Abstract
As of the year 2011, using the search term “HeLa cells” in PubMed yields more than 60 000 articles. Clearly, HeLa cells are the most widely studied cultured cells and have been critical to many advances in the scientific understanding of cell function and to the development of a variety of medical treatments. Nonetheless, much of the story of the origin of HeLa cells remained a mystery (despite a BBC documentary film “The Way of All Flesh” that is currently still available through the Internet at the website http://topdocumentaryfilms.com/the-way-of-all-flesh/) until Rebecca Skloot decided to devote a decade of her life to documenting this tale. As expected from an educator (Skloot is a faculty member at the University of Memphis) who teaches creative writing, this is a captivating 370-page book that reads like a good novel and is hard to put down. In 38 chapters, Skloot interweaves the story of her quest to understand the history of the HeLa cells with the story of Henrietta Lacks and her family and their quest to gain appropriate recognition for the enduring contribution that Henrietta made to the world. In the midst of World War II, Henrietta migrated with her family from her ancestors' rural Virginia tobacco farm to urban industrial life in Baltimore, Maryland, where she subsequently received care at Johns Hopkins Hospital for cancer of the uterine cervix. During her treatment in 1951, a small piece of the tumor was taken by Dr George Gey, who was then for the first time able to sustain human cells in culture. 1 This remarkable feat opened myriad investigative possibilities. For example, the ability of HeLa cells to grow readily in culture became important in evaluating the safety of Salk polio vaccine. 2
The crux of the story, however, is the “sea change” in the attitudes and ethics related to clinical care and biomedical research that has occurred over the more than half century since that original cervical cancer sample was obtained and cultured. Skloot details the paternalistic attitudes of physicians prevailing at the time when the biopsy was unknowingly taken from Henrietta’s tumor for research purposes and when her diagnosis, prognosis, and treatment were never fully explained to her or her family. Skloot also discusses the course of HeLa cells from exciting novelty among researchers desperate for samples for their own laboratories to worldwide contaminant that overwhelmed cultures developed from other cells types, invalidating many years and millions of dollars worth of research efforts. 3 In attempting to understand this contamination problem, the living family members were subjected to genetic testing, again without their understanding or permission to publish the findings. 4
While not condoning the many questionable practices and racial overtones documented throughout this book, the events must be understood in the context of the mores of the United States in the mid-20th century. In contrast, the modern 21st-century “patient-centered” health care model, along with the numerous rules and regulations from United States federal and state government agencies should preclude similar occurrences. Nonetheless, as the noted philosopher George Santayana stated, “Those who cannot remember the past are condemned to repeat it.”5(p284) And, therefore, it is critical to understand these events in order to be vigilant in ensuring that they can never recur. Thus, this book should be required reading as a part of the ethics education for students (and practitioners) in all fields of health care.