Book Review: Song of the Cell

A magnum opus and love letter to the science and medicine of cells

“The discovery of the function of pancreatic cells began, inauspiciously, with a quarrel between two anatomists that ended in a murder.”

This shocking line opens a chapter on hormones and glandular tissue in Dr. Siddartha Mukherjee’s excellent new book The Song of the Cell: An Exploration of Medicine and the New Human. One of his Mukherjee’s greatest gifts as a writer is his ability to unearth and relay the unbelievable human stories behind the dry, official narratives in our medical textbooks, and all of his work is packed with similar tales. I have mentioned this book and Mukherjee’s other writing in passing on this Substack, but after finishing this recently, it was incredible enough that I wanted to dedicate a whole post to reviewing it.

Song of the Cell is a tour de force through the past, present, and future of cell biology. The focus throughout is connecting how the fundamental scientific discoveries of the last 200-300 years paved the way for “New Humans”: People with transplanted organs and artificial tissues, implanted medical devices, and genes modified by viral vectors. While it is—unsurprisingly, given the topic—heavy on the science, he does an excellent job catching up lay readers on the basic terms and concepts and bringing them along for the ride; anyone curious with a solid education should be able to follow without a problem. While his previous books The Emperor of All Maladies and The Gene were also terrific, he is at the top of his game here. His deft prose takes what could be an intimidating, or worse, boring subject and makes it a page turner by weaving in personal stories, medical narratives from his patients, and historical anecdotes that range from the bizarre to the hilarious and tragic (sometimes all three at once).

The characters of this book are often outsiders and rebels, people who dabbled in many different fields and broke rules that held old progress back. Antonie van Leeuwenhoek was an eccentric Dutch merchant who invented the microscope, but his discovery of cells was not appreciated for decades because he stubbornly refused to detail his methods and work with other scientists to replicate his findings. One of the main “heroes” of the book is Rudolph Virchow, a humble German pathologist who originally wanted to be a minister, but chose the solitary path of laboratory medicine because he was too soft-spoken and shy to deliver sermons to the masses. Over decades of careful study at the microscope he changed almost everything we know about biology and medicine and ushered in an era of cellular pathology. He was also an early advocate for the importance of public-health and addressing societal inequality, as well as a bold voice against the rise of racism, anti-semitism and authoritarianism in late 19th century Germany. A character portrayed as close to a “villain” is the Chinese researcher He Jiankui, who used CRISPR to create the world’s first genetically modified human embryos (born as apparently healthy twins Lulu and Nana); his methods were sloppy and potentially dangerous, and he was widely regarded as reckless.

Mukerjee is an expert in cancer and blood-borne diseases, and focuses much of the book on those topics. There are harrowing stories about the brave first patients who underwent bone marrow transplants to fight their leukemia. A fascinating section recounts the development of in vitro fertilization in the 70s and 80s. He delves into why people are so prone to heart attacks, and how modern gene editing techniques may eradicate that modern scourge of humanity in the near future. He explores diseases of both overactive and underactive immune systems.

Like one of my other medical-literary heroes Atul Gawande, Dr. Mukherjee is no stranger to writing about his own difficult moments and emotions. There is a stand-out section dedicated to his experience working in New York City during the covid-19 pandemic, grappling not only with the horrors of those early days without adequate treatments or supplies, as well as with the failures of the government, public health systems, and societal empathy. He also writes beautifully about his difficulty accepting how much we still don’t understand about SARS-CoV-2. Finally, in one of the later chapters he details his battle with severe clinical depression and what brought him back from the depths. This segues into descriptions about experimental treatments at the frontiers of psychiatric medicine such as implantable devices for Deep-Brain Stimulation (DBS) that show promise in certain patients with depression and Parkinson’s Disease.

Should you read this book? My answer, without any hesitation, is yes! Song of the Cell is filled with lyrical writing and poetry allusions, picaresque stories of underdogs making discoveries through unconventional means, passages that invite contemplation about big philosophical questions. You will root for sick patients who fight against their diseases with the help of Dr. Mukherjee and other doctors. The book is ambitious, covering topics spanning not only science and medicine, but also history, politics, economics, literature, and religion; there really is something for everyone here. In the words of Stefon from SNL:

I hope you enjoy it as much as I did.