#50 [2015/CBR7] "The Emperor of All Maladies: A Biography of Cancer" by Siddhartha Mukherjee

Like most people, I find pretty much everything about cancer terrifying. It doesn't help that I've chosen a profession [Firefighter] that has all kinds of increased rates of cancer. Most of us at work don't even like to talk about it because it reminds us that the unknown and uncontrollable might hit us at anytime. So you might wonder why I chose to read The Emperor of all Maladies: A Biography of Cancer (2010) by Siddhartha Mukherjee. Every once in a while I like to delve into a thick, non-fiction book that really teaches me something. It also doesn't hurt that The Emperor of All Maladies won a Pulitzer Prize. But what had me picking this book off the shelf was some half-formed idea of knowing your enemy. If I am terrified by cancer, then I will simply learn more about it. So, did this book give me a better understanding of this vast disease, the amazing progress that's been made in fighting it, and the ridiculously complex task to continue making progress? Definitely. Did it make me fear cancer any less? Not so much.

Let me begin with my admiration for the author, Siddhartha Mukherjee. He is a father and a practicing oncologist in New York, who managed to write this intricate book that covers 500 years of medical history intertwined with politics, philosophy, and literature. He breaks down incredibly complex medical and biological processes into something I could follow. He uses personal stories of his own patients as well as patients throughout history to give a human face to the medical detail required to give the reader an understanding of the vastness of the various diseases that make up cancer. How he managed to compile so much information and make it understandable is beyond me.

Mukherjee begins his book with the story of Carla, a 30-year-old Kindergarten teacher, who'd been feeling sick for about a month and woke up with a wicked headache. Carla dropped off her three children and went to the clinic. When they drew blood for a routine blood test, it was watery and pale, barely resembling blood. It did not take long for them to confirm that she had Leukemia. She becomes Mukherjee's patient, and we learn more about her throughout the book.

This book was very dense, and I ended up reading a number of books in between as I worked on it. Even if I'd read it straight through, I think I'd have had a hard time remembering all of the specific details about doctors and exact breakthroughs. A couple of themes stuck with me, however. First, there are so many different kinds of cancer that there will be no simple cure. Even breast cancers vary so widely that what could save one woman may have no effect on another. Also, cancer is kind of ingenious in how it adapts. Even if you find a medication that is effective against cancer, there is always the risk that the cancer will adapt and become resistant to it. The newest wave of the fight against cancer seems to involve identifying cancer genes and finding medications to turn them off or on as needed. It is remarkably complex.

Second, I found it remarkable how strong personalities and medical trends affected treatment of patients. There was an American doctor, an aggressive surgeon who decided the key to stopping breast cancer was drastic, disfiguring surgery. Unfortunately, this was not true. Local surgery helps if the cancer has not metastasized. If it has already metastasized, then all the disfigurement in the world isn't going to catch all of it. But the world didn't fully understand how cancer metastasized yet, and this doctor's hold was so strong that these surgeries continued. They wouldn't allow any data to contradict their assumptions. It was infuriating. Similarly, an Asian immigrant [I think. Sorry, I told you I couldn't remember all the details] doctor made a real breakthrough in his practice, but his results were ignored and he was kind of left out in the cold. Looking back on it, we realize he was right, but at the time he did not have the power to change the medical status quo.

Finally, throughout the book there was a fascinating and kind of terrifying ethical push and pull between experimenting on patients and the need for progress. This hit home most strongly with children fighting Leukemia in the 1960's [?]. Doctors were literally dosing sick kids with poison--the beginnings of chemotherapy--having very little idea of the effect. It would cause horrendous side effects and possibly increase their lives by a month. On the one hand, these kids were dying and this was their only chance. What doctors learned here contributed to an increased understanding of cancer and hopefully more lives saved in the future. On the other hand, these were kids already suffering a horrible fate. Is it ethical to increase their suffering for the slim hope of a cure? For an extra month? I don't know.

I was very impressed by this book and I learned a lot. Considering the content, it was not as dark and depressing as I feared. However, my anxious stomach still ached at points, and there are many haunting stories of suffering people. I would recommend this remarkable book, but only if you're interested in the subject matter.