Siddhartha Mukherjee in The New York Times:
Recently, I met a very unlucky man. A financial adviser in his mid-60s, he seemed chronically short of breath, and he had an odd habit of widening his eyes and raising his brows every time he finished a sentence. “I’ve had two potentially deadly cancers,” he told me. “Melanoma and lung cancer. They took the lung cancer out, and the melanoma was resected.” The brows lifted and dropped. “But it wasn’t either of the cancers that nearly killed me,” he continued, with what seemed to me an extraordinarily sanguine approach to his medical history. “It was a heart attack.” Months earlier, he had an acute bout of chest pain — a ripping feeling across his chest that arced down to his left arm. He was rushed to the hospital, where doctors discovered a near-complete blockage of one of his heart’s main arteries. By the time cardiologists relieved the block, there was a dying wedge of tissue in his heart; he never recovered normal heart function. If this man’s case had been presented to me a decade earlier, I would have thought of him as the victim of two unrelated illnesses. Heart disease and cancer — Killer 1 and Killer 2 in the United States — inhabited parallel universes of medicine. Coronary heart disease, we were taught as medical residents, was typically caused by the buildup in the arteries of plaque, made up mainly of cholesterol deposits. If the plaque ruptured, a clot formed around it, precipitating an acute blockage of blood flow — a “heart attack.”
Cardiologists learned that they could prevent plaque accumulation by changing diet or habits or by using cholesterol-lowering drugs like Lipitor. Beyond prevention, the doctors could forcibly widen the arterial blockade or inject clot-busting drugs. The image of scales of lead clogging old pipes, and a Roto-Rooter, was hard to shake. Coronary artery disease, it seemed then, was mainly a plumbing problem, demanding a plumber’s toolbox of solutions (to be fair, there’s a cosmos of biology behind cholesterol metabolism and its link to heart disease). Cancer, by contrast, was an exterminator’s problem — a poisoner’s dilemma. Cancer-causing agents unleashed abnormal cellular proliferation by mutating genes involved in regulating growth. These cancer cells, occupying tissues and spreading, demanded a cellular poison — chemotherapy — that would spare normal cells and kill the malignant ones. Cardiologists and oncologists — plumbers and poisoners — lived in different medical realms. We spoke different languages, attended different conferences, read different specialty journals. If our paths intersected, we considered the crossing coincidental, the unavoidable convergence of two common age-related illnesses on the same body.