I have finally finished my slog through the third book by Siddhartha Mukherjee, The Song of the Cell (2022). You may know that Mukherjee won the Pulitzer Prize in 2011 for the extraordinary work, The Emperor of All Maladies: A Biography of Cancer.

I say “slog,” because I understood only a fraction of what I read in this remarkable book and could only take it in small doses. Even then it was a challenge, not because of exposition issues but because I simply cannot understand how scientists know what they know. Much of the story of the cell, which is really a multitude of highly differentiated “things,” has been learned in fairly recent times, but that reality is one of the keys to what I did come to realize as I moved through the astonishing complexities of cell-level biology.

The realization was how most of what we think is known by those who know this stuff is the product of accumulated trial, and sometimes egregious error, by a vast array of people over extended periods of time. Typically, someone in a laboratory somewhere comes up with some idea, inspiration, theory, call it what you will. He (typically a “he,” but thankfully less so over time) works on it, sometimes for years and then, with or without a meaningful or useful conclusion, moves on to other pastures.

Then, and this is the key to the whole story, years, sometimes decades later, some other scientist in a lab somewhere else, or maybe just in a library, finds a paper about the earlier person’s work, decides to take it up for further exploration perhaps with the benefit of intervening developments in the science, expands the theory, tests it and … sometimes … makes a major new discovery. The old idea may be rejected entirely or merely extended with the use of new technologies.

This narrative occurs over and over and over again through time. One discovery or idea builds on another, then is added to by someone else, then another person or entire team takes it up and … discovery occurs. Truth emerges. Theory becomes practice. Concepts become medical solutions to previously unsolvable mysteries of illness. One thing builds on another. Along the way there are many false starts, mis-directions, failed experiments, misunderstandings.

Sometimes the “establishment” rejects out of hand a new idea that challenges the current orthodoxy. Reputations are ruined for some along the way. Some give up and just move on to other subjects until someone else, somewhere, picks up the trail, has a new insight, solves a seemingly unsolvable mystery.

Thus, are born immunotherapy and a multitude of medical “miracles” never conceived of. Transplants of organs become possible. Open heart surgeries. On and on. It’s never easy and there is often resistance to progress. When embryonic stem cells were being investigated,

…critics, mostly from the religious right, would have none of it. They argued that human embryos had been destroyed – defiled – during the production of these cells and that embryos constituted humans. That these IVF [in vitro fertilization]-produced embryos were yet to acquire sentience, had no organs, were no more than a ball of undifferentiated cells that would otherwise have been discarded anyway, hardly placated them; it was their potential to form future humans that made them currently human …. In 2001 President George W. Bush, pressured by opponents of ES cell research, passed a law restricting federal funding to research involving ES cells that had already been derived …; any attempts to make new ES cells could not be federally supported. In Germany and Italy, too, research on human ES cells was highly restricted and, in some cases, banned.

The book touches on other “cutting edge” dilemmas, as well, such as human enhancement through genetic engineering.

But for me, the main story was the way in which science moves forward. Working scientists separated by time and space find each other and each other’s work, building on it and bring humanity the most remarkable discoveries. Not least of these were the vaccines that brought an end, more or less, to the COVID pandemic. At least for now. The work will continue, just as the challenges will continue to come. And the song of the cell will expand into new rhythms, new stanzas, new understandings without end.