I read the majority of the book The Emperor of All Maladies on flights between Baltimore and SoCal during Thanksgiving and winter break, and I still haven’t actually finished the entire thing yet. But as far as I can tell, you would have difficulty finding a narrative that blends the journey of science and humanity as comprehensively and eloquently as this one does.
Siddhartha Mukherjee manages to focus on and unravel cancer both as cancer the cellular process that, to some extent, occurs almost inevitably as a part of the aging process; and as cancer the human disease that we have been struggling to understand and have been succumbing to for thousands of years. The book is split into six different parts, each centering around a different “era” of beliefs about cancer during which something fundamental changed about the way we viewed the disease.
Because of that, I really enjoyed the entire first section of the book that focused on the history of cancer, from history’s first recorded cancer patient to the origins of the term “cancer” (from karkinos, meaning “crab” in ancient Greek) to the galvanizing belief that cancer came in the form of black bile, one of the four humors. To a large extent, our long-standing fear of cancer arose from a lack of understanding of how cancer was transmitted in the first place (was it through a virus, for example?). Much of our history with cancer consisted of trying to figure out how it develops, even if physicians could only make their best guesses at the time.
I’ve written previously about the symbolic force of cancer in modern poetry, as the body turning against itself, and this book touches upon the disease’s poetic elegance — cancer is essentially a “distorted version of our normal selves.”
Through the long timeline of breakthroughs in cancer research and treatment, there were several distinct plot points that stood out to me. In the very first chapter, Mukherjee starts off with Sidney Farber and his accidental discovery that using antifolates to treat leukemia patients could send them into remission, albeit briefly. This jump-started a long era of clinical research and clinical trials based mostly upon guesses as to which drugs and treatments to try on patients next.
From the development of extremely toxic four-drug chemotherapy to William Halsted’s championing of the radical mastectomy, Mukherjee touches upon the dangers of proceeding with such novel regimens without doing basic scientific research to try to understand the fundamental biological processes driving disease development in the first place.
Moreover, the book also devotes a significant portion of its narrative to detailing the intersection between public policy and scientific research, most notably the Nixon-era “War on Cancer.”
For example, something that resonated deeply with me about the narrative of cancer research was the rise of smoking and subsequent increase in lung cancer, which we have yet to experience the worst rates of. I learned about a time punctuated by the public’s refusal to believe that cigarettes could cause lung cancer and the tobacco industry’s influence over the few attempts at government regulation. This calls to mind some unsettling contemporary parallels for different public health issues.
Most notably, in telling this long story, Mukherjee also details the evolution of the patient-physician relationship. He starts from medicine’s origins and moves through vast chunks of the past when paternalistic physicians often had to balance treating patients and using them in clinical trials to test new, possibly fatal drugs or surgeries, The Emperor of All Maladies does not try to vilify cancer or glorify the researchers and doctors that have made advances in treatments.
Instead, the author presents cancer as an ancient and persistent mystery that we are still trying to unearth today and uplifts the stories of people who struggle to survive in the face of this disease with courage just as enduring.