blumberg, Hepatitis B: The Hunt for a Killer Virus (Princeton: Princeton University Press, 2002), 115.

280 By 1969, Japanese researchers: Baruch S. Blumberg, “Australia Antigen and the Biology of Hepatitis B.”; K. Okochi and S. Murakami, “Observations on Australia Antigen in Japanese,” Vox Sanguinis 15, no. 5 (1968): 374–85.

280 But another illness soon stood out: Blumberg, Hepatitis B, 155.

281 “discipline-determined rigidity of the constituent institutes”: Ibid., 72.

281 By 1979, his group had devised one: Ibid., 134–46.

282 “Since the early days of medical bacteriology”: J. Robin Warren, “Helicobacter: The Ease and Difficulty of a New Discovery (Nobel Lecture),” ChemMedChem 1, no. 7 (2006): 672–85.

282 Barry Marshall and Robin Warren’s discovery of ulcer-causing bacteria: J. R. Warren, “Unidentified Curved Bacteria on Gastric Epithelium in Active Chronic Gastritis,” Lancet 321, no. 8336 (1983): 1273–75; Barry J. Marshall and J. Robin Warren, “Unidentified Curved Bacilli in the Stomach of Patients with Gastritis and Peptic Ulceration,” Lancet 323, no. 8390 (1984): 1311–15; Barry Marshall, Helicobacter Pioneers: Firsthand Accounts from the Scientists Who Discovered Helicobacters, 1892–1982 (Hoboken, NJ: Wiley-Blackwell, 2002); Warren, “Helicobacter: The Ease and Difficulty”; Barry J. Marshall, “Heliobacter Connections,” ChemMedChem 1, no. 8 (2006): 783–802.

283 “On the morning of the experiment”: Marshall, “Heliobacter Connections.”

284 The effect of antibiotic therapy on cancer: Johannes G. Kusters, Arnoud H. M. van Vliet, and Ernst J. Kuipers, “Pathogenesis of Helicobacter pylori Infection,” Clinical Microbiology Reviews 19, no. 3 (2006): 449–90.

“A spider’s web”

286 It is to earlier diagnosis that we must look: J. P. Lockhart-Mummery, “Two Hundred Cases of Cancer of the Rectum Treated by Perineal Excision,” British Journal of Surgery 14 (1926–27): 110–24.

286 The greatest need we have today: Sidney Farber, letter to Etta Rosensohn, November 1962.

286 Lady, have you been “Paptized”?: “Lady, Have You Been ‘Paptized’?” New York Amsterdam News, April 13, 1957.

286 George Papanicolaou: For an overview, see George A. Vilos, “After Office Hours: The History of the Papanicolaou Smear and the Odyssey of George and Andromache Papanicolaou,” Obstetrics and Gynecology 91, no. 3 (1998): 479–83; S. Zachariadou-Veneti, “A Tribute to George Papanicolaou (1883–1962),” Cytopathology 11, no. 3 (2000): 152–57.

287 By the late 1920s: Zachariadou-Veneti, “Tribute to George Papanicolaou.”

287 As one gynecologist archly remarked: Edgar Allen, “Abstract of Discussion on Ovarian Follicle Hormone,” Journal of the American Medical Association 85 (1925): 405.

287 Papanicolaou thus began to venture: George N. Papanicolaou, “The Cancer-Diagnostic Potential of Uterine Exfoliative Cytology,” CA: A Cancer Journal for Clinicians 7 (1957): 124–35.

288 “aberrant and bizarre forms”: Ibid.

288 Papanicolaou published his method: G. N. Papanicolaou, “New Cancer Diagnosis,” Proceedings of the Third Race Betterment Conference (1928): 528.

288 “I think this work will be carried”: Ibid.

288 Between 1928 and 1950: George A. Vilos, “After Office Hours,” Obstetrics and Gynecology 91 (March 1998): 3.

288 A Japanese fish and bird painter: George N. Papanicolaou, “The Cell Smear Method of Diagnosing Cancer,” American Journal of Public Health and the Nation’s Health 38, no. 2 (1948): 202–5.

289 At a Christmas party in the winter of 1950: Irena Koprowska, A Woman Wanders through Life and Science (Albany: State University of New York Press, 1997), 167–68.

289 “It was a revelation”: Ibid.

289 In 1952, Papanicolaou convinced the National Cancer Institute: Cyrus C. Erickson, “Exfoliative Cytology in Mass Screening for Uterine Cancer: Memphis and Shelby County, Tennessee,” CA: A Cancer Journal for Clinicians 5 (1955): 63–64.

289 In the initial cohort of about 150,000: Harold Speert, “Memorable Medical Mentors: VI. Thomas S. Cullen (1868–1953),” Obstetrical and Gynecological Survey 59, no. 8 (2004): 557–63.

289 557 women were found to have preinvasive cancers: Ibid.

290 In 1913, a Berlin surgeon named Albert Salomon: D. J. Dronkers et al., eds., The Practice of Mammography: Pathology, Technique, Interpretation, Adjunct Modalities (New York: Thieme, 2001), 256.

291 “trabeculae as thin as a spider’s web”: H. J. Burhenne, J. E. Youker, and R. H. Gold, eds., Mammography (symposium given on August 24, 1968, at the University of California School of Medicine, San Francisco) (New York: S. Karger, 1969), 109.

294 In the winter of 1963, three men set out: Sam Shapiro, Philip Strax, and Louis Venet, “Evaluation of Periodic Breast Cancer Screening with Mammography: Methodology and Early Observations,” Journal of the American Medical Association 195, no. 9 (1966): 731–38.

294 By the mid-1950s, a triad of forces: Thomas A. Hirschl and Tim B. Heaton, eds., New York State in the 21^st Century (Santa Barbara, CA: Greenwood Publishing Group, 1999), 144.

294 By the early 1960s, the plan had enrolled: See, for instance, Philip Strax, “Screening for breast cancer,” Clinical Obstetrics and Gynecology 20, no. 4 (1977): 781–802.

295 Strax and Venet eventually outfitted a mobile van: Philip Strax, “Female Cancer Detection Mobile Unit,” Preventive Medicine 1, no. 3 (1972): 422–25.

295 “Interview . . . 5 stations X 12 women”: Abraham Schiff quoted in Philip Strax, Control of Breast Cancer through Mass Screening (Philadelphia: Mosby, 1979), 148.

296 In 1971, eight years after the study: S. Shapiro et al., “Proceedings: Changes in 5-Year Breast Cancer Mortality in a Breast Cancer Screening Program,” Proceedings of the National Cancer Conference 7 (1972): 663–78.

296 “The radiologist,” he wrote: Philip Strax, “Radiologist’s Role in Screening Mammography,” unpublished document quoted in Barron H. Lerner, “‘To See Today with the Eyes of Tomorrow’: A History of Screening Mammography,” Canadian Bulletin of Medical History 20, no. 2 (2003): 299–321.

296 “Within 5 years, mammography has moved”: G. Melvin Stevens and John F. Weigen, “Mammography Survey for Breast Cancer Detection. A 2-Year Study of 1,223 Clinically Negative Asymptomatic Women over 40,” Cancer 19, no. 1 (2006): 51–59.

296 “The time has come”: Arthur I. Holleb, “Toward Better Control of Breast Cancer,” American Cancer Society press release, October 4, 1971 (New York: ACS Media Division), Folder: Breast Cancer Facts, quoted in Lerner, “‘To See Today with the Eyes of Tomorrow.’”

296 the Breast Cancer Detection and Demonstration Project: Myles P. Cunningham, “The Breast Cancer Detection Demonstration Project 25 Years Later,” CA: A Cancer Journal for Clinicians 47, no. 3 (1997): 131–33.

298 Between 1976 and 1992, enormous parallel trials: See below for particular studies. Also see Madelon Finkel, ed., Understanding the Mammography Controversy (Westport, CT: Praeger, 2005), 101–5.

298 In Canada, meanwhile, researchers lurched: A. B. Miller, G. R. Howe, and C. Wall, “The National Study of Breast Cancer Screening Protocol for a Canadian Randomized Controlled Trial of Screening for Breast Cancer in Women,” Clinical Investigative Medicine 4, nos. 3–4 (1981): 227–58.

298 Edinburgh was a disaster: A. Huggins et al., “Edinburgh Trial of Screening for Breast Cancer: Mortality at Seven Years,” Lancet 335, no. 8684 (1990): 241–46; Denise Donovan et al., “Edinburgh Trial of Screening for Breast Cancer,” Lancet 335, no. 8695 (1990): 968–69.

298 The Canadian trial, meanwhile: Miller, Howe, and Wall, “National Study of Breast Cancer Screening Protocol.”

298 For a critical evaluation of the CNBSS, HIP, and Swedish studies, see David Freedman et al., “On the Efficacy of Screening for Breast Cancer,” International Journal of Epidemiology 33, no. 1 (2004): 43–5.

298 Randomization problems in the Canadian National Breast Screening Study: Curtis J. Mettlin and Charles R. Smart, “The Canadian National Breast Screening Study: An Appraisal and Implications for Early Detection Policy,” Cancer 72, no. S4 (1993): 1461–65; John C. Bailar III and Brian MacMahon, “Randomization in the Canadian National Breast Screening Study: A Review for Evidence of Subversion,” Canadian Medical Association Journal 156, no. 2 (1997): 193–99.

299 “Suspicion, like beauty”: Cornelia Baines, Canadian Medical Association Journal 157 (August 1, 1997): 249.

299 “One lesson is clear”: Norman F. Boyd, “The Review of Randomization in the Canadian National Breast Screening Study: Is the Debate Over?” Canadian Medical Association Journal 156, no. 2 (1997): 207–9.

300 Migration into and out of the city: See, for instance, Scandinavian Journal of Gastroenterology 30 (1995): 33–43.

300 In 1976, forty-two thousand women enrolled: Ingvar Andersson et al., “Mammographic Screening and Mortality from Breast Cancer: The Malmö Mammographic Screening Trial,” British Medical Journal 297, no. 6654 (1988): 943–48.

300 “There was only one”: Ingvar Andersson, interview with author, March 2010.

300 In 1988, at the end of its twelfth year: Andersson et al., “Mammographic Screening and Mortality.” Also Andersson, interview with author.

300 When the groups were analyzed by age: Ibid.

301 In 2002, twenty-six years after the launch of the original: Lennarth Nystöm et al., “Long-Term Effects of Mammography Screening: Updated Overview of the Swedish Randomised Trials,” Lancet 359, no. 9310 (2002): 909–19.

301 Its effects, as the statistician Donald Berry describes it: Donald Berry, interview with author, November 2009.

301 Berry wrote, “Screening is a lottery”: “Mammograms Before 50 a Waste of Time,” Science a Go Go, October 12, 1998, http://www.scienceagogo.com/news/ 19980912094305data_trunc_sys.shtml (accessed December 29, 2009).

302 “This is a textbook example”: Malcolm Gladwell, “The Picture Problem: Mammography, Air Power, and the Limits of Looking,” New Yorker, December 13, 2004.

303 “All photographs are accurate”: Richard Avedon, An Autobiography (New York: Random House, 1993); Richard Avedon, Evidence, 1944–1994 (New York: Random House, 1994).

304 “As the decade ended,” Bruce Chabner: Bruce Chabner, interview with author, August 2009.

STAMP

305 Then did I beat them: 2 Samuel 22:43 (King James Version).

306 Cancer therapy is like beating the dog: Anna Deveare Smith, Let Me Down Easy, script and monologue, December 2009.

306 “If a man die”: William Carlos Williams, The Collected Poems of William Carlos Williams: 1939–1962 (New York: New Directions Publishing, 1991), 2: 334.

306 In his poignant memoir of his mother’s illness: David Rieff, Swimming in a Sea of Death: A Son’s Memoir (New York: Simon & Schuster, 2008), 6–10.

306 “Like so many doctors”: Ibid., 8.

308 “To say this was a time of unreal”: Abraham Verghese, My Own Country: A Doctor’s Story of a Town and Its People in the Age of AIDS (New York: Simon & Schuster, 1994), 24.

308 “There seemed to be little that medicine could not do”: Ibid., 24.

309 E. Donnall Thomas, had shown that bone marrow: E. Donnall Thomas, “Bone Marrow Transplantation from the Personal Viewpoint,” International Journal of Hematology 81 (2005): 89–93.

309 In Thomas’s initial trial at Seattle: E. Thomas et al., “Bone Marrow Transplantation,” New England Journal of Medicine 292, no. 16 (1975): 832–43.

310 “We have a cure for breast cancer”: Craig Henderson, interview with Richard Rettig, quoted in Richard Rettig et al., False Hope: Bone Marrow Transplantation for Breast Cancer (Oxford: Oxford University Press, 2007), 29.

311 “It was an intensely competitive place”: Robert Mayer, interview with author, July 2008.

311 In 1982, Frei recruited William Peters: Shannon Brownlee, “Bad Science and Breast Cancer,” Discover, August 2002.

311 In the fall of 1983, he invited Howard Skipper: William Peters, interview with author, May 2009.

312 a “seminal event”: Ibid.

312 George Canellos, for one, was wary: George Canellos, interview with author, March 2008.

312 “We were going to swing and go for the ring”: Brownlee, “Bad Science and Breast Cancer.”

312 The first patient to “change history” with STAMP: Ibid., and Peters, interview with author.

313 “The ultimate trial of chemotherapeutic intensification”: Peters, interview with author.

314 “Suddenly, everything broke loose”: Ibid.

314 The woman was thirty-six years old: Ibid.

314 “the most beautiful remission you could have imagined”: Ibid.

315 In March 1981, in the journal Lancet: Kenneth B. Hymes et al., “Kaposi’s Sarcoma in Homosexual Men—a Report of Eight Cases,” Lancet 318, no. 8247 (1981): 598–600.

316 “gay compromise syndrome”: Robert O. Brennan and David T. Durack, “Gay Compromise Syndrome,” Lancet 318, no. 8259 (1981): 1338–39.

316 In July 1982, with an understanding of the cause: “July 27, 1982: A Name for the Plague,” Time, March 30, 2003.

316 In a trenchant essay written as a reply: Susan Sontag, Illness as Metaphor and AIDS and Its Metaphors (New York: Picador, 1990).

317 For Volberding, and for many of his earliest: See ACT UP Oral History Project, http://www.actuporalhistory.org/.

317 Volberding borrowed something more ineffable: Arthur J. Amman et al., The AIDS Epidemic in San Francisco: The Medical Response, 1981–1884, vol. 3 (Berkeley: Regional Oral History Office, the Bancroft Library, University of California, Berkeley, 1997).

317 “What we did here”: Ibid.

318 In January 1982, as AIDS cases boomed: “Building Blocks in the Battle on AIDS,” New York Times, March 30, 1997; Randy Shilts, And the Band Played On (New York: St. Martin’s Press).

318 In January 1983, Luc Montagnier’s group: Shilts, And the Band Played On, 219; F. Barré-Sinoussi et al. “Isolation of a T-Lymphotropic Retrovirus from a Patient at Risk for Acquired Immune Deficiency Syndrome (AIDS),” Science 220, no. 4599 (1983): 868–71.

318 Gallo also found a retrovirus: Mikulas Popovic et al., “Detection, Isolation, and Continuous Production of Cytopathic Retroviruses (HTLV-III) from Patients with AIDS and Pre-AIDS,” Science 224, no. 4648 (1984): 497–500; Robert C. Gallo et al., “Frequent Detection and Isolation of Cytopathic Retroviruses (HTLV-III) from Patients with AIDS and at Risk for AIDS,” Science 224, no. 4648 (1984): 500–503.

318 On April 23, 1984, Margaret Heckler: James Kinsella, Covering the Plague: AIDS and the American Media (Piscataway, NJ: Rutgers University Press, 1992), 84.

318 In the spring of 1987: Steven Epstein, Impure Science: AIDS, Activism, and the Politics of Knowledge (Berkeley: University of California Press, 1998), 219.

318 “genocide by neglect”: Ibid., 221.

318 “Many of us who live in daily terror”: “The F.D.A.’s Callous Response to AIDS,” New York Times, March 23, 1987.

318 “Drugs into bodies”: Raymond A. Smith and Patricia D. Siplon, Drugs into Bodies: Global AIDS Treatment Activism (Santa Barbara, CA: Greenwood Publishing Group, 2006).

318 “The FDA is fucked-up”: “Acting Up: March 10, 1987,” Ripples of Hope: Great American Civil Rights Speeches, ed. Josh Gottheimer (New York: Basic Civitas Books, 2003), 392.

318 “Double-blind studies”: “F.D.A.’s Callous Response to AIDS,” New York Times.

318 He concluded, “AIDS sufferers”: Ibid.

320 By the winter of 1984, thirty-two women: Peters, interview with author.

320 “There was so much excitement within the cancer community”: Donald Berry, interview with author, November 2009.

320 Peters flew up from Duke to Boston: Peters, interview with author.

The Map and the Parachute

321 Oedipus: What is the rite of purification?: Sophocles, Oedipus the King.

321 Transplanters, as one oncologist: Craig Henderson, quoted in Brownlee, “Bad Science and Breast Cancer.”

321 Nelene Fox and bone marrow transplantation: See Michael S. Lief and Harry M. Caldwell, And the Walls Came Tumbling Down: Closing Arguments that Changed the Way We Live, from Protecting Free Speech to Winning Women’s Sufferage to Defending the Right to Die (New York: Simon & Schuster, 2004), 299–354; “$89 Million Awarded Family Who Sued H.M.O.,” New York Times, December 30, 1993.

322 On June 19, a retinue: Lief and Caldwell, And the Walls Came Tumbling Down, 310.

322 “You marketed this coverage to her”: Ibid., 307.

323 In August 1992, Nelene Fox: Ibid., 309.

323 “The dose-limiting barrier”: S. Ariad and W. R. Bezwoda, “High-Dose Chemotherapy: Therapeutic Potential in the Age of Growth Factor Support,” Israel Journal of Medical Sciences 28, no. 6 (1992): 377–85.

323 In Johannesburg, more than 90 percent: W. R. Bezwoda, L. Seymour, and R. D. Dansey, “High-Dose Chemotherapy with Hematopoietic Rescue as Primary Treatment for Metastatic Breast Cancer: A Randomized Trial,” Journal of Clinical Oncology 13, no. 10 (1995): 2483–89.

324 On April 22, eleven months after: Lief and Caldwell, And the Walls Came Tumbling Down, 309.

324 In 1993 alone: Papers were assessed on www.pubmed.org.

324 “If all you have is a cold or the flu”: Lief and Caldwell, And the Walls Came Tumbling Down, 234.

324 On the morning of December 28, 1993: Ibid.

324 That evening, it returned a verdict: “$89 Million Awarded Family,” New York Times.

325 In Massachusetts, Charlotte Turner: “Cancer Patient’s Kin Sues Fallon” and “Coverage Denied for Marrow Transplant,” Worcester (MA) Telegram & Gazette, December 7, 1995; Erin Dominique Williams and Leo Van Der Reis, Health Care at the Abyss: Managed Care vs. the Goals of Medicine (Buffalo, NY: William S. Hein Publishing, 1997), 3.

325 Between 1988 and 2002: See Richard Rettig et al., eds., False Hope: Bone Marrow Transplantation for Breast Cancer (New York: Oxford University Press, 2007), 85, and Table 3.2.

325 “complicated, costly and potentially dangerous”: Bruce E. Brockstein and Stephanie F. Williams, “High-Dose Chemotherapy with Autologous Stem Cell Rescue for Breast Cancer: Yesterday, Today and Tomorrow,” Stem Cells 14, no. 1 (1996): 79–89.

325 Between 1991 and 1999, roughly forty thousand: JoAnne Zujewski, Anita Nelson, and Jeffrey Abrams, “Much Ado about Not . . . Enough Data,” Journal of the National Cancer Institute 90 (1998): 200–209. Also see Rettig et al., False Hope, 137.

326 “Transplants, transplants, everywhere”: Robert Mayer, interview with author, July 2008.

326 As Bezwoda presented the data: W. R. Bezwoda, “High Dose Chemotherapy with Haematopoietic Rescue in Breast Cancer,” Hematology and Cell Therapy 41, no. 2 (1999): 58–65. Also see Werner Bezwoda, plenary session, American Society of Clinical Oncology meeting, 1999 (video recordings available at www.asco.org).

326 three other trials presented that afternoon: Ibid.

326 At Duke, embarrassingly enough: Ibid.

326 “even a modest improvement”: Ibid.

326 A complex and tangled trial from Sweden: Ibid.

326 “My goal here,” one discussant began: Ibid.

327 “People who like to transplant will continue to transplant”: “Conference Divided over High-Dose Breast Cancer Treatment,” New York Times, May 19, 1999.

327 Investigation of Bezwoda’s breast cancer study: Raymond B. Weiss et al., “High-Dose Chemotherapy for High-Risk Primary Breast Cancer: An On-Site Review of the Bezwoda Study,” Lancet 355, no. 9208 (2000): 999–1003.

328 Another patient record, tracked back to its origin: “Bezwoda,” Kate Barry (producer), archived in video format at http://beta.mnet.co.za/Carteblanche, M-Net TV Africa (March 19, 2000).

328 “I have committed a serious breach of scientific honesty”: “Breast Cancer Study Results on High-Dose Chemotherapy Falsified,” Imaginis, February 9, 2000, http://www .imaginis.com/breasthealth/news/news2.09.00.asp (accessed January 2, 2010).

328 “By the late 1990s, the romance was already over”: Robert Mayer, interview with author.

328 Maggie Keswick Jencks: Maggie Keswick Jencks, A View from the Front Line (London, 1995).

329 “There you are, the future patient”: Ibid., 9.

330 In May 1997, exactly eleven years after: John C. Bailar and Heather L. Gornik, “Cancer Undefeated,” New England Journal of Medicine 336, no. 22 (1997): 1569–74.

332 Pressed on public television, he begrudgingly conceded: “Treatment vs. Prevention,” NewsHour with Jim Lehrer, May 29, 1997, PBS, transcript available at http://www.pbs .org/newshour/bb/health/may97/cancer_5–29.html (accessed January 2, 2010).

332 “‘Cancer’ is, in truth, a variety of diseases”: Barnett S. Kramer and Richard D. Klausner, “Grappling with Cancer—Defeatism versus the Reality of Progress,” New England Journal of Medicine 337, no. 13 (1997): 931–35.

PART FIVE:
“A DISTORTED VERSION OF OUR NORMAL SELVES”

335 It is vain to speak of cures: Robert Burton, The Anatomy of Melancholy (: C. Armstrong and Son, 1893), 235.

335 You can’t do experiments to see: Samuel S. Epstein, Cancer-Gate: How to Win the Losing Cancer War (Amityville, NY: Baywood Publishing Company, 2005), 57.

335 What can be the “why” of these happenings?: Peyton Rous, “The Challenge to Man of the Neoplastic Cell,” Nobel Lectures, Physiology or Medicine, 1963–1970 (Amsterdam: Elsevier Publishing Company, 1972).

“A unitary cause”

340 As early as 1858: Rudolf Virchow, Lecture XX, Cellular Pathology as Based upon Physiological and Pathological Histology, trans. Frank Chance (London: Churchill, 1860). The passage on irritation appears on page 488 of the translated version: “A pathological tumor in man forms . . . where any pathological irritation occurs . . . all of them depend upon a proliferation of cells.”

340 Walther Flemming, a biologist working in Prague: Neidhard Paweletz, “Walther Flemming: Pioneer of Mitosis Research,” Nature Reviews Molecular Cell Biology 2 (2001): 72–75.

340 It was Virchow’s former assistant David Paul von Hansemann: Leon P. Bignold, Brian L. D. Coghlan, and Hubertus P. A. Jersmann, eds., Contributions to Oncology: Context, Comments and Translations (Basel: Birkhauser Verlag, 2007), 83–90.

341 Boveri devised a highly unnatural experiment: Theodor Boveri, Concerning the Origin of Malignant Tumours by Theodor Boveri, translated and annotated by Henry Harris (New York: Cold Spring Harbor Press, 2006). This is a reprint and new translation of the original text.

342 “unitary cause of carcinoma”: Ibid., 56.

342 not “an unnatural group of different maladies”: Ibid., 56.

342 In 1910, four years before Boveri had published his theory: Peyton Rous, “A Transmissible Avian Neoplasm (Sarcoma of the Common Fowl),” Journal of Experimental Medicine 12, no. 5 (1910): 696–705; Peyton Rous, “A Sarcoma of the Fowl Transmissible by an Agent Separable from the Tumor Cells,” Journal of Experimental Medicine 13, no. 4 (1911): 397–411.

342 In 1909, a year before: Karl Landsteiner et al., “La transmission de la paralysie infantile aux singes,” Compt. Rend. Soc. Biologie 67 (1909).

343 In the early 1860s, working alone: Gregor Mendel, “Versuche über Plfanzenhybriden,” Verhandlungen des Naturforschenden Vereines in Brünn. IV für das Jahr 1865, Abhandlungen (1866): 3–47. English translation available at http://www.esp.org/foundations/genetics/classical/gm-65.pdf (accessed January 2, 2010). Also see Robin Marantz Henig, The Monk in the Garden: The Lost and Found Genius of Gregor Mendel, the Father of Genetics (Boston: Mariner Books, 2001), 142.

343 decades later, in 1909, botanists: Wilhelm Ludwig Johannsen, Elemente der Exakten Erblichkeitlehre (1913), http://caliban.mpiz-koeln.mpg.de/johannsen/elemente/index.html (accessed January 2, 2010).

344 In 1910, Thomas Hunt Morgan: See T. H. Morgan, “Chromosomes and Heredity,” American Naturalist 44 (1910): 449–96. Also see Muriel Lederman, “Research Note: Genes on Chromosomes: the Conversion of Thomas Hunt Morgan,” Journal of the History of Biology 22, no. 1 (1989): 163–76.

344 The third vision of the “gene”: Oswald T. Avery et al., “Studies on the Chemical Nature of the Substance Inducing Transformation of Pneumococcal Types: Induction of Transformation by a Deoxyribonucleic Acid Fraction Isolated from Pneumococcus Type III,” Journal of Experimental Medicine 79 (1944): 137–58.

345 George Beadle, Thomas Morgan’s student: See George Beadle, “Genes and Chemical Reactions in Neurospora,” Nobel Lectures, Physiology or Medicine, 1942–1962 (Amsterdam: Elsevier Publishing Company, 1964), 587–99.

346 In the mid-1950s, biologists termed: See for instance Francis Crick, “Ideas on Protein Synthesis,” October 1956, Francis Crick Papers, National Library of Medicine. Crick’s statement of the central dogma proposed that RNA could be back converted as a special case, but that proteins could never be back converted into DNA or RNA. Reverse transcription was thus left as a possibility.

347 In 1872, Hilário de Gouvêa: A. N. Monteiro and R. Waizbort, “The Accidental Cancer Geneticist: Hilário de Gouvêa and Hereditary Retinoblastoma,” Cancer Biology and Therapy 6, no. 5 (2007): 811–13.

348 In 1928, Hermann Joseph Muller: See Hermann Muller, “The Production of Mutations,” Nobel Lectures, Physiology or Medicine, 1942–1962 (Amsterdam: Elsevier Publishing Company, 1964).

348 “the doctor may then want to call in his geneticist friends for consultation!”: Thomas Morgan, “The Relation of Genetics to Physiology and Medicine,” Nobel Lectures, Physiology or Medicine 1922–1941 (Amsterdam: Elsevier Publishing Company, 1965).

Under the Lamps of Viruses

349 Unidentified flying objects, abominable snowmen: Medical World News, January 11, 1974.

349 The biochemist Arthur Kornberg once joked: Arthur Kornberg, “Ten Commandments: Lessons from the Enzymology of DNA Replication,” Journal of Bacteriology 182, no. 13 (2000): 3613–18.

351 Temin was cooking up an unusual experiment: See Howard Temin and Harry Rubin, “Characteristics of an Assay for Rous Sarcoma Virus,” Virology 6 (1958): 669–83.

351 “The virus, in some structural as well as functional sense”: Howard Temin, quoted in Howard M. Temin et al., The DNA Provirus: Howard Temin’s Scientific Legacy (Washington, DC: ASM Press, 1995), xviii.

352 “Temin had an inkling”: J. Michael Bishop, interview with author, August 2009.

352 “The hypothesis”: J. Michael Bishop in Temin et al., DNA Provirus, 81.

353 Mizutani was a catastrophe: See Robert Weinberg, Racing to the Beginning of the Road (New York: Bantam, 1997), 61.

353 At MIT, in Boston: Ibid., 61–65.

353 “It was all very dry biochemistry”: Ibid., 64.

354 In their respective papers: David Baltimore, “RNA-Dependent DNA Polymerase in Virions of RNA Tumor Viruses,” Nature 226, no. 5252 (1970): 1209–11; and H. M Temin and S. Mizutani, “RNA-Dependent DNA Polymerase in Virions of Rous Sarcoma Virus,” Nature 226, no. 5252 (1970): 1211–13.

355 Spiegelman raced off to prove: Weinberg, Racing to the Beginning, 70.

355 “It became his single-minded preoccupation”: Robert Weinberg, interview with author, January 2009.

356 “The hoped-for human virus”: Weinberg, Racing to the Beginning, 83.

“The hunting of the sarc”

357 For the Snark was a Boojum, you see: Lewis Carroll, The Hunting of the Snark: An Agony in Eight Fits (New York: Macmillan, 1914), 53.

358 By analyzing the genes altered in these mutant viruses: For a review of Duesberg’s and Vogt’s contributions, see G. Steven Martin, “The Hunting of the Src,” Nature Reviews Molecular Cell Biology 2, no. 6 (2001): 467–75.

358 A chance discovery in Ray Erikson’s laboratory: J. S. Brugge and R. L. Erikson, “Identification of a Transformation-Specific Antigen Induced by an Avian Sarcoma Virus,” Nature 269, no. 5626 (1977): 346–48.

360 other scientists nicknamed the project: See, for instance, Martin, “The Hunting of the Src.”

361 “Src,” Varmus wrote in a letter: Harold Varmus to Dominique Stehelin, February 3, 1976, Harold Varmus papers, National Library of Medicine archives. Also see Stehelin et al., “DNA Related to the Transforming Genes of Avian Sarcoma Viruses Is Present in Normal DNA,” Nature 260, no. 5547 (March 1976): 170–73.

362 “Nature,” Rous wrote in 1966: Peyton Rous, “The Challenge to Man of the Neoplastic Cell,” Nobel Lectures, Physiology or Medicine, 1963–1970 (Amsterdam: Elsevier Publishing Company, 1972).

363 “We have not slain our enemy”: Harold Varmus, “Retroviruses and Oncogenes I,” Nobel Lectures, Physiology or Medicine, 1981–1990, ed. Jan Lindsten (Singapore: World Scientific Publishing Co., 1993).

The Wind in the Trees

364 The fine, fine wind: D. H. Lawrence, “The Song of a Man Who Has Come Through,” Penguin Book of First World War Poetry, ed. John Silkin (New York: Penguin Classics, 1996), 213.

365 Rowley’s specialty was studying: Janet Rowley, “Chromosomes in Leukemia and Lymphoma,” Seminars in Hematology 15, no. 3 (1978): 301–19.

365 In the late 1950s, Peter Nowell: P. C. Nowell and D. Hungerford, Science 142 (1960): 1497.

366 In 1969, Knudson moved: Al Knudson, interview with author, July 2009.

367 “The number two,” he recalled: Ibid.

368 Knudson’s two-hit theory: A. Knudson, “Mutation and Cancer: Statistical Study of Retinoblastoma,” Proceedings of the National Academy of Sciences of the United States of America 68, no. 4 (1971): 820–23.

368 “Two classes of genes are apparently critical”: A. Knudson, “The Genetics of Childhood Cancer,” Bulletin du Cancer 75, no. 1 (1988): 135–38.

369 “jammed accelerators” and “missing brakes”: J. Michael Bishop, in Howard M. Temin et al., The DNA Provirus: Howard Temin’s Scientific Legacy (Washington, DC: ASM Press, 1995), 89.

A Risky Prediction

370 They see only their: Plato, The Republic of Plato, Benjamin Jowett, trans. (Oxford: Clarendon Press, 1908), 220.

370 “Isolating such a gene”: Robert Weinberg, interview with author, January 2009.

371 “The chair of the department”: Ibid.

371 Clarity came to him one morning: Ibid.

373 In the summer of 1979, Chiaho Shih: Ibid.

374 “If we were going to trap a real oncogene”: Ibid. Also, Cliff Tabin, interview with author, December 2009.

374 In 1982, Weinberg: C. Shih and R. A. Weinberg (1982), “Isolation of a Transforming Sequence from a Human Bladder Carcinoma Cell Line,” Cell 29: 161–169. Also see M. Goldfarb, K. Shimizu, M. Perucho, and M. Wigler, “Isolation and Preliminary Characterization of a Human Transforming Gene from T24 Bladder Carcinoma Cells,” Nature 296 (1982): 404–9. Also see S. Pulciani et al., “Oncogenes in Human Tumor Cell Lines: Molecular Cloning of a Transforming Gene from Human Bladder Carcinoma Cells,” Proceedings of the National Academy of Sciences. USA 79: 2845–49.

375 “Once we had cloned”: Robert Weinberg, Racing to the Beginning of the Road (New York: Bantam, 1997), 165.

375 Ray Erikson traveled to Washington: Ray Erikson, interview with author, October 2009.

375 “I don’t remember any enthusiasm”: Ibid.

376 “How can one capture genes”: Robert Weinberg, One Renegade Cell (New York: Basic Books, 1999), 74.

376 “We knew where Rb lived”: Weinberg, interview with author.

377 Dryja began his hunt for Rb: Thaddeus Dryja, interview with author, November 2008.

378 “I stored the tumors obsessively”: Ibid.

378 “It was at that moment”: Ibid.

380 “We have isolated [a human gene]”: Stephen H. Friend et al., “A Human DNA Segment with Properties of the Gene that Predisposes to Retinoblastoma and Osteosarcoma,” Nature 323, no. 6089 (1986): 643–46.

380 When scientists tested the gene isolated by Dryja: D. W. Yandell et al., “Oncogenic Point Mutations in the Human Retinoblastoma Gene: Their Application to Genetic Counseling,” New England Journal of Medicine 321, no. 25 (1989): 1689–95.

380 Its chief function is to bind to several other proteins: See for instance James A. DeCaprio, “How the Rb Tumor Suppressor Structure and Function was Revealed by the Study of Adenovirus and SV40,” Virology 384, no. 2 (2009): 274–84.

380 a horde of other oncogenes and anti-oncogenes: George Klein, “The Approaching Era of the Tumor Suppressor Genes,” Science 238, no. 4833 (1987): 1539–45.

382 Philip Leder’s team at Harvard engineered: Timothy A. Stewart, Paul K. Pattengale, and Philip Leder, “Spontaneous Mammary Adenocarcinomas in Transgenic Mice That Carry and Express MTV/myc Fusion Genes,” Cell 38 (1984): 627–37.

382 In 1988, he successfully applied for a patent: Daniel J. Kevles, “Of Mice & Money: The Story of the World’s First Animal Patent,” Daedalus 131, no. 2 (2002): 78.

382 “The active myc gene does not appear to be sufficient”: Stewart, Pattengale, and Leder, “Spontaneous Mammary Adenocarcinomas,” 627–37.

383 Leder created a second OncoMouse: E. Sinn et al., “Coexpression of MMTV/v-Ha-ras and MMTV/c-myc Genes in Transgenic Mice: Synergistic Action of Oncogenes in Vivo,” Cell 49, no. 4 (1987): 465–75.

383 “Cancer genetics,” as the geneticist Cliff Tabin: Tabin, interview with author, November 2009.

The Hallmarks of Cancer

384 I do not wish to achieve immortality: Eric Lax, Woody Allen and His Comedy (London: Elm Tree Books, 1976).

385 “The four molecular alterations accumulated”: B. Vogelstein et al., “Genetic Alterations During Colorectal-Tumor Development,” New England Journal of Medicine 319, no. 9 (1988): 525–32.

387 A tumor could thus “acquire” its own blood supply: Judah Folkman, “Angiogenesis,” Annual Review of Medicine 57 (2006): 1–18.

387 Folkman’s Harvard colleague Stan Korsmeyer: W. B. Graninger et al., “Expression of Bcl-2 and Bcl-2-Ig Fusion Transcripts in Normal and Neoplastic Cells,” Journal of Clinical Investigation 80, no. 5 (1987): 1512–15. Also see Stanley J. Korsemeyer, “Regulators of Cell Death,” 11, no. 3 (1995): 101–5.

390 In the fall of 1999, Robert Weinberg attended: Robert Weinberg, interview with author, January 2009.

390 In January 2000, a few months after their walk: Douglas Hanahan and Robert A. Weinberg, “The Hallmarks of Cancer,” Cell 100, no. 1 (2000): 57–70.

390 “We discuss . . . rules that govern”: Ibid.

392 “With holistic clarity of mechanism”: Ibid. Also see Bruce Chabner, “Biological Basis for Cancer Treatment,” Annals of Internal Medicine 118, no. 8 (1993): 633–37.

PART SIX:
THE FRUITS OF LONG ENDEAVORS

393 We are really reaping the fruits: Mike Gorman, letter to Mary Lasker, September 6, 1985, Mary Lasker Papers.

393 The National Cancer Institute, which has overseen: “To Fight Cancer, Know the Enemy,” New York Times, August 5, 2009.

393 The more perfect a power is: See for instance St. Aquinas, Commentary on the Book of Causes, trans. Vincent Guagliardo et al. (CUA Press, 1996), 9.

“No one had labored in vain”

395 Have you met Jimmy?: Jimmy Fund solicitation pamphlet, 1963.

395 In the summer of 1997: “Einar Gustafson, 65, ‘Jimmy’ of Child Cancer Fund, Dies,” New York Times, January 24, 2001; “Jimmy Found,” People, June 8, 1998.

395 Only Sidney Farber had known: Phyllis Clauson, interview with author, 2009.

395 “Jimmy’s story,” she recalled: Ibid.

396 A few weeks later, in January 1998: Karen Cummings, interview with author, 2009.

396 And so it was in May 1998: Ibid.

397 “Everything has changed”: Clauson, interview with author.

398 “How to overcome him became”: Max Lerner, Wrestling with the Angel: A Memoir of My Triumph over Illness (New York: Touchstone, 1990), 26.

398 The poet Jason Shinder wrote, “Cancer”: “The Lure of Death,” New York Times, December 24, 2008.

400 “I’ve made a long voyage”: Maxwell E. Perkins, “The Last Letter of Thomas Wolfe and the Reply to It,” Harvard Library Bulletin, Autumn 1947, 278.

401 In 2005, an avalanche of papers: See, for example, Peter Boyle and Jacques Ferlay, “Mortality and Survival in Breast and Colorectal Cancer,” Nature Reviews and Clinical Oncology 2 (2005): 424–25; Itsuro Yoshimi and S. Kaneko, “Comparison of Cancer Mortality (All Malignant Neoplasms) in Five Countries: France, Italy, Japan, UK and USA from the WHO Mortality Database (1960–2000),” Japanese Journal of Clinical Oncology 35, no. 1 (2005): 48–51; Alison L. Jones, “Reduction in Mortality from Breast Cancer,” British Medical Journal 330, no. 7485 (2005): 205–6.

401 The mortality for nearly every major: Eric J. Kort et al., “The Decline in U.S. Cancer Mortality in People Born Since 1925,” Cancer Research 69 (2009): 6500–6505.

401 mortality had declined by about 1 percent: Ibid. Also see Ahmedin Jemal et al., “Cancer Statistics, 2005,” CA: A Cancer Journal for Clinicians 55 (2005): 10–30; “Annual Report to the Nation on the Status of Cancer, 1975–2002,” Journal of the National Cancer Institute, October 5, 2005.

401 between 1990 and 2005, the cancer-specific: Ibid.

401 more than half a million American men and women: American Cancer Society, Cancer Facts & Figures 2008 (Atlanta: American Cancer Society, 2008), 6.

402 Donald Berry, a statistician in Houston: Donald A. Berry, “Effect of Screening and Adjuvant Therapy on Mortality from Breast Cancer,” New England Journal of Medicine 353, no. 17 (2005): 1784–92.

402 “No one,” as Berry said: Donald Berry, interview with author, November 2009.

403 Mary Lasker died of heart failure: “Mary W. Lasker, Philanthropist for Medical Research, Dies at 93,” New York Times, February 23, 1994.

403 the cancer geneticist Ed Harlow captured: Ed Harlow, “An Introduction to the Puzzle,” Cold Spring Harbor Symposia on Quantitative Biology 59 (1994): 709–23.

404 In the winter of 1945, Vannevar Bush: Vannevar Bush, Science the Endless Frontier: A Report to the President by Vannevar Bush, Director of the Office of Scientific Research and Development, July 1945 (Washington, D.C.: U.S. Government Printing Office, 1945).

New Drugs for Old Cancers

405 In the story of Patroclus: Louise Gluck, The Triumph of Achilles (New York: Ecco Press, 1985), 16.

405 The perfect therapy has not been developed: Bruce Chabner letter to Rose Kushner, Rose Kushner Papers, Box 50.

408 In the summer of 1985: Laurent Degos, “The History of Acute Promyelocytic Leukaemia,” British Journal of Haematology 122, no. 4 (2003): 539–53; Raymond P. Warrell et al., “Acute Promyelocytic Leukemia,” New England Journal of Medicine 329, no. 3 (1993): 177–89; Huang Meng-er et al., “Use of All-Trans Retinoic Acid in the Treatment of Acute Promyelocytic Leukemia,” Blood 72 (1988): 567–72.

409 “The nucleus became larger”: Meng-er et al., “Use of All-Trans Retinoic Acid.”

410 In 1982, a postdoctoral scientist: Robert Bazell, Her-2: The Making of Herceptin, a Revolutionary Treatment for Breast Cancer (New York: Random House, 1998), 17.

411 “It would have been an overnight test”: Ibid.

411 although Padhy’s discovery was published: Lakshmi Charon Padhy et al., “Identification of a Phosphoprotein Specifically Induced by the Transforming DNA of Rat Neuroblastomas,” Cell 28, no. 4 (1982): 865–71.

A City of Strings

412 In Ersilia, to establish the relationships: Italo Calvino, Invisible Cities (Boston: Houghton Mifflin Harcourt, 1978), 76.

412 In his book Invisible Cities: Ibid.

413 In the summer of 1984: Robert Bazell, Her-2: The Making of Herceptin, a Revolutionary Treatment for Breast Cancer (New York: Random House, 1998).

414 In 1982, Genentech unveiled the first: “A New Insulin Given Approval for Use in U.S.,” New York Times, October 30, 1982.

414 in 1984, it produced a clotting factor: “Genentech Corporate Chronology,” http://www .gene.com/gene/about/corporate/history/timeline.html (accessed January 30, 2010).

414 in 1985, it created a recombinant version: Ibid.

414 It was under the aegis: L. Coussens et al., “3 Groups Discovered the Neu Homolog (Her-2, Also Called Erb-b2),” Science 230 (1985): 1132–39. Also see T. Yamamoto et al., Nature 319 (1986): 230–34, and C. King et al., Science 229 (1985): 974–76.

415 In the summer of 1986: Bazell, Her-2, and Dennis Slamon, interview with author, April 2010.

415 Dennis Slamon, a UCLA oncologist: Ibid.

415 a “velvet jackhammer”: Eli Dansky, “Dennis Slamon: From New Castle to New Science,” SU2C Mag, http://www.standup2cancer.org/node/194 (accessed January 24, 2010).

415 “a murderous resolve”: Ibid.

415 In Chicago, Slamon had performed a series: See, for example, I. S. Chen et al., “The x Gene Is Essential for HTLV Replication,” Science 229, no. 4708 (1985): 54–58; W. Wachsman et al., “HTLV x Gene Mutants Exhibit Novel Transcription Regulatory Phenotypes,” Science 235, no. 4789 (1987): 647–77; C. T. Fang et al., “Detection of Antibodies to Human T-Lymphotropic Virus Type 1 (HTLV-1),” Transfusion 28, no. 2 (1988): 179–83.

415 If Ullrich sent him the DNA probes: Details of the Ullrich and Slamon collaboration are outlined in Bazell, Her-2, and from Slamon, interview with author.

416 In a few months: D. Slamon et al., “Human Breast Cancer: Correlation of Relapse and Survival with Amplification of the Her-2/Neu Oncogene,” Science 235 (1987): 177–82.

417 In the mid-1970s, two immunologists at Cambridge University: See Nobel Lectures, Physiology or Medicine, 1981–1990, ed. Jan Lindsten (Singapore: World Scientific Publishing, 1993).

418 “allergic to cancer”: Merrill Goozner, The $800 Million Pill: The Truth Behind the Cost of New Drugs (Berkeley: University of California Press, 2004), 195.

418 Drained and dejected: Ibid.

418 “Nobody gave a shit”: Bazell, Her-2, 49.

419 “When I was finished with all that”: Ibid. Also Barbara Bradfield, interview with author, July 2008.

419 But there was more river to ford: Ibid.

420 “His tone changed,” she recalled: Ibid.

420 “I was at the end of my road”: Ibid

420 “Survivors look back and see omens”: Joan Didion, The Year of Magical Thinking (New York: Vintage, 2006), 152.

420 On a warm August morning in 1992: Bradfield, interview with author. Details of the trial and the treatment are from Bradfield’s interview, from Bazell’s Her-2, and from Slamon, interview with author, April 2010.

Drugs, Bodies, and Proof

423 Dying people don’t have time or energy: “Dying for Compassion,” Breast Cancer Action Newsletter 31 (August 1995).

423 It seemed as if we had: Musa Mayer, Breast Cancer Action Newsletter 80 (February/March 2004).

423 “True success happens”: Breast Cancer Action Newsletter 32 (October 1995).

424 The number of women enrolled in these trials: Robert Bazell, Her-2: The Making of Herceptin, a Revolutionary Treatment for Breast Cancer (New York: Random House, 1998), 160–80.

424 “We do not provide . . . compassionate use”: Ibid., 117.

424 “If you start making exceptions”: Ibid., 127.

424 “Why do women dying of breast cancer”: “Dying for Compassion,” Breast Cancer Action Newsletter.

424 “Scientific uncertainty is no excuse”: Charlotte Brody et al., “Rachel’s Daughters, Searching for the Causes of Breast Cancer: A Light-Saraf-Evans Production Community Action & Resource Guide,” http://www.wmm.com/filmCatalog/study/rachelsdaughters.pdf (accessed January 31, 2010).

424 Marti Nelson, for one, certainly could not: Marti Nelson’s case and its aftermath are described in Bazell, Her-2.

427 On Sunday, May 17: Bruce A. Chabner, “ASCO 1998: A Commentary,” Oncologist 3, no. 4 (1998): 263–66; D. J. Slamon et al., “Addition of Herceptin to First-Line Chemotherapy for HER-2 Overexpressing Metastatic Breast Cancer Markedly Increases Anti-Cancer Activity: A Randomized, Multinational Controlled Phase III Trial (abstract 377),” Proceedings of the American Society of Clinical Oncology 16 (1998): 377.

427 In the pivotal 648 study: Slamon et al., “Addition of Herceptin to First-Line Chemotherapy,” 377.

428 In 2003, two enormous multinational studies: Romond et al. and Piccart-Gebhart et al., New England Journal of Medicine 353 (2005): 1659–84.

428 “The results,” one oncologist wrote: Gabriel Hortobagyi, “Trastuzumab in the treatment of breast cancer,” editorial, New England Journal of Medicine, 353, no. 16 (2005): 1734.

428 “The company,” Robert Bazell, the journalist: Bazell, Her-2, 180–82.

A Four-Minute Mile

430 The nontoxic curative compound: James F. Holland, “Hopes for Tomorrow versus Realities of Today: Therapy and Prognosis in Acute Lymphocytic Leukemia of Childhood,” Pediatrics 45:191–93.

430 Why, it is asked, does the supply of new miracle drugs: Lewis Thomas, The Lives of a Cell (New York: Penguin, 1978), 115.

430 This abnormality, the so-called Philadelphia chromosome: John M. Goldman and Junia V. Melo, “Targeting the BCR-ABL Tyrosine Kinase in Chronic Myeloid Leukemia,” New England Journal of Medicine 344, no. 14 (2001): 1084–86.

431 The identity of the gene: Annelies de Klein et al., “A Cellular Oncogene Is Translocated to the Philadelphia Chromosome in Chronic Myelocitic Leukemia,” Nature 300, no. 5894 (1982): 765–67.

431 The mouse developed the fatal spleen-choking: E. Fainstein et al., “A New Fused Transcript in Philadelphia Chromosome Positive Acute Lymphocytic Leukaemia,” Nature 330, no. 6146 (1987): 386–88; Nora Heisterkamp et al., “Structural Organization of the Bcr Gene and Its Role in the Ph’ Translocation,” Nature 315, no. 6022 (1985): 758–61; de Klein et al., “Cellular Oncogene Is Translocated”; Nora Heisterkamp et al., “Chromosomal Localization of Human Cellular Homologues of Two Viral Oncogenes,” Nature 299, no. 5885 (1982): 747–49.

431 In the mid-1980s: Daniel Vasella and Robert Slater, Magic Cancer Bullet: How a Tiny Orange Pill Is Rewriting Medical History (New York: HarperCollins, 2003), 40–48; Elisabeth Buchdunger and Jürg Zimmermann, “The Story of Gleevec,” innovation.org, http://www.innovation.org/index.cfm/StoriesofInnovation/InnovatorStories/The_Story_of_Gleevec (accessed January 31, 2010).

433 Jürg Zimmermann, a talented chemist: Howard Brody, Hooked: Ethics, the Medical Profession, and the Pharmaceutical Industry (Lanham, MD: Rowman & Littlefield, 2007), 14–15; Buchdunger and Zimmermann, “Story of Gleevec.”

433 “[It was] what a locksmith does”: Buchdunger and Zimmermann, “Story of Gleevec.”

433 “I was drawn to oncology as a medical student”: Brian Druker, interview with author, November 2009.

434 In 1993, he left Boston: Ibid.

434 “Everyone just humored me”: Ibid.

434 In October 1992, just a few months: Ibid.

435 “Although freedom from leukemia”: S. Tura et al., “Evaluating Survival After Allogeneic Bone Marrow Transplant for Chronic Myeloid Leukaemia in Chronic Phase: A Comparison of Transplant Versus No-Transplant in a Cohort of 258 Patients First Seen in Italy Between 1984 and 1986,” British Journal of Haematology 85 (1993): 292–99.

435 “Cancer is complicated”: Druker, interview with author.

435 In the summer of 1993, when Lydon’s drug: Ibid.

435 Druker described the findings in the journal: Brian J. Druker, “Effects of a Selective Inhibitor of the Abl Tyrosine Kinase on the Growth of Bcr-Abl Positive Cells,” Nature Medicine 2, no. 5 (1996): 561–66.

436 “The drug . . . would never work”: The story of Gleevec’s development is from Druker, interview with author.

436 In early 1998, Novartis finally relented: Lauren Sompayrac, How Cancer Works (Sudbury, MA: Jones and Bartlett, 2004), 21.

438 Druker edged into higher and higher: Brian J. Druker et al., “Efficacy and Safety of a Specific Inhibitor of the BCR-ABL Tyrosine Kinase in Chronic Myeloid Leukemia,” New England Journal of Medicine 344, no. 14 (2001): 1031–37.

438 Of the fifty-four patients: Ibid.

438 “Before the year 2000”: Hagop Kantarjian, Georgetown Oncology Board Review Lectures, 2008.

439 “When I was a youngster in Illinois”: Bruce A. Chabner, “The Oncologic Four-Minute Mile,” Oncologist 6, no. 3 (2001): 230–32.

439 “It proves a principle”: Ibid.

The Red Queen’s Race

441 “Well, in our country,” said Alice: Lewis Carroll, Alice in Wonderland and Through the Looking Glass (Boston: Lothrop, 1898), 125.

441 In August 2000: Details of Jerry Mayfield’s case are from the CML blog newcmldrug .com. This website is run by Mayfield to provide information to patients about CML and targeted therapy.

442 CML cells, Sawyers discovered: See for instance M. E. Gorre et al., “Clinical Resistance to STI-571 Cancer Therapy Caused by BCR-ABL Gene Mutation or Amplification,” Science 293, no. 5531 (2001): 876–80; Neil P. Shah et al., “Multiple BCR-ABL Kinase Domain Mutations Confer Polyclonal Resistance to the Tyrosine Kinase Inhibitor Imatinib (STI571) in Chronic Phase and Blast Crisis Chronic Myeloid Leukemia,” Cancer Cell 2, no. 2 (2002): 117–25.

442 “an arrow pierced through the center of the protein’s heart”: Attributed to John Kuriyan; quoted by George Dmitri to the author at a Columbia University seminar, November 2009.

442 In 2005, working with chemists: Jagabandhu Das et al., “2-Aminothiazole as a Novel Kinase Inhibitor Template. Structure-Activity Relationship Studies toward the Discovery of N-(2-Chloro-6-methylphenyl)-2-[[6-[4-(2-hydroxyethyl)-1-(piperazinyl)]-2-methyl-4-pyrimidinyl](amino)]-1,3-thiazole-5-carboxamide (Dasatinib, BMS-354825) as a Potent pan-Src Kinase Inhibitor,” Journal of Medicinal Chemistry 49, no. 23 (2006): 6819–32; Neil P. Shah et al., “Overriding Imatinib Resistance with a Novel ABL Kinase Inhibitor,” Science 305, no. 5682 (2004): 399–401; Moshe Talpaz et al., “Dasatinib in Imatinib-Resistant Philadelphia Chromosome–Positive Leukemias,” New England Journal of Medicine 354, no. 24 (2006): 2531–41.

443 twenty-four novel drugs: For a full list, see National Cancer Institute, targeted therapies list, http://www.cancer.gov/cancertopics/factsheet/Therapy/targeted (accessed February 23, 2010). This website also details the role of such drugs as Avastin and bortezomib.

443 Over a decade: “Velcade (Bortezomib) Is Approved for Initial Treatment of Patients with Multiple Myeloma,” U.S. Food and Drug Administration, http://www.fda.gov/AboutFDA/CentersOffices/CDER/ucm094633.htm (accessed January 31, 2010); “FDA Approval for Lenalidomide,” National Cancer Institute, U.S. National Institutes of Health, http://www.cancer.gov/cancertopics/druginfo/fda-lenalidomide (accessed January 31, 2010).

444 In 1948, epidemiologists identified a cohort: Framingham Heart Study, the National Heart, Lung and Blood Institute and Boston University, http://www.framinghamheartstudy.org/ (accessed January 31, 2010).

445 In May 2008, two Harvard epidemiologists: Nicholas A. Christakis, “The Collective Dynamics of Smoking in a Large Social Network,” New England Journal of Medicine 358, no. 21 (2008): 2249–58.

447 “Cancer at the fin de siècle”: Harold J. Burstein, “Cancer at the Fin de Siècle,” Medscape Today, February 1, 2000, http://www.medscape.com/viewarticle/408448 (accessed January 31, 2010).

Thirteen Mountains

448 “Every sickness is a musical problem”: W. H. Auden, “The Art of Healing (In Memoriam David Protetch, M.D.),” New Yorker, September 27, 1969.

448 The revolution in cancer research: Bert Vogelstein and Kenneth Kinzler, “Cancer Genes and the Pathways They Control,” Nature Medicine 10, no. 8 (2004): 789–99.

449 “The purpose of my book”: Susan Sontag, Illness as Metaphor and AIDS and Its Metaphors (New York: Picador, 1990), 102.

450 The Human Genome Project: “Once Again, Scientists Say Human Genome Is Complete,” New York Times, April 15, 2003.

450 the Cancer Genome Atlas: “New Genome Project to Focus on Genetic Links in Cancer,” New York Times, December 14, 2005.

450 “When applied to the 50 most common”: “Mapping the Cancer Genome,” Scientific American, March 2007.

450 In 2006, the Vogelstein team revealed: Tobias Sjöblom et al., “The Consensus Coding Sequences of Human Breast and Colorectal Cancers,” Science 314, no. 5797 (2006): 268–74.

450 In 2008, both Vogelstein’s group and the Cancer Genome Atlas: Roger McLendon et al., “Comprehensive Genomic Characterization Defines Human Glioblastoma Genes and Core Pathways,” Nature 455, no. 7216 (2008): 1061–68. Also see D. Williams Parsons et al., “An Integrated Genomic Analysis of Human Glioblastoma Multiforme,” Science 321, no. 5897 (2008): 1807–12; and Roger McLendon et al., “Comprehensive Genomic Characterization.”

452 Only a few cancers are notable exceptions: C. G. Mullighan et al., “Genome-Wide Analysis of Genetic Alterations in Acute Lymphoblastic Leukemia,” Nature 446, no. 7137 (2007): 758–64.

452 “In the end,” as Vogelstein put it: Bert Vogelstein, comments on lecture at Massachusetts General Hospital, 2009; also see Vogelstein and Kinzler, “Cancer Genes and the Pathways They Control.”

453 Other mutations are not passive players: The distinction between passenger and driver mutations has generated an enormous debate in cancer genetics. Many scientists suspect that the initial analysis of the breast cancer genome may have overestimated the number of driver mutations. Currently, this remains an open question in cancer genetics. See, for instance, Getz et al., Rubin et al., and Forrest et al., Science 317, no 5844: 1500, comments on Sjöblom article above.

453 In a recent series of studies, Vogelstein’s team: See, for example, Rebecca J. Leary, “Integrated Analysis of Homozygous Deletions, Focal Amplifications, and Sequence Alterations in Breast and Colorectal Cancers,” Proceedings of the National Academy of Sciences of the United States of America 105, no. 42 (2008): 16224–29; Siân Jones et al., “Core Signaling Pathways in Human Pancreatic Cancer Revealed by Global Genomic Analyses,” Science 321, no. 5897 (2008): 1801–6.

454 “Cancer,” as one scientist recently put it: Emmanuel Petricoin, quoted in Dan Jones, “Pathways to Cancer Therapy,” Nature Reviews Drug Discovery 7 (2008): 875–76.

455 In a piece published in the New York Times: “To Fight Cancer, Know the Enemy,” New York Times, August 5, 2009.

456 In 2000, the so-called Million Women Study: Valerie Beral et al., “Breast Cancer and Hormone-Replacement Therapy in the Million Women Study,” Lancet 362, no. 9382 (2003): 419–27.

456 The second controversy also has its antecedents: See, for instance, F. J. Roe and M. C. Lancaster et al., “Natural, Metallic and Other Substances, as Carcinogens,” British Medical Bulletin 20 (1964): 127–33; and Jan Dich et al., “Pesticides and Cancer,” Cancer Causes & Control 8, no. 3 (1997): 420–43.

457 In 2005, the Harvard epidemiologist David Hunter: Yen-Ching Chen and David J. Hunter, “Molecular Epidemiology of Cancer,” CA: A Cancer Journal for Clinicians 55 (2005): 45–54.

457 In the mid-1990s, building on the prior decade’s advances: Yoshio Miki et al., “A Strong Candidate for the Breast and Ovarian Cancer Susceptibility Gene BRCA1,” Science 266, no. 5182 (1994): 66–71; R. Wooster et al., “Localization of a Breast Cancer Susceptibility Gene, BRCA2, to Chromosome 13q12–13,” Science 265, no. 5181 (1994): 2088–90; J. M. Hall et al., “Linkage of Early-Onset Familial Breast Cancer to Chromosome 17q21,” Science 250, no. 4988 (1990): 1684–89; Michael R. Stratton et al., “Familial Male Breast Cancer Is Not Linked to the BRCA1 Locus on Chromosome 17q,” Nature Genetics 7, no. 1 (1994): 103–7.

457 An Israeli woman: Breast cancer patient O. B-L. (name withheld), interview with author, December 2008.

458 In the mid-1990s, John Dick: Tsvee Lapidot et al., “A Cell Initiating Human Acute Myeloid Leukaemia After Transplantation into SCID Mice,” Nature 367, no. 6464 (1994): 645–58.

459 Indeed, as the fraction of those affected by cancer creeps: “One in three” is from the recent evaluation by the National Cancer Institute. See http://www.cancer.gov/newscenter/tip-sheet-cancer-health-disparities. The number “one in two” comes from the NCI seer statistics, http://seer.cancer.gov/statfacts/html/all.html, but includes all cancer sites, summarized in Matthew Hayat et al., “Cancer Statistics, Trends and Multiple Primary Cancer Analyses,” Oncologist 12 (2007): 20–37.

ATOSSA’S WAR

461 We aged a hundred years: Anna Akhmatova, “In Memoriam, July 19, 1914,” in The Complete Poems of Anna Akhmatova, vol. 1 (Chicago: Zephyr Press, 1990), 449.

461 It is time, it is time for me too to depart: Aleksandr Solzhenitsyn, Cancer Ward (New York: Farrar, Straus and Giroux, 1974), 476.

461 On May 17, 1973: “A Memorial Tribute in Honor of Dr. Sidney Farber, 1903–1973,” Thursday, May 17, 1973. Gift of Thomas Farber to the author.

464 It is impossible to enumerate: Atossa’s case and her survival numbers are speculative, but based on several sources. See, for instance, “Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: An overview of the randomised trials,” Lancet, 365, no. 9472: 1687–1717.

465 In 1997, the NCI director, Richard Klausner: See Barnett S. Kramer and Richard D. Klausner, “Grappling with Cancer—Defeatism Versus the Reality of Progress,” New England Journal of Medicine 337, no. 13 (1997): 931–35.

467 The new drug was none other than Gleevec: See, for example, H. Joensuu, “Treatment of Inoperable Gastrointestinal Stromal Tumors (GIST) with Imatinib (Glivec, Gleevec),” Medizinische Klinik (Munich) 97, suppl. 1 (2002): 28–30; M. V. Chandu de Silva and Robin Reid, “Gastrointestinal Stromal Tumors (GIST): C-kit Mutations, CD117 Expression, Differential Diagnosis and Targeted Cancer Therapy with Imatinib,” Pathology Oncology Research 9, no. 1 (2003): 13–19.