The Emperor of All Maladies
Kiranjeet Gill finds Siddhartha Mukherjee's 'Biography of Cancer' an interesting and eloquent read
Just six letters. For a while I’d been intrigued by the effect they have on people. Cancer. Why was it that my friend lowered her voice to a whisper every time she said the name of her grandmother’s illness? I noticed, too, that for a long time my dad struggled to acknowledge that my grandfather had cancer. ‘They’re calling it leukaemia’, he’d say to people, those first three words revealing his desperate wish for it not to be true. We fear cancer like no other disease, and understandably so – it is a sickness that invades from within and for which the treatment may at times feel worse than the disease itself. But why do we still not seem particularly close to a definitive cure? More importantly, when, if ever, will we find one?
In the hope of finding out the answers to these questions, I was really interested in reading ‘The Emperor of All Maladies’ by American oncologist Siddartha Mukherjee. Popular science books rarely make headlines, but this one, described as a ‘biography of cancer’ certainly caused a stir. In the last year Mukherjee has notched up a number of accolades including the Pullitzer Prize for General Non-Fiction and the Guardian First Book Award, as well as making it into TIME magazine’s 2011 list of the 100 most influential people in the world.
The book begins with a quote from historian and scientist June Goodfield – ‘Cancer begins and ends with people. In the midst of scientific abstraction, it is sometimes possible to forget this one basic fact… Doctors treat diseases, but they also treat people, and this precondition of their professional existence sometimes pulls them in two directions at once’, and it is clear that Mukherjee has been mindful of this as he has written. ‘The Emperor of all Maladies’ is therefore a combination of things – part doctor’s memoir and part crash course in the history of oncology and its pioneers, interspersed with personal stories of patients’ battles with the most feared of diseases.
Throughout the book, cancer is spoken of as an enemy with whom we are locked in a bitter and seemingly never-ending battle. Indeed, Mukherjee even describes his book as ‘a military history – one in which the adversary is formless, timeless and pervasive’. ‘The Emperor of All Maladies’ began as an attempt by the author to answer a simple question asked by a terminally ill patient – what was it, exactly, that she was up against? It is not too hard to imagine the author of such a book falling into the trap of inflating his own importance but Mukherjee does not do this, focusing instead on pioneers and patients.
The breadth and detail of the book reveal the painstaking effort the author put into research. Mukherjee begins the story with ancient Egyptian physician Imhotep, who described ‘a bulging mass on the breast’ as far back as 2500 BC. Then there were over 2000 years of silence on the matter before Hippocrates coined the term ‘karkinos’, the Greek word for ‘crab’, to describe the appearance of tumours. We then move onto Galen, whose four humours theory would prevail for centuries to come. An excess of black bile was thought to be the cause of cancer, and, significantly, just one other condition – depression, thus inextricably linking the two.
Primitive treatment for cancer revolved mostly around excision of tumours, supplemented with ‘remedies’ such as tincture of lead, arsenic, goat’s dung and tortoise liver. The more recent story of humankind’s war against cancer, however, is as much about the reckless leaps of mavericks into unchartered territory as it is the systematic research methods we know today. The discovery of X-rays, then chemotherapy and radiotherapy revolutionised cancer treatment, yet battles between traditionalists and those who wanted to break new ground often hindered progress. Min Chiu Li, of the National Cancer Institute, was forced to resign for trials he conducted in which chemotherapy was continued long after the visible signs of cancer had disappeared, and researchers who wanted to try out combination chemotherapy experienced similar resistance. Needless to say, these turned out to be fundamental principles upon which future treatments would be based.
Periods of rapid discovery were often followed by long periods of stagnation, and progress was often halted by the dogmatic persistence of only partially successful treatments. The brutal ‘radical mastectomy’, for example, became the mainstay of breast cancer treatment for many years, culminating in an obscene arms race of sorts, such that ‘radical’ soon became ‘super-radical’, which in turn became ‘ultra-radical’. Each incarnation was more invasive and disfiguring than the last, each surgeon labouring under the misguided conviction that removing more and more of the chest was the only way to treat women with breast cancer.
After years with little progress, what the battle against cancer needed was a charismatic and persuasive figurehead, and it found this in the form of Mary Lasker, a rich and influential American socialite who, whilst raising huge amounts of money for research, also turned cancer into a national obsession. The resulting political pressure made curing cancer a key agenda for then president Richard Nixon, and the creation of an apparently neutral committee, the Commission on the Conquest of Cancer, who were able to secure the diversion of billions of dollars towards finding a cure.
The unfailing optimism of the scientists of yesteryear seems almost darkly comical now. ‘I believe this treatment is an absolute cure for all forms of cancer… I do not know what its limitations are’, said one Chicago physician of X-ray therapy in 1901. And on an unrelated note, I couldn’t help but feel slightly amused at 19th century New York surgeon William Stewart Halsted, who developed a rather unhealthy addiction whilst using himself as a guinea pig for the latest anaesthetic at the time. Attempts to treat his cocaine addiction using morphine were, unsurprisingly, not only unsuccessful but led to him becoming addicted to both drugs instead. Nevertheless, he remained a successful and productive surgeon, eventually being recruited to John Hopkins Hospital. Well, whatever works for you…
What strikes me most about this book is the skill with which Mukherjee writes. He writes with great empathy and sensitivity, and with no overestimation of his involvement in the story – he is merely the storyteller, but a great one at that. It is hard not to be moved by his patients’ stories, but equally impressive is his ability to make the history of cancer research, of all things, into an utterly riveting story, an unlikely feat to achieve, surely.
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