Friday, February 4, 2011

THE EMPEROR OF ALL MALADIES by Siddhartha Mukherjee

When I posted on Facebook that my husband was reading a book about sewers while I was reading a book about cancer, a lot of our friends made wisecracks. Yes, we probably do need to get a life - but not because of these particular books. The mark of a really good nonfiction author is the ability to interest readers in a topic that normally bores or even repels them. Siddhartha Mukherjee is a really good author, and The Emperor of Maladies is a gripping read.

An oncologist who researches and teaches at Columbia University and a staff physician at Columbia University Medical Center, Mukherjee writes about science so clearly that even nonscientific liberal-arts people like me can follow. He's obviously a liberal-arts person himself, referring to Plato's Republic as well as Agatha Christie's St. Mary Mead; using the Red Queen's race in Through the Looking-Glass as a metaphor for contemporary cancer research and an ancient Persian queen's self-directed mastectomy as a metaphor for progress in cancer treatment; quoting Shakespeare, William Blake, Voltaire, and Kafka along with cancer researchers and patients and surgeons-general.

The incredibly erudite Dr. Mukherjee, who is still a young man, may be the one who needs to get a life, but I'm grateful that he's chosen to write this long, detailed, fascinating account of the history of cancer research instead.

The book begins with Carla:
On the morning of May 19, 2004, Carla Reed, a thirty-year-old kindergarten teacher from Ipswich, Massachusetts, a mother of three young children, woke up in bed with a headache. "Not just any headache," she would recall later, "but a sort of numbness in my head. The kind of numbness that instantly tells you that something is terribly wrong."
It ends with Germaine:
Her quest for a cure had taken her on a strange and limitless journey, through Internet blogs and teaching hospitals, chemotherapy and clinical trials halfway across the country, through a landscape more desolate, desperate, and disquieting than she had ever imagined. She had deployed every morsel of energy to the quest, mobilizing and remobilizing the last dregs of her courage, summoning her will and wit and imagination, until, that final evening, she had stared into the vault of her resourcefulness and resilience and found it empty. In that haunted last night, hanging on to her life by no more than a tenuous thread, summoning all her strength and dignity as she wheeled herself to the privacy of her bathroom, it was as if she had encapsulated the essence of a four-thousand-year-old war.
In the 470 pages between Carla and Germaine, Mukherjee gives us what he calls "a biography of cancer" - the story of a disease born before recorded time and first mentioned in an Egyptian manuscript from 2500 B.C., a disease that may never die but that is increasingly being contained and managed. Most of the book follows 19th- and 20th-century researchers as they seek to understand what cancer is and how to target it; surgeons as they try to contain it by removing tumors and, sometimes, unaffected body parts as well; politicians and lobbyists as they campaign for more money for cancer research; and geneticists as they discover which parts of which genes are responsible for cancer's mad proliferation.

We all have friends and family members who are living with - or have died from - cancer, and we all are familiar with procedures like radiation and chemotherapy. This book will help you understand what cancer is,  how it is being fought nowadays, why various approaches are used, and how typical treatments have changed over the last decade or two. It does not, however, recommend treatments. It does not tell you what to do or what to avoid in order to escape or recover from cancer - with one exception: Don't smoke. And if you smoke, quit.

In four fascinating chapters in Part Four, "Prevention Is the Cure," Mukherjee tells the story of America's love affair with cigarettes. In the early 20th century, four out of five American men, including doctors and cancer researchers, were smokers. It was hard to get physicians even to consider the possibility that smoking was related to lung cancer, even harder to get policymakers to try to protect the public, and just about impossible to get tobacco companies to speak honestly about their product. Not until the 1960s did a brave and savvy surgeon-general dare to confront Big Tobacco, and U.S. smoking rates started to fall. In response, the tobacco companies began targeting the developing world, where cancer rates are now predictably rising.

"It is difficult for me to convey the range and depth of devastation that I witnessed in the cancer wards that could be directly attributed to cigarette smoking," Mukherjee writes.
It remains an astonishing, disturbing fact that in America - a nation where nearly every new drug is subjected to rigorous scrutiny as a potential carcinogen, and even the bare hint of a substance's link to cancer ignites a firestorm of public hysteria and media anxiety - one of the most potent and common carcinogens known to humans can be freely bought and sold at every corner store for a few dollars.
Amazon listed The Emperor of All Maladies among its best books of November 2010. Publishers Weekly and Booklist gave it starred reviews. The New York Times called it one of the 10 best books of 2010. No, reading about cancer doesn't sound like an exciting way to spend an evening (well, in a book this big, several evenings), but be willing to surprise yourself.

Hey, even Oprah's reviewer loved it: "With a Dickensian command of character and an instinct for the drama of discovery," he wrote,  Mukherjee "makes science not merely intelligible but thrilling."

Coming next: David's review of the book about sewers.

1 comment:

  1. This was a fascinating book about the history of and man's fight against cancer. I lost a loved one to leukemia, the type of cancer that figures prominently in the medical history of this disease, so it was especially moving to me.

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