The Emperor of All Maladies
A Biography of Cancer
Scribner: 572 pp., $30
Siddhartha Mukherjee's "The Emperor of All Maladies," a remarkable history of the 4,000-year-old war on cancer, shines a focused beam of light on a disease that has become our human shadow, so closely does it live beside us. The reader devours this fascinating book, hoping, like the countless scientists and doctors with their clinical trials, drugs and oncogenes, that there will be a cure, a miracle, a discovery.
Mukherjee is a clear, determined writer. He is invested in this story, personally and professionally. He wants the reader to understand that this is not a tale of heroes and dragons:
"The story of leukemia — the story of cancer — isn't the story of doctors who struggle and survive, moving from one institution to another. It is the story of patients who struggle and survive, moving from one embankment of illness to another. Resilience, inventiveness, and survivorship — qualities often ascribed to great physicians — are reflected qualities, emanating first from those who struggle with illness and only then mirrored by those who treat them. If the history of medicine is told through the stories of doctors, it is because their contributions stand in place of the more substantive heroism of their patients."
This perspective alone makes "The Emperor of All Maladies" an unusually humble, insightful book.
Among the laity (non-scientists whose information about cancer comes from firsthand experience, or the experiences of friends and relatives), there is that feeling of impatience: They can send a man to the moon but they can't cure cancer? Why is the war taking so long to win? Mukherjee's book provides an answer, many answers to that question. In the writings of the Egyptian physician, Imhotep, in a papyrus dated around the 17th century BC, one finds a description of breast cancer followed by this comment about treatment: "There is none." Recent drugs, however, and breakthroughs in the genetics of cancer, Mukherjee shows that there has been a progression — a ratcheting forward of research, technology and treatment.
Where does this word, cancer, come from? It was Hippocrates, the author tells us, who, around 400 BC, coined the term "Karkinos," from the Greek word for crab, because tumors, surrounded by swollen blood vessels, reminded him of a crab "dug in the sand with its legs spread in a circle." Mukherjee walks us through the development of radical surgeries to remove tumors; the realization that cancer was (is) a systemic illness; the use of X-rays and radiation, the search for selective poisons — anti-cancer drugs such as Tamoxifen, Herceptin and Gleevec — the important strides in palliative care when it became evident in the 1980s that the disease was stronger than our ability to cure it.
Much of the book's action takes place in Boston, in part because so much of the early research on cancer took place there. Mukherjee's training was at Harvard Medical School (he is now an assistant professor of medicine at Columbia University and a physician at Columbia University Medical Center). The author tells the story of Sidney Farber, a pediatric pathologist who worked on children's diseases, specifically childhood leukemia, at Children's Hospital in Boston in the late 1940s. Mukherjee returns to him often. Farber's experiments with antifolates to treat cancer were the first real ray of hope in cancer research.
Mukherjee describes the evolution of our understanding of cancer — from seeing it as a single, monolithic disease to our efforts today to identify the many varieties of cancer. He describes the discovery of chemotherapy, the breakthroughs and the players. He also describes the growth of activism — fundraising by charismatic warriors and "fairy godmothers" such as successful businesswoman and New York socialite Mary Woodard Lasker. With her husband, ad executive Albert Lasker, she conceived and first led the "war" on cancer in the 1940s. We also learn about the Jimmy Fund, a tremendously successful fundraising campaign in the early 1950s which used real children with leukemia, in particular a young man from Maine named Einar Gustafson, nicknamed "Jimmy." The Jimmy Fund raised money and enlisted celebrities like baseball star Ted Williams to increase the public's awareness and support research.
Mukherjee describes the crusade against the tobacco industry that never ceases to appall. He walks us through the known and the unknown links between environmental toxins and cancer — the story of mesothelioma and its occurrence in certain professions. He tells the story of AIDS from the discovery in the 1980s of an unusual form of Kaposi's sarcoma. He tells the sad story of Werner Bezwoda's efforts to treat breast cancer with bone marrow transplants and how his falsified studies shook the world of cancer research.
Mukherjee tries to end on a hopeful note. With screening, surgery, radiation, the use of certain drugs (particularly for breast cancer) and better technology to target hyperactive genes, mortality rates from cancer seem to be dropping. The book makes a reader feel that there has been slow but steady progress — sharp peaks in understanding followed by plateaus in which it can seem that nothing is happening. In the 60 years since Farber began his research, the growth of understanding has been enormous, even if the treatments available are not slashing mortality rates quickly enough.
Cancer, the author concludes, is "stitched in to our genome." That may not be the answer one wants to hear, nor is his further point: "Possibly cancer is our normalcy … as the fraction of those affected by cancer creeps inexorably in some nations from one in four to one in three to one in two, cancer will, indeed, be the new normal — an inevitability. The question then will not be if we will encounter this immortal illness in our lives, but when."
Susan Salter Reynolds is a writer in Los Angeles.Copyright © 2015, Los Angeles Times