Carrie Bengston Reviews The Emperor of all Maladies – A Biography of Cancer by Siddharta Mukherjee
Review by Carrie Bengston
The obscure title, taken from a quote about cancer by an 19th century surgeon, gives a hint at the kind of science book this is. It’s a meticulously researched ‘history of cancer . . . a chronicle of an ancient disease’ and the development of our understanding over 4,000 years. The book is an ambitious one, driven primarily by its author’s curiosity, and is sweeping in the best sense of the word. Author Siddharta Mukherjee is himself a US oncologist and researcher. His latest book, ‘Gene’, was published last year. ‘The Emperor of all Maladies’, published in 2010, was an impressive debut and won the Pulitzer Prize for Non-Fiction in 2011.
The disease we call cancer, actually many diseases, is the lead protagonist in this book. Mukherjee traces ideas and discoveries about cancer and its treatment. The book also tackles social changes and political ideas, for example, the tobacco wars that emerge from the realisation that cancer prevention was necessary to reduce cancer deaths. It charts the ‘War in Cancer’ during the Nixon era, which led to billions of dollars of extra research funding, new laws, and the formation of new institutions like the National Cancer Institute.
Among the book’s surprising highlights is its beautiful prose. For such a grim subject, the writing is lovely to read. Perhaps that’s needed to keep us going. The book is hard work, full of detail, but definitely worth the effort. Several friends and colleagues told me they’d started it but not got far. Others read it in 2 days. It took me almost two months, chipping away a chapter or part chapter at a time, letting it sink in.
The book is broad and thorough. It brings together medical history, social history, politics, personal anecdotes and science to give us a multidimensional view of cancer and the search for a cure. Into the mix, the author weaves personal stories of key researchers, doctors and movers and shakers – their eccentricities, their Eureka moments and missed opportunities. Notables include Sidney Farber (of Boston’s Dana-Farber Institute), Halsted, Marie Curie, and Robert Weinberg. Mukherjee sprinkles in anecdotes of patients from his own oncology practice. The story of one patient, Carla, is threaded through the book like a motif.
Particularly clever is the way Mukherjee brings all the elements together to create an emotional response. He is a master storyteller. As he says, stories are central to medicine. Patients give their stories to doctors, doctors’ medical records are stories, and medical science is full stories of research twists and turns, blind alleys and serendipity, progress rational and random.
Breast cancer treatment ideas overturned
One of the most fascinating chapters I felt was about breast cancer, particularly relevant during October, Breast Cancer Awareness Month. This chapter, ‘In God we trust, All others must have data’, started with the radical mastectomies that disfigured women from the 1890s right to the late 1970s. Seen as the only way to ‘extirpate’ the cancer, this often-brutal treatment was administered to desperate patients by surgeons whose authority could not be questioned. Then clinical trials, which surgeons eventually deigned to participate in, generated data that tested the validity of the prevailing view. They showed ‘lumpectomies’ (denigrated by proponents of radical mastectomies) to be just as or more effective for many types of breast cancer. This finding coincided with a burgeoning feminist movement in the 1960s-70s which led to patient activism that gave women a voice in their own medical treatment. Mukherjee brings together the social, medical and scientific elements of that story very powerfully. Awe-inspiring stuff.
Biographies often conclude with a death yet, as Mukherjee points out, cancer is not dead. Despite improvements in treatments, we are still some way off a cure for all cancers. There will not be the single, ‘universal cure’ surmised by Farber and others. The disease is too complex and finds ways to resist the treatments meted out to stop it. But progress continues and some cancers aren’t the terror they once were. Recent developments in molecular studies and understanding the cancer genome and oncogenes conclude the book. They presage developments not covered due to the book’s 2010 publication date, like immunotherapy, personalised medicine initiatives and the recent first-ever US FDA approval a drug for a specific mutation. If Mukherjee ever does an update, I hope that’s a chapter he will add. But don’t wait. Read it anyhow.
Carrie Bengston is a science communicator with Children’s Cancer Institute. A bit of a tragic science nerd, she loves to see research findings reach a wider public and enjoys making that happen. She’s been a member of a book club in her community that reads fiction, occasionally fiction with a science bent.