Review: The Emperor of All Maladies

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

My rating: 5 of 5 stars


I do not consider myself a superstitious person—not even remotely—but somehow I felt a deep reluctance to pick up this book. It may have taken us a long time to figure out the germ theory of diseases, yet the psychology of contagion runs deep. I had the irrational fear that even learning about cancer would somehow unleash it into my life.

But turning away from frightful things is not a good way to live. And, anyway, even though there is a lot of sadness in this book, and a lot to stoke your fears (perhaps it is best to avoid if you have a tendency toward hypochondria), but this is basically a story of innovation.

Mukherjee moves through surgery, radiation therapy, chemotherapy, cancer prevention, and modern targeted drugs, showing how each arose and developed in response to different sorts of cancer and out of the science and technology of the moment. It is a vast story, which includes the development of anasthesia and antibiotics, the discovery of genes and chromosomes, the first research into radioactivity, and the campaign against smoking. To use the obvious metaphor, it is a war waged on multiple fronts.

The challenges are manifold. I had naively thought that all cancer was basically the same disease, with its subtypes just minor variations. But it turns out that there is enormous genetic and chemical variety among cancers, so that a treatment effective for one may do little for another. Indeed, even for a single type—breast cancer, say—treatment can be unpredictable. This is what makes the story of doctor’s attempt to treat the disease so riveting, as it feels like a battle between two equally wily antagonists. At several points in this history, doctors attempt extreme cures—radical surgeries, or nearly fatal doses of chemotherapy—only to be defeated. Meanwhile, the victories can be as modest as a remission of just a few months.

It is probably best not to philosophize about a fatal disease, but there does seem to be a lot of irony in our quest to defeat cancer. For one, it has only become so prevalent in the modern period, because we have started living so long. Its appearance as the great killer, then, is a kind of perverse mark of progress. Further, there is the irony of trying to fight what is, in essence, a corrupted version of ourselves—a group of renegade cells which have figured out how to replicate and survive even better than our own body. There is great scope for metaphor here, but if there is a moral to cancer then I don’t think it is a simple one.

Mukherjee does an admirable job weaving a potentially chaotic and depressing story into something coherent and even hopeful. Though the book is composed of history, science, and his own experience as a doctor, these different threads reinforce one another rather than clash. The clinical anecdotes are sparing—just enough to connect the past to the present—and his thumbnail explanations of science are lucid and illuminating. But, most important, despite the many tragic deaths which litter these pages, the final impression is of how much can be accomplished when a researcher’s diligence, a doctor’s pledge to save life, and a patient’s will to live work together, generation after generation.



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