Book review: “The Emperor of All Maladies: A Biography of Cancer” by Siddhartha Mukherjee

The Emperor of All Maladies by Siddhartha Mukherjee was a difficult book for me to read, as I suspect it will be for most people.

That’s not because it’s a bad book, but because it is such a thorough, courageous look at a disease — well, a family of many diseases — that is bedeviling humanity to an ever greater extent today as we live longer and survive or avoid other causes of death.

It is difficult, in part, because cancer is a great fear. Most of us know someone who has or has had cancer, or have or have had it ourselves. Many know people who have died from it.

A poignant element for me as I read this book over the last month or so was to learn from the news that Janet Rowley, a University of Chicago researcher mentioned often in Mukherjee’s text, had died on December 17, of complications from ovarian cancer.

Scientific searchings

It was difficult for me because the final 130 or so pages of The Emperor of All Maladies deals with the exquisitely refined scientific searchings and discoveries of the nature of cancer and of new methods for attacking various versions of the disease.

Mukherjee is a fine writer, very clear, very direct with a sharp eye for emotional and physical detail. As his reader, though, I was a failure in this last section. My brain doesn’t handle scientific information well. I don’t have the context for it. I don’t understand much of it. And I didn’t understand many of the details of the final section although I did grasp some key points.

Such as:

Every patient’s cancer is unique because every cancer genome is unique. (page 452)

Cancer, we have discovered is stitched into our genome….Cancer is a flaw in our growth, but this flaw is deeply entrenched in ourselves. We can rid ourselves of cancer, then, only as much as we can rid ourselves of the processes of our physiology that depend on growth — aging, regeneration, healing, reproduction. (page 472)

But with cancer, where no simple, universal, or definitive cure is in sight — and is never likely to be — the past is constantly conversing with the future. Old observations crystallize into new theories; time past is always contained in time future. (page 466)

The companion of humanity

I’m sure I can’t explain in detail how Mukherjee reaches those insights, but I have a sense of their implication.

Which is that cancer is and will be the companion of humanity for a long time, and probably forever.

And that the search for a “cure” over the past century was, essentially, ham-fisted, lacking the nuance that today’s scientists and doctors are aware of and dealing with. (Still, as The Emperor of All Maladies shows extremely well, those awkward, almost blind efforts to find ways to fight cancer, in many cases, gave patients more months and years and, for the lucky ones, a full lifetime to live.)

And that the declaration of war on cancer in the 1970s — as if it were as simple (relatively) as putting people on the Moon — had no hope of victory. (Yet, that crusade was an important step on the ladder of learning what cancer is and how to address it.)

Oncologists and researchers

The Emperor of All Maladies was difficult for me to read because it’s clear from the story Mukherjee tells that oncologists and researchers are human. They’re flawed.

Why should I be surprised? Yet, I don’t like to think — and I’m sure you don’t — that anyone in the medical profession isn’t fully informed and isn’t tainted by ambition and isn’t seeing me as a “case” instead of as Pat Reardon.

One of the stories at the heart of The Emperor of All Maladies is how cancer surgeons have been adventurers in the bodies of their patients. Think of the era of radical mastectomies. Or think of the early efforts at chemotherapy.

“Playing chicken”

Mukherjee describes one group this way:

These were the daredevils of medical research, acrobats devising new drugs that nearly killed patients; these men played chicken with death.

Yes, yes, they did. But it wasn’t their own deaths they played chicken with.

Their efforts were an important step in the evolution of cancer research and treatment. Nonetheless, there are times in The Emperor of All Maladies when I wondered about the patients.

There is a tendency to make heroes of the doctors and researchers. But I couldn’t stop thinking of the patients on which they were fighting their battles.

There is an arrogance in the medical profession that is so off-putting.

Circling back to patients

Mukherjee makes many attempts to circle back to the patients, and maybe does as well as anyone has a right to expect. He certainly gives the impression of a cancer doctor and researcher with a human touch and, even more important, a respect for the scared, desperate person who has put herself or himself into his hands.

Maybe one other thing that made this book difficult for me to read was something akin to being told how sausage is made.

Cancer is a subject that’s only partly understood by the women and men who have spent their lives studying it.

This is a difficult fact to swallow when I know that, in the future, I or my loved ones or my friends — or all of us — will have to grapple with our own cancer.

I don’t know that having read this book will help me when that time comes.

Maybe it will.

Patrick T. Reardon
1.9.14