The First Cell: And the Human Costs of Pursuing Cancer to the Last
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- Update Date：2025-09-06
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- Author：Azra Raza
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Summary
With the fascinating scholarship of The Emperor of All Maladies and the deeply personal experience of When Breath Becomes Air， a world-class oncologist examines the current state of cancer and its devastating impact on the individuals it affects -- including herself。
In The First Cell， Azra Raza offers a searing account of how both medicine and our society （mis）treats cancer， how we can do better， and why we must。 A lyrical journey from hope to despair and back again， The First Cell explores cancer from every angle: medical， scientific， cultural， and personal。 Indeed， Raza describes how she bore the terrible burden of being her own husband's oncologist as he succumbed to leukemia。 Like When Breath Becomes Air， The First Cell is no ordinary book of medicine， but a book of wisdom and grace by an author who has devoted her life to making the unbearable easier to bear。
In The First Cell， Azra Raza offers a searing account of how both medicine and our society （mis）treats cancer， how we can do better， and why we must。 A lyrical journey from hope to despair and back again， The First Cell explores cancer from every angle: medical， scientific， cultural， and personal。 Indeed， Raza describes how she bore the terrible burden of being her own husband's oncologist as he succumbed to leukemia。 Like When Breath Becomes Air， The First Cell is no ordinary book of medicine， but a book of wisdom and grace by an author who has devoted her life to making the unbearable easier to bear。
Reviews
Abby Mueller
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Thoughtful patient narratives interspersed with calls to action against the current oncology treatment landscape。 At times the flow didn’t make much sense， but Raza’s opinions will make you think and leave you wondering “is what we’re doing enough”
Jaiden
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This review has been hidden because it contains spoilers。 To view it， click here。 The First Cell， by Dr。 Azra Raza， chronicles the emotional stories of an oncologist’s patients， friends and loved ones tackling various cancers。 These stories are intermingled with the history and development of cancer research。 Over the course of the book， Dr。 Raza exposes the apparent state of disfunction within the cancer research field。 Between antiquated and inaccurate mice models， to misplaced intentions fueled by funding， to low efficacy standards within regulating agencies， I am alarmed The First Cell， by Dr。 Azra Raza， chronicles the emotional stories of an oncologist’s patients， friends and loved ones tackling various cancers。 These stories are intermingled with the history and development of cancer research。 Over the course of the book， Dr。 Raza exposes the apparent state of disfunction within the cancer research field。 Between antiquated and inaccurate mice models， to misplaced intentions fueled by funding， to low efficacy standards within regulating agencies， I am alarmed yet unsurprised by the lack of groundbreaking and revolutionary changes to cancer treatment。 Given the amount of money put into cancer research， I always thought the lack of revolutionary solutions was due to the elusiveness of the disease。 While this certainly plays a role， Dr。 Raza makes it clear that there is plenty of potential improvements that ARE within the capabilities of the scientific community。 The stories of patients are inspiring， emotional， heart-warming and saddening at different points throughout their treatment。 Yet， above all， these stories demand changes in the field of cancer research， for the sake of current and future patients around the world。 。。。more
Canadian Reader
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Azra Raza is a professor of medicine at Columbia University and a practising oncologist。 She specializes in and researches myelodysplastic syndromes （MDS）， which the Canadian Cancer Society describes as “a group of diseases in which the bone marrow doesn’t make enough healthy mature blood cells。” Immature blood cells—blasts—don’t function properly， and they build up in the bone marrow and blood。 Healthy red blood cells， white blood cells， and platelets are crowded out; there are fewer of them to Azra Raza is a professor of medicine at Columbia University and a practising oncologist。 She specializes in and researches myelodysplastic syndromes （MDS）， which the Canadian Cancer Society describes as “a group of diseases in which the bone marrow doesn’t make enough healthy mature blood cells。” Immature blood cells—blasts—don’t function properly， and they build up in the bone marrow and blood。 Healthy red blood cells， white blood cells， and platelets are crowded out; there are fewer of them to do their vital work。 MDS patients， who are usually older， often have debilitating anemia and require frequent blood transfusions， though some can be successfully treated with thalidomide。 MDS used to be thought of as disease of low malignant potential， pre-leukaemia， but the syndrome is now considered blood cancer。 One third of MDS patients go on to develop acute myeloid leukaemia （AML）， another disease researched and treated by the author。 In over three decades of practice， Dr。 Raza has cared for thousands of people with blood cancers。 In her book， she tells the stories of several of these patients， as well as providing accounts of bright young people with other cancers—one， an intellectually gifted family acquaintance diagnosed with an aggressive sarcoma of the shoulder; the other， her daughter’s close friend， a young man in his early twenties， stricken with a lethal glioblastoma of the spinal cord。 In a tender touch， she provides photographs of these patients， making them even more real and present for the reader。 She documents how they negotiated their illness， made medical decisions， and confronted their end。The author notes that over the years the billions of dollars directed towards cancer research have yielded valuable knowledge about its biology， but medicine has frustratingly little to show for this enormous investment in terms of actual treatments。 Most of what is offered to the AML patients she sees （as well as to those with the most common types of cancer） has changed very little over the last forty to fifty years。 Raza’s husband， cancer researcher Dr。 Harvey Preisler—who himself succumbed to lymphoma in the early 2000s and whose suffering she describes in one chapter of her book—received the same combination of drugs that was used in 1977。 Only about five percent of new cancer drugs are actually approved， and 70 percent of those provide no improvement in survival rates and are even harmful to patients。 （America’s FDA is willing to approve an agent if it can prolong survival by 2。5 months over existing treatments—even if that additional couple of months is a living hell。） Treatments that are deemed “successful” employ the same old “slash-poison-burn approach” to cancer that’s always been used。 While some novel immune therapies for lung cancer， lymphoma， and melanoma have come on the scene in recent years， they benefit only a few， and their cost is prohibitive。 Even families with insurance plans frequently lose their life savings pursuing treatment for an afflicted loved one。 Recent declines in cancer mortality rates are due to early detection—as is seen with colon and cervical cancer， for example—and smoking cessation。 Given these realities， it’s not at all surprising that Raza’s impassioned main argument in the book is that cancer research needs to radically change。 The author aptly describes cancer as an example of malevolent “intelligence at a molecular level”。 Perceiving its environment， it “takes actions that maximize its chances of survival，” becoming “stronger， smarter， and more dangerous with each successive cell division。” Many cancers are are still only diagnosed when they are quite advanced and extremely complex， having quickly transformed themselves， eliminating genes and entire chromosomes and acquiring multiple mutations。 At this point， they are next-to-impossible to successfully treat。 What is needed， says the author， is a commitment “to stop chasing after the last cancer cell and focus on eliminating the first” or， even better， “prevent the appearance of the first cancer cell by finding its earliest footprints。” She points out that oncologists and researchers are “already using sophisticated technologies to detect residues of disease that linger after treatment。” Why not harness and redirect these technologies to discover cancer early before it has laid waste to the body， she asks， pointing to the work of Bert Vogelstein’s team at Johns Hopkins， whose members are looking for the earliest markers （mutations， molecules， and metabolites） of breast， colon， lung， and pancreatic cancers in body fluids。Early in her career， Dr。 Raza treated a woman her age， a young mother in her thirties， who was terminally ill with acute myeloid leukaemia。 Heartbroken that she could do little for a patient she had quickly grown to love， she took a decisive step in 1984: She began to build an MDS-AML tissue repository， banking samples from bone-marrow biopsies in order to study how these blood cancers evolve。 Her tissue bank， which contains over 60，000 samples from thousands of patients， is the world’s oldest one created by a single doctor。 A great challenge for Dr。 Raza is actually gaining the research funds to carry out her work。 She often has to court celebrities and hold benefits to get the financial backing needed to keep her project going。The idea of actually harnessing new technology to look at “disease-caused perturbations” years ahead of their clinical appearance is not yet widely embraced by a “sclerotic” cancer industry。 Over the years a huge bureaucracy and byzantine funding process has developed around in vitro and animal studies， even though these have yielded little of practical value to patients with cancer。 Raza does not advocate for the abandonment of these studies， but she does offer an illuminating explanation of their limitations。 Cultured cells are grown in controlled environments， quite unlike their natural ones， and the cells are forced to adapt to this hostile habitat。 In time， they diverge wildly from their parents， genetically and in form and structure。 Their doubling time is also much faster。 While animal models may offer cell lines an environment more comparable to a human’s than petri dishes do， the complexity of the human environment is not fully understood and consequently can’t be replicated。 Mice and human lineages diverged approximately 85 million years ago， and human and mice genomes are only about 50 percent identical。 The life cycle of a mouse is short （three years）， and the animal reaches sexual maturity at six to eight weeks。 Furthermore， its metabolic rate is seven times faster than a human’s， so drugs are very rapidly metabolized in mice。 Doses for clinical trials have to be drastically reduced because of the much slower metabolism of humans。 Perhaps most critically， the immune system of mice evolved to be very different from that of humans。 Ours developed to combat airborne pathogens and mice’s to handle earth-borne ones。 A target lab mouse is healthy—not debilitated， as a human cancer patient is。 Its immune system would naturally reject transplanted human cells; therefore， its immune system has to be destroyed before human cells are introduced。 Needless to say， the tiny bodies of immunocompromised creatures hardly resemble the ones in which human cancer cells thrive。 Yet， writes Raza， scientists have expected these transplanted cells to help them identify useful drugs for cancer patients。 The First Cell is an ambitious， rich， and informative book。 It is also a demanding one at times。 It will reward the persistent and motivated lay reader。 My chief criticism is that it is occasionally repetitive。 I believe some judicious cuts would have served the book well。 As a lover of literature， Dr。 Raza includes passages from great novelists and poets， but I’ll admit to having struggled at times with their pertinence。 However， these are relatively minor complaints about an illuminating book that I’m glad to have read—one with a message that deserves to be heard。Thanks to the publisher and to Net Galley for providing me with a digital copy for review purposes。 。。。more
Eunice
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I found Dr。 Raza from her podcast interview with Peter Attia and fell in love with the way she spoke she discusses pharmacological therapeutics。 They referenced this book quite frequently so I decided to give it a read and likewise with her demeanor in the podcast， Dr。 Raza writes eloquently and beautifully。 This book is moving， melancholic， insightful， impassioned， and hopeful。 I love that Dr。 Raza focuses the setbacks of oncology research around personal recollection and insight of her patient I found Dr。 Raza from her podcast interview with Peter Attia and fell in love with the way she spoke she discusses pharmacological therapeutics。 They referenced this book quite frequently so I decided to give it a read and likewise with her demeanor in the podcast， Dr。 Raza writes eloquently and beautifully。 This book is moving， melancholic， insightful， impassioned， and hopeful。 I love that Dr。 Raza focuses the setbacks of oncology research around personal recollection and insight of her patients。 All around a beautiful read whether you’re interested in science or not。 Definitely give it a try。 10/10！！ 。。。more
Mindaugas Grigas
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Be filtro。 Onkologė， netekusi dėl vėžio savo vyro， skyrusio visą savo gyvenimą kovai su šia liga， parašė puikią knygą apie tai， kodėl， jos nuomone， žmonija pralaimi kovą su vėžiu。 Knyga sunki。 Tikrai。 Aprašo ligos eigą taip， kaip yra - be pagražinimų。 Ir knygos kalba。 Jaučiasi， kad autorė yra eruditas ir žiauriai išprususi asmenybė。 Man padarė didelį įspūdį。 Ir， labai tikiuosi， kad ateityje mes tikrai galėsime “išgliaudyti” tą pirmąją vėžio ląstelę， o ne kovoti su liga， kuri apėmusi visą kūną ir Be filtro。 Onkologė， netekusi dėl vėžio savo vyro， skyrusio visą savo gyvenimą kovai su šia liga， parašė puikią knygą apie tai， kodėl， jos nuomone， žmonija pralaimi kovą su vėžiu。 Knyga sunki。 Tikrai。 Aprašo ligos eigą taip， kaip yra - be pagražinimų。 Ir knygos kalba。 Jaučiasi， kad autorė yra eruditas ir žiauriai išprususi asmenybė。 Man padarė didelį įspūdį。 Ir， labai tikiuosi， kad ateityje mes tikrai galėsime “išgliaudyti” tą pirmąją vėžio ląstelę， o ne kovoti su liga， kuri apėmusi visą kūną ir， praktiškai， nebeaišku nuo ko pacientas greičiau užsilenkia - nuo pačio vėžio ar nuo jo gydymo būdų。 。。。more
Jack Crowley
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I'm a graduate student studying Breast Cancer， so this is the book I needed to read。 Everyone like me in the world should read it - but I would not recommend it to anyone who isn't in a public health， medicine， or disease-related career。 It can be distressing and disheartening to readers who's are affected by cancer。 Dr。 Raza is an inspiration to me。 I'm a graduate student studying Breast Cancer， so this is the book I needed to read。 Everyone like me in the world should read it - but I would not recommend it to anyone who isn't in a public health， medicine， or disease-related career。 It can be distressing and disheartening to readers who's are affected by cancer。 Dr。 Raza is an inspiration to me。 。。。more
Petter Wolff
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This is truly a damning account of the state of cancer research。 The industry would do well to heed Dr。 Raza's call to change， but too many actors are likely entrenched for this to happen。 Tragic This is truly a damning account of the state of cancer research。 The industry would do well to heed Dr。 Raza's call to change， but too many actors are likely entrenched for this to happen。 Tragic 。。。more
McKenzie Andrews
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Anti mouse models。 More money should be spent on early cancer detection。 Heart wrenching personal narratives of life and death with cancer。 Interspersed quotes from literary greats。 Interesting read！
Ina
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Azra Raza's book is a very necessary gut punch to the field of oncology。 The war on cancer has been misguided in its focus on end stage treatments-extending life mere months， and in its use of animal models-which fall short of modelling the complex， dynamic， and evolving battlefield， combatants， and tactics， that comprise the infinite incarnations which comprise this disease in human beings in vivo。 She says that we must shift our energies， our monies， our policies， towards the goals of preventi Azra Raza's book is a very necessary gut punch to the field of oncology。 The war on cancer has been misguided in its focus on end stage treatments-extending life mere months， and in its use of animal models-which fall short of modelling the complex， dynamic， and evolving battlefield， combatants， and tactics， that comprise the infinite incarnations which comprise this disease in human beings in vivo。 She says that we must shift our energies， our monies， our policies， towards the goals of prevention and early detection， if we are to save lives。Those interested in a better return on investment where this disease is concerned should regard this as necessary reading。 Her recommendations are not the sum of reforms needed in the fight against cancer， nor does she claim that they are， but they are central among them。 Finally， this work paints a sobering picture of the current state of oncology-for the patient and loved ones， for the aspiring oncologist， for the scientist， for the policymaker。 To paraphrase David Hume， we shall at least apprise ourselves of our ignorance， if we do not augment our knowledge。 Dr。 Raza did say something with which I do not agree， however。 She， herself， pointed up the complexity of cancer-the inflammatory soil in which it takes root， its mutations and metastases， its nutritional supply， and the quality and quantity of the immune response。 She disparaged funding which requires a "detailed， intricate understanding of every molecular signaling pathway in a cancer cell。" （288） I do not know any preparation for battle， however， which is not benefitted by an intimate knowledge of the enemy-through primary research。 For in knowing the enemy intimately， we may discover its nurseries， and kill it in the cradle。 。。。more
Matt Margolis
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Best book i've read on healthcare/oncology to date Best book i've read on healthcare/oncology to date 。。。more
James Kozubek
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I just read First Cell and I appreciate the authors tone and good sense。 I am left wondering how many people would regularly participate in preventative liquid biopsies and how accurate these techniques would actually be。 Nevertheless， it's a good "idea book" and the writing was arresting。 I just read First Cell and I appreciate the authors tone and good sense。 I am left wondering how many people would regularly participate in preventative liquid biopsies and how accurate these techniques would actually be。 Nevertheless， it's a good "idea book" and the writing was arresting。 。。。more
Jeff
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The Myth Of （Cancer） Experience。 This book actually does a phenomenal job of using both hard data and anecdotal case studies to show what the current state of cancer research and treatment is - and why it is costing us far too much in both lives and dollars。 This is a cancer doc/ researcher who has been in the field longer than this reader has been alive， and yet she attacks the problem in a way that genuinely makes sense: if cancer is effectively a group of cells that begin replicating uncontro The Myth Of （Cancer） Experience。 This book actually does a phenomenal job of using both hard data and anecdotal case studies to show what the current state of cancer research and treatment is - and why it is costing us far too much in both lives and dollars。 This is a cancer doc/ researcher who has been in the field longer than this reader has been alive， and yet she attacks the problem in a way that genuinely makes sense: if cancer is effectively a group of cells that begin replicating uncontrollably， the best way to eliminate this phenomenon is to detect these cells as early as possible and eliminate them before they become problematic。 Using several patient case studies - including her husband， who apparently started out as her boss， and her daughter's best friend among them - Raza does an excellent job of providing names and faces （yes， the book has pictures of the patients as well） to go along with the alarming yet decently documented data。 （Roughly 18% of the book is bibliography， which is perhaps a touch low - 25-30% is more typical - but is better than one might expect from such a case study driven narrative。） Ultimately this book actually makes the case for The Myth of Experience better than the authors of the book by that title did， which is actually fairly interesting to this reader。 :） And the Urdu poetry （with English translations as well） was a nice touch to lighten a text that could otherwise be a bit dreary。 Very much recommended。 。。。more
Thomas
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Amazing that after spending 100's of billions of dollars on the war against cancer， nothing much has changed in over 40 years。 Since 2000， over 90 new cancer drugs have been approved， almost half with no randomized clinical trials and still only about 2-3 months have been added to the life of a cancer patient on average。 The author suggests and entirely different course be undertaken in the search for answers。 We spend outrageous sums to exact few positive， definitive results and thus the cost t Amazing that after spending 100's of billions of dollars on the war against cancer， nothing much has changed in over 40 years。 Since 2000， over 90 new cancer drugs have been approved， almost half with no randomized clinical trials and still only about 2-3 months have been added to the life of a cancer patient on average。 The author suggests and entirely different course be undertaken in the search for answers。 We spend outrageous sums to exact few positive， definitive results and thus the cost to humanity is stifling。 I agree with the author but nothing will change because our current medical system is extremely dependent on sickness and disease being managed， not prevented or cured。 。。。more
Joc ✨
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A very informative and eye opening novel in which Dr。 Raza shares insight not just on cancer， but into the reality of having cancer or being someone who has a loved one with cancer。 For many it is a disease that means death， but for many it has also become a challenge as something they must overcome。 I’ll be honest at times it was a difficult read as I have had a relative recently die from a form of cancer and this book does not shy away from the realities of the disease。 It is a must read thoug A very informative and eye opening novel in which Dr。 Raza shares insight not just on cancer， but into the reality of having cancer or being someone who has a loved one with cancer。 For many it is a disease that means death， but for many it has also become a challenge as something they must overcome。 I’ll be honest at times it was a difficult read as I have had a relative recently die from a form of cancer and this book does not shy away from the realities of the disease。 It is a must read though not just for those who have experienced it in some form， but to also gain a better understanding。 Dr。 Raza’s vulnerability is on display in this book and it brings faces to the millions of those affected by cancer and for those who decide to learn more。 My wish is that we are able to find a cure in this lifetime or at least better policies to detect the disease early。 With more awareness and pressure put onto the government， everyday we come closer to providing more life。 As Dr。 Raza notes:“The future is in preventing cancer by identifying the earliest markers of the first cancer cell rather than chasing after the last” 。。。more
Sujay Rainchwar
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The author is Cancer physician and researcherat Columbia University NY。 She has described about why we are losing war on cancer？ The approach to studying cancer is outdated and has not produced any meaningful results to date，and sadly it's true。She is a revolutionary scientist who wants to overhaul the existing approach towards cancer research i。e reductionist approach。 She has provided enough evidence to support that fact and a intelligent cancer doc can attest to this fact。 Also， she has set a The author is Cancer physician and researcherat Columbia University NY。 She has described about why we are losing war on cancer？ The approach to studying cancer is outdated and has not produced any meaningful results to date，and sadly it's true。She is a revolutionary scientist who wants to overhaul the existing approach towards cancer research i。e reductionist approach。 She has provided enough evidence to support that fact and a intelligent cancer doc can attest to this fact。 Also， she has set an example by sincerely travelling the 'road not taken' and is on the mission of studying the cancer thru different approach。 Her goal is to prevent the cancer by identifying earliest stage of cancer rather than spending millions on treatment of cancer at late stage with no gain。She has endured the suffering of cancer on personal front。 It describes the journey of many cancer patients。Her approach is to study first cell rather than last cell ， that's when cancer has sufficiently grown。 How this can be done is described in the book。 Also important groundwork which she has laid to do that is also worth noting in the book。So we definitely need a different approach to study cancer so that we can unify the mechanisms underlying different cancers and find cheaper treatment and attain the Cure，which is a dream。 。。。more
Ellen
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I'm a layman （who is fairly scientifically literate but still certainly not professionally trained） and found this book to be entirely readable， interesting and the argument compelling。 She certainly had me convinced that we as a society should be asking for our resources to be redirected towards early detection。 I do wish she had spent more time talking about how she envisions treating these very early stage cancers as the book spend a lot of time building up towards the topic without a lot of I'm a layman （who is fairly scientifically literate but still certainly not professionally trained） and found this book to be entirely readable， interesting and the argument compelling。 She certainly had me convinced that we as a society should be asking for our resources to be redirected towards early detection。 I do wish she had spent more time talking about how she envisions treating these very early stage cancers as the book spend a lot of time building up towards the topic without a lot of information once we got there。Overall definitely worth reading， even for people who are just interested members of the general public。 。。。more
Daniel Bastardo
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A candid and emphatic view of the current state of cancer research， powerfully written。
José Antonio Lopez
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In most diseases early detection is key。 The current COVID-19 pandemic has proven again that early detection and reaction is key to survival and fine resolution。 However when it come to cancer Science is looking at the wrong direction。 Azra Raza raises the issue in a very compassionate book。 Her narrative of patient struggle is empathetic and eye opening。 Research for over 60 years has followed a reductionist approach that costs zillions of dollars， false hopes， late intervention and fringe resu In most diseases early detection is key。 The current COVID-19 pandemic has proven again that early detection and reaction is key to survival and fine resolution。 However when it come to cancer Science is looking at the wrong direction。 Azra Raza raises the issue in a very compassionate book。 Her narrative of patient struggle is empathetic and eye opening。 Research for over 60 years has followed a reductionist approach that costs zillions of dollars， false hopes， late intervention and fringe results。 An approach based on finding a unique key to kill just cancer cells instead of healthy and bad one as it is today。 Cancer treatments poison the patient in exchange of hope to survive a little longer。According to Raza， most cancer improvements come from better lifestyle and early testing， not drugs and treatments。 People trust scientist， scholars and politicians; while they are letting us down。 If you want to learn more about Raza's work you can connect to the enlightening conversation with Russ Roberts， econTalk: https://www。econtalk。org/azra-raza-on。。。 。。。more
Kaylee
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Dr。 Raza has many profound insights and is obviously extremely knowledgeable in her field。 However， it was impossible for me to overlook her lack of personal and professional boundaries with her patients。 As seen through her recollections， her intense emotional involvement with her patients has caused herself and at times those she was treating， a great deal of pain。
CatReader
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I enjoyed reading about Dr。 Raza's 30+-year career as a hematologist/oncologist specializing in the treatment of myelodysplastic syndrome （MDS）， a type of blood cancer that's debilitating in and of itself and can serve as a precursor to the more aggressive disease acute myeloid leukemia （AML）。 In this book， Dr。 Raza conveyed her efforts toward researching earlier detection of cancers， at a stage where cure is possible， as well as finding novel treatments for various blood cancers。 Unlike most re I enjoyed reading about Dr。 Raza's 30+-year career as a hematologist/oncologist specializing in the treatment of myelodysplastic syndrome （MDS）， a type of blood cancer that's debilitating in and of itself and can serve as a precursor to the more aggressive disease acute myeloid leukemia （AML）。 In this book， Dr。 Raza conveyed her efforts toward researching earlier detection of cancers， at a stage where cure is possible， as well as finding novel treatments for various blood cancers。 Unlike most researchers， she isn't a big fan of animal models as selection criteria for which candidate drugs move onto human trials， and in this aspect， I find myself agreeing with her based on my own experiences in basic science and translational research as both a physician and a scientist。 Dr。 Raza also shares a number of patient vignettes， including that of her own husband， a fellow hem/onc physician who died of lymphoma in his early 60s。 These vignettes can be heartbreaking to read -- stories of Dr。 Raza's patients and their families， who were both helped and harmed by the best therapies on offer at the time， and who grappled with their own mortality or remained in denial of their impending demises。I'd definitely recommend this book for anyone who's a fan of Siddhartha Muhkerjee's books （he and Dr。 Raza are colleagues） or the growing number of memoirs from people who've recounted their own cancer journeys （Paul Kalanithi's When Breath Becomes Air， Nina Riggs' The Bright Hour， Julie Yip-Williams' The Unwinding of the Miracle）。 While parts of this book are probably best suited to a physician/researcher/healthcare audience， I think all readers will find good takeaway points。 。。。more
Pedro Pinto
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Decided to read this book after listening to the Author on an Econtalk podcast。 There was something on how Azra Raza explained the key message of the book and the humanity conveyed in such discussion that immediately "magnated" me into reading it。A disturbing book about cancer， its impact on the lives of those who have to deal with it （on the first person or related family and friends）， that more than once made me stop， take a deep breath and reflect， before i could continue。The key message pres Decided to read this book after listening to the Author on an Econtalk podcast。 There was something on how Azra Raza explained the key message of the book and the humanity conveyed in such discussion that immediately "magnated" me into reading it。A disturbing book about cancer， its impact on the lives of those who have to deal with it （on the first person or related family and friends）， that more than once made me stop， take a deep breath and reflect， before i could continue。The key message presented， that the cancer research and associated mainstream treatment （slash， poison and burn） did do not evolve that much in the last 50 years， adheres to reality and that the proposed paradigm shift that she proposes looks also so well grounded。 balanced and logic that it seems strange that the proposed approach （to detect the first cell instead of treating millions of them after it is widespread） does not have more interest， momentum and investment。Sometime it seems that， once again， it's a question of an incorrect incentives and rewards system put in place， that does not allow to make tangible progress on this important subject。Regarding the author， an oncologist， that experienced all the portrayed stories being an active participant in each of them， you can feel the humanity， empathy， care， frustration and sense impotence she experience with each。Strongly recommend its reading to all interested in the subject。 。。。more
Vida
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This is a very well written book。 In some ways， it's a 5 star book。 In other ways， it's not。 It's hard to understand who is audience for this book。 It seems Azra Raza feels regular people （people not in the field of oncology） are the intended audience， but it is written in such a way that it would really be very hard for someone not in oncology to fully understand。 It's very detailed and treatments and disease processes she mentions or discusses are not always explained。 Yet， it does not seem th This is a very well written book。 In some ways， it's a 5 star book。 In other ways， it's not。 It's hard to understand who is audience for this book。 It seems Azra Raza feels regular people （people not in the field of oncology） are the intended audience， but it is written in such a way that it would really be very hard for someone not in oncology to fully understand。 It's very detailed and treatments and disease processes she mentions or discusses are not always explained。 Yet， it does not seem that the author intends people who work in oncology or onocologists to be the audience for the book。 Her overarching theme - that cancer is usually diagnosed in late stage， with treatment options that only really extend life a few months， and the bulk of research focused on animal models and drugs that only nominally have any benefit at the end - is very clear， and it is an excellent theme for a book on cancer。 She spends a lot of time describing the challenges and symptoms of advanced cancer。 However， she spends very little time - a very small portion of one chapter at the end - actually discussing what the alternatives are in terms of research and what she envisions treatment in early stages （essentially before cancer is detectable）。 She also spends a great amount of time discussing all the pitfalls of treatment and cancer screening， and yet presents a very glossed over， brief， rosy view of alternative research and early detection methods， and is not at all critical of how these options could be implemented or problems or shortfalls that may arise from them。 While her focus is on the lack of cancer treatment options， sometimes it is a bit more challenging to understand the point she is making in the moment as you read。 Her chapters are ostensibly broken up by patient， but within those chapters she jumps around quite a bit and discusses in passing other patients with other cancers， so the result is a bit choppy and disjointed。 She brings up different ideas - how surprising it was that one patient was older and yet seemed to be fully in denial of the natural course of life that she would one day die， and hell bent on every treatment - yet the author continued to describe patients in their 80s and be angered that they would have an eventual decline and death from MDS or AML。 So while she herself is shocked by this one patient's inability to recognize that she will one day die， the author herself also seems to have that same fault when she discusses other advanced age patients。 The author mentions hospice and palliative care， but it does not really seem to factor much into her thinking。 In many ways， despite the poetry she intersperses throughout， and the reflecting she does in the book on her patients and their experience， she is really not that different from most very treatment driven oncologists， at all costs， without much regard to age， at the benefit of weeks or months， holding out hope to heroic measures that will likely fail。 She also never acknowledges that phase 1 clinical trials are not really designed to benefit the patient - they are intended to further cancer research when all proven treatment has been exhausted。 She only nominally acknowledges that metastatic sarcoma is terminal when discussing Omar。 Like her patients， she seems to have trouble coming to terms with this， and goes through his treatment course in what seems like shock at his eventual decline and death when treatments eventually fail。 But they were always going to fail， and she knows that。 In the letters from his family members， they fixate on being told his prognosis was 85%。 Patients and their families have a very hard time hearing "your cancer is terminal" but "we have these treatments。" They focus on certain things， and do not hear certain other things。 Metastatic sarcoma is not ultimately curable。 Did the oncologist lie and tell Omar and his family it was？ More likely， the oncologist told them it was not curable very quickly at the initial visit， but went on to discuss and focus on what treatment was available at every subsequent visit。 Illness and death are messy - sometimes they are brutal and cruel， as she chronicles for Andrew。 While this is true of cancer - it is also true of many illnesses - Alzheimer's， parkinsons， debilitating strokes， ALS， etc。 Death is not always easy。 Perhaps I hoped for a more nuanced approach to life and death and mortality in this book。 It is not Atul Gawande's Being Mortal。 As a nurse who worked in oncology for 10 years， this is a decent book to read。 It has a heart， it's written with empathy， and it at times helps zoom out， when often cancer care is zoomed in。 It proposes an alternate research reality （though it doesn't take a very good in depth view of what that research is） and it highlights very well the current problems with cancer treatment and the bulk of current cancer research。 It's a flawed book， and I was ultimately expecting slightly better。 。。。more
Adrianna
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Pros - She is an incredibly intelligent oncologist and is passionate and empathetic in her work。 I respect her for putting patients first and admire that she leads with intellect while remaining emotional and caring， especially in a field like oncology。 As a researcher， it’s important to acknowledge the limitations of our in vitro and in vivo models so I really valued her perspective。 Someone should be championing a paradigm shift in the field， and I’m thankful to have read this book to shift my Pros - She is an incredibly intelligent oncologist and is passionate and empathetic in her work。 I respect her for putting patients first and admire that she leads with intellect while remaining emotional and caring， especially in a field like oncology。 As a researcher， it’s important to acknowledge the limitations of our in vitro and in vivo models so I really valued her perspective。 Someone should be championing a paradigm shift in the field， and I’m thankful to have read this book to shift my own thinking。 Cons - I can’t imagine her writing being accessible to patients and their families， aside from the well connected and educated favorites she mentions in her book。 Her writing is also lofty and comes across as pompous at times。 Raza’s main message is that we should be putting more resources into preventative testing and early detection， so it was disappointing that she didn’t initiate a conversation surrounding inaccessibility to this type of healthcare。 。。。more
Johanne
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I’m guilty of not having read all the case studies in the book。 I don’t have the brain to understand the scientific explanations and the horrors of cancer were hitting me too much。 Nonetheless， I really appreciated the point the author is making about bureaucracy being the glue greasing the wheels of progress， the wasted efforts and money and， especially， the lack of progress in curing cancer or even prolonging life past a few months。 I also enjoyed the literature references and the author’s wri I’m guilty of not having read all the case studies in the book。 I don’t have the brain to understand the scientific explanations and the horrors of cancer were hitting me too much。 Nonetheless， I really appreciated the point the author is making about bureaucracy being the glue greasing the wheels of progress， the wasted efforts and money and， especially， the lack of progress in curing cancer or even prolonging life past a few months。 I also enjoyed the literature references and the author’s writing skills when it came to descriptions and reflection of feelings。I was particularly moved by last two chapters （Aftermath and Epilogue）。 。。。more
Randy Cook
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‘The First Cell’ is a deep look at Cancer。 It is written by Dr， Azra Raza。 It is a tough book in more than one way。 I found the insights into Dr。 Raza’ patients moving and at times very sad。 From the young people stricken， the older patients struggling through treatment， and the rare case of someone who after treatment gets a number of years to their lives。 Some of these stories are heartbreaking and so sad。 We also get a sense of frustration at the system。 How research focus on extending life b ‘The First Cell’ is a deep look at Cancer。 It is written by Dr， Azra Raza。 It is a tough book in more than one way。 I found the insights into Dr。 Raza’ patients moving and at times very sad。 From the young people stricken， the older patients struggling through treatment， and the rare case of someone who after treatment gets a number of years to their lives。 Some of these stories are heartbreaking and so sad。 We also get a sense of frustration at the system。 How research focus on extending life by mere weeks。 Patients to not always get the true chances of survival and the efficacy of the treatment options。Dr Raza has an platform that she is presenting。 She believes more focus should be made on identifying when a cancer is just beginning。 Being able to determine when a cancer is likely to form， gives the doctors a much better chance to stop the disease rather than wait until the cancer has invaded an organ。 Her points make tremendous sense。 I am worried that changing the way the system attacks cancer is a very heavy weight to lift。The book at times reads very well。 The stories， as previously mentioned， are gripping and moving。 They are not easy to get through， but I think that is the point。 The are sections where Dr。 Raza goes depp into the science of the disease and treatments。 Some of these section are just too dense to understand。 I am not an oncologist， but an engineer。 I still found it very challenging and dry。 At times I felt that her point of view on cancer treatment and future research was repeated too much。 I am not sure who the audience is。 I am glad I read it， and have a deeper appreciation for the people and their loved ones who ahve to suffer through this disease。Having lost my mother to a kidney cancer， the message was a little close to home。 。。。more
Ashwini Shenoy
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A good chronicle of cancer but not exactly a piece of researchCame across a podcast with Dr Raza's interview by Peter Attia。 She is an acclaimed oncologist with a novel concept at approaching cancer at 'The First Cell' ， to catch and stop it at its origin。 Has critiqued the 'burn-posion-slash' approach to malignancy as archaic。 This in particular is bold of her and ， being a part of an oncology team myself， caught my interest。 Is there a radical new way that we are missing¿ I think she is on the A good chronicle of cancer but not exactly a piece of researchCame across a podcast with Dr Raza's interview by Peter Attia。 She is an acclaimed oncologist with a novel concept at approaching cancer at 'The First Cell' ， to catch and stop it at its origin。 Has critiqued the 'burn-posion-slash' approach to malignancy as archaic。 This in particular is bold of her and ， being a part of an oncology team myself， caught my interest。 Is there a radical new way that we are missing¿ I think she is on the right track thereI admit I had hoped the book would be a research on these new techniques， maybe not unlike what Siddhartha Mukherjee achieves with 'The emperor of all maladies' 。 The concepts do get mentioned but this is largely one of those you could title 'Diary of an Oncologist' and is to do largely with personal experiences and patient interactions。 Dr Raza is an intellectual and that much is evident， especially with her ardent Urdu poetry interspersed strategically in the book。 With the right expectations this is a good enough chronicle。If you need a succinct version， listen to the podcast， that should summarize it well enough。 。。。more
Graeme Roberts
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Azra Raza stands alone in the depth of her clinical experience as an oncologist， her scientific knowledge and commitment to evidence， her intellectual depth and literary knowledge， her passion and emotional intensity， and her willingness to challenge convention。 I am agog that such an astonishing human being exists。Her most important message is that too much money and effort is being devoted to the predominantly failing efforts to offer small extensions of life to cancer patients in the later st Azra Raza stands alone in the depth of her clinical experience as an oncologist， her scientific knowledge and commitment to evidence， her intellectual depth and literary knowledge， her passion and emotional intensity， and her willingness to challenge convention。 I am agog that such an astonishing human being exists。Her most important message is that too much money and effort is being devoted to the predominantly failing efforts to offer small extensions of life to cancer patients in the later stages of the diseases。 She builds a convincing case that more of the massive investment should be directed to diagnosing and stopping it at or close to inception。 Thus the title of the book: The First Cell: And the Human Costs of Pursuing Cancer to the Last。Dr。 Raza relates stories， at several levels of detail， of cases of （mostly hematologic） cancers which she treated or observed。 Reading them was a scarifying experience for me， and quite depressing， although I couldn't put the book down。 One of the patients was her own beloved husband， Harvey （also an oncologist）， whose lymphoma is a horror story indeed。 Her capacity for love and compassion is apparent throughout the book， in the stories of the patients that she came to love if she didn't already。 My only objection to the stories of weighing the endless pain and suffering of primitive conventional treatment against the pain and suffering of the illness and death is that suicide was never acknowledged as an option。 That may reflect her religious beliefs if any， but I for one provide for just such a contingency， and I am sure that others consider it too。Read this beautiful and important book， but he ready for a rough ride。 。。。more
Salman Mehedy Titas
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I don't know if I can formulate words to honor this book， but at the very least， the attempt has to be made。 To be attempted。 I don't know if I can formulate words to honor this book， but at the very least， the attempt has to be made。 To be attempted。 。。。more
Cat
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I think just about everyone has known or knows of someone suffering from cancer。 I really don't believe the disease is beatable。 A friend of mine once told me， cancer may go into remission， but it's just hiding somewhere in a person's body， waiting for another round of attacking it。 Her mother had died of cancer。 I've known too many people myself who have been treated for it。 One， an aunt， upon finding her cancer had returned， rejected further treatment a second time。 She said she'd rather die a I think just about everyone has known or knows of someone suffering from cancer。 I really don't believe the disease is beatable。 A friend of mine once told me， cancer may go into remission， but it's just hiding somewhere in a person's body， waiting for another round of attacking it。 Her mother had died of cancer。 I've known too many people myself who have been treated for it。 One， an aunt， upon finding her cancer had returned， rejected further treatment a second time。 She said she'd rather die an easier death then go through the treatment again。 I think this book is a book for everyone。 It's factual and informative。I received a Kindle copy from Netgalley in exchange for a fair review。 。。。more
Kyle
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