Book Review – The Emperor of All Maladies: A Biography of Cancer by Siddhartha Mukherjee

But the story of leukemia—the story of cancer—isn’t the story of doctors who struggle and survive, moving from one institution to another. It is the story of patients who struggle and survive, moving from one embankment of illness to another. Resilience, inventiveness, and survivorship—qualities often ascribed to great physicians—are reflected qualities, emanating first from those who struggle with illness and only then mirrored by those who treat them. If the history of medicine is told through the stories of doctors, it is because their contributions stand in place of the more substantive heroism of their patients. (Page 148)

In the prologue to The Emperor of all Maladies, Dr. Mukherjee wrote:

 In 2010, about six hundred thousand Americans, and more than 7 million humans around the world, will die of cancer. In the United States, one in three women and one in two men will develop cancer during their lifetime. A quarter of all American deaths, and about 15 percent of all deaths worldwide, will be attributed to cancer. In some nations, cancer will surpass heart disease to become the most common cause of death.

The author quoted journalist Paul Brodeur who observed, “Statistics are human beings with the tears wiped off.” (Page 267)

That statement’s accuracy resonates with me. My mother passed away from cancer. Her brother passed away from cancer at the age of 49. My paternal grandmother survived cancer twice. Myriad acquaintances of mine have battled the disease. Because of this, I felt compelled to read Dr. Mukherjee’s book.

The author is a cancer physician, researcher and an assistant professor of medicine at Columbia University. He’s also a gifted author. I thank him for writing such an accessible work about one of the most complex medical challenges to afflict human kind. While he lost me with some of his bio-chemical explanations and descriptions of how various drugs function, I found the overall work understandable.

Instead of presenting a dry scientific tome, Dr. Mukherjee chose to present his story as a “biography” of cancer. He called this scourge “possibly the oldest disease among humans.” (Page 43) Throughout the story he described the (sometimes quirky) physicians who made breakthrough discoveries. He also detailed the innovative ways researchers sought new means to combat this “emperor of all maladies.”

The most intriguing revelation I found concerned how the Ancient Egyptians may have identified the disease. He included the physician Imhotep’s chilling description of the treatment: “There is none.” (Page 41)

The author began each chapter with quotes. As someone more grounded in the humanities than the sciences, I liked that he chose to include some from literary figures. Here’s a poem from Hilaire Belloc.

Physicians of the Utmost Fame

Were called at once; but whence they came

They answered, as they took their Fees,

“There is no Cure for this Disease.” (Page 11)

The doctor apparently had a good background in verse. He included “The Fall” from Czeslaw Milosz.

The death of a man is like the fall of a mighty nation

That had valiant armies, captains, and prophets,

And wealthy ports and ships all over the seas

But now it will not relieve any besieged city

It will not enter into an alliance. (Page 116)

In one of the sections where he discussed drugs he referenced the Pulitzer Prize winning drama, Wit by Margaret Edson. The play detailed a woman’s battle with cancer; especially, her cancer treatment and the effects of the drugs prescribed to her.

These references helped to round out the narrative. They balanced out the technical sections nicely.

While the author presented a host of concrete scientific details, he did allow his personal views to permeate the text. He made no effort to conceal his disdain for the tobacco industry. Numerous times he described smoking in the same way most others would recount heroin addiction. He included the following statement when explaining a meeting that took place at the National Institute for Health in the 1960’s.

Ashtrays with cigarette butts littered the tables. (The committee was split exactly five to five among nonsmokers and smokers—men whose addiction was so deep that it could not be shaken even when deliberating the carcinogenesis of smoke.) (Page 261)

His comments on the passage of the Federal Cigarette Labelling and Advertising Act of 1965 were much harsher. He wrote:

…it changed the FTC’s warning label (on cigarette packs) to Caution: Cigarette smoking may be hazardous to your health. The dire, potent language of the original label—most notably the words cancer, cause, and death—was expunged. To ensure uniformity, state laws were also enfolded into the FCLAA—in effect, ensuring that no stronger warning label could exist in any state in America. The result, as journalist Elizabeth Drew noted in the Atlantic Monthly, was “an unabashed act to protect private industry from government regulation.” Politicians were far more protective of the narrow interests of tobacco than of the broad interest in public health. Tobacco makers need not have bothered inventing protective filters, Drew wrote dryly: Congress had turned out to be “the best filter yet.” (Page 265)

Obviously, The Emperor of All Maladies does not have a happy conclusion. Towards the end of the book, the author included an anecdote about a lab sample he worked with.

The cells, technically speaking, are immortal. The woman from whose body they were once taken had been dead for thirty years. (Page 339)

Sadly, even with the vast advancements in the diagnosis and treatment of the disease, the war on cancer may last just as long.

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