If [TeLinde] could prove that carcinoma in situ and invasive carcinoma looked and behaved similarly in the laboratory, he could end the debate, showing that he'd been right all along, and doctors who ignored him were killing their patients. So he called George Gey [...] head of tissue culture research at Hopkins. (30)
There's a whole lotta science happening in this book, so hold on tight. This first bit is crucial to understand. The understanding of cancer staging was still pretty basic in Henrietta's day, so we fully appreciate the contribution of HeLa cells to research. With Henrietta's cells, TeLinde could see just how cancer cells metastasized and became even more deadly.
The Geys were determined to grow the first immortal human cells: a continuously dividing line of cells all descended from one original sample, cells that would constantly replenish themselves and never die. (30)
Explanation Alert!!! Make sure you don't miss this one, or you'll miss the core issue in Henrietta Lacks' story. Gey knew the importance of having an immortal cell line for scientific research: scientists could conduct experiments repeatedly and see how the human body would react on the cellular level without using actual humans. And this is good, because infecting actual people with major diseases isn't nice.
The pouches were called Brack plaques, after the Hopkins doctor who invented them and oversaw Henrietta's radium treatment. He would later die of cancer, most likely caused by his regular exposure to radium, as would a resident who traveled with Kelly and also transported radium in his pockets. (32)
Radium, used in research and treatment, killed a lot of people back in the day; its dangers weren't widely appreciated. Even today, treatments involving radiation and chemo create secondary cancers. It's a risk we now know more about, so patients are informed about the possibility. That in itself is a huge advance.
Finding the perfect medium was an ongoing experiment, but the biggest problem facing cell culture was contamination. Bacteria and a host of other microorganisms could find their way into cultures from people's unwashed hands, their breath, and dust particles floating through the air, and destroy them. (36)
George and Margaret Gey knew what they wanted to achieve: an immortal cell line that could be constantly replenished in the lab for research purposes. But getting to that point required a lot of hoop-jumping and a fair amount of improvisation. Both George and Margaret had to adapt their lab techniques based on what they knew from surgical procedures and from the mistakes that they inevitably made in the lab. That said, it's kind of a miracle things worked out at all.
[…] Henrietta's cells weren't merely surviving, they were growing with mythological intensity. By the next morning they'd doubled. Mary divided the contents of each tube into two, giving them room to grow, and within twenty-four hours, they'd doubled again. Soon she was dividing them into four tubes, then six. (40)
Mary Kubicek, Gey's lab assistant, was perfectly ready for Henrietta's cancer cells to die in culture as all other cells before them. But at this moment, she was beginning to realize that they had a winner; Henrietta's cancer was wicked strong. Mary doesn't realize it, but the person who those cancer cells had come from was about to suffer one of the most aggressive cases of cervical cancer anyone at Hopkins had ever seen.
The reason Henrietta's cells were so precious was because they allowed scientists to perform experiments that would have been impossible with a living human. They cut HeLa cells apart and exposed them to endless toxins, radiation, and infection. They bombarded them with drugs, hoping to find one that would kill malignant cells without destroying normal ones. (58)
Skloot is really careful to explain to us—more than once—why HeLa cells are da bomb. For one thing, they were plentiful: HeLa cells grew like "crabgrass." And this meant that scientists all over the world had a never-ending supply on which to conduct experiments. By doing all this crazy stuff to HeLa, research didn't have to be conducted on humans.
Tissue culture was the stuff of racism, creepy science fiction, Nazis, and snake oil. It wasn't something to be celebrated. (62)
This was the legacy of Alexis Carrel and his "immortal chicken heart." Carrel did contribute a great deal to the practice of surgery. But his association with Hitler and the fact that his "immortal" chicken cell line was really contaminated with other cells didn't help the scientific community's credibility when it introduced HeLa to the rest of the world. Like we said, scientific progress never occurs in a vacuum. There's always a historical and cultural context.
If researchers wanted to figure out how cells behaved in a certain environment, or reacted to a specific chemical, or produced a certain protein, they turned to Henrietta's cells. They did that because, despite being cancerous, HeLa still shared many basic characteristics with normal cells […]. (97)
This is key thing for us to understand about HeLa cells: they succeeded in culture precisely because they are cancer cells, which have no limit to how many times they can divide and multiply. And yet they're still useful because they're human cells. This is a hard truth for Deborah and Zakariyya to accept when they first see the HeLa cells in Lengauer's lab, since they expected the cells to have been a "normal" part of their mother.
In the early fifties, scientists were just beginning to understand viruses, so as Henrietta's cells arrived in labs around the country, researchers began exposing them to viruses of all kinds—herpes, measles, mumps, fowl pox, equine encephalitis--to study how each one entered cells, reproduced, and spread. (98)
Skloot wants us to understand the serendipity of George Gey's cultivation of HeLa cells at just this moment in medical research history: the knowledge of viral mechanisms was just emerging, but there was so much more to learn. It was hugely helpful that HeLa cells were so easy to grow in culture when there was such an enormous demand for them.
Scientists wanted to grow cellular clones—lines of cells descended from individual cells—so they could harness those unique traits. With HeLa, a group of scientists in Colorado succeeded, and soon the world of science had not only HeLa but also its hundreds, then thousands, of clones. (100)
Skloot explains that individual cells in a single body, while similar, make their own proteins and behave differently. It was important for scientists to be able to isolate desirable traits and copy them for future use. But cellular cloning is quite a different thing than making a Xerox copy of a complete human being. The confusion over this led Deborah to suffer a lot of anxiety about the "cloning" of her mother.
I later learned that while Elsie was at Crownsville, scientists often conducted research on patients there without consent, including one study titled "Pneumoencephalographic and skull X-ray studies in 100 epileptics [...]. " Pneumoencephalography involved drilling holes into the skulls of research subjects, draining the fluid surrounding their brains, and pumping air or helium into the skull in place of the fluid to allow crisp X-rays of the brain through the skull. (275-276)
Skloot uncovers the nature of the scientific experiments at the institution where Elsie lived until her death in 1955, all conducted without consent of the family or the patient. She also assumes that Elsie was probably a subject in these horrific experiments, since she was one of the patients with epilepsy. The takeaway from all this? These abuses happened because no one cared about the marginalized and "inferior" patients of Crownsville. Alexis Carrel would have approved.