Number of words: 778 In the early 1940s, a similar notion had gripped the eccentric Oxford geneticist Edmund Ford. A firm believer in Darwinian evolution, Ford nonetheless knew that Darwin’s theory suffered from an important limitation: thus far, the evolutionary progression had been inferred indirectly from the fossil record, but never demonstrated directly on a … Read more
Number of words: 270 In a case-control study, risk is estimated post hoc—in Doll’s and Wynder’s case by asking patients with lung cancer whether they had smoked. In an often-quoted statistical analogy, this is akin to asking car accident victims whether they had been driving under the influence of alcohol—but interviewing them after their accident. … Read more
Number of words: 181 But many epidemiologists argued that such cause-effect relationships could only be established for infectious diseases, where there was a known pathogen and a known carrier (called a vector) for a disease—the mosquito for malaria or the tsetse fly for sleeping sickness. Chronic, noninfectious diseases such as cancer and diabetes were too … Read more
Number of words: 487 In England, meanwhile, tobacco was rapidly escalating into a national addiction. In pubs, smoking parlors, and coffeehouses—in “close, clouded, hot, narcotic rooms”—men in periwigs, stockings, and lace ruffs gathered through the day and night to pull smoke from pipes and cigars or sniff snuff from decorated boxes. The commercial potential of … Read more
Number of words: 994 Bailar and Smith published their article in May 1986—and it shook the world of oncology by its roots. Even the moderately pessimistic Cairns had expected at least a small decrease in cancerrelated mortality over time. Bailar and Smith found that even Cairns had been overgenerous: between 1962 and 1985, cancer-related deaths … Read more
Number of words: 750 To understand the Bailar-Smith analysis, we need to begin by understanding what it was not. Right from the outset, Bailar rejected the metric most familiar to patients: changes in survival rates over time. A five-year survival rate is a measure of the fraction of patients diagnosed with a particular kind of … Read more
Number of words: 147 In the history of medicine, no significant disease had ever been eradicated by a treatment-related program alone. If one plotted the decline in deaths from tuberculosis, for instance, the decline predated the arrival of new antibiotics by several decades. Far more potently than any miracle medicine, relatively uncelebrated shifts in civic … Read more
Number of words: 540 Yet a third voice of dissent arose in oncology in the 1980s, although this voice had skirted the peripheries of cancer for several centuries. As trial after trial of chemotherapy and surgery failed to chisel down the mortality rate for advanced cancers, a generation of surgeons and chemotherapists, unable to cure … Read more
Number of words: 758 To choose a medical specialty is also to choose its cardinal bodily liquid. Hematologists have blood. Hepatologists have bile. Huggins had prostatic fluid: a runny, straw-colored mixture of salt and sugar meant to lubricate and nourish sperm. Its source, the prostate, is a small gland buried deep in the perineum, wrapped … Read more
Number of words: 185 In 1965, at Michigan State University, a biophysicist, Barnett Rosenberg, began to investigate whether electrical currents might stimulate bacterial cell division. Rosenberg devised a bacterial flask through which an electrical current could be run using two platinum electrodes. When Rosenberg turned the electricity on, he found, astonishingly, that the bacterial cells … Read more
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