The Occasional Reader

Short abstract

The editors of The Oncologist offer suggestions for summer reading of books that provide insight into our field of endeavor, our civil discourse, and our personal lives.

With the advent of summer, the editors of The Oncologist have taken time out to read several outstanding books that provide dramatic insights into our field of endeavor, our civil discourse, and our personal lives. We offer the following examples.

The first, Ravenous by Sam Apple [1], a New York Times magazine writer, tells the strange and even incredible story of Otto Warburg, the discoverer of the classical Warburg effect of tumor metabolism. Warburg was a descendant of the famous Warburg banking family with roots in Warburg, Germany, and grew up in opulent surroundings and with imperial tastes. His early interest in sea urchin eggs led to his later observation in the 1920s that tumor cells show an unexpected dependence on fermentation, later defined as glycolysis, rather than on oxygen‐mediated breakdown of glucose. Warburg, as a Jew of mixed parentage (father Jewish, mother Christian), managed to sustain his laboratory at the Kaiser Wilhelm Society, supported by generous grants from the Rockefeller Foundation. His work continued throughout the period of Nazi rule and the Second World War, ostensibly because Adolf Hitler and other leading Nazis were desperately afraid of cancer and believed that Warburg's insights into the role of diet in cancer causation would lead to prevention and cure of the disease. Despite constant threats from Nazi officials, he and his research laboratory survived the war and remained productive during those impossible years. As a scientist he had significant flaws: an inability to admit when he was wrong, an intolerance, even loathing, for his “competition,” and an imperious personal demeanor. Attributing cancer causality to byproducts of glycolysis, he drew grandiose conclusions from minimal data but spurred interest in metabolic pathways that have become targets of great interest to present day cancer research. The book provides many interesting aspects of his interaction with Hans Krebs, a former student in his laboratory who left for England shortly before the war and elucidated the oxidative pathway of glucose metabolism. Warburg's work also inspired Emil Fischer, the father of organic chemistry, to search for inhibitors of glycolysis. In his later chapters, the author relates Warburg's discovery to the transformative recent work of Craig Thompson, Matt Vander Heiden, and Lewis Cantley, all of whom have greatly extended our current understanding of cancer cell metabolism. The hope for a “magic bullet” derived from this understanding is still elusive. The life and work of Warburg, his scientific findings, and the intense past and current interest he evoked in cancer metabolism and diet form a fascinating story of great relevance to current cancer research.

In sharp contrast to the privileged upbringing of Warburg and his willingness to abide by the despotic regime in Germany, the story of Frederick Douglass, as detailed in a recent biography by Professor David Blight of Yale [2], is equally instructive for our current generation. Douglass was an escaped slave, a self‐taught orator, and 19th century advocate for freedom and equality for Blacks in the U.S. and abroad. A man of impressive bearing and prodigious talent as an author and orator, he wielded remarkable authority in the pre–Civil War abolition movement and influence in post–Civil War politics. His speeches retain their relevance to the current concerns for racial equality and the dangers of inherent cultural racism in this country. In his famous speech, “Our National Capital” (1877), he accurately foresaw the resurgence of racism through disenfranchisement of Blacks and the failure of the federal government to enforce equality in the recalcitrant states. The Blight biography is in essence a history of the winning and then losing of the Civil War, a war still being fought on legal battlefields and in the hearts and minds of Americans. This is a long book, more than 750 pages, but throughout, it commands the reader's attention to the spoken and written words of Douglass, which have immediate relevance to racial justice still unrealized in our current society.

Two other books caught my eye and deserve mention. First, The Twilight of Democracy by Ann Applebaum [3] provides a searing and very personal history of the growth of totalitarian regimes in Poland, Hungary, and other Eastern European countries in recent years. Applebaum, a Yale graduate and political and cultural historian, is married to a conservative Polish lawyer who was active in his country's politics over the past 30 years. She vividly describes the role of misinformation, the “big lie,” in undermining democracy in Poland and, in the process, disrupting her personal friendship with centrist intellectuals who became outspoken proponents of authoritarian regimes. It is a short book, devoted to personal experiences during this period of political upheaval, but her warnings about how easily democracy can be lost are frightening and real.

And second, for those who are devotees of American theater, I recommend the biography of Tennessee Williams by John Lahr [4], an incredibly thoughtful work that offers insights into the dysfunctional family and adult relationships that became the motivation for his plays. I found it particularly interesting to watch the movie versions of “The Glass Menagerie,” “A Streetcar Named Desire,” “Night of the Iguana,” and “Suddenly Last Summer” after reading relevant sections of the book. The overbearing mother, the abusive father, the suicidal sister, and the besieged, besotted, and addicted protagonist are all there in a strange mixture of characters and personalities. Also present in this biography are the major personalities of the post–World War II American theater, including Williams’ longtime producer on Broadway, Elia Kazan, fellow playwrights William Inge and Arthur Miller, and the star that first shone in “A Streetcar Named Desire,” Marlon Brando, among many other notables. In essence it is a history of the transformation of the American theater from entertainment to the intense and often uncomfortable dissection of interpersonal relationships.

A final note. Jean Becker's very personal homage to George H.W. Bush, 41, The Man I Knew, has just been published [5]. Jean served as his Chief of Staff for the more than 2 decades of his post‐presidency years, perhaps the most rewarding of his long career as a statesman, exemplary American, and tireless supporter of cancer research. As Becker writes, “He lived what he preached: Any definition of a successful life must include serving others.” She goes on to describe how Bush “rebuilt his life” and “found a way to continue making a difference.” “This is the story of Bush's modest journey from president to a man of the people and how, after his emotionally draining and heartbreaking defeat to Bill Clinton in the 1992 presidential election, he found a way to make a difference. By the time of his death in November 2018, he was one of the most admired, respected, and beloved former statesmen.” President Bush founded the CEO Roundtable on Cancer in the U.S. and its counterpart in China. These are lasting tributes to him and in memory of the 3‐year‐old daughter, Robin, whom he and Barbara lost to childhood leukemia in 1953. I had the pleasure of walking the last holes of the 1999 Ryder Cup with 41 and, subsequently, learned of his friendship with The Oncologist's deputy editor, Marty Murphy, who is founding chief executive of the CEO Roundtable in the U.S. and China.

Take your pick. They are all worth reading.

Disclosures

Bruce A. Chabner: PharmaMar, EMD Serono, Cyteir, Eli Lilly & Co., Chugai Pharmaceuticals, Takeda (C/A), Cyteir (H), Biomarin, Seattle Genetics, GlaxoSmithKline, PharmaMar, Loxo, Blueprint, Immunomedics, Constellation, Bluebird, Alnylam, SpringWorks, Forty Seven (OI), Eli Lilly & Co., Genentech (ET)

(C/A) Consulting/advisory relationship; (RF) Research funding; (E) Employment; (ET) Expert testimony; (H) Honoraria received; (OI) Ownership interests; (IP) Intellectual property rights/inventor/patent holder; (SAB) Scientific advisory board