Blind Spots

What happens when scientists fall sick with the very disease they study?

IN THE WINDOW of her office at Stanford University Medical Center, Dr. Kimberly Allison keeps a transparency of breast cancer cells. “Beautiful,” she says, gazing at the tumor cells, each traced in a thin orange line and arranged in clusters resembling a honeycomb.

Allison’s job is to examine tissue samples for clues that can explain what exactly has gone wrong inside a person’s cells. She began her career in the mid-2000s, right when medical researchers started to recognize that all tumors and cancers are genetically and biologically distinct. In other words, two women with breast cancer might have two different types of cancer with little in common other than that they both occur in the breast.

Suddenly, drugs that targeted specific types of cancer were hitting the market, and a pathologist’s description of cancer became a powerful guide in determining which patients received the new treatments. The first of this class of drugs, Herceptin, debuted in 2006 to treat women with breast cancer tumors that have abnormally high numbers of a cellular receptor called HER2 that stimulates growth of cancer cells.

Allison became a breast cancer expert, in large part because of the HER2 discovery. “It was exciting to me that you could make such a difference in a patient’s treatment plan,” she says. “You weren’t just describing cancers. You were saving lives.”

Then, in March 2008, at the age of 33, she felt a shelf-like formation under her arm and went to the doctor for a diagnosis. She had breast cancer. “It was completely disorienting,” she says. She remembers thinking, “I look at this all the time under the microscope, but this isn’t my story.”

Slow-growing cancers appear almost like normal cells under a microscope’s lens. But then, Allison says, there are “big, bad and ugly” aggressive cancers. Instead of being neatly arranged into structures, these cancer cells swell and lose their tidy alignment. That’s what Allison saw when she peered through the microscope at her own cells. The cells’ outer membranes also glowed orange—the color of a special stain adhering to HER2 receptors. Allison had Her2-positive breast cancer.

It’s not often that scientists and physicians are stricken with the precise disease they study, but when it happens the shock is unsettling. Even after years of research, experiencing a familiar illness firsthand can make the disease suddenly terrifying. It can lend new urgency to tedious bench work that probes the molecular and genetic undercarriage of illness—but researchers tossed into the turmoil of life as a patient can also quickly lose sight of the neutrality they’ve developed.

In 1971, Ernie Garcia, a young astrophysicist turned radiologist at Emory University, developed software to allow cardiologists to peer into patients’ hearts. His Emory Cardiac Toolbox includes a program that tracks a “tracer”—radioactive material injected through veins—into the muscle of a beating heart. On a screen, physicians can watch chambers light up in bright colors if blood flow is normal, or turn black if it’s not. An abnormal reading indicates

coronary heart disease, which can cause heart attacks and affects 15 million Americans.

Garcia spent the next three decades working with heart patients. But he missed the signs completely in 2008, when he had a heart attack. One night in April, after a pasta dinner—heavy on the garlic—he felt a sharp pain in his chest. He attributed it to heartburn. “The esophagus and the heart tend to share a lot of the same nerves,” he shrugs. When he woke up the next day, his heart was racing. Colleagues at Emory University Hospital hooked him up to the toolbox he had invented to see how blood was flowing through his heart. Afterward, Garcia found his cardiologists just outside the door, huddled around a screen displaying his results. “They didn’t even have to say a word,” he says. The blackened sections showed that the sharp pangs he felt months earlier were signs of a heart attack caused by coronary heart disease, and the damage was severe. Twenty percent of the functionality in his left ventricle was lost forever.

Garcia’s expertise had almost killed him. He dismissed his symptoms because over years of studying fatal heart conditions he had persuaded himself that he would never develop one. That psychological distance allowed him to treat others without fretting over the inevitability of his heart’s decline. “It gets to the point where you