Ep 1. Magic Bullets

Cancer: The Emperor of All Maladies is a gripping, three-part documentary series that examines the history of cancer and the scientific progress that has been made in preventing, treating, and ultimately curing this deadly disease. Produced by Ken Burns and directed by award-winning filmmaker Barak Goodman, this series features interviews with leading cancer researchers, oncologists, patients and their families, and political figures involved in the fight against cancer.

Episode one, "Magic Bullets," tells the story of the earliest attempts to treat cancer with chemotherapy. While chemotherapy is now widely used as a cancer treatment, it was initially developed as a weapon of war. During World War II, a group of scientists in the US and Europe discovered that chemicals used in mustard gas could also destroy fast-growing cancer cells. These early drugs were crude, toxic, and often ineffective, but they set the stage for a new era of cancer treatment.

The episode begins with the story of a young woman named Libby, who was diagnosed with acute lymphoblastic leukemia (ALL) at the age of nine. In the 1960s, ALL was considered a death sentence for most children, with only a 4% chance of survival. Libby's parents were told to take her home and enjoy the time they had left with her. But Libby's parents refused to give up and sought out a pioneering doctor named Sydney Farber, who was experimenting with a new drug called methotrexate. Farber believed that cancer could be cured with chemicals that targeted fast-growing cells, and methotrexate was one of his "magic bullets."

Through archive footage and interviews with Libby and her family, we see the transformative effect that methotrexate had on cancer treatment. For the first time, children with ALL were surviving, and Farber's work was hailed as a miracle. The episode also covers the early development of other chemotherapy drugs like 5-fluorouracil and vincristine, which were discovered in the 1950s and 1960s.

But as the episode shows, these early medications were far from perfect. Chemotherapy caused horrifying side effects such as hair loss, vomiting, and immune system suppression. Patients often suffered as much from the treatment as they did from the disease. And cancer cells, which are smart, adaptive, and highly aggressive, quickly found ways to resist chemotherapy drugs. The episode details the rise of multidrug regimens, which used combinations of chemicals to attack cancer from multiple angles, and the use of genetics to predict which treatments would be most effective for individual patients.

The episode also covers the story of Dr. Emil Frei III, a leading oncologist who worked at the National Cancer Institute in the 1960s and 1970s. Frei was a brilliant scientist who pioneered many of the chemotherapy drugs still used today, but he was also controversial for his aggressive treatment protocols. Frei's patients often suffered severe side effects, and some of his colleagues accused him of violating medical ethics. The episode explores the ethical dilemmas of cancer treatment, including the difficult choices that doctors and patients must make when faced with life-or-death decisions.

The episode ends with a note of hope: the discovery of a new "magic bullet" called imatinib, which targeted a specific genetic mutation that causes a rare form of leukemia. Imatinib, which was introduced in 2001, was a breakthrough in cancer treatment, offering a potential cure for a disease that had once been untreatable. As the narrator notes, "In the battle against cancer, the magic bullets keep coming."

Overall, "Magic Bullets" is a fascinating and deeply emotional exploration of the history of cancer treatment. Through the stories of patients like Libby and doctors like Farber and Frei, the episode offers a nuanced portrait of the challenges, triumphs, and ethical complexities of fighting a disease that has plagued humanity for centuries. For anyone interested in the history of medicine, the science of cancer, or the human experience of illness, this episode is a must-watch.