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August 2, 2012


The Emperor of all Maladies: A Biography of Cancer

by Jeremy Arnone

Few books can combine the eminent readability of a pulp fiction thriller with the penetrating insight of a biography, the precision of biology, the encompassing breadth of history, and the compassion of a cancer clinician.  Like a master alchemist, Siddhartha Mukherjee combines these to produce a work of distilled magnificence – The Emperor of All Maladies, a biography of cancer.

I was a somewhat reluctant reader, wondering if a topic as macabre and frightening as cancer would make a good read.  I wouldn’t, for instance, find a biography of car crashes or parachute failures to be especially interesting.  The difference is that Mukherjee is able to identify an implacable, ever-resourceful protagonist, an anti-hero, and then recount how we’ve been engaged in a 5,000-year struggle to understand and establish supremacy over our own bodies.  From Egyptian hieroglyphics circa 1600 BC (describing a breast cancer and the chilling prognosis:  “None”),  to the almost tragically comedic “insights” of ancient Greece, from nineteenth century recipients of crude radiation and chemotherapy, to the many false leads of the first half of the twentieth century, to the past 20 years of comprehension and progress.

From a  strategy perspective, what I found fascinating was the contrast between the top-down approach to curing cancer vs. the bottom-up approach, which focused on the internal goings-on of the cell.  In the fight against cancer, we see that a blanket spending of billions of dollars had almost no impact on long-term survivability (between 1971 – 1990), but that the science (and prognosis) dramatically improved when researchers started from the ground up, exploring at a cellular level the link between cancer and genes.  Many companies create strategy in the Boardroom with limited understanding of the appropriateness of the strategies given conditions “on the ground.”  Conversely, companies that patiently inform their strategies with careful analysis are better prepared, with a road map for success.

A self-portrait of photographer Heather Perry and her son Finn. In 2005, when five-months pregnant, she was diagnosed with Stage 4 non-Hodgkins lymphoma. Finn was born seven weeks early, and Ms. Perry underwent more than a year of intensive treatment. Both mother and son are thriving in 2010.

But the soul of The Emperor of All Maladies is the author’s recognition that all of the progress and discovery and development come at the cost of human suffering, that the biography of cancer is composed of the mini-biographies of every patient.   “A patient, long before he becomes the subject of medical scrutiny, is, at first, simply a storyteller, a narrator of suffering – a traveler who has visited the kingdom of ill.”

Mukherjee doesn’t promise a cure, and alternates between guarded optimism and resignation.  For every patient who sees sustainable remission, there are others with seemingly identical conditions who fail to respond, for whom palliative care is the best prescription.  The reality is that Cancer may always be with us -the Greek word onkos means “mass” or “burden.”  As Mukherjee writes, “Cancer is indeed the load built into our genome, the leaden counterweight to our aspirations for immortality.”

But onkos comes from the ancient Indo-European nek, meaning to carry the burden: the spirit “so inextricably human, to outwit, to outlive and survive.” Mukherjee has now seen many patients voyage into the night. “But surely,” he writes, “it was the most sublime moment of my clinical life to have watched that voyage in reverse, to encounter men and women returning from that strange country— to see them so very close, ­clambering back.”

While there isn’t yet (and may never be) a happy ending in our fight against cancer, the past 30 years have seen improvements that dwarf what we’d seen in the previous 5,000 years.  We haven’t beaten cancer, but we’re on more equal footing everyday, and it’s now as worried about us as we are about it.

8 Comments Post a comment
  1. Jessica
    Aug 3 2012

    I’m going to trust you that this isn’t a depressing book! You make it sound really interesting, just ordered it from Amazon. Will let you know what I think! 🙂

  2. Aug 3 2012

    great review. I have it on my to-read shelf, despite the possibly depressing subject, I am thinking of suggesting it for my non-fiction book group. would you say it makes for a good discussion?

  3. JP Lokoto
    Aug 5 2012

    Yes. I agree that this book is THAT good and everyone should read it! If for no other reason than that many of us may eventually have to deal with cancer personally. And when (unfortunately) or if (hopefully not) that day occurs, it will be necessary to “know your enemy”. You MUST know what you are dealing with and personally do the work necessary to learn everything you can about cancer – and then gather the proper team together to help you battle this ruthless enemy. You may not end up defeating this enemy in the end. In fact, as this book pointed out to me, the best you may end up with is holding it at bay until something else ends your life. But a stalemate is OK to me – at least until the day comes when people like Siddhartha Mukherjee finally figure out how to slay the cancer monster for good. Do yourself a favor and read this book BEFORE you must personally battle your cancer.

  4. Kenneth Williams
    Aug 5 2012

    Well written. I completely agree with everything you wrote – this book is a “must read” for anyone curious about this disease, including those of us who have battled it. It is a very positive and forward-thinking look at the history and the future of cancer research.

  5. Anne Dottie
    Aug 12 2012

    This is one of the most compelling reviews I have ever read!! The reviewer convinced me that the book has appeal on many levels to many different kinds of readers. I am convinced enough to read it, although I approach the subject with the same trepidation that many of us have to dealing with the subject of “cancer” (whispered under the breath, as my mother-in-law used to do).

  6. Charles Maron
    Aug 12 2012

    Well said, I completely agree with everything you wrote – this book is a “must read” for anyone curious about this disease, including those of us who have battled it. It is a very positive and forward-thinking look at the history and the future of cancer research.

  7. Dec 25 2012

    I’ll right away grab your rss feed as I can not find your email subscription link or newsletter service. Do you have any? Kindly let me know so that I could subscribe. Thanks.


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