Living Medicine by Frederick Appelbaum

In the ever-evolving landscape of healthcare system development, the story of bone marrow transplantation stands as a testament to medical progress and innovation. Living Medicine: Don Thomas, Marrow Transplantation, and the Cell Therapy Revolution by Frederick Appelbaum expertly chronicles this journey. In this review, we will explore how the book addresses the development of healthcare systems, with a specific focus on the evolution of bone marrow transplantation. Join us as we uncover the challenges, triumphs, and enduring impact of this transformative medical procedure.

His extensive body of work spans from investigating fundamental molecular irregularities related to the disease to overseeing both national and international research endeavours focused on its treatment. Dr. Appelbaum has previously held the role of chair for the National Cancer Institute’s Board of Scientific Advisors and is an esteemed member of the National Academy of Medicine.

Living Medicine by Frederick Appelbaum offers a captivating account of the remarkable journey undertaken by an oncologist and haematologist Dr. Don Thomas in pioneering bone marrow transplantation as a viable treatment for various forms of acute leukaemia and genetic bone marrow disorders. This narrative delves into the challenges and hurdles faced by Dr. Thomas, shedding light on his unwavering dedication to replacing defective marrow and his deep concern for both individual patient well-being and the broader implications of his research.

Dr. Thomas’s groundbreaking efforts, which built upon Nobel Prize-winning discoveries made by others, culminated in his own Nobel Prize recognition in 1990 for his pioneering work in bone marrow treatment. The book masterfully combines the personal and scientific aspects of this journey, making it accessible and engaging for readers with varying levels of medical knowledge.

For the author, this story holds a personal connection, as he tragically lost a niece to lymphoma, who had been eligible for a bone marrow transplant at the Cancer Research Center where Dr. Thomas worked. Living Medicine provides valuable insights into the criteria for such transplants and the critical importance of finding compatible donors, shedding light on the author’s own frantic search for their niece’s biological family.

Readers should be aware that the book does not shy away from the realities of medical research, including the significant suffering and sacrifices endured by both humans and animals in the pursuit of advancements in bone marrow transplantation.

• Introduction
• 1. Atomic Bomb Disease
• 2. The Shielded Spleen

Don Thomas’s groundbreaking work in bone marrow transplantation began in the 1950s when he envisioned the possibility of using marrow transplants to treat hematologic diseases. Despite facing scepticism and obstacles, Thomas’s unwavering dedication to the idea led to the first successful marrow transplant in 1960 from an identical twin, paving the way for further breakthroughs in HLA-compatible transplants. His vision and persistence laid the foundation for the revolutionary field of bone marrow transplantation, which has since saved countless lives.

In the early days of bone marrow transplantation, the procedure offered hope to patients with end-stage leukaemia, albeit with significant risks and challenges. The treatment’s success rate was low, and patients often faced complications such as infections and mucositis.

The ethical dilemma of whether to pursue transplantation with limited chances of success or opt for palliative care raised complex questions. This period reflects the tension between medical innovation and patient well-being, emphasising the importance of patient choice in life-threatening situations.

Don Thomas’s work extended beyond marrow transplantation, encompassing the development of comprehensive supportive care measures. His approach involved assembling multidisciplinary teams to address the major complications associated with transplantation, including infections, malnutrition, and social disruptions.

Thomas’s emphasis on nurses as a “secret weapon” and his dedication to creating specialised wards demonstrated the holistic approach required for successful transplantation. His legacy not only transformed marrow transplantation but also catalysed a broader revolution in cell therapy, changing the landscape of modern medicine.

Strengths

Weaknesses

“When Thomas first developed allogeneic transplantation, the roles of central tolerance and negative selection weren’t understood. Early after transplantation, donor B and T cells within the transplanted marrow possessing receptors that recognize the patient’s cells become activated.”

“One of the better-known spontaneous remissions occurred in 1885 in a patient named Fred Stein, a thirty-one-year-old with a sarcoma (a tumor arising from muscle, bone, or fat) growing in the left side of his neck. Surgery was unsuccessful in removing the tumor, and after the operation, the surgical wound became infected with Streptococcus pyogenes, an often deadly complication of surgery in the pre-antibiotic era. Infections with S.pyogenes can result in erysipelas, a syndrome in which patients develop a fiery red rash, raging fever, and unrelenting cycles of chills and sweats, often ending in death. According to the hospital records, not only did Stein eventually recover from erysipelas, but as he did, his tumor melted away. The story of Fred Stein might also have melted away if it hadn’t caught the attention of a surgeon, William Coley.”

Where to buy

You may purchase Living Medicine on Amazon at the best price. It is available in hardcover, audio and Kindle versions, so you may choose an option that appeals to you the most.

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