The global march of medical research stands interrupted. Before Covid-19, new technologies such as genome editing, stem-cell therapy and tissue transplants were promising to improve quality of life and postpone death. Scientists even dreamt of reversing the physical and mental toll of ageing, a natural phenomenon that now counts as a disease in our greying world.
Today, the desperate need for coronavirus drugs and vaccines has sidelined those ambitions; laboratories everywhere have switched to assisting the Covid-19 effort. At some point, though, the pandemic virus will either disappear or settle (hopefully) invisibly into the background of our future lives, as so many other diseases have done.
Then, medical science can go back to business as usual. As three books illustrate, that business is developing and applying technologies to exercise ever greater control over the human body — whether living or dead.
Given that the seat of existence lies in the brain, which decays with age like the rest of the body, the idea of neural renewal is a genuinely exciting development to watch. In The Future of Brain Repair, Jack Price, professor of developmental neurobiology at King’s College London, takes a dispassionate look at stem-cell therapies, long hailed as a miracle cure for almost any disease and now a possible elixir for our withering grey matter.
Stem cells can turn into cells of different types, making them a potential universal fix for any disease where replacement tissue is needed. Given there are still no effective treatments or cures for degenerative brain disorders such as Alzheimer’s and Parkinson’s, could stem-cell transplants be the answer?
You might not feel that encouraged by reading news reports. One Australian woman died after having stem cells sucked out of her abdomen to treat her dementia. Price warns: “Patients enrolling for [certain types of] therapies are playing a particularly crazy game of Russian roulette . . . There might be a chamber that offers something of value (Feeling lucky, Punk?), but more likely is a chamber containing a bullet that will blow the top of your head off.”
A “spectacular regulatory hole”, he explains, has seen this branch of medical science turn into a new Wild West of stem-cell clinics (best avoided). But it’s not all unscrupulous doctors offering the unproven to the unwise: pluripotent stem cells, the most chameleon-like of stem cells, do show promise in the treatment of spinal cord injury, Parkinson’s disease and retinal disorders, and careful trials are under way.
The subject is technically demanding but Price’s style is light and accessible, essential for such a frontier subject. Given the tendency towards stem cell hype, there is also an appealing touch of the cynic about him. The book opens with an anecdote about how, as a company scientist in 1996, he turned down two university researchers seeking a $5m investment for a stem-cell project. Price told them it couldn’t work; the two had already done experiments showing it could. The embarrassed Price later become a consultant to their start-up.
By the end, our friendly curmudgeon has just about decided his field isn’t a waste of time: “We have been here before. The ultimate success with advanced therapies always seems to be just around the corner. Nonetheless, there are reasons to be optimistic.”
Not only might stem-cell transplants become viable but it might also be possible to reprogramme and redeploy brain cells near damaged areas so that lost neurological function can be regained. Whether any of these therapies will be affordable is a different question.
Three books on the new frontiers of medical research
Jack Price, a professor of developmental neurobiology, takes a dispassionate look at stem-cell therapies, long hailed as a miracle cure for almost any disease
Professor John Troyer charts the unexpectedly complex history of the dead body, and the various technical advances that have transformed our relationship with it
Joshua Mezrich, a transplant surgeon, is evangelical about organ transplantation in this part-memoir, part historical account of the field’s extraordinary pioneers
When it comes to resurrection, the brain is yet to be conquered but revivifying the body by transplantation is almost commonplace. That sense of mastery over mortality is most vividly captured in the title of transplant surgeon Joshua Mezrich’s debut: How Death Becomes Life. First published in 2019, it is newly pertinent given that English law changed last month so that organ donation is assumed unless a person has previously opted out.
Mezrich, an associate professor at the University of Wisconsin, is evangelical about the field of organ transplantation and especially keen on kidneys: “I like to tell my residents that ‘the dumbest kidney is smarter than the smartest doctor.’” There is, he admits, something “almost godlike” about transplantation.
This is part-memoir and part historical account of the extraordinary pioneers who believed that people could be repaired and revived as the sum of their working parts. One early visionary was Alexis Carrel, a Frenchman who saw President Carnot knifed in 1894 and was shocked that surgeons could not save him.
Carrel set out to advance the field, developing vascular suturing methods using the finest needles and threads that Lyon haberdashers could offer. His efforts won him the 1912 Nobel Prize for Medicine or Physiology.
He attempted transplantation in animals and speculated there was a “biological force” that prevented successful organ transfer, which we now understand as immune rejection. Had Carrel not spent his later life championing eugenics under the Vichy regime, he might have been more readily remembered as one of the premier experimental surgeons of the 20th century.
Carrel, like all great surgeons, displayed craftsmanship as well as genius. “There are natural surgeons whose hands are so good that within just a few minutes of working with them, you can tell they are off the bell curve,” writes Mezrich, who practised for two years so that his technique became second nature. “There are no wasted motions.”
There are cinematic snippets of the operating theatre; Mezrich’s description of inserting a new kidney put me in mind of how an experienced seamstress might cut and sew a haute couture gown. Both artisans, one thinks, might hope for fluid movement; in kidney transfer this aspiration is literal. “I release the clamps and watch the newly transplanted donor kidney turn pink. A minute later, it squirts urine . . . on our hands while we continue working. What a beautiful sight!”
The thrill of success is always tempered by the fear of screwing up. For those who think surgeons coldly chop and stitch their way through a conveyor belt of bodies, Mezrich offers a moving insight into their duties to all participants. He must first evaluate who on the waiting list gets a prospective organ, knowing that skipping someone possibly too sick to survive the op is “likely signing her death warrant”. Donated organs, a priceless legacy in the eyes of the bereaved, require reverential stewarding; and then there is the patient herself, whose fate lies in his hands.
But, oh, when the magic happens! His account of a bereaved mother listening through a stethoscope to her daughter’s heart beating in someone else’s chest, made my own skip a beat. Fans of Henry Marsh and Atul Gawande will enjoy this thoughtful dissection of what death becoming life really means for everyone involved.
Medical science, though, will always have limits. As we are learning anew with Covid-19, not all diseases can be cured and not all bodies can be healed. Each of us is destined to become a corpse. That entity is explored in macabre detail by John Troyer, who grew up in a family of funeral directors and now directs the Centre for Death and Society at the University of Bath in the UK. In Technologies of the Human Corpse, Troyer charts the unexpectedly complex history of the dead body, and the various technical advances that have transformed our relationship with it.
I found it tough going and disjointed but happily the tricky terrain was studded with curious facts from the world of cadavers. Readers can meet the Bisga Man, “an embalmed male corpse sitting upright in a chair, with one leg crossed over the other, and wearing a fashionable suit”. He represented a landmark moment in the chronology of corpses: thanks to Bisga Embalming Fluid, never had a dead body looked so alive.
Revolutionary preservation methods represented a stiff leap forward from the death photography of the American mid-19th century. One Boston daguerreotype and photography studio of that era boasted: “We take great pains to have Miniatures of Deceased Persons (wallet or postcard-sized images) agreeable and satisfactory, and they are often so natural as to seem, even to Artists, in a deep sleep.” Through techniques such as embalming and photography, the “modern human corpse . . . became an invented and manufactured consumer product”. The railroads also benefited from what Troyer calls the industrialisation of the corpse; bodies in caskets required their own first-class ticket.
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The corpse, he points out, exists in a social, cultural and political context. The arrival of HIV-Aids in the 1980s saw some funeral directors refusing to handle the bodies, further marginalising communities already on society’s fringes. There is economic context too: a global trade in body parts and tissues (quite distinct from the altruistic tradition of organ donation) amounts to a “necroeconomy” in which corpses can command as much as $50,000 (and shadowy “body brokers” operate a black market). Surprisingly for a book of this title, there is no mention of cryonics, the fad among the rich techno-crowd for having one’s body frozen upon death, so it can be resurrected when (if?) science learns how to bring the dead to life.
Poignantly, Troyer’s sister died of a brain tumour in 2018, after undergoing surgery, radiotherapy and chemotherapy; he recounts in the preface the disorienting experience of losing his only sibling, and scatters poems about her throughout. His evident grief, a miasma over his writing, reminds us that the limits of medical science very much remain. Despite the power of transplantation today and the potential of brain repair tomorrow, medical science is unlikely to ever erase that terrible endpoint when life becomes death.
The Future of Brain Repair: A Realist’s Guide to Stem Cell Therapy, by Jack Price, MIT Press, RRP$29.95/£25, 288 pages
Technologies of the Human Corpse, by John Troyer, MIT Press, RRP$24.95/£20, 272 pages
How Death Becomes Life: Notes from a Transplant Surgeon, by Joshua Mezrich, Harper/Atlantic, RRP$27.99/£16.99, 384 pages
Anjana Ahuja is a science commentator
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