The Song of the Cell: An Exploration of Medicine and the New Human
71 pages • 2-hour read
Siddhartha MukherjeeThe Song of the Cell: An Exploration of Medicine and the New Human
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Prelude-IntroductionChapter Summaries & Analyses
Prelude Summary: “‘The Elementary Particles of Organisms’”
Mukherjee begins the book with the story of how German botanist Matthias Schleiden and German zoologist Theodor Schwann discovered cell theory. Over dinner one evening, the two scientists discussed the origin and evolutionary development of plants or phytogenesis. Schleiden told Schwann about two important discoveries he uncovered while examining the structure and development of numerous plant tissues. The first was that all plant specimens had a nucleus, or subcellular structure. The second was that the plant tissues had a “deep uniformity” (xiv), which Schleiden called cells. Similarly, Schwann had discovered cells in a developing tadpole and identified a nucleus within the cell. Mukherjee notes that “the two friends had converged on a universal and essential scientific truth: both animals and plants had a ‘common means of formation through cells’” (xiv). For this reason, Schleiden and Schwann are considered the founders of cell theory—the theory that all living beings are made up of cells.
Introduction Summary: “‘We Shall Always Return to the Cell’”
Mukherjee introduces his friend and patient Sam P., who died from melanoma cancer. The cancer started from a mole on his cheek, which had been there for years. Like many people, Sam repeatedly asked Mukherjee “how, how, how […] a cell that had sat perfectly still in his skin for decades” (1) turned into cancer. The answer lies in the malfunction of cells.
Mukherjee initially prescribed Sam a drug to help his T cells fight the cancer cells. T cells are a type of white blood cell that is part of the body’s immune system and develops in the bone marrow from stem cells. The drug that Mukherjee prescribed for Sam made the cancer cells visible to the T cells. The goal of the drug was to “make visible what had previously been invisible” (2).
The drug initially worked and helped reduce the size of the tumor. Unfortunately, the cancer returned with a vengeance and spread to other parts of Sam’s body; in addition, the drug caused autoimmune hepatitis (inflammation of the liver that resulted from the T cells erroneously attacking liver cells). The doctors tried to treat the autoimmune hepatitis with immune-suppressive drugs, but this caused the cancer to continue growing. To slow the cancer’s spread, the doctors halted the immune-suppressive drugs and restarted immunotherapy to attack the cancer cells, but this resulted in the return of autoimmune hepatitis. As Mukherjee notes, “It was like watching […] bestial warfare: put the immune cells on a leash, and the animals would strain against their chains to attack and kill. Unleash them, and they would indiscriminately attack both the cancer and the liver” (3). Sam was unable to win this war.
Mukherjee turns next to the story of Emily Whitehead. At a young age, Emily was diagnosed with acute lymphoblastic leukemia (ALL), one of the most aggressive forms of cancer that primarily impacts young children. She was cured through a novel approach in which her T cells were extracted, modified, and reintroduced into her body. This treatment represented a breakthrough in cellular therapy.
Emily and Sam’s stories illustrate an emerging way to battle illnesses, which is cellular engineering. In both cases, researchers manipulated cells—and essentially manipulated the individual. As a result, cellular engineering produces “new humans.” Mukherjee defines new humans as “a human rebuilt anew with modified cells who looks and feels (mostly) like you and me” (8).
On the premise that cells are the building blocks of life, Mukherjee begins to explore the question “What is ‘life’” (10)? He emphasizes that researchers still struggle to define the term “life.” The working definition is that life is “a series of things, a set of behaviors, a series of processes, not a single property” (10). Nevertheless, one can’t truly understand life without understanding cells. While science has come a long way in understanding cells, there is still much to learn.
For this reason, Mukherjee examines the cell. Cells fulfill three roles. The first is that they decode genes. Genes, which are located in the double-stranded, helical molecule called deoxyribonucleic acid (DNA), contain instructions that tell the cells to build proteins. Proteins perform numerous biological tasks in the cell. Tightly packed DNA forms chromosomes inside the nuclei of cells. Without cells, genes would be lifeless, akin to “a lonely library with no one to read the books within it” (12).
The second role of cells is to integrate genes. Cells coordinate the different sets of proteins into specific behaviors (e.g., attacking foreign invaders, metabolism, and movement). These behaviors define an organism.
The final role of cells is to replicate; cells are dividing machines. Cells divide continuously in the body. Splitting DNA as perfectly as possible is the primary goal of cell division. Healthy cells divide in a controlled manner, proceeding only when the conditions for division are right. Unhealthy cells, including cancer cells, divide in uncontrolled ways. Mukherjee notes that “cell division is what drives growth, repair, regeneration, and ultimately reproduction, among the fundamental, defining features of life” (12).
Prelude-Introduction Analysis
The introductory sections of The Song of the Cell provide an important overview for the perspective of the book as a whole. In the Prelude, Mukherjee explains the development of the book: What began as three articles for The New Yorker magazine, published between 2017 and 2021, eventually became a 377-page book, split into six parts. Mukherjee notes that “each part of the book takes a fundamental property of complex living beings and explores its story” (15), including the history of its discovery and the new cellular technologies that stem from it. Using these parts or mini-histories, Mukherjee builds a compelling argument of the foundational role of cells in humanness and how manipulating cells (the very essence of being) is transforming not only medicine but also human beings themselves.
Mukherjee then begins to explore several key themes that recur throughout the book. One theme is Breakthroughs in Biology and the Evolving Understanding of Cells, which he illustrates using the story of Schleiden and Schwann. While earlier scientists viewed cells and realized that they were likely the building blocks of living beings, Schleiden and Schwann were the first to make the connection “that a deep unity of organization and function ran through living beings” (xv). Mukherjee considers this a significant moment—the discovery radically altering researchers’ understanding of cells, a change that led to many advances in biology and medicine.
Mukherjee uses the different treatments for Sam and Emily’s cancers to further investigate breakthroughs. In Sam’s case, he received treatment that activated “immunity inside his body” (5). This drug was known as an “uncloaking medicine” since its purpose was to help Sam’s T cells recognize the cancer cells as invaders and attack them.
Emily’s treatment, in contrast, used her “T cells that had been extracted and grown outside her body” (5). This was a novel treatment. Emily was among the first patients to receive it. Researchers extracted Emily’s T cells and modified a portion of them to recognize and kill her cancer. Once this modification was complete, researchers re-injected Emily with her modified T cells. Emily nearly died, but the treatment was ultimately successful and revolutionized how oncologists could treat this rare and aggressive form of leukemia. The treatments for both Sam and Emily were possible only because of advances in the scientific understanding of the T cell since the 1950s. While these treatments show how far the field has progressed, Sam’s ultimate death emphasizes how much more there is to understand about manipulating cells.
Another theme that Mukherjee begins to build is What It Means to Be Human. From the beginning of the book, Mukherjee establishes that cells are the building blocks of life. To understand humans, one must understand cells. Nevertheless, cell manipulation and reengineering mean that science is altering the essence of humanness. Mukherjee suggests that Emily and Sam are “new humans.” They’re mostly the same as humans but with some modified cells. Mukherjee hints that all people will likely be new humans in the not-so-distant future.
Mukherjee emphasizes the importance of reframing the human body as a cellular ecosystem. Humans are built from the coordination of cells. For this reason, humans are “ecosystems of these living units” (9). This reframing led to transformations in the field of medicine based on cell manipulation. He identifies four applications that reflect this transformation. The first is the use of stimulants, chemical substances, and drugs to manipulate cells. The second is the transfer of cells from one human body to another (e.g., bone marrow and blood transplants and in vitro fertilization). The third is the use of cells to create a treatment that impacts an illness caused by cell malfunction. The final category is the creation of cells, organs, and human bodies through genetic modification and transplantation of cells. These advances in cell therapy are changing the understanding of What It Means to be Human.
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