The Emperor of All Maladies: A Biography of Cancer

Updated: Jan 4

Siddhartha Mukherjee's book is a definitive magnum opus on cancer. Mukherjee, a physician-scientist, has the rare vantage point of looking at cancer through a scientist’s eye, the allure of an insurmountable challenge and ever-elusive hypotheses, and through a physician’s eye, his respect and care for his patients are reflected in his narrative of their lives. To this ingenious hybrid of talents, Mukherjee effortlessly adds another one of a capable science historian. In fact, the historical account of cancer was my favorite part of the book. The breadth and depth of cultural, political, and scientific tales that shape each other and the story of cancer, are deserving of the highest praise. In that sense, it is truly a biography of cancer. The disease almost becomes an intelligent force, an invisible/visible common enemy of lives in homeostasis: mysterious, evasive and immortal.

The book has something to offer every reader: patients and their families, doctors, scientists, and laypersons. However, each of these may find different parts of the book to have a painstaking amount of detail (aka treat for the nerds). There are innumerable characters and events that spin around cancer - the misguided surgeries, the life-threatening drug trials, the unexplainable recurrences, the powerful and fraudulent lobbies, and the miraculous cures. Mukherjee truly captures the drama that has spanned centuries.

Barring the author’s fascination with imbuing cancer with a human personality (not entirely misguided, cancer cells are motivated by the same force as us - to reproduce themselves and live forever), two human characters stood out to me. Sidney Farber is the hero of this saga. Farber made important leaps in the field: he was the first person to recognize that cancer could be treated or minimized with a chemical drug. While he lost many of his patients to disease and unsuccessful drug trials, he was also the first to change how his patients, most of them children, experienced the disease externally. He made sure they had a colorful and cheery atmosphere in the hospital. He waged a war against cancer, soon realizing that treating and preventing cancer would need more than scientists and physicians to come together at a large scale. Farber, while still seeing and treating patients, met policymakers, congressmen, donors - no one was out of bounds when it came to making cancer a subject of national importance. One of the earliest public campaigns against childhood leukemia in the US - the Jimmy Fund, was instigated by Farber in an effort to raise money and awareness for his patients (“Jimmy” was one of his patients (name changed)). Farber was soon joined by an accomplice in many such endeavors. Mary Woodward Lasker was a charismatic lobbyist, a political activist, and a philanthropist who, along with her husband, dedicated her life to the cause with as much zeal. So much so that her group of fellow activists came to be called as Laskerites. The Lasker foundation was, at one point, the largest funding agency for cancer research.

Even as we travel in time through the book, the author elegantly weaves his own learning experiences as a Hematology/Oncology Resident Fellow at Mass. General Hospital/Dana-Farber into the larger story. For Mukherjee, not only his patients’ longevity but also the richness and complexity of their lives is at the center of his treatment and service. His nervous excitement at the complete long-lasting remission of his patient is an indicator of how the battle against cancer is most severely fought by the patient's mind and body, joined by her family and the doctors in the second place. Mukherjee closes with a futuristic view of the long arc of cancer treatment - having worked on and thought about cancer though, in a much more peripheral manner, I cannot but join in on this fantasy: One day, we may carry our genomes on flash drives, be able to leverage early detection and personalized medicine to overcome the emperor of all maladies.

I'm truly in awe of Mukherjee for his prowess of bringing together knowledge from many perspectives and his sensitivity to the patients' experiences.

Though not discussed in the book, in countries like my own (India), there are many additional hurdles. I would be remiss not to mention them: the financial burden and inaccessibility of diagnostic tests, chemotherapy, surgeries AND mental health support.

While the physical battle of cancer is fought by the patients with help from doctors, we as a community could do so much more to make the other aspects, emotional and financial challenges, easier on them and their families.

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