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The First Cell: And the Human Costs of Pursuing Cancer to the Last
With the fascinating scholarship of The Emperor of All Maladies and the deeply personal experience of When Breath Becomes Air , a world-class oncologist examines the current state of cancer and its devastating impact on the individuals it affects -- including herself.
In The First Cell , Azra Raza offers a searing account of how both medicine and our society (mis)treats cancer, how we can do better, and why we must. A lyrical journey from hope to despair and back again, The First Cell explores cancer from every medical, scientific, cultural, and personal. Indeed, Raza describes how she bore the terrible burden of being her own husband's oncologist as he succumbed to leukemia. Like When Breath Becomes Air , The First Cell is no ordinary book of medicine, but a book of wisdom and grace by an author who has devoted her life to making the unbearable easier to bear.
In The First Cell , Azra Raza offers a searing account of how both medicine and our society (mis)treats cancer, how we can do better, and why we must. A lyrical journey from hope to despair and back again, The First Cell explores cancer from every medical, scientific, cultural, and personal. Indeed, Raza describes how she bore the terrible burden of being her own husband's oncologist as he succumbed to leukemia. Like When Breath Becomes Air , The First Cell is no ordinary book of medicine, but a book of wisdom and grace by an author who has devoted her life to making the unbearable easier to bear.
368 pages, Hardcover
First published October 15, 2019
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Displaying 1 - 30 of 212 reviews
August 7, 2019
Aamir Jafarey, Karachi Pakistan
I found the reading of “The First Cell” unnervingly disturbing, to the point that I had to put the book down periodically to let myself ‘recover’. I cannot even imagine what Azra Raza must have gone through personally in putting to paper her own extremely private thoughts, and those of the contributors, who found the courage to share their immense pain with unknown readers through this narrative.
While Raza has a clear mission, that of advocating a fresh approach to the battle against cancer, and something she has been pursuing for a while despite significant opposition from her own oncology circles, the fact that she chose to embed her scientific pursuit into a very human plot poignantly brings out the urgency of her struggle. It is the human factor that makes her struggle against cancer a very personal one for the reader. And the way she seamlessly weaves seemingly different disconnected human stories into each other, and into the science behind the failure, makes for gripping reading.
Her stress on differentiating disease from illness is particularly appealing. This is in fact the ability that gets lost as many of us go through medical schooling, and residency training, gradually losing our humanness. Good communication with patients, something that emerges repeatedly from these narratives, is such a rarity apparently all over the world. In objectifying the patient and the disease, we have severed our ties from what was once a vocation, and has now been reduced to a mere business.
But for me, the most appealing part of this book is how Raza has brought in literature to drive home the points she wish to make. What a treat it is to see how the poet Iqbal reflects on cancer, and how the great poet Ghalib explains, through Azra’s voice, that “the cure part is the pearl; heating is the tear. You can do both”. Wah! I was familiar with this verse but never ever had I thought of applying that to training and education and patient care. I can see Raza taking a whole session woven around just this one couplet, unpacking the pearls of wisdom that Ghalib locked in this oyster, and that only she can pry open. Even though I have a declared bias towards Urdu poetry, I enjoyed how the author repeatedly brings English literature into the discussion equally effectively.
This is a book that both scientists, as well as the general public, will find appealing at a very personal level.
I found the reading of “The First Cell” unnervingly disturbing, to the point that I had to put the book down periodically to let myself ‘recover’. I cannot even imagine what Azra Raza must have gone through personally in putting to paper her own extremely private thoughts, and those of the contributors, who found the courage to share their immense pain with unknown readers through this narrative.
While Raza has a clear mission, that of advocating a fresh approach to the battle against cancer, and something she has been pursuing for a while despite significant opposition from her own oncology circles, the fact that she chose to embed her scientific pursuit into a very human plot poignantly brings out the urgency of her struggle. It is the human factor that makes her struggle against cancer a very personal one for the reader. And the way she seamlessly weaves seemingly different disconnected human stories into each other, and into the science behind the failure, makes for gripping reading.
Her stress on differentiating disease from illness is particularly appealing. This is in fact the ability that gets lost as many of us go through medical schooling, and residency training, gradually losing our humanness. Good communication with patients, something that emerges repeatedly from these narratives, is such a rarity apparently all over the world. In objectifying the patient and the disease, we have severed our ties from what was once a vocation, and has now been reduced to a mere business.
But for me, the most appealing part of this book is how Raza has brought in literature to drive home the points she wish to make. What a treat it is to see how the poet Iqbal reflects on cancer, and how the great poet Ghalib explains, through Azra’s voice, that “the cure part is the pearl; heating is the tear. You can do both”. Wah! I was familiar with this verse but never ever had I thought of applying that to training and education and patient care. I can see Raza taking a whole session woven around just this one couplet, unpacking the pearls of wisdom that Ghalib locked in this oyster, and that only she can pry open. Even though I have a declared bias towards Urdu poetry, I enjoyed how the author repeatedly brings English literature into the discussion equally effectively.
This is a book that both scientists, as well as the general public, will find appealing at a very personal level.
January 11, 2020
Do you want to read a shortlist of major problems in cancer therapy? This is your book.
Do you want to hear how difficult is to cure cancer patients? This is your book.
Have you or your relatives suffered from cancer and have no one to blame? This is your book.
Do you want to hear a few dramatic cancer stories (including the writer’s husband's) mixed with some poetry? This is your book.
Are you willing to hear that medical oncologists that suffer with cancer patients are the heroes, whereas molecular oncologists and most cancer researchers are arrogant, overconfident and content with current status? This is your book.
Do you know that investigating the origin of cancer is the key, that the author has keeping proposing it since 1984, whereas no one hears her claiming and this is why patients die of cancer? Please find, further details in the book.
Do you know that current cancer models should be mostly abandoned because the advances are very limited? Yes….? But do you want to hear what the alternative is? Well…, then you should look for good books on the topic.
I do agree that the book may call for new ways of thinking, re-visit the cost of current treatments, etc. but the views are really biased.. You may agree with them (and I do agree with all numbers and many criticisms provided) and they can be discussed, of course, but what is unacceptable is to go against all the effort that is being put to cure cancer without proposing any alternative [investigating the first cell is what everyone wants to do, especilly using cells (by definition), mouse models and other "models" of human cancer (everything is a "model" unless you want to do the whole research, from scracht, in a single patient)].
And there is no need to repeat in every chapter the idea that "molecular biologists" or "basic researchers" are the ones to blame whereas compassionate medical oncologists are the only professionals doing something useful for patients.
I would say that this may be a stimulating book for some cancer researchers (after removing a lot of dirty stuff) and very harmful for some cancer patients or funding agencies that may take the wrong message.
Do you want to hear how difficult is to cure cancer patients? This is your book.
Have you or your relatives suffered from cancer and have no one to blame? This is your book.
Do you want to hear a few dramatic cancer stories (including the writer’s husband's) mixed with some poetry? This is your book.
Are you willing to hear that medical oncologists that suffer with cancer patients are the heroes, whereas molecular oncologists and most cancer researchers are arrogant, overconfident and content with current status? This is your book.
Do you know that investigating the origin of cancer is the key, that the author has keeping proposing it since 1984, whereas no one hears her claiming and this is why patients die of cancer? Please find, further details in the book.
Do you know that current cancer models should be mostly abandoned because the advances are very limited? Yes….? But do you want to hear what the alternative is? Well…, then you should look for good books on the topic.
I do agree that the book may call for new ways of thinking, re-visit the cost of current treatments, etc. but the views are really biased.. You may agree with them (and I do agree with all numbers and many criticisms provided) and they can be discussed, of course, but what is unacceptable is to go against all the effort that is being put to cure cancer without proposing any alternative [investigating the first cell is what everyone wants to do, especilly using cells (by definition), mouse models and other "models" of human cancer (everything is a "model" unless you want to do the whole research, from scracht, in a single patient)].
And there is no need to repeat in every chapter the idea that "molecular biologists" or "basic researchers" are the ones to blame whereas compassionate medical oncologists are the only professionals doing something useful for patients.
I would say that this may be a stimulating book for some cancer researchers (after removing a lot of dirty stuff) and very harmful for some cancer patients or funding agencies that may take the wrong message.
October 27, 2019
This book reflects some very important thinking about the deficiencies in the way that cancer drug research is performed in this country and recommendations for a different protocol, and I totally buy what she says.
Unfortunately, it also is very detailed about the molecular mechanisms in a way that is difficult for the layman to follow. The more powerful statement is the simple one, the one she tells in stories about her patients. Here, too, though, it is sometimes hard to connect the human story with the point she is trying to illustrate.
Edit to add:
A couple of other points have been weighing on me since I wrote the above review. First, I think that she overlooks some rather remarkable strides in the treatment of breast cancer that have come about in the last 50 years or so, and which her colleague Siddartha Mukherjee wrote about in . But then, perhaps more problematic, she talks about the future of testing for cancer markers and repeatedly discusses the ideal of "one drop of blood" holding all the information necessary. That would be great but frankly every time she mentioned that kind of work, I couldn't help but wonder if she were referring to the now wholly discredited claims of Elizabeth Holmes and her company Theranos (see ). And then that illustrated another problem, which is that her citation method made it pretty much impossible for me to figure out whose work she was citing when she was talking about the innovative theories, so I couldn't reverse engineer to determine who sponsored the studies. I hope she is not chasing pipe dreams here, but the whole Theranos debacle made me wary of her predictions.
Unfortunately, it also is very detailed about the molecular mechanisms in a way that is difficult for the layman to follow. The more powerful statement is the simple one, the one she tells in stories about her patients. Here, too, though, it is sometimes hard to connect the human story with the point she is trying to illustrate.
Edit to add:
A couple of other points have been weighing on me since I wrote the above review. First, I think that she overlooks some rather remarkable strides in the treatment of breast cancer that have come about in the last 50 years or so, and which her colleague Siddartha Mukherjee wrote about in . But then, perhaps more problematic, she talks about the future of testing for cancer markers and repeatedly discusses the ideal of "one drop of blood" holding all the information necessary. That would be great but frankly every time she mentioned that kind of work, I couldn't help but wonder if she were referring to the now wholly discredited claims of Elizabeth Holmes and her company Theranos (see ). And then that illustrated another problem, which is that her citation method made it pretty much impossible for me to figure out whose work she was citing when she was talking about the innovative theories, so I couldn't reverse engineer to determine who sponsored the studies. I hope she is not chasing pipe dreams here, but the whole Theranos debacle made me wary of her predictions.
August 6, 2019
In her remarkable book “The First Cell,” Azra has been brutally honest at every level. President Nixon declared “War on Cancer” in 1972, but as shown in this book there has been little improvement in the prognosis of most cancers. The only decline in the death rates from cancer we have seen are due to early diagnosis from routine screening and the ability to treat cancers at such an early stage. Yet we hear of new miracle cures, transformational new drugs and so on frequently, followed by the same disappointments. No one in the leadership of those treating cancers are willing to accept their failure and continue to give false hope to the patients. If we really are serious about winning the war on cancer we need to start by exactly what this book does. Take stock of where we are. What have we learnt from the billions of dollars spent on research in the cancer field and how to go forward. The book informs us that 95% of the new drugs tried for treating cancer don’t make it through the FDA approval and the 5% that do get approved have increased the survival by a few months only. Azra correctly asks if it is not time to acknowledge our failure and try some new venues of research. To think outside the box. To make a 180 degree turn.
This book is a must read for all physicians and everyone who has been effected by cancer personally or in their loved ones and by those who have even remote interest in cancer. It should be required reading for those in cancer research and for those in the medical bureaucracy who are in positions of power to make decisions where the research funding goes.
This book is a must read for all physicians and everyone who has been effected by cancer personally or in their loved ones and by those who have even remote interest in cancer. It should be required reading for those in cancer research and for those in the medical bureaucracy who are in positions of power to make decisions where the research funding goes.
October 20, 2019
I enjoyed the first half very much. It got repetitive, I thought, in the second half, confusing in spots, a little syrupy for my taste (everyone was her dearest friend) and a little too strident in tone. I guess she wrote that part more for the people she has seen as opponents since 1984. Still, highly illuminating and I am highly sympathetic to the views she expresses, especially how nominally many people benefit from radiation and chemo, yet how tortured they are physically and financially.
January 11, 2020
As a cancer biology PhD student, I’ll be the first to say that these are all known facts in the field. Like not only known but well understood across every scientific field. Dr. Raza doesn’t share one original idea or anything close to novel. She rants the majority of the book without offering any clear solutions. And these rants didn’t originate from her. Yes, Dr. Raza, we know animal models are artificial so what’s your solution? She reveals her extraordinary bias of her own research which has produced no solution to her stated problems. It’s as if this book wasn’t peer-reviewed.
I originally got this book as a gift simply because of sid’s review on the front – one of my favorite authors. In the book you learn repeatedly why he left such a review – not only are they colleagues but they are close friends and her daughter even worked in his lab. The humble brag throughout the book is unbelievably annoying. She finishes the book with “I will not be silenced” nonsense. That’s really what caused me to leave this review. EVERYONE WITH THE IQ OF A POTATO KNOWS WHAT YOU ARE CLAIMING. It’s not original so quit acting like you are some hero in the field. MDs are notorious for this. They don’t recognize their own bias, they think they know everything and are not up to date on scientific literature.
Her writing style is beautiful when she describes her interaction with her patients. Stick with that and write another book.
I originally got this book as a gift simply because of sid’s review on the front – one of my favorite authors. In the book you learn repeatedly why he left such a review – not only are they colleagues but they are close friends and her daughter even worked in his lab. The humble brag throughout the book is unbelievably annoying. She finishes the book with “I will not be silenced” nonsense. That’s really what caused me to leave this review. EVERYONE WITH THE IQ OF A POTATO KNOWS WHAT YOU ARE CLAIMING. It’s not original so quit acting like you are some hero in the field. MDs are notorious for this. They don’t recognize their own bias, they think they know everything and are not up to date on scientific literature.
Her writing style is beautiful when she describes her interaction with her patients. Stick with that and write another book.
April 25, 2020
This is not ordinarily a book I would read during the plague days, but it was first on my nonfiction list when I agreed to pick up chairing the Otherwise Award jury late in 2019, and one of my closest frineds recommended it very highly.
Raza is an oncologist specializing in certain leukemias, has intense personal history with cancer deaths, and has a radical take on how we treat cancer, and how we could do much better. Especially now, I don’t want to go into detail about this book, but I will say that she is extremely aware of the way various systems intertwine to preserve the status quo in not only cancer treatment but cancer research, and she is very convincing about how that can and must be changed. She also writes like an angel, with a precise combination of the personal and the scientific, and lots of poetry in both English and Arabic. If this is your kind of book, it’s one of the best of that kind.
Raza is an oncologist specializing in certain leukemias, has intense personal history with cancer deaths, and has a radical take on how we treat cancer, and how we could do much better. Especially now, I don’t want to go into detail about this book, but I will say that she is extremely aware of the way various systems intertwine to preserve the status quo in not only cancer treatment but cancer research, and she is very convincing about how that can and must be changed. She also writes like an angel, with a precise combination of the personal and the scientific, and lots of poetry in both English and Arabic. If this is your kind of book, it’s one of the best of that kind.
March 22, 2021
Azra Raza is a professor of medicine at Columbia University and a practising oncologist. She specializes in and researches myelodysplastic syndromes (MDS), which the Canadian Cancer Society describes as “a group of diseases in which the bone marrow doesn’t make enough healthy mature blood cells.” Immature blood cells—blasts—don’t function properly, and they build up in the bone marrow and blood. Healthy red blood cells, white blood cells, and platelets are crowded out; there are fewer of them to do their vital work. MDS patients, who are usually older, often have debilitating anemia and require frequent blood transfusions, though some can be successfully treated with thalidomide. MDS used to be thought of as disease of low malignant potential, pre-leukaemia, but the syndrome is now considered blood cancer. One third of MDS patients go on to develop acute myeloid leukaemia (AML), another disease researched and treated by the author.
In over three decades of practice, Dr. Raza has cared for thousands of people with blood cancers. In her book, she tells the stories of several of these patients, as well as providing accounts of bright young people with other cancers—one, an intellectually gifted family acquaintance diagnosed with an aggressive sarcoma of the shoulder; the other, her daughter’s close friend, a young man in his early twenties, stricken with a lethal glioblastoma of the spinal cord. In a tender touch, she provides photographs of these patients, making them even more real and present for the reader. She documents how they negotiated their illness, made medical decisions, and confronted their end.
The author notes that over the years the billions of dollars directed towards cancer research have yielded valuable knowledge about its biology, but medicine has frustratingly little to show for this enormous investment in terms of actual treatments. Most of what is offered to the AML patients she sees (as well as to those with the most common types of cancer) has changed very little over the last forty to fifty years. Raza’s husband, cancer researcher Dr. Harvey Preisler—who himself succumbed to lymphoma in the early 2000s and whose suffering she describes in one chapter of her book—received the same combination of drugs that was used in 1977. Only about five percent of new cancer drugs are actually approved, and 70 percent of those provide no improvement in survival rates and are even harmful to patients. (America’s FDA is willing to approve an agent if it can prolong survival by 2.5 months over existing treatments—even if that additional couple of months is a living hell.) Treatments that are deemed “successful” employ the same old “slash-poison-burn approach” to cancer that’s always been used. While some novel immune therapies for lung cancer, lymphoma, and melanoma have come on the scene in recent years, they benefit only a few, and their cost is prohibitive. Even families with insurance plans frequently lose their life savings pursuing treatment for an afflicted loved one. Recent declines in cancer mortality rates are due to early detection—as is seen with colon and cervical cancer, for example—and smoking cessation. Given these realities, it’s not at all surprising that Raza’s impassioned main argument in the book is that cancer research needs to radically change.
The author aptly describes cancer as an example of malevolent “intelligence at a molecular level”. Perceiving its environment, it “takes actions that maximize its chances of survival,” becoming “stronger, smarter, and more dangerous with each successive cell division.” Many cancers are are still only diagnosed when they are quite advanced and extremely complex, having quickly transformed themselves, eliminating genes and entire chromosomes and acquiring multiple mutations. At this point, they are next-to-impossible to successfully treat. What is needed, says the author, is a commitment “to stop chasing after the last cancer cell and focus on eliminating the first” or, even better, “prevent the appearance of the first cancer cell by finding its earliest footprints.” She points out that oncologists and researchers are “already using sophisticated technologies to detect residues of disease that linger after treatment.” Why not harness and redirect these technologies to discover cancer early before it has laid waste to the body, she asks, pointing to the work of Bert Vogelstein’s team at Johns Hopkins, whose members are looking for the earliest markers (mutations, molecules, and metabolites) of breast, colon, lung, and pancreatic cancers in body fluids.
Early in her career, Dr. Raza treated a woman her age, a young mother in her thirties, who was terminally ill with acute myeloid leukaemia. Heartbroken that she could do little for a patient she had quickly grown to love, she took a decisive step in 1984: She began to build an MDS-AML tissue repository, banking samples from bone-marrow biopsies in order to study how these blood cancers evolve. Her tissue bank, which contains over 60,000 samples from thousands of patients, is the world’s oldest one created by a single doctor. A great challenge for Dr. Raza is actually gaining the research funds to carry out her work. She often has to court celebrities and hold benefits to get the financial backing needed to keep her project going.
The idea of actually harnessing new technology to look at “disease-caused perturbations” years ahead of their clinical appearance is not yet widely embraced by a “sclerotic” cancer industry. Over the years a huge bureaucracy and byzantine funding process has developed around in vitro and animal studies, even though these have yielded little of practical value to patients with cancer. Raza does not advocate for the abandonment of these studies, but she does offer an illuminating explanation of their limitations. Cultured cells are grown in controlled environments, quite unlike their natural ones, and the cells are forced to adapt to this hostile habitat. In time, they diverge wildly from their parents, genetically and in form and structure. Their doubling time is also much faster. While animal models may offer cell lines an environment more comparable to a human’s than petri dishes do, the complexity of the human environment is not fully understood and consequently can’t be replicated. Mice and human lineages diverged approximately 85 million years ago, and human and mice genomes are only about 50 percent identical. The life cycle of a mouse is short (three years), and the animal reaches sexual maturity at six to eight weeks. Furthermore, its metabolic rate is seven times faster than a human’s, so drugs are very rapidly metabolized in mice. Doses for clinical trials have to be drastically reduced because of the much slower metabolism of humans. Perhaps most critically, the immune system of mice evolved to be very different from that of humans. Ours developed to combat airborne pathogens and mice’s to handle earth-borne ones. A target lab mouse is healthy—not debilitated, as a human cancer patient is. Its immune system would naturally reject transplanted human cells; therefore, its immune system has to be destroyed before human cells are introduced. Needless to say, the tiny bodies of immunocompromised creatures hardly resemble the ones in which human cancer cells thrive. Yet, writes Raza, scientists have expected these transplanted cells to help them identify useful drugs for cancer patients.
The First Cell is an ambitious, rich, and informative book. It is also a demanding one at times. It will reward the persistent and motivated lay reader. My chief criticism is that it is occasionally repetitive. I believe some judicious cuts would have served the book well. As a lover of literature, Dr. Raza includes passages from great novelists and poets, but I’ll admit to having struggled at times with their pertinence. However, these are relatively minor complaints about an illuminating book that I’m glad to have read—one with a message that deserves to be heard.
Thanks to the publisher and to Net Galley for providing me with a digital copy for review purposes.
In over three decades of practice, Dr. Raza has cared for thousands of people with blood cancers. In her book, she tells the stories of several of these patients, as well as providing accounts of bright young people with other cancers—one, an intellectually gifted family acquaintance diagnosed with an aggressive sarcoma of the shoulder; the other, her daughter’s close friend, a young man in his early twenties, stricken with a lethal glioblastoma of the spinal cord. In a tender touch, she provides photographs of these patients, making them even more real and present for the reader. She documents how they negotiated their illness, made medical decisions, and confronted their end.
The author notes that over the years the billions of dollars directed towards cancer research have yielded valuable knowledge about its biology, but medicine has frustratingly little to show for this enormous investment in terms of actual treatments. Most of what is offered to the AML patients she sees (as well as to those with the most common types of cancer) has changed very little over the last forty to fifty years. Raza’s husband, cancer researcher Dr. Harvey Preisler—who himself succumbed to lymphoma in the early 2000s and whose suffering she describes in one chapter of her book—received the same combination of drugs that was used in 1977. Only about five percent of new cancer drugs are actually approved, and 70 percent of those provide no improvement in survival rates and are even harmful to patients. (America’s FDA is willing to approve an agent if it can prolong survival by 2.5 months over existing treatments—even if that additional couple of months is a living hell.) Treatments that are deemed “successful” employ the same old “slash-poison-burn approach” to cancer that’s always been used. While some novel immune therapies for lung cancer, lymphoma, and melanoma have come on the scene in recent years, they benefit only a few, and their cost is prohibitive. Even families with insurance plans frequently lose their life savings pursuing treatment for an afflicted loved one. Recent declines in cancer mortality rates are due to early detection—as is seen with colon and cervical cancer, for example—and smoking cessation. Given these realities, it’s not at all surprising that Raza’s impassioned main argument in the book is that cancer research needs to radically change.
The author aptly describes cancer as an example of malevolent “intelligence at a molecular level”. Perceiving its environment, it “takes actions that maximize its chances of survival,” becoming “stronger, smarter, and more dangerous with each successive cell division.” Many cancers are are still only diagnosed when they are quite advanced and extremely complex, having quickly transformed themselves, eliminating genes and entire chromosomes and acquiring multiple mutations. At this point, they are next-to-impossible to successfully treat. What is needed, says the author, is a commitment “to stop chasing after the last cancer cell and focus on eliminating the first” or, even better, “prevent the appearance of the first cancer cell by finding its earliest footprints.” She points out that oncologists and researchers are “already using sophisticated technologies to detect residues of disease that linger after treatment.” Why not harness and redirect these technologies to discover cancer early before it has laid waste to the body, she asks, pointing to the work of Bert Vogelstein’s team at Johns Hopkins, whose members are looking for the earliest markers (mutations, molecules, and metabolites) of breast, colon, lung, and pancreatic cancers in body fluids.
Early in her career, Dr. Raza treated a woman her age, a young mother in her thirties, who was terminally ill with acute myeloid leukaemia. Heartbroken that she could do little for a patient she had quickly grown to love, she took a decisive step in 1984: She began to build an MDS-AML tissue repository, banking samples from bone-marrow biopsies in order to study how these blood cancers evolve. Her tissue bank, which contains over 60,000 samples from thousands of patients, is the world’s oldest one created by a single doctor. A great challenge for Dr. Raza is actually gaining the research funds to carry out her work. She often has to court celebrities and hold benefits to get the financial backing needed to keep her project going.
The idea of actually harnessing new technology to look at “disease-caused perturbations” years ahead of their clinical appearance is not yet widely embraced by a “sclerotic” cancer industry. Over the years a huge bureaucracy and byzantine funding process has developed around in vitro and animal studies, even though these have yielded little of practical value to patients with cancer. Raza does not advocate for the abandonment of these studies, but she does offer an illuminating explanation of their limitations. Cultured cells are grown in controlled environments, quite unlike their natural ones, and the cells are forced to adapt to this hostile habitat. In time, they diverge wildly from their parents, genetically and in form and structure. Their doubling time is also much faster. While animal models may offer cell lines an environment more comparable to a human’s than petri dishes do, the complexity of the human environment is not fully understood and consequently can’t be replicated. Mice and human lineages diverged approximately 85 million years ago, and human and mice genomes are only about 50 percent identical. The life cycle of a mouse is short (three years), and the animal reaches sexual maturity at six to eight weeks. Furthermore, its metabolic rate is seven times faster than a human’s, so drugs are very rapidly metabolized in mice. Doses for clinical trials have to be drastically reduced because of the much slower metabolism of humans. Perhaps most critically, the immune system of mice evolved to be very different from that of humans. Ours developed to combat airborne pathogens and mice’s to handle earth-borne ones. A target lab mouse is healthy—not debilitated, as a human cancer patient is. Its immune system would naturally reject transplanted human cells; therefore, its immune system has to be destroyed before human cells are introduced. Needless to say, the tiny bodies of immunocompromised creatures hardly resemble the ones in which human cancer cells thrive. Yet, writes Raza, scientists have expected these transplanted cells to help them identify useful drugs for cancer patients.
The First Cell is an ambitious, rich, and informative book. It is also a demanding one at times. It will reward the persistent and motivated lay reader. My chief criticism is that it is occasionally repetitive. I believe some judicious cuts would have served the book well. As a lover of literature, Dr. Raza includes passages from great novelists and poets, but I’ll admit to having struggled at times with their pertinence. However, these are relatively minor complaints about an illuminating book that I’m glad to have read—one with a message that deserves to be heard.
Thanks to the publisher and to Net Galley for providing me with a digital copy for review purposes.
August 7, 2019
Cancer has impacted everyone on this planet in some way, and this book offers hope while also reflecting how medicine needs to reevaluate how it tackles this disease. Through this book, it is clear that the author deeply cares about her patients, and it is an inspiring and sobering read at the same time.
February 9, 2020
Dr. Azra Raza is a trail blazer. She would not take no for an answer. She is a warier. She will fight cancer cells at their origin. She is a champion for developing new approach of early detection of pre-cancerous cell at the first mutation toward immortality. As a person, a researcher and a physician she earn my respect and admiration. She explained her ideas very clearly in her book. That said, there were a lot of repetitions through the book to the level that more than once, I question myself if I insert previous CD instead of the next. On the other hand using abbreviations of 3 word cancer disease names after one time of saying their full names or complex names of medications sometime were hard to follow. All in all I find this book a must read. Her ideas are radical and may bring new hope for eradicate this awful disease.
November 25, 2021
Ever since I was a little girl, I have been obsessed with cancer. I love to research new things about cancer that wasn’t included in our syllabus.
And when I saw this book and read the synopsis that an oncologist wrote this book whose husband tragically died of cancer, I just knew this book called my name and I had to read it.
This book is a partly memoir but also the author provides a raw reality at the scenario of cancer research. A book that is quite similar to this book is When Breath Becomes Air by Paul Kalithini.
Since the author is an oncologist herself, she is quite familiar with the dire situation of the cancer research at the moment. She accounts many issues about the misdirection that the cancer research is going on. For example, despite the millions and millions of dollars that is being invested in the cancer drug development, the results are practically none. No new drug has been successfully been developed and it seems it’s improbable to even develop one. Clearly, new drug development is not the right way to fight this disease.
First few pages just crushed me when she showed all the negatives of the cancer research and how hopeless the situation is. She starts off very pessimistic and realistically. But then she also offers the solution and shows us a way that can change the cancer research in the future. Basically, she says that this field of research needs change and it needs it asap.
The thing I loved about this book was that she showed bravely that she’s deeply affected by her patients and gets attached to them. She cried when her patients were suffering. And my God, I cried so many times reading this book. It was absolutely heartbreaking getting to know the patients well and their sufferings.
You can tell she is deeply unhappy with the situation of the cancer treatment right now. She wants to do more than treat the patients with just with palliation.
One more thing, this book is extremely well written. The language is poetic and beautiful but also manages to articulate the medical stuff clearly. There were so many sentences and passages that literally made me stop reading and stare at the wall for 5 minutes. Like I felt the world had stopped spinning. They were impactful, and absolutely heartbreaking.
In conclusion, it was a great nonfiction book. I would highly highly recommend this book!
And when I saw this book and read the synopsis that an oncologist wrote this book whose husband tragically died of cancer, I just knew this book called my name and I had to read it.
This book is a partly memoir but also the author provides a raw reality at the scenario of cancer research. A book that is quite similar to this book is When Breath Becomes Air by Paul Kalithini.
Since the author is an oncologist herself, she is quite familiar with the dire situation of the cancer research at the moment. She accounts many issues about the misdirection that the cancer research is going on. For example, despite the millions and millions of dollars that is being invested in the cancer drug development, the results are practically none. No new drug has been successfully been developed and it seems it’s improbable to even develop one. Clearly, new drug development is not the right way to fight this disease.
First few pages just crushed me when she showed all the negatives of the cancer research and how hopeless the situation is. She starts off very pessimistic and realistically. But then she also offers the solution and shows us a way that can change the cancer research in the future. Basically, she says that this field of research needs change and it needs it asap.
The thing I loved about this book was that she showed bravely that she’s deeply affected by her patients and gets attached to them. She cried when her patients were suffering. And my God, I cried so many times reading this book. It was absolutely heartbreaking getting to know the patients well and their sufferings.
You can tell she is deeply unhappy with the situation of the cancer treatment right now. She wants to do more than treat the patients with just with palliation.
One more thing, this book is extremely well written. The language is poetic and beautiful but also manages to articulate the medical stuff clearly. There were so many sentences and passages that literally made me stop reading and stare at the wall for 5 minutes. Like I felt the world had stopped spinning. They were impactful, and absolutely heartbreaking.
In conclusion, it was a great nonfiction book. I would highly highly recommend this book!
April 22, 2023
2.5 stars honestly, rounded up to 3
I have a lot of mixed feelings about this book. On the one hand, I have only the utmost respect for Dr. Raza and her empathy, compassion, and sense of not being able to give enough to alleviate the pain of her cancer patients is one that hit home for me. She's clearly a clinician who also embodies the nobility and pride of medicine and a calling for healing. In terms of writing, I really enjoyed reading the poetry interwoven through quotes from Emily Dickenson as well as different Urdu poems, and her more lyrical passages were quite beautiful too.
However.
I respectfully disagree and also find confusing her main take on cancer research, which is that animal models (xenografts, etc.) should be discontinued. I whole-heartedly agree that animal models are a model, and do not replicate exactly what is seen in humans. Cancer therapeutics that pass clinical trials are bad, but you can see this even clearly in Alzheimer's drugs and other fields too. So why do we use them even if they're so poor? Frankly, I was confused (so potentially this may be my own lack of understanding even after rereading this passage) as to using a "phase 0" trial for cancer therapeutics where the drugs would be used directly on human patients first. This sounds like an obvious recipe for disaster, as animal models might indicate toxicity of a drug before giving this to a person. I'm hoping I read that wrong, because no matter how poor of a substitute an animal model might be for a patient, if a mouse reacts badly (or honestly, dies) from a treatment, it would be a hard sell for me to recommend this to a patient just because "a human has a different physiology than a mouse".
Further, I could not find any recommendations that Dr. Raza may have in terms of research for cancer patients who are at late stages. She is currently conducting clinical research for identifying biomarkers to identify early the cancer that she is studying, and upholds this style of research as superior to animal model-type studies. I agree that biomarkers and preventative medicine is surely key for decreasing the number of patients who end up in the dire straits that Dr. Raza describes in her book. However, what does this mean for patients who can NOT be identified so quickly? I am skeptical that by looking into biomarkers, you will find every single person who can ever have cancer and you will never miss a single patient. Biomarkers are useless at that point. So what research is worth doing then, endless experimental trials? I thoroughly disagree that the throwing something until it sticks method is the way to go, especially given how horrific and painful many cancer treatments are in terms of physical side effects as well as the deep emotional toll and pain on the patient and their family. The key to preventing such a waste of time like this would be to understand the mechanisms behind what is occurring, and unfortunately, only animal models (or potentially 3D organoid systems?) rather than an actual human patient seems plausible in my mind.
Finally, to this point on animal models, this is more of a personal thing but I found it slightly hypocritical that Dr. Raza would claim that animal models are such a waste of time after going into such depths about the molecular pathways of cancer a few pages prior. However, I acknowledge that she does give a disclaimer that she doesn't think that all basic science is useless at the start and end of her book. So maybe this is what she means? And I found that comparing the protests and fight against apartheid as similar to her fight against animal models to be a bit off. Not enough to be full-on off, but just enough for it to give me a bad taste in my mouth.
Beyond the animal model critiques, the only other thing that was uncomfortable may be the level of privilege throughout the text. I don't know, this is a very personal thing and it's not necessarily bad, it's just not a style of memoir that I usually read. I felt myself engaged and admired Dr. Raza for her strong conviction in medicine and her thoughts on life and death, but distanced at the mentions of fancy dinner parties, clothes brands, vacations, etc. However, this is not anything that takes away from the content of the book, but rather a reflection on my own background.
Overall, I read this book in basically one sitting. Was it a hate-read? I'm not sure. I was going to take a break before reading "The Emperor of Maladies" (which was what I was originally going to read first), but now I think I'll go for it to compare. I admire Dr. Raza so much as a physician, and I hope to take in what she wrote as an incoming medical student. However, I really felt the chasm of the basic sciences/ researchers/ "the scientists" versus the clinical realm/ doctors/ "the oncologists" in this book, so I think this was a good reflection as someone interested in a MD/PhD.
I have a lot of mixed feelings about this book. On the one hand, I have only the utmost respect for Dr. Raza and her empathy, compassion, and sense of not being able to give enough to alleviate the pain of her cancer patients is one that hit home for me. She's clearly a clinician who also embodies the nobility and pride of medicine and a calling for healing. In terms of writing, I really enjoyed reading the poetry interwoven through quotes from Emily Dickenson as well as different Urdu poems, and her more lyrical passages were quite beautiful too.
However.
I respectfully disagree and also find confusing her main take on cancer research, which is that animal models (xenografts, etc.) should be discontinued. I whole-heartedly agree that animal models are a model, and do not replicate exactly what is seen in humans. Cancer therapeutics that pass clinical trials are bad, but you can see this even clearly in Alzheimer's drugs and other fields too. So why do we use them even if they're so poor? Frankly, I was confused (so potentially this may be my own lack of understanding even after rereading this passage) as to using a "phase 0" trial for cancer therapeutics where the drugs would be used directly on human patients first. This sounds like an obvious recipe for disaster, as animal models might indicate toxicity of a drug before giving this to a person. I'm hoping I read that wrong, because no matter how poor of a substitute an animal model might be for a patient, if a mouse reacts badly (or honestly, dies) from a treatment, it would be a hard sell for me to recommend this to a patient just because "a human has a different physiology than a mouse".
Further, I could not find any recommendations that Dr. Raza may have in terms of research for cancer patients who are at late stages. She is currently conducting clinical research for identifying biomarkers to identify early the cancer that she is studying, and upholds this style of research as superior to animal model-type studies. I agree that biomarkers and preventative medicine is surely key for decreasing the number of patients who end up in the dire straits that Dr. Raza describes in her book. However, what does this mean for patients who can NOT be identified so quickly? I am skeptical that by looking into biomarkers, you will find every single person who can ever have cancer and you will never miss a single patient. Biomarkers are useless at that point. So what research is worth doing then, endless experimental trials? I thoroughly disagree that the throwing something until it sticks method is the way to go, especially given how horrific and painful many cancer treatments are in terms of physical side effects as well as the deep emotional toll and pain on the patient and their family. The key to preventing such a waste of time like this would be to understand the mechanisms behind what is occurring, and unfortunately, only animal models (or potentially 3D organoid systems?) rather than an actual human patient seems plausible in my mind.
Finally, to this point on animal models, this is more of a personal thing but I found it slightly hypocritical that Dr. Raza would claim that animal models are such a waste of time after going into such depths about the molecular pathways of cancer a few pages prior. However, I acknowledge that she does give a disclaimer that she doesn't think that all basic science is useless at the start and end of her book. So maybe this is what she means? And I found that comparing the protests and fight against apartheid as similar to her fight against animal models to be a bit off. Not enough to be full-on off, but just enough for it to give me a bad taste in my mouth.
Beyond the animal model critiques, the only other thing that was uncomfortable may be the level of privilege throughout the text. I don't know, this is a very personal thing and it's not necessarily bad, it's just not a style of memoir that I usually read. I felt myself engaged and admired Dr. Raza for her strong conviction in medicine and her thoughts on life and death, but distanced at the mentions of fancy dinner parties, clothes brands, vacations, etc. However, this is not anything that takes away from the content of the book, but rather a reflection on my own background.
Overall, I read this book in basically one sitting. Was it a hate-read? I'm not sure. I was going to take a break before reading "The Emperor of Maladies" (which was what I was originally going to read first), but now I think I'll go for it to compare. I admire Dr. Raza so much as a physician, and I hope to take in what she wrote as an incoming medical student. However, I really felt the chasm of the basic sciences/ researchers/ "the scientists" versus the clinical realm/ doctors/ "the oncologists" in this book, so I think this was a good reflection as someone interested in a MD/PhD.
December 13, 2024
I loved reading this book even though it made me sad. I loved reading about Dr. Raza's relationship to her patients and how she thinks about cancer. It gave me a lot to think about especially when considering cancer and cancer prevention in different spaces like prison
March 16, 2021
Thoughtful patient narratives interspersed with calls to action against the current oncology treatment landscape. At times the flow didn’t make much sense, but Raza’s opinions will make you think and leave you wondering “is what we’re doing enough”
September 6, 2020
This is a very well written book. In some ways, it's a 5 star book. In other ways, it's not.
It's hard to understand who is audience for this book. It seems Azra Raza feels regular people (people not in the field of oncology) are the intended audience, but it is written in such a way that it would really be very hard for someone not in oncology to fully understand. It's very detailed and treatments and disease processes she mentions or discusses are not always explained. Yet, it does not seem that the author intends people who work in oncology or onocologists to be the audience for the book. Her overarching theme - that cancer is usually diagnosed in late stage, with treatment options that only really extend life a few months, and the bulk of research focused on animal models and drugs that only nominally have any benefit at the end - is very clear, and it is an excellent theme for a book on cancer. She spends a lot of time describing the challenges and symptoms of advanced cancer. However, she spends very little time - a very small portion of one chapter at the end - actually discussing what the alternatives are in terms of research and what she envisions treatment in early stages (essentially before cancer is detectable). She also spends a great amount of time discussing all the pitfalls of treatment and cancer screening, and yet presents a very glossed over, brief, rosy view of alternative research and early detection methods, and is not at all critical of how these options could be implemented or problems or shortfalls that may arise from them.
While her focus is on the lack of cancer treatment options, sometimes it is a bit more challenging to understand the point she is making in the moment as you read. Her chapters are ostensibly broken up by patient, but within those chapters she jumps around quite a bit and discusses in passing other patients with other cancers, so the result is a bit choppy and disjointed. She brings up different ideas - how surprising it was that one patient was older and yet seemed to be fully in denial of the natural course of life that she would one day die, and hell bent on every treatment - yet the author continued to describe patients in their 80s and be angered that they would have an eventual decline and death from MDS or AML. So while she herself is shocked by this one patient's inability to recognize that she will one day die, the author herself also seems to have that same fault when she discusses other advanced age patients. The author mentions hospice and palliative care, but it does not really seem to factor much into her thinking. In many ways, despite the poetry she intersperses throughout, and the reflecting she does in the book on her patients and their experience, she is really not that different from most very treatment driven oncologists, at all costs, without much regard to age, at the benefit of weeks or months, holding out hope to heroic measures that will likely fail. She also never acknowledges that phase 1 clinical trials are not really designed to benefit the patient - they are intended to further cancer research when all proven treatment has been exhausted. She only nominally acknowledges that metastatic sarcoma is terminal when discussing Omar. Like her patients, she seems to have trouble coming to terms with this, and goes through his treatment course in what seems like shock at his eventual decline and death when treatments eventually fail. But they were always going to fail, and she knows that. In the letters from his family members, they fixate on being told his prognosis was 85%. Patients and their families have a very hard time hearing "your cancer is terminal" but "we have these treatments." They focus on certain things, and do not hear certain other things. Metastatic sarcoma is not ultimately curable. Did the oncologist lie and tell Omar and his family it was? More likely, the oncologist told them it was not curable very quickly at the initial visit, but went on to discuss and focus on what treatment was available at every subsequent visit. Illness and death are messy - sometimes they are brutal and cruel, as she chronicles for Andrew. While this is true of cancer - it is also true of many illnesses - Alzheimer's, parkinsons, debilitating strokes, ALS, etc. Death is not always easy. Perhaps I hoped for a more nuanced approach to life and death and mortality in this book. It is not Atul Gawande's Being Mortal.
As a nurse who worked in oncology for 10 years, this is a decent book to read. It has a heart, it's written with empathy, and it at times helps zoom out, when often cancer care is zoomed in. It proposes an alternate research reality (though it doesn't take a very good in depth view of what that research is) and it highlights very well the current problems with cancer treatment and the bulk of current cancer research. It's a flawed book, and I was ultimately expecting slightly better.
It's hard to understand who is audience for this book. It seems Azra Raza feels regular people (people not in the field of oncology) are the intended audience, but it is written in such a way that it would really be very hard for someone not in oncology to fully understand. It's very detailed and treatments and disease processes she mentions or discusses are not always explained. Yet, it does not seem that the author intends people who work in oncology or onocologists to be the audience for the book. Her overarching theme - that cancer is usually diagnosed in late stage, with treatment options that only really extend life a few months, and the bulk of research focused on animal models and drugs that only nominally have any benefit at the end - is very clear, and it is an excellent theme for a book on cancer. She spends a lot of time describing the challenges and symptoms of advanced cancer. However, she spends very little time - a very small portion of one chapter at the end - actually discussing what the alternatives are in terms of research and what she envisions treatment in early stages (essentially before cancer is detectable). She also spends a great amount of time discussing all the pitfalls of treatment and cancer screening, and yet presents a very glossed over, brief, rosy view of alternative research and early detection methods, and is not at all critical of how these options could be implemented or problems or shortfalls that may arise from them.
While her focus is on the lack of cancer treatment options, sometimes it is a bit more challenging to understand the point she is making in the moment as you read. Her chapters are ostensibly broken up by patient, but within those chapters she jumps around quite a bit and discusses in passing other patients with other cancers, so the result is a bit choppy and disjointed. She brings up different ideas - how surprising it was that one patient was older and yet seemed to be fully in denial of the natural course of life that she would one day die, and hell bent on every treatment - yet the author continued to describe patients in their 80s and be angered that they would have an eventual decline and death from MDS or AML. So while she herself is shocked by this one patient's inability to recognize that she will one day die, the author herself also seems to have that same fault when she discusses other advanced age patients. The author mentions hospice and palliative care, but it does not really seem to factor much into her thinking. In many ways, despite the poetry she intersperses throughout, and the reflecting she does in the book on her patients and their experience, she is really not that different from most very treatment driven oncologists, at all costs, without much regard to age, at the benefit of weeks or months, holding out hope to heroic measures that will likely fail. She also never acknowledges that phase 1 clinical trials are not really designed to benefit the patient - they are intended to further cancer research when all proven treatment has been exhausted. She only nominally acknowledges that metastatic sarcoma is terminal when discussing Omar. Like her patients, she seems to have trouble coming to terms with this, and goes through his treatment course in what seems like shock at his eventual decline and death when treatments eventually fail. But they were always going to fail, and she knows that. In the letters from his family members, they fixate on being told his prognosis was 85%. Patients and their families have a very hard time hearing "your cancer is terminal" but "we have these treatments." They focus on certain things, and do not hear certain other things. Metastatic sarcoma is not ultimately curable. Did the oncologist lie and tell Omar and his family it was? More likely, the oncologist told them it was not curable very quickly at the initial visit, but went on to discuss and focus on what treatment was available at every subsequent visit. Illness and death are messy - sometimes they are brutal and cruel, as she chronicles for Andrew. While this is true of cancer - it is also true of many illnesses - Alzheimer's, parkinsons, debilitating strokes, ALS, etc. Death is not always easy. Perhaps I hoped for a more nuanced approach to life and death and mortality in this book. It is not Atul Gawande's Being Mortal.
As a nurse who worked in oncology for 10 years, this is a decent book to read. It has a heart, it's written with empathy, and it at times helps zoom out, when often cancer care is zoomed in. It proposes an alternate research reality (though it doesn't take a very good in depth view of what that research is) and it highlights very well the current problems with cancer treatment and the bulk of current cancer research. It's a flawed book, and I was ultimately expecting slightly better.
December 11, 2019
Dr. Azra Raza, a medical researcher, makes a very compelling argument that there needs to be a paradigm shift in cancer research so that we are looking for very early signs of cancer and finding the first cells, rather than our pretty unsuccessful approach of trying to eradicate the last remaining cell after cancer is pretty advanced. A very thought provoking book.
December 1, 2019
Something is seriously wrong with the way cancer research is being done today. Dr. Raza, a prominent oncologist, has written a devastating critique of the way cancer care is being researched and practiced and she is calling for a revolutionary new treatment paradigm. Currently, cancer research is centered on the end stages of care, and the drugs approved through that research, at almost inconceivable expense and excruciatingly long years of research, are producing drugs that, according to Dr. Raza, extend the survival of patients by months, not years. She believes that there is a better way, focused on detecting and curing the disease at the earliest stages before it becomes too complicated. People may disagree about the paradigm that she proposes, but it is an inescapable fact that the staggering costs of research that she cites call for a thorough reevaluation of what we are doing. There must be something wrong with a system that requires 10 years of drug development at a total cost of about 3 billion dollars for a single approved drug! We must face the question of how a “free” society gets itself into this kind of a predicament. Why have we lost our freedom to take the responsibility of making our own life and death decisions about our health? What are the implications of having the FDA protecting our health? The book does not raise these questions, but they are a logical consequence in terms of the drug costs, suffering and life expectancy of cancer patients.
If the change in incentives that Dr. Raza is calling for to allow the development of this new paradigm is to occur, then a reevaluation of what the FDA is protecting us from needs to be done. What we need is for our health to be protected, not to be killed by that protection and prevented from doing all the required research needed to eradicate cancer. In politics, as in medicine, we must ask: “is the cure is worse than the disease?” As individuals, we must accept responsibility for making our own decisions about health care in consultation with our doctors, privately incentivized researchers (who don’t look to government for funding politically approved research), and privately incentivized certification agencies.
Anyone should read this book who wants to understand why medical progress is so interminably long and so incredibly expensive, why the patients must endure so much suffering, which she describes in extraordinary detail, and why a paradigm change is needed to avoid becoming a victim of the medical bureaucracy.
If the change in incentives that Dr. Raza is calling for to allow the development of this new paradigm is to occur, then a reevaluation of what the FDA is protecting us from needs to be done. What we need is for our health to be protected, not to be killed by that protection and prevented from doing all the required research needed to eradicate cancer. In politics, as in medicine, we must ask: “is the cure is worse than the disease?” As individuals, we must accept responsibility for making our own decisions about health care in consultation with our doctors, privately incentivized researchers (who don’t look to government for funding politically approved research), and privately incentivized certification agencies.
Anyone should read this book who wants to understand why medical progress is so interminably long and so incredibly expensive, why the patients must endure so much suffering, which she describes in extraordinary detail, and why a paradigm change is needed to avoid becoming a victim of the medical bureaucracy.
September 9, 2019
Love this book, truly. Wasn't sure what to expect and did also love Emperor of All Maladies.This gives a new, exciting, if painful, perspective on the whole cancer landscape. From her own first professional, then intensely personal experience with the relentlessness of the disease, the author is exemplary is her discussions.
Her detailed knowledge of the process of disease, diagnosis and treatment mirrors the clusterfuck having cancer in this day and age really is. From the pursuit of a cure - similar in many cases to locking the barn door after the horses have fled, to the shotgun of let's try everything, the approach has been backwards. With the knowledge we have now, looking at cancer from the first cell is only logical and reasonable.
I too have had cancer, and it did and continues to scare me....I can only hope that her voice and call resonate for all of us who have had and will have to face that situation. Nipping it in the bud is far and away more preferable than chasing errant, racing cells throughout the body, and laying waste to things in its path.
Thorough, detailed and thoughtful, thank you. I enthusiastically recommend and am gategelu for the advance copy.
Her detailed knowledge of the process of disease, diagnosis and treatment mirrors the clusterfuck having cancer in this day and age really is. From the pursuit of a cure - similar in many cases to locking the barn door after the horses have fled, to the shotgun of let's try everything, the approach has been backwards. With the knowledge we have now, looking at cancer from the first cell is only logical and reasonable.
I too have had cancer, and it did and continues to scare me....I can only hope that her voice and call resonate for all of us who have had and will have to face that situation. Nipping it in the bud is far and away more preferable than chasing errant, racing cells throughout the body, and laying waste to things in its path.
Thorough, detailed and thoughtful, thank you. I enthusiastically recommend and am gategelu for the advance copy.
January 15, 2020
The First Cell is an important book, and shocking, and depressing. It's also incredibly confusing. Part of that is my own inadequacies as a science reader - some sections of the book are just really dense and seem geared more toward fellow doctors and scientists than the average person just interested in new non-fiction. That being said, I think much of the confusion arises because it's essentially part memoir, part science book, and sometimes the shifts between those get blurry and jumbled. The book was divided into chapters, each focusing on a specific patient of Dr. Raza's. But more often than not, she would switch to discussing other cases without any clear transition. Dr. Raza is admirably passionate and has helped countless people throughout her career while suffering immense loss herself. One thing that does consistently come through her writing is how much she cares and wants to change the status quo of cancer research. I just felt it could use some better editing, and possibly be divided better as memoir chapters and research chapters.
December 10, 2021
The First Cell by oncologist and professor of medicine Dr. Azra Raza is not an easy book to read. In it, she profiles the cancer treatments of a number of her patients. Given that she specializes in myelodysplastic syndromes-acute myeloid leukemia (MDS-AML, a devastating cancer of the blood and bone marrow) the book chronicles their final days as well (including those of her husband who died of lymphoma in 2002).
She tells these stories with a larger point in mind. Dr. Raza believes that the current focus of cancer research on ‘treatment’ is misplaced and should instead be directed towards early detection. In other words, she believes the problem of detecting and treating the first cancer cell, is more tractable than that of eliminating the last cell once cancer has invaded the body.
The reason this is the case is that cancer is incredibly complex. Once in the body it constantly mutates, attacking different parts of the body in different ways. A treatment that achieves success against one type of malignant cell is often not effective against others. As a result, the surviving cells are free to continue their assault on the patient.
Current cancer research focuses on the use of mouse models and tissue culture cell lines. This approach has a failure rate of nearly 95%. The 5% that of studies that actually lead to successful treatments typically extend life by a few weeks or months at a cost of millions of dollars, while impairing the quality of the patient’s final days due to their toxic side-effects.
Instead, she argues that more effort should be spent identifying biomarkers that can be used to noninvasively identify the presence of genetic material from cancer cells. Currently only 5.7% of the total budget of the National Cancer Institute is allocated toward this critical area of research.
As to the book itself, it was quite good. Dr. Raza writes with tremendous compassion for the suffering of her patients. There were a few sections where she describes some of the genetic findings in her field that will be over the heads of most readers (including my own), but these can be skimmed with no loss towards understanding of her overall point. Given that 40% of people will develop cancer at some point in their lifetimes and that 20% of deaths are due to the disease it's an important subject to have at least a basic understanding. As the quote goes: "Know thy enemy and know yourself; in a hundred battles, you will never be defeated. When you are ignorant of the enemy but know yourself, your chances of winning or losing are equal. If ignorant both of your enemy and of yourself, you are sure to be defeated in every battle."
She tells these stories with a larger point in mind. Dr. Raza believes that the current focus of cancer research on ‘treatment’ is misplaced and should instead be directed towards early detection. In other words, she believes the problem of detecting and treating the first cancer cell, is more tractable than that of eliminating the last cell once cancer has invaded the body.
The reason this is the case is that cancer is incredibly complex. Once in the body it constantly mutates, attacking different parts of the body in different ways. A treatment that achieves success against one type of malignant cell is often not effective against others. As a result, the surviving cells are free to continue their assault on the patient.
Current cancer research focuses on the use of mouse models and tissue culture cell lines. This approach has a failure rate of nearly 95%. The 5% that of studies that actually lead to successful treatments typically extend life by a few weeks or months at a cost of millions of dollars, while impairing the quality of the patient’s final days due to their toxic side-effects.
Instead, she argues that more effort should be spent identifying biomarkers that can be used to noninvasively identify the presence of genetic material from cancer cells. Currently only 5.7% of the total budget of the National Cancer Institute is allocated toward this critical area of research.
As to the book itself, it was quite good. Dr. Raza writes with tremendous compassion for the suffering of her patients. There were a few sections where she describes some of the genetic findings in her field that will be over the heads of most readers (including my own), but these can be skimmed with no loss towards understanding of her overall point. Given that 40% of people will develop cancer at some point in their lifetimes and that 20% of deaths are due to the disease it's an important subject to have at least a basic understanding. As the quote goes: "Know thy enemy and know yourself; in a hundred battles, you will never be defeated. When you are ignorant of the enemy but know yourself, your chances of winning or losing are equal. If ignorant both of your enemy and of yourself, you are sure to be defeated in every battle."
June 5, 2020
CW/TW: frank descriptions of cancer treatments
Cancer: we're doing it wrong.
Raza would know: she's spent her entire career treating a very rare type of cancer, and the book she's written is the literary equivalent of throwing your hands up in the air and saying, "Look, we just don't fucking know, okay?"
Well, we know a few things: we know that the treatments we currently have are the same treatments we've been using for decades. The great leaps and bounds in cancer treatments we've been promised all these years haven't materialized, for a variety of reasons, none of which have anything to do with conspiracy theories or Big Healthcare. The major problem is that cancer isn't ONE disease: it's an EVOLVING disease. So you're treating an enemy that's constantly outsmarting you.
This is a wonderful critique of cancer treatments from the inside, paired with the painful stories of several people who succumbed to their illnesses, sometimes suffering horribly along the way because they weren't ready to give up, but the treatments were just as awful as the disease. It's not an easy read, but Raza walks that delicate edge of description and empathy without tipping over into melodrama. This is even more remarkable because one of the patients she discusses is her own husband, Harvey.
Many of the players in this book are rich, urban, and privileged, but Raza makes ample room for discussions of issues surrounding cancer treatments for the less affluent, both in America and elsewhere. It's one of the few books I've read that is limited in scope, but not in a bad way: it's a conscious laser focus on an issue so complex that talking about it without drilling down to very specific situations is almost impossible.
What it boils down to for Raza, in the end, is this: the way we're treating cancer now is, for the most part, not working. We should, instead, be focusing on prevention and extremely early intervention. As in, interventions that don't exist yet, mostly because we can imagine them, but -- given the current state of cancer research and its attendant red tape -- we cannot easily create.
This is not a fun read, but it's a fascinating one. If you've lost anyone you love to cancer, or have grappled with it yourself, it might be too much. If you have the spoons for it, though, Raza is an excellent guide to the issues. Recommended for all public library collections and academic libraries that support medical schools.
Cancer: we're doing it wrong.
Raza would know: she's spent her entire career treating a very rare type of cancer, and the book she's written is the literary equivalent of throwing your hands up in the air and saying, "Look, we just don't fucking know, okay?"
Well, we know a few things: we know that the treatments we currently have are the same treatments we've been using for decades. The great leaps and bounds in cancer treatments we've been promised all these years haven't materialized, for a variety of reasons, none of which have anything to do with conspiracy theories or Big Healthcare. The major problem is that cancer isn't ONE disease: it's an EVOLVING disease. So you're treating an enemy that's constantly outsmarting you.
This is a wonderful critique of cancer treatments from the inside, paired with the painful stories of several people who succumbed to their illnesses, sometimes suffering horribly along the way because they weren't ready to give up, but the treatments were just as awful as the disease. It's not an easy read, but Raza walks that delicate edge of description and empathy without tipping over into melodrama. This is even more remarkable because one of the patients she discusses is her own husband, Harvey.
Many of the players in this book are rich, urban, and privileged, but Raza makes ample room for discussions of issues surrounding cancer treatments for the less affluent, both in America and elsewhere. It's one of the few books I've read that is limited in scope, but not in a bad way: it's a conscious laser focus on an issue so complex that talking about it without drilling down to very specific situations is almost impossible.
What it boils down to for Raza, in the end, is this: the way we're treating cancer now is, for the most part, not working. We should, instead, be focusing on prevention and extremely early intervention. As in, interventions that don't exist yet, mostly because we can imagine them, but -- given the current state of cancer research and its attendant red tape -- we cannot easily create.
This is not a fun read, but it's a fascinating one. If you've lost anyone you love to cancer, or have grappled with it yourself, it might be too much. If you have the spoons for it, though, Raza is an excellent guide to the issues. Recommended for all public library collections and academic libraries that support medical schools.
August 16, 2020
stands alone in the depth of her clinical experience as an oncologist, her scientific knowledge and commitment to evidence, her intellectual depth and literary knowledge, her passion and emotional intensity, and her willingness to challenge convention. I am agog that such an astonishing human being exists.
Her most important message is that too much money and effort is being devoted to the predominantly failing efforts to offer small extensions of life to cancer patients in the later stages of the diseases. She builds a convincing case that more of the massive investment should be directed to diagnosing and stopping it at or close to inception. Thus the title of the book: .
Dr. Raza relates stories, at several levels of detail, of cases of (mostly hematologic) cancers which she treated or observed. Reading them was a scarifying experience for me, and quite depressing, although I couldn't put the book down. One of the patients was her own beloved husband, Harvey (also an oncologist), whose lymphoma is a horror story indeed. Her capacity for love and compassion is apparent throughout the book, in the stories of the patients that she came to love if she didn't already. My only objection to the stories of weighing the endless pain and suffering of primitive conventional treatment against the pain and suffering of the illness and death is that suicide was never acknowledged as an option. That may reflect her religious beliefs if any, but I for one provide for just such a contingency, and I am sure that others consider it too.
Read this beautiful and important book, but he ready for a rough ride.
Her most important message is that too much money and effort is being devoted to the predominantly failing efforts to offer small extensions of life to cancer patients in the later stages of the diseases. She builds a convincing case that more of the massive investment should be directed to diagnosing and stopping it at or close to inception. Thus the title of the book: .
Dr. Raza relates stories, at several levels of detail, of cases of (mostly hematologic) cancers which she treated or observed. Reading them was a scarifying experience for me, and quite depressing, although I couldn't put the book down. One of the patients was her own beloved husband, Harvey (also an oncologist), whose lymphoma is a horror story indeed. Her capacity for love and compassion is apparent throughout the book, in the stories of the patients that she came to love if she didn't already. My only objection to the stories of weighing the endless pain and suffering of primitive conventional treatment against the pain and suffering of the illness and death is that suicide was never acknowledged as an option. That may reflect her religious beliefs if any, but I for one provide for just such a contingency, and I am sure that others consider it too.
Read this beautiful and important book, but he ready for a rough ride.
September 19, 2020
Decided to read this book after listening to the Author on an Econtalk podcast.
There was something on how Azra Raza explained the key message of the book and the humanity conveyed in such discussion that immediately "magnated" me into reading it.
A disturbing book about cancer, its impact on the lives of those who have to deal with it (on the first person or related family and friends), that more than once made me stop, take a deep breath and reflect, before i could continue.
The key message presented, that the cancer research and associated mainstream treatment (slash, poison and burn) did do not evolve that much in the last 50 years, adheres to reality and that the proposed paradigm shift that she proposes looks also so well grounded. balanced and logic that it seems strange that the proposed approach (to detect the first cell instead of treating millions of them after it is widespread) does not have more interest, momentum and investment.
Sometime it seems that, once again, it's a question of an incorrect incentives and rewards system put in place, that does not allow to make tangible progress on this important subject.
Regarding the author, an oncologist, that experienced all the portrayed stories being an active participant in each of them, you can feel the humanity, empathy, care, frustration and sense impotence she experience with each.
Strongly recommend its reading to all interested in the subject.
There was something on how Azra Raza explained the key message of the book and the humanity conveyed in such discussion that immediately "magnated" me into reading it.
A disturbing book about cancer, its impact on the lives of those who have to deal with it (on the first person or related family and friends), that more than once made me stop, take a deep breath and reflect, before i could continue.
The key message presented, that the cancer research and associated mainstream treatment (slash, poison and burn) did do not evolve that much in the last 50 years, adheres to reality and that the proposed paradigm shift that she proposes looks also so well grounded. balanced and logic that it seems strange that the proposed approach (to detect the first cell instead of treating millions of them after it is widespread) does not have more interest, momentum and investment.
Sometime it seems that, once again, it's a question of an incorrect incentives and rewards system put in place, that does not allow to make tangible progress on this important subject.
Regarding the author, an oncologist, that experienced all the portrayed stories being an active participant in each of them, you can feel the humanity, empathy, care, frustration and sense impotence she experience with each.
Strongly recommend its reading to all interested in the subject.
May 16, 2022
The First Cell by Azra Raza is a book that is in equal parts harrowing, stimulating and informative. Dr. Raza in establishing her hypothesis that the more effective way to spend R&D dollars in cancer therapy is on having a disproportionate amount of resources allocated to early detection (detection of the first cell) vs. spending billions on drugs that work on specific indications/ manifestations of the disease, draws on the pragmatic problems faced by the cancer patients and families as well as emotional. In highlighting that majority of cancer therapies available take a slash (surgery), poison (chemotherapy) or burn (radiation) approach, she brings out almost a medieval mindset that still persists in oncology.
This book was not a bland/ drag read on a very technical subject. The book, in drawing inspiration from poetry (English and Urdu alike), personal stories of patients and from other fields of study, makes the conversation on cancer far more accessible to all. Highly recommend this book- if for nothing else, just to rethink how we approach any class of therapy for any disease really; and of course for the interspersed poetry in the book, directly and indirectly through the author's own command over language.
This book was not a bland/ drag read on a very technical subject. The book, in drawing inspiration from poetry (English and Urdu alike), personal stories of patients and from other fields of study, makes the conversation on cancer far more accessible to all. Highly recommend this book- if for nothing else, just to rethink how we approach any class of therapy for any disease really; and of course for the interspersed poetry in the book, directly and indirectly through the author's own command over language.
August 23, 2020
A good chronicle of cancer but not exactly a piece of research
Came across a podcast with Dr Raza's interview by Peter Attia. She is an acclaimed oncologist with a novel concept at approaching cancer at 'The First Cell' , to catch and stop it at its origin. Has critiqued the 'burn-posion-slash' approach to malignancy as archaic. This in particular is bold of her and , being a part of an oncology team myself, caught my interest. Is there a radical new way that we are missing¿ I think she is on the right track there
I admit I had hoped the book would be a research on these new techniques, maybe not unlike what Siddhartha Mukherjee achieves with 'The emperor of all maladies' . The concepts do get mentioned but this is largely one of those you could title 'Diary of an Oncologist' and is to do largely with personal experiences and patient interactions. Dr Raza is an intellectual and that much is evident, especially with her ardent Urdu poetry interspersed strategically in the book. With the right expectations this is a good enough chronicle.
If you need a succinct version, listen to the podcast, that should summarize it well enough.
Came across a podcast with Dr Raza's interview by Peter Attia. She is an acclaimed oncologist with a novel concept at approaching cancer at 'The First Cell' , to catch and stop it at its origin. Has critiqued the 'burn-posion-slash' approach to malignancy as archaic. This in particular is bold of her and , being a part of an oncology team myself, caught my interest. Is there a radical new way that we are missing¿ I think she is on the right track there
I admit I had hoped the book would be a research on these new techniques, maybe not unlike what Siddhartha Mukherjee achieves with 'The emperor of all maladies' . The concepts do get mentioned but this is largely one of those you could title 'Diary of an Oncologist' and is to do largely with personal experiences and patient interactions. Dr Raza is an intellectual and that much is evident, especially with her ardent Urdu poetry interspersed strategically in the book. With the right expectations this is a good enough chronicle.
If you need a succinct version, listen to the podcast, that should summarize it well enough.
November 28, 2019
Azra Raza makes a bold claim in this book and backs it up. "The art of medicine, once based purely on experience and observation, a hostage to tradition, gradually evolved into a practice increasingly driven by scientific evidence. More recently, it has undergone an unexpected transition by morphing into a monstrous business enterprise" (144). Raza is not against funding for cancer research as she has made this profession and knows the personal costs as her husband died because of cancer.
Her frustration revolves around how funds are distributed and how research is separated from treatment. "The funding agencies continue to reward basic research in petri dishes and mouse models that bear little relevance for humans" (143). She is not alone in this as she quotes another critic, oncologist Vinay Prasad, who claims that the $700 billion spent on health care still leaves practiced medicine occurring based on scant evidence.
Raza has a solution. "The two immediate steps should be a shift from studying animals to studying humans and a shift from chasing after the last cancer cell to developing the means to detect the first cancer cell." She is after the causes for cancer instead for treating it after cancer has been diagnosed.
The books tries to add a personal side with stories, but many go on too long and Raza is very good at quoting other people saying how incredible she is. "Call Azar, mom. She is on the cutting edge of cancer. I want her involved in my care" (199) is an example that happens often and her "aw, shucks" at all this praise is thin since she puts it in so often. She does not seem to need this type of support as she makes a strong argument on her own.
Having watched my six-year-old die from neuroblastoma cancer, this is personal for me. We has the opportunity to have a researcher who was a practioner work with him after his first relapse and he made good progress for a year before succumbing. That connection between research and practice is what Raza wants, and I think she is right.
Her frustration revolves around how funds are distributed and how research is separated from treatment. "The funding agencies continue to reward basic research in petri dishes and mouse models that bear little relevance for humans" (143). She is not alone in this as she quotes another critic, oncologist Vinay Prasad, who claims that the $700 billion spent on health care still leaves practiced medicine occurring based on scant evidence.
Raza has a solution. "The two immediate steps should be a shift from studying animals to studying humans and a shift from chasing after the last cancer cell to developing the means to detect the first cancer cell." She is after the causes for cancer instead for treating it after cancer has been diagnosed.
The books tries to add a personal side with stories, but many go on too long and Raza is very good at quoting other people saying how incredible she is. "Call Azar, mom. She is on the cutting edge of cancer. I want her involved in my care" (199) is an example that happens often and her "aw, shucks" at all this praise is thin since she puts it in so often. She does not seem to need this type of support as she makes a strong argument on her own.
Having watched my six-year-old die from neuroblastoma cancer, this is personal for me. We has the opportunity to have a researcher who was a practioner work with him after his first relapse and he made good progress for a year before succumbing. That connection between research and practice is what Raza wants, and I think she is right.
January 28, 2020
Physicians are not scientists and their play science efforts are part of the problem this book rails against. This smug intro is written as though her family is the only one to have had the miserable experience with cancer - after treating patients for years now she finally gets to reflect. Her enormous ego let her write this book as though she presents anything new or creative. Nope, in fact, limitations in research design and the understanding that prevention and early detection are the best defenses is nothing new. Arrogance aside, at least the tone is an improvement over Emperor of all Maladies, as she doesn’t perceive succumbing to cancer as a failure of strength. (Although like that book, this one needed to cull the epigraphs.) It would make a nice tribute to her patients if that were the author’s intent. But as much as she is saddened by her patients’ bankruptcy due to the cost of care, she is content to flaunt her material wealth and access to specialists. She wants to rail against the science and offers no solutions. Because she is a clinician, not a scientist.
November 10, 2023
It is funny to see how personally some people take it. These, who rated with one star. Hey, haters, here is my message to you:
Its not true, that she blames researchers. I am a "basic researcher" and I don't feel blamed at all after reading this book. Moreover, I spent some years using mouse models to investigate cancer, among other things. She says - it is less efficient way to use limited resources. Well, she is not an expert in humanized mice, luckily. Nor you. But I am, and I have nothing to proof her wrong. Not yet, at least. It is the reality in 2023.
And it is not true, she blames "researchers" and does not propose anything. She proposes alternative solutions: early screening, research of predictive biomarkers, trials on human volunteers directly.
She might be a bit emotional, in HER own book with HER own life. So what?
And lastly, "she sends wrong messages to funding agencies and people". What??? Since when funding agencies use non-fiction books to take decisions? In that case, I definitely need to re-consider my grant application procces and start writing books 😀
This book is about suffering, helplessness and hope, but selfish people see only them being assaulted. As always. Message isn't wrong. Recievers are.
Its not true, that she blames researchers. I am a "basic researcher" and I don't feel blamed at all after reading this book. Moreover, I spent some years using mouse models to investigate cancer, among other things. She says - it is less efficient way to use limited resources. Well, she is not an expert in humanized mice, luckily. Nor you. But I am, and I have nothing to proof her wrong. Not yet, at least. It is the reality in 2023.
And it is not true, she blames "researchers" and does not propose anything. She proposes alternative solutions: early screening, research of predictive biomarkers, trials on human volunteers directly.
She might be a bit emotional, in HER own book with HER own life. So what?
And lastly, "she sends wrong messages to funding agencies and people". What??? Since when funding agencies use non-fiction books to take decisions? In that case, I definitely need to re-consider my grant application procces and start writing books 😀
This book is about suffering, helplessness and hope, but selfish people see only them being assaulted. As always. Message isn't wrong. Recievers are.
July 17, 2020
I saw the author speak in Chicago last year, and was so compelled by her views and story that I’d wanted to read her book since then. I listened to the audiobook, narrated by her daughter. It was really good, and the author’s pleas are important and very clear. I did think the book was going to be a lot more ethnographic than it was, focused more on the stories of her patients — and even though the author was extremely empathetic and humanized the fight against cancer, the stories still very much focused on the medical aspects of their cancers and treatments. I often got lost in the clinical language, so I do think the book’s more appropriate for those in healthcare or scientific professions. I hope that the powers that be in these communities pay attention to the author’s point of view, and she sees the changes she puts forth during her lifetime.
February 15, 2021
Be filtro. Onkologė, netekusi dėl vėžio savo vyro, skyrusio visą savo gyvenimą kovai su šia liga, parašė puikią knygą apie tai, kodėl, jos nuomone, žmonija pralaimi kovą su vėžiu. Knyga sunki. Tikrai. Aprašo ligos eigą taip, kaip yra - be pagražinimų. Ir knygos kalba. Jaučiasi, kad autorė yra eruditas ir žiauriai išprususi asmenybė. Man padarė didelį įspūdį. Ir, labai tikiuosi, kad ateityje mes tikrai galėsime “išgliaudyti” tą pirmąją vėžio ląstelę, o ne kovoti su liga, kuri apėmusi visą kūną ir, praktiškai, nebeaišku nuo ko pacientas greičiau užsilenkia - nuo pačio vėžio ar nuo jo gydymo būdų.
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