‘The Emperor of All Maladies’: Cancer history bestseller

by | Dec 5, 2013

The Emperor of All Maladies: A Biography of Cancer, by Siddhartha MukherjeeI haven’t blogged in months. I’ve been mostly absent from Twitter and Facebook as well. Initially, I wanted to spend less time in these scattered and distracted modes of thought, and more time on focused and linear avenues like reading books.

But then my wife Amy was diagnosed with breast cancer. It turns out that there is nothing to get you focused and reading like a serious cancer diagnosis. You find yourself wide awake at three in the morning, wrapping your brain around estrogen receptors and Adriamycin. (The back-lit Kindle Paperwhite is very handy for such nocturnal research.)

At first, thrown headlong into this grim and convoluted machinery, you scramble to grasp the basics. What are the options? Are there options? As a basic introduction to breast cancer, Be a Survivor: Your Guide to Breast Cancer Treatment, by Vladimir Lange, sets a high standard with its clear and organized explanations, first-hand testimony, and high-quality color illustrations. (We read the paperback, so I don’t know how well the illustrations would work on a Kindle.)

Eventually, though, having met with surgeons, oncologists, a reconstructive surgeon and a radiation oncologist — and having settled into a chemotherapy regimen with surgery and radiation to follow — this need to learn about cancer broadened into more general questions. What is cancer, exactly? What causes it? What cures it? Where are we on the path to overcoming it?

As a listener to NPR’s Fresh Air, I recalled a Terry Gross interview with Siddhartha Mukherjee upon the publication of his book The Emperor of All Maladies: A Biography of Cancer.

The book, published three years ago at 592 pages in hardcover, is being turned into a six-hour Ken Burns documentary, CANCER: The Emperor of All Maladies, coming to PBS on Monday, March 30, 2015.

To call it a “biography of cancer” is a peculiar conceit. The book is, however, a wide-ranging overview that spans from the first mention of cancer in ancient Egypt to very recent progress in cancer genome sequencing. Along the way, Dr. Mukherjee sprinkles in a few of his personal experiences with cancer patients as a hematologist and oncologist. Mostly, however, the book is a step-by-step progression through the various eras of cancer research and treatment (with cancer prevention eventually added to the mix) driven by the leading figures of these periods.

Like a scholarly and passionate museum guide, Mukherjee walks the reader through Galen‘s “black bile” circa 160 AD, John Hughes Bennett and his “suppuration of blood” (leukemia), Rudolf Virchow and his revolutionary approach to pathology. He tells us of Andreas Vesalius and his breathtaking anatomical advancements, Joseph Lister‘s development of antiseptics and subsequent breast cancer surgery on his own sister, William Stewart Halsted‘s radical mastectomies and Marie Curie‘s groundbreaking research on (and eventual death from) radioactivity.

A good many pages are focused on Sidney Farber, the “father of modern chemotherapy,” not only for his discoveries in childhood acute lymphoblastic leukemia, but also for his anti-cancer fundraising work which created “The Jimmy Fund” and, with philanthropist/activist Mary Lasker, the modern American Cancer Society and its “War on Cancer”.

Through all this and much more, what emerges is a sketch of cancer as a prodigious family of insidious diseases. Instead of sure and steady progress, supposed victories on one front often lead to crushing defeats around the corner. Statistics that show promise can be reevaluated to show no effect whatsoever — or, as in the case of high-dose chemotherapy and bone marrow transplants, utter fabrication.

The cancer story is at times perverse. In less than a century, the average American goes from smoking less than one cigarette per year to smoking 3,500. British researcher Richard Doll, studying lung cancer in 1948 with Austin Bradford Hill, steps away from his work for habitual cigarette breaks — until the results of his study finally begin to become clear to him.

In the book’s 49 chapters, Mukherjee illustrates many other disconnects — between research and therapy, cost and effectiveness, compassion and scientific method. He quotes National Cancer Advisory Board member Rose Kushner regarding the “smiling oncologists” with no consideration for whether “you just vomit so hard that you break the blood vessels in your eyes.”

Expanding on the poet Jason Shinder’s observation that “Cancer is a tremendous opportunity to have your face pressed right up against the glass of your mortality,” Mukherjee adds that “what patients see through the glass is not a world outside cancer, but a world taken over by it — cancer reflected endlessly around them like a hall of mirrors.”

Frustration and disappointment temper breakthroughs and expectations over and over again. Near the end of his book, Dr. Mukherjee describes one of his patients as “someone locked in a chess game.”

Sometimes, especially once this contest moved to the genetic field, I struggled to understand the moves. With no education in molecular or genetic science, concepts like oncogene mutations and the functions of kinase inhibitors were at times difficult for me to picture going on in my wife, sleeping next to me in the dark. I imagine the TV series will be more illuminating in these areas.

Nevertheless, Mukherjee writes that a patient’s “need to know what it is I’m battling” was his initial and then daily motivation to begin and complete this book, and he has certainly provided a detailed recap of the epic tournament and many of its key players thus far, era by era and trial by trial.

As someone coming late and ignorant to the game, yet with an immeasurable stake in it, I am grateful for his arduous accomplishment.


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