71 pages • 2 hours read
The Song of the Cell: An Exploration of Medicine and the New Human
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Symbols & Motifs
Kampf
The German word “Kampf” means struggle. Zoologist Elie (or Ilya) Metchnikoff was the first to use Kampf “to encapsulate the relationship between an organism and its invaders” (175). He argued that a struggle occurred between the microbe (invader) and the organism’s white blood cells. Sometimes the invader succeeds in replicating within cells, but typically the white blood cells get to the site of invasion (or injury or inflammation) and consume the invader. By doing so, they help the body build immunity.
Mukherjee uses battles and soldiers to describe how cells defend against infection and inflammation. Neutrophils, a type of short-lived white blood cell, are “hot for combat, their faces granulated, their nuclei dilated—a fleet of teenage soldiers deployed to battle” (175). The release of proteins (cytokines and chemokines) at the site of injury drives the guardian cells (neutrophils) to their mission: to defend the cells against infection and inflammation. Neutrophils inherently recognize some bacteria, so even when microbes aren’t invading cells, they’re still always a part of the human body, further highlighting Kampf.
However, viruses can confuse cells, preventing them from fighting. The COVID-19 pandemic is a poignant example. This virus tricks cells in patients with already compromised antiviral response systems into treating it as nonpathogenic. This prevents cells from sounding an early alert about the virus. As the infection takes a toll on the body, the immune system tries to mount a defense. This defense represents “an uncoordinated army of cells—confused, bamboozled soldiers” (252) that can’t fight back against the virus.
The fight against microbial invaders can “degenerate into the civil war of horror autotoxicus” (245). One example is autoimmune disease, in which the immune system attacks healthy cells and thus literally poisons the body. Autoimmune diseases can be triggered by cancer treatments because they target T cells.
Osprey
In Chapter 18, Mukherjee describes watching two osprey fly above the ocean. He notes that in midair, they seem to pause, despite strong gusts of wind. Mukherjee compares the osprey’s midair pause to the balance between homeostasis and pathology. For example, the principal organs of homeostasis—the brain, liver, kidney, and pancreas—work together to maintain fixity: Beta cells in the pancreas secrete insulin, which helps maintain metabolism; nephrons in the kidney maintain salinity in the bloodstream; the liver helps remove poison; and the brain oversees all these activities, checking in on physiological functions and sending out hormones to make adjustments. Even when cellular malfunctions occur within these organs, they try to maintain homeostasis. In this way, these organs are like the wings of the osprey maintaining stillness in the face of the wind. However, the body can succumb to the pathology, just like the osprey can succumb to the wind, if the “delicate balance is thrown off” (312). In this case, neither the organs nor the osprey can be still.
Another example is the “maintenance of balance between injury and repair” (348). Bone cells continuously repair themselves to battle repair. Diseases like osteoarthritis illustrate what happens when decay begins to win over repair. Mukherjee emphasizes that this tipping toward the rate of decay is akin to falling off the edge of a cliff, like an osprey that “buffeted by the changing winds, cannot remain suspended in midair” (348).
Jammed Accelerators and Failed Brakes
In another metaphor, Mukherjee describes how cancer metastasizes by comparing cells to car parts. Cell division marked by malfunction is like a jammed accelerator or failed brake. The genes that control cell division are broken or mutated and can no longer work in the appropriate context. Oncogenes become like a jammed accelerator. They transform numerous normal cells into tumor cells. Tumor suppressors become like failed brakes when they stop working because of mutations. In essence, “the accelerators are stuck in the on position and the brakes stuck in the off position” (356). When a car has broken parts, it isn’t drivable. Likewise, when the body has malfunctioning cells, it isn’t in homeostasis. It’s difficult for the body to regulate cancer cells without the help of drugs or treatment. However, even with such a treatment, the cancer often sneakily avoids it, switching “to a new list of genes, or even scrambles the song” (356).
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By Siddhartha Mukherjee
