When I first started this blog, I have to admit that I never thought to do book reviews. While the material I tend to talk about has more to do with forensics, science and history, this particular review came as a suggestion by one of my crit team members. Following the post on the recovery of Tsar Nicolas II and his family, Jenny and I had a discussion about The Immortal Life of Henrietta Lacks, the narrative non-fiction retelling of Henrietta Lacks’ life and the immortal cell line, HeLa, that arose from her cervical tumor. Jenny was curious about my impressions of this book, both from the standpoint of someone who writes science for the layperson, but also as someone who has personally worked with HeLa cells. I was happy to take up her challenge.
The Immortal Life of Henrietta Lacks was one of the top non-fiction books of 2010 and was awarded the 2011 Best Book Award by the National Academies of Science. It tells the dual-track stories of Henrietta Lacks through the 1940s and 1950s, and her family through the 1990s and early 2000s, mostly through the experiences of Henrietta’s youngest daughter, Deborah.
Henrietta was born in 1920 to poor parents in Roanoke, Virginia. After her mother died in 1924 while giving birth to her tenth child, Henrietta and her siblings moved to Clover, Virginia, where they were split up amongst different members of the family. Henrietta was raised by her grandfather, alongside David Lacks, her first cousin. Henrietta and David had their first child together when Henrietta was 14 and they later married when she was 21. They had five children together, the last being born only four months before her diagnosis.
Henrietta was diagnosed with cervical cancer at Johns Hopkins Hospital in Baltimore when she was only 31 years old. She underwent the current cancer treatments of the day, but, in the end, they proved unsuccessful. Henrietta died on October 4, 1951, a scant eight and a half months later. An autopsy performed following her death showed that her very aggressive cancer had metastasized to practically every organ in her body.
The book documents a fascinating tale of historic doctor-patient relationships and ethics. While Henrietta was unconscious, about to undergo her first treatment where radioactive radium was packed into her vagina to deliver ionizing radiation directly to her cervix, two dime-sized slices of tissue were excised from the tumour and sent to the lab of Dr. George Gey. In the 1950s, patient consent was not required for sample collection or use, so it’s doubtful that Henrietta ever knew about the extra procedure.
From the point of view of a scientist, this is where the book really became interesting to me. I’ve worked with HeLa cells for twenty years; they’re a staple in any cellular biology lab. More than that, from a personal research standpoint, they played a crucial role in discovering how HIV infects human T-cells, opening up the possibility of treatments and vaccines based on that information. In a scientific world where everything arrives at the lab as sterile-packed and disposable plastic, the challenges of culturing cells in 1951 were fascinating. Up to that point, no one had been able to produce an immortal human cell line (cells that can live long-term outside the host; most died in only a few days), and all cell culture was done using autoclaved glass dishes and equipment. There weren’t even any commercially available culture media; Dr. Gey created his own, and had to regularly visit slaughterhouses to collect chicken serum for his homespun recipe.
Henrietta’s cells did something that no other human tissue cultures had done before ― they not only survived the culture process, but they grew and thrived. The cell line established from these cells was called HeLa, based on the first two letters of Henrietta’s first and last names (something that would never be done today as it violates patient confidentiality). In an effort to further scientific discovery, Dr. Gey sent samples of the cells to anyone who requested them. In very short order, HeLa was a worldwide phenomenon.
HeLa has been used for some of the most important biological research of the past 60 years. In the 1950s, Dr. Jonas Salk used HeLa cells to test the first polio vaccine. Much later, HeLa cells were used in cancer research to discover telomeres, the repetitive sequences on the ends of chromosomes that in a normal cells shorten with each division and, when gone, signal cell death. Telomeres are maintained in cancer cells, allowing for out-of-control growth of those cells. HeLa cells have been used to determine the damaging effects of radiation, to establish procedures for in vitro fertilization, and were even sent into space to determine the effects of zero gravity on human cells. The HeLa cell line has been a crucial part of the scientific community since it was established, outliving Henrietta by twice her own life span so far.
Henrietta’s family was not aware that samples had been taken in 1951 and that her cells were still alive decades later. In 1976, after an article was published in Rolling Stone about the cells, they became aware that a part of Henrietta was still alive, 25 years after her death.
Ms. Skloot spends a large portion of the book detailing the family’s struggles with the existence of the cell line. While companies were selling the cells for hundreds of dollars a vial (current price is $279 USD from the ATCC), the Lacks family lived in poverty and couldn’t afford health insurance. It caused an immense amount of stress for the family once Henrietta’s name was released to the public, leading to ill health and finally a stroke in Deborah. To date, the family has received no compensation for any profits made from Henrietta’s cells.
The Immortal Life of Henrietta Lacks is a fascinating read. For me, the most interesting part of the book was the early days of cancer treatments, tissue culture, and the scientific progress that came from the cell line. In discussions with other scientists, I’ve seen a consensus of opinion ― that in long sections in the last third of the book, the storytelling dragged a bit when it centered around Henrietta’s family and their struggles. But I suspect for the non-science crowd that might be the part of the story they’d really connect with. Ms. Skloot does an excellent job of explaining the science of cell culture and research for the layperson, but kept the level advanced enough that those of us in the field stayed interested and involved.
There are some very complex issues that are brought to light in the book. Was it ethical to take Henrietta’s cells without her consent? Does the fact that these cells have been crucial in progressing scientific knowledge negate the fact the cells were taken without her knowledge or that her personal and family medical details were released as public information? Should the family receive compensation considering the current commercial value of the cells? It was many decades before consent was required for human sample collection, but ownership of those samples is now in question. So far, the courts have decided that once the sample is removed from a patient, it is simply medical waste and that a patient has no right to it or any monies that might arise from it. They are complicated issues in many shades of grey that even the highest courts still struggle with.
For those non-science based readers who have read The Immortal Life of Henrietta Lacks, what did you think? Were the scientific aspects of the book hard slogging and was the emotional struggle of the Lacks family the heart of the book for you? For any science-oriented readers, what was your favourite part of the book?