"The Emperor of All Maladies"
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Attached here is an excerpt from the book, "The Emperor of All Maladies" by Siddhartha Mukherjee

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  1. What really surprised me was how long cancer has been around. I always thought of cancer as a new disease but reading that it has been a thing since at least 400 BC was a shock. It was interesting to read about how all these different doctors approached cancer. They built off each other’s work and found success in their studies. For example, from Galen classifying cancer as the black bile of the body making it rather impossible to rid the body of, to Vesalius realizing that there is no black bile then Baillie using that to suggest that if that’s the case cancer can be gotten rid of. Then Hunter with his surgical procedures and the discovery of anesthesia and microbes. We know what we know about cancer today because so many doctors invested their time and efforts, took risks, learned from their mistakes and made new discoveries.

    1. I didn’t realize that cancer has been around for a couple thousand years until recently, too. In my psych and anatomy & physiology classes we discussed how Hippocrates came up with the humoral theory; and if there was an imbalance between the four humors, that could cause cancer. In this reading they mentioned both Hippocrates and Galen’s black bile theory, but they also talked about Imhotep. He described 48 cases of cancer around 2625 BC, which was before Hippocrates’s time. Louis Leakey also discovered a human jaw bone from 2 millions years ago that showed signs of lymphoma, and this was before Imhotep’s time.

    2. I also was surprised that cancer has been around for such a long period of times, and I think the idea that cancer is a relatively new disease comes about simply because current doctors are focusing their time and attention much more on cancer and cancer treatment, compared to a long time ago when not many doctors would pay the slightest interest to the disease.

    3. Even though I understood that since cancer has a genetic basis and is not entirely linked to recently emerging environmental factors, I too considered cancer to be a disease which is more prevalent in relatively more recent years. I could not explain this thought in the same way that alzheimer's is explained to be an ever more occuring disease due to an increase in life expectancy. Cancer affects people of all ages, not just those within age ranges which were previously uncommonly high. I now feel that cancer is considered “newer” because its mysterious and non-contagious nature shrouded our understanding of it until recently. 

  2. While reading, I was surprised by the past treatments they used for cancer patients. They were bizarre and, now in modern times, we've realized they do not relate to helping cancer patients. They were violent, dirty, and harmful. But over time, through trial and error, we've discovered ways to properly treat cancer.

    • For the earlier treatments of cancer, there was no treatment. Hippocrates believed it best to leave cancer untreated, and Imhotep said cancer was incurable. 
    • Using Hippocrates humoral theory around 100 BC, Galen believed black bile caused cancer. The apothecary’s treatments included tincture of lead, extracts of arsenic, fox lungs, boar’s tooth, rasped ivory, hulled castor, ground-white coral, ipecac, senna, and laxatives. Ointments were made from goat’s poop, frogs, cow feet, and many other odd choices. Galen believed if these treatments and ointments failed, then bleeding would squeeze the humor out of the body, removing the cancer. 
    • In the late 1800s, William Halsted cut out the pectoralis minor and major of breast cancer patients in hopes of removing all remnants of the cancer. When the cancer relapsed, Halsted continued to cut farther down. The surgeons used rusty knives and leather straps for restraint; nothing was sterile. Infection after surgery was lethal, and doctors did not know the cause of it until the mid-1800s. Joseph Lister realized it was due to a wound being left opened and exposed to bacteria. 
    • Ambrose Paré burned tumors with iron heated on coals or chemically burning them with sulfuric acid. 
    • John Hunter believed only movable tumors were worth removing surgically and his treatment for immovable tumors was "remote sympathy". Hunter also drugged his patients with alcohol and opium to “near oblivion”.
    • Sydney Farber injected children who had leukemia with folic acid — Lucy Wills discovered that it could restore the normal genesis of blood to nutrient-deprived patients. The folic acid accelerated the progression of leukemia, which meant the children would die sooner. Farber later injected leukemia patients with pteroylaspartic acid, this lowered the patient's white blood cell count.
    • Emil Grubbe used radiation to treat cancers locally, but the radiation exposure produced cancer too. Many who were exposed died of leukemia. Radium workers also complained of jaw pain (bones in jaw had necrosis), fatigue, and they became anemic. Exposure could also lead to someone glowing with radioactivity.
    1. I thought these treatments were interesting as well. For me, I was interested in this because it showed the steps that have to be taken to start to understand and formulating treatments that actually do work. By using trial and error and performing surgeries that were completely ineffective, or only somewhat effective, scientists and doctors slowly began to understand what works and what doesn't. I liked reading about all of the steps because it is the first time I feel like I have really been able to see a large amount of the history of a disease and what goes into understanding it. 

  3. One aspect of the history of cancer and understanding cancer that I found particularly interesting was when the surgeon-writer Sherwin Nuland described cancer as "in every possible sense, a nonconformist." When scientists were beginning to understand cancer and its nature of killing victims by overrunning areas of the body with too many cells and invading tissues and then spreading to other organs and parts of the body, Nuland realized that cancer could be looked at as the "desperate, malevolent, and contemporary doppelgänger" to our species. This was especially interesting for me to read because it put cancer and just how intricate and well adapted it is into perspective for me. When describing cancer as a phenomenal product of evolution and Darwinian selection, Nuland allowed me to understand why creating the ultimate cure to cancer has been such a hurdle for so long. To think about some treatment or medicine that could kill off and destroy any and all areas of cancer in a person, I understand now is to kill off a disease that is made and adapted to fiercely survive, especially when being threatened with destruction. When I compare this to our own amazingly adapted and evolved species, it is interesting because of just how true it is. 

    1. I really like the way that you highlighted the connection between Darwinian evolution and cancer's evolution. It definitely makes it obvious how complicated cancer has gotten and how difficult it will be to find a cure. I would like to add that this connection between evolution in humans/animals and evolution in cancer highlights how humanlike cancer really is. Cancer is not a foreign disease, infection, or virus that can be attacked as an invader to humans, but rather a nasty disease that comes from the human itself. This is why cancer is so complicated and hard to treat, as an attack on cancer is an attack on the human. 

  4. One aspect of cancer's history that surprised me was how fast its mortality rate grew in the early 1900s. On page 24, when Mukherjee explains that "Between 1900 and 1916, cancer-related mortality grew by 29.8 percent, edging out tuberculosis as a cause of death" and later states that cancer became the nation's second-deadliest disease really shocked me. Such a large percentage growth in only sixteen years opens the door to insight in how cancer was able to spread so quickly when it is not a contagious disease. The early 1900s saw a good amount of progress in medicine but nothing compared to what would be done after the World Wars. With this being said, other diseases were still very much around to compete with cancer, which was not just bursting onto the scene, as it was documented thousands of years before. One possible explanation for this large spike in cancer deaths was the increased sanitation in cities mentioned earlier in the excerpt, which lengthened the average American's lifespan and could have opened the door for cancer to cause death later in life. The overall pattern that appeared in this excerpt was the contrast between health and the opposite of health, whether that be poisons (chemotherapy, radiation) or other competing diseases, and how this relates to cancer. It seems that cancer thrives when one is otherwise healthy and the only way to treat cancer inevitably causes other damage to the patient. In the early 1900s, this contrast was demonstrated with increasing public health being met with increasing cancer rates, and marks a notable subject to be discussed further.

    1. I also felt astonished about the fact that cancer became a common cause of death in America at such a rapid rate. However, I didn’t try to combine this information with other details in the book and merely consider it statistics the author utilized to emphasize the serious situation people used to face. The explanation of the significantly rising mortality rate you mentioned really offers a new viewpoint leading to further comprehension of the author’s purposeful arrangement throughout the whole book. As researchers discover more about the relationship between health and disease, we might develop new understandings of curing or conquering cancer.

    2. I was too surprised by the rapid increase in cancer victims in the early 1900s. It was interesting to read that with the development of penicillin in 1939, America was seeming to become an invincible society, with the exception of cancer. It was strange to see how so many diseases were being treated and many life expectancies going up, yet the presence of cancer increasing exponentially. This further demonstrates how unique cancer is compared to any other disease. 

       

    3. Your statement on cancer targeting healthy people and the cure being to basically poison them caught my attention.  It really brings home to me how strange a disease cancer is that the usual idea of making sick people healthy is reversed in these cases.  Another factor that may have lead to the sharp increase in cancer mortality may be the boom in industrialization seen in the late 1800s.  The level of carcinogens in the atmosphere would have been steadily increasing since the industrial revolution and this may have been the time period when their affect really shown through.  It would be really interesting to look at the demographics and see where cancer was increasing and what was happening in those areas at the time. 

  5. I was surprised when I read about how difficult it had been in the 1900s for advocates to call the public’s attention to fighting cancer. In the early 1900s, the cancer research funds remained stagnant and the American society was under the illusion of “eternal health” while the dreadful disease continued to take lives. When the efforts made by people like Neely finally started to pay off, the outbreak of World War II unexpectedly hindered the possible scientific progress at NCI. The history of cancer tells us not only about human fighting against disease, but also of how the subject had been perplexed over time. It was surprising to find out that political factor played an important role in people’s knowledge about cancer back then. The historical background is carefully documented in “The Emperor of All Maladies” so that readers who haven’t experienced that period of time can better understand the dilemma faced by doctors and scientists. The lack of ideal environment for conducting experiments as well as insufficient case study may help explain some of the scientists’ absurd attempts.

    1. I was also very surprised at how hard it was to gain support and awareness in fighting cancer. In a way it made me upset to see the public and government turn their backs to these scientists fighting cancer because of what we know today about cancer. But knowing that they lacked the knowledge we possess today, I can't really blame them. However, I was happy to see that the scientists persevered in their research even when they had no support.

    2. I was also surprised to see the almost blatant disregard for the people fighting cancer who were seeking out help. To think that one cause is more "worthy" than another, but in both cases, people are dying and people need help. It shouldn't be one or the other, rather it should be a division so that both groups can benefit. This also surprised me because today's society is so centered around supporting the cancer community and cancer research, one would never think to ignore it. 

  6. I find it interesting that cancer has been approached with so many different perspectives and techniques. Since cancer is such a diverse illness, it makes sense that each type needs to be targeted using a very specialized method. However as Virchow discovered in early studies, cancer comes in many different forms but are all similar on a cellular level: rapid, uncontrollable and unregulated cell growth. Many treatments were tested and discussed in this book, with varying degrees of effectiveness. In the early twentieth century, there were only two methods being practiced: radiation or removal of the tumor. Surgery remained and is to this day a major strategy at targeting cancer. Another method that I had never heard of until reading this book was the use of folic acid against leukemia. It is interesting that they chose this approach based off of anemia as both need to target blood cells. I do not believe this approach would be effective on other types of cancer, because folic acid is known to boost red blood cell development, and therefore is most practical to be used on blood related diseases or illnesses. On the other hand, surgery would not always be the best alternative. As William Stewart Halsted stated, radical operations would be difficult, if not impossible on certain forms of cancer, as some organs could not be extracted in full, such as the brain. Additionally, the benefits of radiation were discussed for certain types of cancer in specific locations that have not yet metastasized, such as breast tumors or lymphoma lumps. All of these different approaches to treating cancer, ranging from surgery, to drug use, to vitamin supplements, to chemotherapy are so different. I find it interesting that the approaches are so diverse, to combat the same issue of uncontrollable cell division. No one best solution has been discovered, and I believe it never will be just one cure. Each type of cancer will have many different ways to fight it, and now it is necessary to determine what the best way is for each kind. 

    1. I agree that it is very interesting how many different approaches have been used in order to both treat and research cancer. It is amazing many different diseases fall under the category of “cancer,” yet each case and each different type of cancer can be so unique, leading to the need for many different treatment options so that the best treatment can be matched to a certain case of cancer. It is also fascinating to see how many different options have been discovered through trial and error, and how certain treatments have worked effectively for some cases, but have not worked well at all for other cases.

    2. I also thought the diversity and breadth of methods used to try to combat cancer was interesting. I think it's also interesting that cancer was the impetus for the creation many new techniques, not just the target of varied methods. New techniques that arose from the study of cancer, like Billroth's abdominal procedures and Vesalius's exhaustive medical diagrams, had to have been used in fields beyond oncology. In this, I found it interesting that cancer treatment both utilized varied treatments and spawned new procedures.

  7. I found it interesting how many different subtypes of the disease there are, as well as how different cases there seem to be. When I first think of leukemia, I expected most cases are similar in terms of how aggressive the cancer is or what cells it targets, but I have learned that this is not true. There are cases where leukemia is chronic and more slow spreading, and it slowly engulfs the bone marrow and spleen, while there are other cases where it can almost the opposite, as it behaves more intensely and violently, and becomes almost a different illness with severe symptoms. Not only are there different intensities of the disease, but there is also a second version, acute leukemia, which also has two further subtypes, acute myeloid leukemia, which involves myeloid cells, and acute lymphoblastic leukemia, which involves lymphoid cells.

    One case in the article mentioned that a person experienced leukemia that was  so aggressive that the child died only about three days after the cancer was discovered, while in another case it was not as aggressive, but unique in its own way-- there was an overproduction of the cancer cells, but the other cells in the body were not able to fully mature, so there were many cancer cells and fewer healthy cells than normal. I was amazed at how many different cases and experiences with the same cancer there can be, and how different an individual's experience with the disease may be-- leading to the need for different treatments for different people. 

    1. I agree that it is crazy how many different types of the same kind of cancer there can be but it kind of makes sense when you look at what is happening with the cells.  A cancer cell itself if a mutation of a type of cell found in the body.  As that cell divides it creates more and more cells, each with it's own possible mutation and each dividing uncontrollably.  It's like when you look at the worlds population.  Each of us is similar but no two people are the same.  It makes sense that are cells would't be the same and even more sense that our abnormal cells wouldn't act the same either.  It just brings it home how individualistic a disease cancer is.

  8. One thing that surprised me the most was that the Nuremberg code for human experimentation which requires a voluntary consent from patients wasn't even drafted until late 1947. Think of how long people had been doing medical procedures. Up until that point, doctors weren't required to inform their patients if they were using a toxic, experimental drug and almost never were children informed. To me, that is incredibly crazy not to know what exactly is going into your body and what it might do. And I would also want to know what people were thinking going to the doctor for their sick child and having them not know what was going on. Today, not only are doctors very careful and explain everything about a procedure to their patient, patients are also made to sign a form that they know every pro and con to the situation. That's just how careful we have become and to think that it wasn't even close to how things were just amazes me.

    1. I was surprised by this lack of doctor-patient communication as well. It is hard to think about not needing to consent to the use of an experimental drug in our day and age. However, this makes me wonder what the future of consent and communication between doctor and patient holds. If we are shocked over the methods used by doctors a century ago, will people be shocked at the current methods a century from now? Or have we reached a plateau in this area? 

    2. I also found this to be a shocking theme throughout the book. The amount of testing and surgery that was practiced on unsuspecting patients surprised me, considering the fact that most of these procedures were sooner to end in death than the actual disease. Today such experimental procedures take years and years of government approval, legal documents, with very few experiments ever making it to the human level. It makes me wonder how different the time period in which these discoveries of cancer would have been had it not been for a lack of the Nuremberg code pre World War II. Would scientists still have made the same discoveries, or could it be argued that the current regulations on new discoveries is actually hindering our ability to find new ways to tackle cancer? 

  9. I found it really interesting how Dr. Mukherjee personified cancer.  In chapter 4, "A Private Plague," Mukherjee describes cancer as a nonconformist, individualistic, an expansionist disease.  By describing cancer, it's traits, abilities, and motivations, Mukerjee helps us to better understand just what cancer is and what makes it different to other diseases such as tuberculosis.  This personification draws on human nature to demonize illnesses but also unmasks the disease so we can better understand it and learn how to deal with it.  It is surprising to me how long it took to get to this level of understanding.  Scientist and Doctors seemed to get stuck for long stretches of time on the last great idea.  Hippocrates theory of four main humors lasted from Ancient Greece to 1793 when Baillie found no evidence for black bile in even abnormal anatomy.  Anesthesia and antibiotics increase the survival rates of surgeons patients but this leads to radical surgery.  Surgeons like Halsted raced to make a name for themselves by removing more and more form the human body without checking to see if their data supported their ideas.  Radiation therapy was turned on to max power in order to destroy cancers but was still unable to combat those that had metastasized.  It took outsiders like Farber, Young, Elion, and Yella to break away from the common practices and find new solutions to the cancer problem.  As we move forward with a more informed society, I think that public concern will keep cancer research in check and focused on a permanent cure rather than short lived fame.

    1.      Personifying cancer was an interesting strategy. The personification makes cancer feel like an entity, especially when examined across the course of history. Many see cancer as a purely modern disease, or if not that just another illness, but looking at Dr. Murkherjee's work, cancer shifts to a morbid companion of human society. 

           Much of the medical and scientific knowledge "established" by the Ancient Greeks and Romans, even if it was completely inaccurate, remained unchallenged for millennia. Turning that onto modern knowledge, the same thing is likely happening in ways we just can't see. 1000 years from now, how archaic will our modern knowledge be? Also highlighted here is the realization that science often moves in leaps and bounds, and not at a steady rate. 

  10. One section of this excerpt that particularly captured my mind was "A Private Plague." Specifically, when Mukherjee delves into the extreme defense abilities of the cancer cell. He explains that generations of cells are created via uncontrolled growth, yielding limitless cell division and survival. Every generation of these cells has a group that carry different genetics from their parents. A form of Darwinian selection takes place when the cells come under attack, leaving the the fittest of them all to survive and continue the cycle of growth. This power of illness wrenches my stomach yet intrigues me at the same time. Mukherjee possesses a similar fascination, as he follows this paragraph with the idea that his book was becoming less of a history of cancer, and more of the biography of cancer- with its abilities reaching beyond that of something that could fall under the category of "illness." Mukherjee putting his own realizations into words in these few paragraphs provided me with my own realizations of how significant this illness really is. It spans through decades and continents, with the ability to kill like no other. I believe it will take similar time, space, and cooperation to develop something to wipe out what has evolved with us over all this time.

  11.      That was a long reading, but a good one! For me, I think the most surprising aspect of the history of cancer was the idea of the "radical mastectomy" that William S. Halsted invented. Besides the horror from how gruesome procedure was, I also had a good idea of what the results of the surgery would be for all (disfigurement, decreased function in the arm) and for those who had metastasized cancer (the same disfigurement and decreased function, but no cure.) I think this type of incident highlights some of the important parts of good medicine and the dangers of going in without knowledge. First, the lack of knowledge about cancer, which was not completely Halsted's fault, resulted in a treatment that failed patients through excessive surgery for those with early stage cancer and, for those with metastasized cancer, too much of a delayed operation. There was no easy, non-invasive way to detect this metastasized cancer in Halsted's time, but surely some reasoning could have been used, since it was known that cancer could spread. Considering that there was no way to fully know if cancer was eliminated or was present in other unreachable areas of the body at the time, the best option would seem to be to eliminate the cancerous region and a significant but not excessively disablingly buffer zone. This kind of surgery also demonstrates the lengths people will go to to get well. This means that doctors have a responsibility to ensure that their treatments are effective and truly improving the quality of life for the patient. I think this part of the history of cancer and other similar occurrences in medicine should be taken as a warning that we don't know everything about medicine, even in today's much more advanced state of affairs. Without proper knowledge, doctors can take paths and treatments that are ineffective or even damaging to the patients that they are trying to cure. 

    1. I agree with everything you are saying. It was really shocking to read about how invasive this procedure was. When I first read this I thought it was a stupid and unnecessary procedure that people were doing out of desperation even thought it could almost never do any good. However, the more I think about it, I feel that it was necessary for these intrusive procedures to occur. Without mistakes and horrible outcomes, we will never make any progress in medicine. Take bloodletting – it was never going to work, but people tried it because they believed it could help. The tragic deaths of the patients who underwent bloodletting eventually, with lots of time and studying, proved that this was not the correct way to go about treating anything, and it advanced medicine by taking out a worthless procedure and creating reason to study harder and deeper. I think that seemingly stupid and worthless procedures are actually necessary in science in order to eventually realize that there is something wrong, and to eventually change it. Who knows, maybe something we are doing now will seem as intrusive and gruesome to people in the future as this mastectomy seems to us.

      1. Yes! Your point on the unfortunate, but sometimes necessary gruesome treatments was something I was thinking of expressing but didn't get to. Thanks for elaborating on that! 

  12. What I found significant was the fact that cancer had been a relatively unknown illness. Personally, I've only ever known cancer to be the worst of the worst. There have been so many instances of it in all types of media, from music to movies, that the thought of cancer not being a medical priority was completely alien at first. Of course, for the majority of human history, cancer was not at the forefront of medicine, as described in the excerpt. 2000 years passed between Imhotep's description and cancer's appearance in Herodotus's Histories. People weren't living long enough for cancer to truly become the substantial threat to human health. But what really surprised me, was the fact that cancer research and funding fell off so sharply as WWII broke out. Right as a national effort to battle cancer was forming, it was halted. I was surprised that Congress would never even deliver the funds to research cancer treatment, but then again, cancer did not carry the weight it does today. Overall, it was cancer's lack of historical prominence and medical importance that surprised and intrigued me.

    1. The lack of medical importance that was given to cancer is indeed surprising. I feel like we as humans have problems preventing such things (diseases, disasters etc.) before they get serious. We only take action once it has a huge impact on our lives. We can see the same scenario in the fight against global warming. Just thinking about how reckless we are towards these things makes me wonder how we survived over thousands of years as species.

  13. Since I knew nothing about cancer or its origins before reading this, basically everything was both interesting and surprising to me. Right from the beginning we read about Farber studying tissues and blood in the basement of a children’s research hospital. And as I read on, I learned that Farber made so many contributions to the future of cancer, including extending the lives of leukemia patients by up to 6 months with his antifolate, and by further studying the effects of chemicals on cancer and paving the way to modern drugs that are used today. However, other shocking news to me was the fact that there were recordings of cancer as early as 440 BC with descriptions of a bleeding lump in the breast of the Queen of Persia. I always have believed cancer to have been a modern disease. When I think of cancer, I do not think of times before the 19thcentury. But now I know that people have been working on finding a cure for cancer for thousands of years, extending from bloodletting to surgery to chemicals to other modern treatments. 

  14. The aspect of cancer that I found most striking was Claudius Galen's association of cancer with black bile. It seemed to summarize the view of cancer that has been held up until recently, as a mysterious, incurable disease, hidden in the dark as much as possible. I never realized how ancient cancer was until the reading, and part of that ignorance I think was fueled by a historic belief that cancer, because of it's incurability, should not be addressed. As put by Hunter, the only way cancer should be tackled is with "remote sympathy." The other reason why I found the association of cancer and black bile so interesting though is the fact that the only other disease Galen linked to black bile was depression. The continuing view that depression should be hidden away, not to be admitted to in public, and how people are prone to view those with depression with "remote sympathy," is eerily similar to how the book describes the history of cancer. I find it fascinating how two illnesses which are so biologically different, but both devastating to our world today, were linked by Galen in 160 CE. 

    1. For me, I was fascinated more by how long and true the black bile theory stood up without really having any proof other than the so called discovery of it by Galen. Although it was later eliminated by logical answers which the theory could not explain, people seemed to still try to cling onto the theory.

  15. I found the part where Imhotep wrote "There is none" under therapy of cancer really interesting. The nature of the disease gave him the impression that there wasn't a cure when he did actually try to find cures for other diseases. We will never know why he ended up leaving it blank but in my opinion, it shows the horrific side of cancer as a disease; it spreads and takes over our body and we can't even see what it looks like.

  16. What I found interesting in this is that we know already that radiation is a cause of cancer, but the scientists and doctors that were using radiation had no idea what harm they were putting themselves in. Had nobody figured out the dangers of radiation, our modern use of X-Ray and other medical procedures would not be where they are at today.

  17. This reading fascinated me as I have had such a basic understanding of cancer and even less so of its history. I found the most interesting peace was how cancer research seemed to be intertwined with so many other aspects of medical science, such as cellular theory, anesthetic treatments, surgeries, etc. Without this perplexing disease which drove medical professionals to advance the field we may not be as medically advanced today. What surprised me in this is how the approaches varied very widely from draining blood to radical operations. Seeing as cancer is such a ancient human disease it makes sense to concur that people have been advancing its research for a long time. The quote "If we, as a species, are the ultimate product of Darwinian selection then so, too, is this incredible disease that lurks inside us"  particularly stuck with me because it showed that as we evolve the agressive disease evolves with.

     

  18. I was interested in how the differing approaches to research, taken by Bennett and Virchow respectively, mirrors society’s gradual transition towards a scientific process in which the burden of proof is placed on the individual making the claim, lack of understanding is acknowledged, and a healthy level of skepticism is maintained throughout. As a student who intends to major in psychology, I am interested in the way that language interacts with the ways that we perceive the world around us. We often hear of the framing effect and the ways in which it can be used for persuasion. It was interesting to examine the implications of this psychological principle in the field of medicine. Not only can a specific use of language affect public perception of a disease, as was the case with the labeling of the AIDS, but also the direction which scientific inquiry takes within the medical field. It now seems all the more apparent why medical and scientific terminology tends to be very dry and calculated rather than dramatic or flower. The excerpt from “The Emperor of all Maladies” describes this language as having a degree of humility which stood in contrast to the grandiose and typically unfounded medical claims which were so common in Virchow’s era.