The Anime That Every Medical Student Must Watch

By Louie Dy (Class 2021) and Sean Cua (Class 2021)

Artworks by Albert Jason Olaya (Class 2022) and Paul Kenny Ko (Class 2021)

 

Cells at Work Fanart by Albert Jason Olaya (Class 2022)

 

“人間の体の中には 約三十七兆二千億の細胞たちが 毎日毎日 二十四時間三百六十五日 元気に働いています。” – 働く細胞

(“Inside the human body, around 37.2 trillion cells energetically work each and every day, for 24 hours and 365 days.” – Cells At Work)

 

Cells at Work (Hataraku Saibou / 働く細胞) is a Japanese manga written and illustrated by Akane Shimizu (清水茜). The uncanny, out-of-this-world brilliance of the author is manifested at how each character, such as the Red Blood Cell, is personified into the series protagonist. By adding life and character to each cell, human physiology, especially concerning the basics of Hematology and Immunology, become quite palatable even for the layperson. The magnificence and miracle that is the human body is successfully translated into the exuberance that is the anime series. Even if you might think that this article is a spoiler of the series, you can never really call this a spoiler because there is exponentially more fun in watching and reading the series itself.

Bacteria and parasites, such as Pneumococcus sp., Staphylococcus aureus, Pseudomonas aeruginosa, and Clonorchis sp., are personified into polymorphic monsters which do somehow resemble the specimens in real life. Red Blood Cells deliver oxygen and carbon dioxide to their respective places. White Blood Cells fight bacteria using their daggers. Helper T-Cells coordinate and facilitate the activation of Naive T-Cells into Cytotoxic T-Cells. Macrophages deal massive damage to the bacterial army. Platelets, with their stress-relieving, permafrost-melting cuteness repair damages to the blood vessel and just somehow make your day happier. These are just examples of basic processes that occur in the human body every day, yet Cells At Work showed how beautiful and important these “basic” processes are.

Numerous analogies bridge the molecular and cytological mechanisms into concrete actions done by each characters. Clotting factors are shown as some “gadget” used by the Platelets, and the fibrin clot is shown as a “net”. Helper T-Cells coordinate in a “command center” across classes of immunocytes in order to fight infections. Antigen presentation is illustrated as “transferring of information or a book”. Enucleation is shown as the “graduation ceremony” of the Red Blood Cells (from being Reticulocytes). The Dendritic Cell is shown as a tree with an operator, which satisfies the etymology of the word “Dendritic” from “Dendro”, which means “tree”. The Cancer Cell appears to be an ordinary cell until the Natural Killer Cell, being able to sniff abnormalities in such cells, finding out how monstrous he was. The fact that tumor cells needed a humongous blood supply was also translated into massive hordes of Red Blood Cells accomplishing a “giant delivery order”.

Aside from concrete analogies, the anime also stimulates imaginative thinking, such as how the characters would play their roles in more devastating and debilitating conditions. Perhaps, for example, in a more morbid setting, Idiopathic Thrombocytopenic Purpura (ITP) could involve a mass murder of the poor cute little Platelets, or perhaps in Meningococcemia, the bacteria could act like a ninja that causes damage to the skin and meninges (nervous system), leading to fast world destruction and armageddon.

As such, multiple spinoffs have emerged, and one of them, while still a manga, is the darker, Seinen (成年), and probably R-16 Cells At Work BLACK (Hataraku Saibou BLACK), by Shigemitsu Harada (原田重光) and Issei Hatsuyoshi (初嘉屋一生). In this manga, cells in a “black”, harsher environment attempt to do their job. Topics include erectile dysfunction and the use of Sildenafil, “illegal” LDL deposition and atherosclerosis, liver disease, gonorrhea, among others. Other spin-offs, such as Bacteria At Work and Cells That Do Not Work, are underway.

This only proves the anime not only to be quite entertaining, but also quite educational. Physiology and pathophysiology, which are the foundations of modern medicine, can be easily remembered. Things that are often skimmed in medical school are paid more attention throughout the series. Cuter diagrams such as the Hematopoietic Stem Cell Line diagram at the end of Chapter 6 of the manga would definitely help in the board exams.

 

For those who would like to go and see the show beyond its zany depiction of biology, the show can be perceived as a microcosm of a real world utilitarian society. Every cell’s identity and function are already determined from the start, their purpose already known, and they live out their paths all in support of the human body’s betterment. Anytime something goes awry, the body has agents in its arsenal (the immune system cells) to reclaim the gentle homeostasis under duress. The society thus represents the potential of a real world scenario when every individual focuses on their utility for the good of the body and where exogenous foreign factors that strive to disrupt the peace are properly identified and eliminated. The show then presents an interesting twist to their utopia once they realize that some disruptive factors are actually cells of their own kind that had an error in its production.

This problem then explores the question, “What are to be done to disruptive agents who don’t have the capacity to do what they were meant to do and instead cause harm to the society?” Do they try and help them reform (as in the case of the main character – a red blood cell who has no sense of direction and can’t deliver the important nutrients of the body) or do they simply eliminate these “threats to society” (as in the case of the cancer cell who was at the point of metastasizing)? By making its viewers pause and think about these questions, the anime goes deeper than its medmonics surface level façade to unveil the questions we seldom ask, and yet need to answer as they will reflect how we actually view the world we see before us.  

 

Beyond this show, every Japanese manga and anime is quite educational and often even quite deep and philosophical. There also exists an anime about Microbiology and the production of alcohol – Moyashimon (もやしもん), where bacteria are personified into cute Chibi characters such that the main character is able to see them and interact with them. In the manga The Promised Neverland (約束のネバーランド), The Hayflick Limit is a concept that defines the maximum number of times a cell can divide in a lifetime – a concept that was never taught in medical school.

Cells at Work by Akane Shimizu is still ongoing. An episode is released every weekend.

 

Cells at Work Fanart by Paul Kenny Ko (Class 2021)

 

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