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2099-12-31-on-the-logo-and-its-color.md (7376B)

      1 ---
      2 layout: post
      3 title: "On the logo and its color"
      4 categories:
      5   - medicine
      6 tags:
      7   - arsenic
      8   - cancer
      9   - iconography
     10   - color
     11   - medicine
     12 ---
     13 
     14 ## Arsenic
     15 
     16 ![One of several alchemical symbols for arsenic](data:image/svg+xml;base64,PD94bWwgdmVyc2lvbj0iMS4wIiBlbmNvZGluZz0iVVRGLTgiIHN0YW5kYWxvbmU9Im5vIj8+Cjxz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)
     17 
     18 On my first day in leukemia clinic in 2015, with a [certain young fellow from Syria](https://my.clevelandclinic.org/staff/20358-aziz-nazha) and a [certain attending physician who is rather fond of a good story](https://www.nytimes.com/by/mikkael-a-sekeres), I was told the story of how arsenic made its way back into medicine as a treatment (and often cure) for one of the worst types of blood cancer, "Acute Promyelocytic Leukemia" (APL).
     19 
     20 Arsenic has been used for [thousands of years](https://doi.org/10.1007/s00204-012-0866-7) for everything from [medicine to candy to wallpaper to rat/king poison](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1036521/). It was used widely for this last purpose, because it is [odorless, tasteless, dissolves instantly in liquid, and is among the more deadly poisons known to man](https://giphy.com/explore/the-princess-bride). In low doses it is a mild stimulant (and, apparently, aphrodisiac), and in higher doses bad things happen, [even if not ingested](https://wellcomecollection.org/works/g32gywph).
     21 
     22 In the 1800s in the West arsenic was found to be helpful in certain blood cancers if ingested and in certain skin and breast cancers if applied to the skin. A string of studies from China in the 1990s using arsenic trioxide for patients with APL had remarkable results, which led to studies in the U.S and a remarkably swift change in standard medical practice. APL was a disease that would almost invariably bring you into the hospital in critical condition and send you out in a bag to. Now, last time I was with a patient with APL, that young Syrian fellow (who is now an attending) kept repeating:
     23 
     24 ↵ Sun HD, Ma L, Hu X-C et al. Ai-Lin 1 treated 32 cases of acute promyelocytic leukemia. Chin J Integrat Chin Western Med 1992;12:170-172. Google Scholar
     25 Zhang P, Wang SY, Hu XH. Arsenic trioxide treated 72 cases of acute promyelocytic leukemia. Chin J Hematol 1996;17:58-62. Google Scholar
     26 ↵ Shen Z-X, Chen G-Q, Ni J-H et al. Use of arsenic trioxide (As2O3) in the treatment of acute promyelocytic leukemia (APL): II. Clinical efficacy and pharmacokinetics in relapsed patients. Blood 1997;89:3354-3360. Abstract/FREE Full Text
     27 ↵ Soignet SL, Maslak P, Wang Z-G et al. Complete remission after treatment of acute promyelocytic leukemia with arsenic trioxide. N Engl J Med 1998;339:1341-1348. CrossRefMedlineGoogle Scholar
     28 ↵ Soignet S, Frankel S, Tallman M et al. U.S. multicenter trial of arsenic trioxide (AT) in acute promyelocytic leukemia (APL) [abstract 3084]. Blood 1999;94(suppl 10):698a. Google Scholar
     29 
     30 [!['Bottle of iron, arsenic and digitalin tablets, London, 1916-' by Science Museum, London. Credit: Science Museum, London. CC BY](https://github.com/cbeauhilton/cbeauhilton.github.io/raw/code/images/arsenic-iron-digitalin-wellcome-collection.jpg)](https://wellcomecollection.org/works/z8ssmfqa?query=arsenic&page=1)