Last night, I found myself describing to my husband and son the way that the cancer, melanoma, can invade the eye and how scientists are learning to decipher messages encoded in those tumors. Not our normal dinner conversation (mostly) but the details of a story on the subject by The New York Time's Gina Kolata had just stayed with me through the day.
Partly because Kolata's writing was so memorably graphic. Here's a line from Wednesday's story, describing the removal of a cancer damaged eye: "He took the eyeball to a metal table and cut it open. It was filled with what looked like slices of brown olives, the melanoma. A fluid squirted out, the vitreous. Normally it would be clear and jellylike. But cancer had made it liquid and the color of weak tea."
Partly, because the story was so human, not just about doctors' decisions but about patients' as well. In the tale of ocular melanoma, researchers have learned that a genetic profile of a tumor offers strong clues as to how quickly the disease may turn deadly. But "can patients in the throes of getting this terrifying news really make an informed choice about whether they want the test?" asks Kolata.
And I liked this story - the last of three in a series called Genetic Gamble - because it of its precise focus. There's no grandiose claims here of diagnostic miracles. There are possibilities, even good ones, but Kolata doesn't try to stretch this beyond an examination of a doctor and his patients trying to do their best with promising but still limited tools.
And that's what I liked about the whole series - that balance of scientific promise and challenge. The first story, on Sunday, set the tone. Titled "In Treatment for Leukemia, Glimpses of the Future", it followed a research lab's genome sequencing of an aggressive leukemia to hunt for a targeted chemotherapy program. Why? The scientists were trying to save a colleague, a researcher in the laboratory in question.
And while that quest is successful, it's not the stuff of everyday medicine. It's a story of the dedication of friendship as much as a story of the possibilities of genome sequencing in cancer treatment. It's further balanced by Monday's story, the second in the series, A New Treatment's Tantalizing Promise Brings Heartbreaking Ups and Downs. Again, this is the story of a quest. But this one, an attempt to save a scientist's mother from a terrible lymphoma - fails to find salvation. By the end, the research team isn't even sure of whether they helped.
Kolata has been criticized in the past for over-hyping scientific results, here at the Tracker and elsewhere. And if you read through the comments on this latest series you'll find some of these complaints - that leukemia is too easy a target, that sequencing is more complicated than she suggests, that the genetic discoveries are hardly the newest in the pipeline. You'll find others arguing that she should have explored more of the medical ethics, looked harder at the fact that these treatments are so pricey and so complex that they are as yet available only to a privileged few.
I'm willing to stipulate that there are imperfections. But having read the series, I don't find them overwhelming. And I admire what she's accomplished in this case: a compelling portrait of a difficult science driven by personal as well as professional angst, of a devastating disease beginning, perhaps, to reveal its secrets.
--- Deborah Blum