The Emperor of all Maladies: a Biography of Cancer by Siddhartha Mukherjee
New York: Scribner, 2011 ISBN 9781439170915
This book won the Pulitzer Prize, and once you've read it, it's easy to understand why. Siddhartha Mukherjee has written a page-turning, easy to understand tour through medical history to describe the past, present and possible futures of cancer.
The book really has two foci - a description of what cancer is, and the history of our efforts to cure, prevent and palliate it. As the book progresses, so does the reader's understanding of just how insidious an enemy cancer is, and how any success against it however small, is hard-won.
Mukherjee describes how cancer has been seen through the centuries, from black bile to our current understanding that genetic mutation is the prime cause of cancer but there is still some way to go in our journey to fully understand how cancer behaves. In the meantime cancer continues to grow as a cause of death for the world. While the sufferers wait for a breakthrough in treatment, Mukherjee tempers enthusiasm by suggesting, as has happened in the past, our fight against this disease is a long, slow campaign.
The metaphors of war appear many times in this book - Mukherjee covers the fight for funding led by the redoubtable Mary Lasker, who finally got the government to not only take the disease seriously, but to put dollars behind the effort of scientists and doctors to work for a cure.
The heart of Mukherjee's book is that effort for a cure - how the scientists made breakthroughs in our understanding, the doctors had fixations on how to cure, and the patients had very little say in their treatment. The history of cancer treatment is one of.... I want to write, brutalism. From early treatments of breast cancer with sulphur and mercury, to radical mastectomies, to toxic cocktails of drugs, it is the patient that has suffered from whatever latest fad had taken the medical world by storm.
For, until the twenty-first century and the discovery of cancer's genetic origins, all sorts of cures were thrown at patients in the hope that some stuck. Removal of tumours only worked if the cancer hadn't metastasized, X-Rays had a similar problem (and, insidiously, caused cancers of their own), and chemotherapy drugs are toxic to all cells, which cause the obvious problems that come from that.
Some of these therapies had some success, but cancer was a word that sent a shiver of dread through those that heard it, as it seemed that until recently it was a death sentence for those that had it. Mukherjee explains that cancer is simply our body malfunctioning, cells failing to know when to stop duplicating or when to die, and our new understanding of how cancer occurs and continues has enabled new genetic therapies that are much more effective in lengthening survival and even curing some forms of the disease, to the extent that cancer is now becoming one disease among many.
The failures and follies of medicine and science that Mukherjee documents that are the most painful things to read about (especially if, like me you have lost friends and relatives to this disease). Mukherjee chronicles the rise and fall of radical mastectomy, X-Ray, and chemotherapy as a cure. Each of these methods had their champions, and unfortunately they jealously guarded their "patch" to the detriment of patients. Mukherjee shows that it was only slowly by degrees that the medical establishment realised that a combination of therapies creates the best chance for victory over the disease.
For a reader that doesn't know much about what cancer is, or how and why treatments were tried and discarded, or how science has advanced our understanding, The Emperor of Maladies is a fantastic book - it would be fascinating to read an updated version to see what advances have happened in the ten years since this book has been published.
A few minor quibbles that I had with this book: overall Mukherjee writes a tight and informative prose, but when he reaches for "literate" quality his touch is less sure. There is one section where he abuses the metaphor of Achilles' heel which was hard to read. A failure possibly by Mukherjee, but certainly by his editors and proofreaders is to suggest that Richard Burton wrote the Anatomy of Melancholy in 1893....really got my goat.
Those are minor quibbles about what is truly an excellent book, and one I would heartily recommend.
Cheers for now, from
A View Over the Bell
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