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.

Book Review – Notes on Andre Gide by Roger Martin du Gard

Andre Gide dedicated his first novel, The Counterfeiters, to Roger Martin du Gard. The later repaid this act of kindness by publishing Notes on Andre Gide as an encomium to his friend and mentor. What a book! It’s not just one Nobel Laureate in Literature’s biographical sketch of another Nobel Laureate in Literature, it’s a record of some serious conversations between two of the greatest authors of the twentieth century. The author’s powers of description made me feel like I was in the room listening to his subject’s ruminations. I could visualize Gide telling me, “Whenever I have the chance to enjoy myself, I do it.” (Page 11)

I’m a huge fan of both men’s work. Du Gard’s decision to publish his memoirs on Gide elated me. For those more familiar with music, imagine Eddie Van Halen and Jimmy Page struck up a friendship. Years later one of them released recordings of their jam sessions. Notes on Andre Gide is in the same category for fans of great writing.

Emulating Ben Franklin, du Gard presented his thoughts on Gide “warts and all.” Literally.

The light falls on Gide’s fine head. His whole face is alive with pleasure. He puts on the tortoiseshell spectacles (which sit now above, now below, the wart on his nose, according to whether it is me or the transcript that he is looking at.) (Page 13)

Du Gard delivered a very balanced view of his subject. I didn’t expect the level of explicitness. Even when critical he still strove for fairness. Here’s an excerpt dated 1928.

Gide is being spoiled by the complaisance of his entourage. He no longer pays the least attention to the preoccupations, the desires, the troubles, or the tastes of anyone but himself. He can hardly conceive that somebody should not, at any given moment, be free. And by ‘free’ he means: ready to give up everything in order to put one’s self entirely at his disposition; ready, not only to visit him, but to share, for the inside of a day, his life, his work, his pleasures, and his meals; ready to enter into the most trifling of his anxieties; ready to speak of the subjects which preoccupy him, to the exclusion of all others; ready to laugh, if he is in the mood to be amused; or wax indignant, if he has some pretext for annoyance or chagrin; ready to sit patiently with a newspaper or a magazine while he has his siesta; ready to read the letters he has just received, and to discuss with him the answers he has prepared; ready to read on with him the book he has already begun; ready to go out, if he takes it into his head to go to an exhibition or a cinema, or to call on a colleague… (Page 59)

That’s a long passage and du Gard had a few other issues to add at the end. I included it to show the author’s eloquence and command of detail. It certainly presented an unfavorable view of Gide. The author followed it up with the very next paragraph.

(How unjust I am! And how shameful of me to give way to that moment of bad temper! Have I ever spent an hour with him, and not been the richer for it? Even on his most tyrannical days he finds an opportunity twenty times over, of giving more than he gets. He gives fresh life to everything he touches. He talks as the sower sows; and the seeds that he scatters all around him ask only to be allowed to take root, and to flower.) (Page 59)

I’ve read many biographies and memoirs. I cannot recollect an instance where the author attempted, let alone achieved, this level of objectivity.

In a previous post, I reviewed Gide’s Corydon. I wanted to get insights from this book about just why he published something so controversial. Du Gard objected to the choice, but offered an explanation.

The idea of a public confession is infectious; like the hero of a Russian novel, Gide is burning to affront Society and invite its punishment; outrage, opprobrium, the pillory—those are the things to which he aspires…He has such a strange inspired smile when he disposes of my objections! When he thinks of being misunderstood, shunned and despised—the expiatory victim of a sublime sincerity—I believe he feels enlarged and exalted. (Pages 26 – 27)

I wonder if the Chinese curse about getting what one wishes for had been around in Gide’s time.

At any rate, for his myriad contributions to the field of letters the Nobel Prize Committee honored him with the award for literature in 1947. Du Gard included the following except from the citation.

Gide has often been accused of corrupting young people and leading them astray; the great influence which none can deny him is regarded by many as an influence for evil. That is the ancient accusation which has been laid against all the emancipators of the human spirit. Protests are superfluous, however; we need only consider the worth of those who are his real disciples…It is doubtless this, as much as, or more than, his literary work which has made him well worthy of the signal honor which Sweden has just accorded him. (Pages 94 -95)

Gide once wrote, “Believe those who seek the truth. Doubt those who find it.” If he’d had the opportunity to read du Gard’s Notes, even he just may have reconsidered.

Book Review: Laura Hillenbrand – Unbroken

If you think you’ve had a bad day you’ve got to read this book. Without a doubt Laura Hillenbrand detailed the most moving testament to the power of the human spirit possibly ever written. In this biography that read like a novel, the author related the remarkable life story of Louie Zamperini. Hillenbrand wrote, “From earliest childhood, Louie had regarded every limitation placed on him as a challenge to his wits, his resourcefulness, and his determination to rebel.” In the rest of her narrative she proceeded to show just how much these skills would aid Zamperini in later life.

Zamperini competed in the 5000 meter distance event in the 1936 Olympics. Without doubt a great accomplishment, but what really made him noteworthy came later. Following his time as an athlete he enlisted in the U. S. Army Air Force just before the Second World War. This decision would shape his entire future.

Hillenbrand related how Zamperini’s plane crashed in the Pacific, ironically, while searching for another downed plane. At this point the book became impossible to put down. Zamperini endured hardships that would defy reason had they not happened to him. Hillenbrand movingly described how Zamperini and two of his fellow airmen struggled to survive adrift in the South Pacific. At one point a Japanese plane even strafed him and his shipmates. I found my hands shaking as I read this passage.

Zamperini and one of the men on the raft survived for 47 days at sea. Hillenbrand had the following thoughts on how they did the miraculous.

Though all three men faced the same hardship, their differing perceptions of it appeared to be shaping their fates. Louie and Phil’s hope displaced their fear and inspired them to work toward their survival, and each success renewed their physical and emotional vigor. Mac’s resignation seemed to paralyze him, and the less he participated in the efforts to survive, the more he slipped. Though he did the least, as the days passed, it was he who faded the most. Louie and Phil’s optimism, and Mac’s hopelessness, were becoming self-fulfilling.

…and then the real horror started. Louie and Phil landed in Japanese occupied territory where soldiers captured them. But it got even worse. Zamperini ended up getting transferred to a POW camp where a particularly sadistic guard—nicknamed “The Bird”—took a particular interest in harassing and torturing him. “The Bird” and his “fatal poison of irresponsible power” had a particular distain for Louie’s Olympic past. Hillenbrand wrote, “Without dignity, identity is erased. In its absence, men are defined not by themselves, but by their captors and the circumstances in which they are forced to live.” But Zamperini and his fellow POWs decided, “If they were going to die in Japan, at least they could take a path that they and not their captors chose, declaring, in this last act of life, that they remained sovereign over their own souls.”

Hillenbrand’s did an outstanding job of researching the subject. She portrayed Zamperini’s ordeal in a compelling way without crossing into sensationalism. I really enjoyed how she interspersed stories of his family’s ordeal back in the U.S. with Zamperini’s tribulations. His relatives knew Louie’s plane crashed at sea, but they didn’t know what happened to him. At one point the military declared him Killed in Action. I thought incorporating the narrative about the family back home enhanced the emotional aspect of the story. Even though Louie’s relations weren’t brutalized by Japanese guards, they suffered almost as much as he did by not knowing his fate.

This is one of those things where due to the length of the book a reader knows that Zamperini survived. It demonstrated Hillenbrand’s proficiency as a writer that I found myself anxiously devouring every word to find out what happened next.

Like many people who experience a dreadful situation, Zamperini returned home to find solace in alcohol and resentment. “During the war, the Bird had been unwilling to let go of Louie; after the war, Louie was unable to let go of the Bird.” Hillenbrand also added, “The paradox of vengefulness is that it makes men dependent upon those who have harmed them, believing that their release from pain will come only when they make their tormentors suffer.”

Without question, the most interesting point in the book came near the end. Zamperini travelled to Japan in 1998 and wanted to meet the Bird. (The later had evaded authorities and lived in the open at the time.) In spite of the Bird’s refusal to see him, Zamperini still forgave him.

The only thing I could suggest for improving this story occurred in the section following Zamperini’s return him. He drank heavily, battled post traumatic stress disorder, and these factors put a tremendous strain on his marriage. His wife made him attend a religious revival meeting and then suddenly Zamperini gave up drinking and let go of his anger. For me this passage seemed a little cliché. Hillenbrand did note that while adrift at sea Zamperini made a promise to God that he’d live a righteous life if he survived. He recalled this after one of the services. I thought this section of the book too quick. Hillenbrand wrote, “At that moment, something shifted sweetly inside him. It was forgiveness, beautiful and effortless and complete. For Louie Zamperini, the war was over.” I learned a lot about Zamperini’s physical ordeals, I thought this would’ve been a great opportunity to analyze his dark night of the soul in more depth.

After reading Unbroken I felt guilty every time I told someone I had a “bad day.” It wouldn’t be possible to have a worse day than Louie Zamperini; and that could be from any period between his plane crashing and his learning to forgive his enemies. How did he do it? If I had to select one memorable line from the book to answer it would be the following:

Dignity is as essential to human life as water, food, and oxygen. The stubborn retention of it, even in the face of extreme physical hardship, can hold a man’s soul in his body long past the point at which the body should have surrendered it.

There is no greater testament to the power of human dignity than the story of Louie Zamperini. Mr. Zamperini celebrated his 97th birthday this past January 26th.

Book Review – Promise and Power : The Life and Times of Robert McNamara by Deborah Shapley

Many called Robert McNamara the “greatest management genius” of his era and yet today his name is synonymous with failure, mismanagement, and deceit. In this book, Shapely narrated this “whiz kid’s” meteoric rise to the heights of respect and prominence, through his downfall and disgrace as the architect of “McNamara’s War”: the tragedy that was the Vietnam conflict.


Shapely described McNamara’s education as the formative years of his life. He received an undergraduate degree in Economics from Berkley and later received his MBA from Harvard. McNamara was driven to do so by an idealistic belief that management was the key to solving the problems that plagued his society. He was an ardent believer in the capability of business to benefit society.


In school, McNamara learned the concepts of statistical controls and “throughput” which were pioneered by Donaldson Brown at du Pont and later adopted by Alfred Sloan at General Motors. These ideas were to shape American industry and make the 20th Century the “American Century.”


McNamara rigorously applied these ideas to first the U.S. Army and later to Ford Motor Company. For his efforts, he rapidly rose through the ranks of both organizations: he left the Army as a Lieutenant-Colonel and eventually rose to the Presidency of Ford. The later was a post he held for only a month as he was summoned by newly elected President John F. Kennedy to accept a position of even greater responsibility to society: that of Secretary of Defense. Because of his belief in public service, it was a call he couldn’t refuse.


The majority of Shapely’s narrative focused on McNamara’s seven years as head of the Defense Department. It was to be a tumultuous time as McNamara’s unshakable faith in statistical controls was to alienate many members of the military, and later the American public as a whole.


Shapely sharply criticized McNamara’s management of the Defense Department. McNamara took the ideas of economies of scale he leaned at Ford and contracted to design a plane that could be used both by the Navy and the Air Force. Both services didn’t like this concept, but it went forward anyway as McNamara believed, “the more important the decision, the fewer people should be involved in making it.” The plane never got off the ground and the project was later scrapped.


McNamara’s intractable belief in his brand of management blinded him to larger political considerations. Shapely described the cause of the Cuban Missile Crisis as a “political issue” as opposed to a matter that jeopardized U.S. national security. She also disparaged how McNamara tended to promote people in the military who were “numbers crunchers” instead of individuals with “operational” proficiency. And then there was the Vietnam War…


McNamara has been pilloried by many historians and journalists for his conduct of the Vietnam War. Shapely emphasized the duplicitous way in which McNamara was positive about the way the war was going in public and yet expressed grave reservations in private. The biggest criticism of McNamara was his “gradualist” approach to the war; in other words, his belief that the war in Vietnam could be a war fought with limited means for limited ends.


This may seem like an inordinate amount of criticism for the “greatest management genius” of his age, but Shapely had more to come. Shapely disparaged McNamara’s presidency of the World Bank. Through his emphasis on “throughput” McNamara made development the Bank’s primary mission. While this was a well intentioned move on McNamara’s part, it led to the developing world becoming overloaded with debt.


Shapely painted a very tragic portrait of our longest serving Secretary of Defense, but there’s a larger point that she missed. Robert McNamara was a brilliant man who received the best education this country had to offer. He studied and mastered the conventional management theories of the time and applied them rigorously in every organization he worked. He did exactly what he was trained to do and did so better than anyone else in his time. He applied these lessons in some of the most powerful public and private institutions in the world: and today “the computer with legs” is regarded as the epitome of hubris and failure. That is the tragedy of Robert McNamara.