Tag Archives: medicine

Book Review: The Immortal Life of Henrietta Lacks by Rebecca Skloot

This was one of those books I just picked up almost at random as I was browsing round a Waterstones in Covent Garden one day. Having looked at the endorsements on the front cover, I was surprised as to why I hadn’t heard of it before. It seems to have garnered lots of praise and accolades yet I can’t recall a single reviewer ever mentioning it, nor had I seen it mentioned in the press. After buying it, it came back to mind recently when I noted it being mentioned in Adam Rutherford’s Creation.

What we have here is science told as a narrative. It is not only the narrative of the events and discoveries that were made, but also the narrative of the uncovering of the story. So while it starts out as a biography of Henrietta Lacks (prefaced by a personal story of how Skloot became interested in Henrietta) it expands its scope and becomes a part autobiography of Skloot’s battles to be able to tell Henrietta’s story, and that of her family.

Henrietta Lacks was a black American woman who died in 1954. The crux of the story is what happened shortly before she died. You see, she died young. She died of cancer. After her diagnosis a biopsy was taken from her cervix and the cells grown in culture. It is those cells that are the heart of the story. From here, we go back a short time and tell the story, as far as it is known of Henrietta’s life, growing up and getting married in the American state of Maryland.

The cells that were taken from her body were capable of being grown in a laboratory, something that scientists had been aiming for but had not been successful with. With these cells (named HeLa), it enabled labs across the world to be able to a variety of tests without doing them on living humans. After all, even though they were cancerous, they were still human cells and behaved as such. Skloot tells us the story of 20th century medicine from the cells’ point of view, both the good and the bad. Many of the greatest developments seen in the last 60 years have involved the HeLa cells in one way or another. Sometimes this was unintentional as it turns out that where other cells were grown in cultivation they were in fact contaminated by HeLa.

Coupled with this is the story of the Lacks family and their struggle to come to terms with Henrietta’s legacy. It was years before they even realised that her cells were being used for research purposes. When they did, this was around the time that details were emerging of the Tuskegee syphilis scandal where, if you’ve not heard it before (I confess I hadn’t), black people in America were deliberately infected with syphilis under the guise of free healthcare. So there was deep suspicion over what Henrietta’s cells were being used for and also who was profiting from them. Skloot’s role here was not only as someone researching a book but also of the one who helped the Lacks family, especially Henrietta’s daughter Deborah, understand what happened.

The book ranges over a number of diverse topics. One of those that I noted in particular was the development of medical ethics; not so much in theory, but the practice. For the descriptions (and yes, as a warning, they are quite graphic – particularly at the start of the book) may well strike you as particularly barbaric. The reason why this jars against a modern sensibility is that when the facts surrounding the lack of consent about what was done with Henrietta’s cells became more widely known within the medical community it spurred people into action.

As an aside, I encountered a slight confluence of issues as I read this, as I was also watching the American tv show, The Wire, during the same period of time as I was reading this (actually, I’ve been on The Wire all year; the book took about 3 weeks to read). But they are both predominantly based in the city of Baltimore and have a huge amount to say, in microcosm, of the state of racism in America in the last half a century or so.

One of the things that becomes clear, though whether this was the author’s intention, I’m not sure, was the sheer barbarism that still persists within what passes for a national healthcare service within America. One of the ongoing battles the Lacks has had, and a cause of their major gripes were that the vast leaps in scientific work as a result of Henrietta’s cells did not allow them the financial means to be able to pay for their healthcare. The USA remains a country so backwards that if you go to a hospital, they have the audacity to present you with a bill – which the rich usually pay for through insurance and the poor are made to go without. The concept of universal healthcare which is free at the point of need still hasn’t made the journey across the Atlantic.

The book has apparently become a standard text in some university courses on cell biology. That’s not because the science is overly technical, though what is there is excellently communicated, but because it is a story of one aspect of modern science that has rippled far beyond the Maryland origins of one bereaved family. C.P. Snow famously espoused the notion of the two cultures: humanities and sciences. Here, Skloot has woven the two together to make a fabric that is stronger than either and makes for a fabulous piece of writing. It is educating, enthralling and overall one of the best pieces of writing I have had the pleasure of reading. It was only because of the more immediate need to heed the words of Harry Leslie Smith that this missed out on being my top book of 2014.

Book Review: Confessions of a GP by Benjamin Daniels

This was a bit of a break from my normal reading. I’m not a big one for “real life stories” but in the past I quite enjoyed A Paramedic’s Diary: Life and Death on the Streets by Stuart Gray. So it was a case of reading something that I wasn’t expecting to be particularly taxing, but still enjoyable.

It’s best described as a series of anecdotes. Each ‘chapter’ is minute, being only 3-5 pages long for the most part. So it’s a book that is very easy to pick up, read a little, and put down again; what I would describe as a coffee table book. You may have another phrase for it.

Benjamin Daniels is a pseudonym of a general practitioner (GP) working for the National Health Service (NHS). As such, this is very distinctly British in its setting, approach and tone. It may not translate that well, even to other English-speaking nations, though I would be fascinated to see what an American might make of it.

The book was a big seller in the e-book market, partly due to aggressive pricing, though as an old-fashioned fuddy-duddy, I bought the paperback version. This brings me to my only complaint about the book: it wastes a lot of paper. There are so blank pages in between chapters and white space on the pages that in spite of it being 325 pages long, there is far less by way of text. For example, there is the equivalent of 5 blank pages just in the first 13.

Aside from that though, it is an excellent book which I would highly recommend. In stark contrast to A Paramedic’s Diary, this is told with no bitterness and only mild cynicism. The doctor’s passion for the NHS and backing for a service free at the point of need is clear throughout. He gives us an insight into all the things he wishes he’d been told during his medical training but which he has had to learn through experience. We also get a glimpse of the ethical dilemmas he faces, such as when he convinced that one of his patients is having affair, but can’t tell the patient’s spouse, another patient of his.

Though there are moments of extreme pathos, the book is lit up by the doctor’s sense of humour and the glasses through which he chooses to view the world. He’s willing to admit his mistakes, giving probably the best message that any patient reader ought to bear in mind when they next see their GP: doctors are humans too.

Book review: Bad Science by Ben Goldacre

I ought to say from the outset that I am a regular reader of Ben Goldacre’s column in The Guardian, so did not come to this entirely clueless regarding the approach and views of the author. I the think the best way to describe it is Goldacre having a scratch at a few particularly irritating itches. The aims of the book are very good, and to be applauded.

There can be little doubt that this is something of crusade against poorly done medical science, and it is my personal hope that this goes on to have as much social impact as Silent Spring and No Logo. However, don’t be deceived into thinking that this covers all of science. Goldacre is a medical doctor and so, with the exception of a couple of chapters on statistics, this is a book on medicine. There is very little mathematics (other than that mentioned above), virtually no physics and just a smattering of chemistry where it overlaps with biology.

One of the slightly uglier aspects of the book is a series of personal attacks around the middle of the book. I had quite a mixed reaction to these. While it does to demonstrate some points that were much needed, the near unrelenting attacks does show a certain insensitivity on the part of the author. Here, we have to consider how well the author communicates; I have heard Goldacre talk and he tends to come across as quite reasonable, with a hint of mild exasperation, but in the book he comes across as a bit more patronising and sneery. This is most evident in the introduction where he states that anyone who dares disagrees with him is wrong; whereas a true scientist would always be open to the possibility that they themselves may be wrong. His choice of target is also interesting, as Gillian McKeith does not appear to have caused any physical harm by her lack of understanding, his later target Matthias Rath, almost certainly has. In this respect, even though the chapter on McKeith is one of the most famous, it is also one of the most unnecessary.

The last third of the book looks at one area in which Goldacre himself works: the media. Mentioned in the introduction, he goes on to look at CP Scott’s “two worlds” hypothesis between the humanities and the sciences, with an exasperated moan that the media is dominated by humanities graduates who cannot understand the sciences, before looking at some of the consequences that has had.

Overall, the aim of the book is noble and many of the examples are well-put. Given that Goldacre advocates (rightly, I believe) transparency in science, it would have been nicer to have included more references at the back since at present they have the appearance of being cherry-picked. For anyone interested in medicine this is an essential read, though I think the focus on medicine does make the title a bit misleading. If the statistics chapters interest you, then I would recommend Leonard Mlodinow’s The Drunkard’s Walk as a follow-up which expands in more detail some of the topics touched upon by Goldacre.