Radical Treatment

by Julia M. Klein
The Emperor of All Maladies: A Biography of Cancer
By Siddhartha Mukherjee
Scribner, 571 pages, $30
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The Emperor of All Maladies: A Biography of Cancer by Siddhartha MukherjeeIt is difficult, if not impossible, to reach middle age without experiencing at close hand the ravages of cancer. In my case, the litany of loss includes a grandmother killed by colon cancer, a longtime friend who succumbed to metastatic breast cancer, and a mother who survived breast cancer in her 60s but died, two years ago, of stomach cancer. 

By the time it was diagnosed, my mother’s disease was advanced, metastatic, and therefore inevitably fatal. She was nevertheless offered chemotherapy, which might have retarded the progress of her cancer; there is no way of knowing for sure. My mother, in her early 80s, was both valiant and hopeful about her treatment. “I want to live,” she told the oncologist. She persisted in believing that she might somehow be cured, despite having been told that a cure was impossible. Her faith in modern cancer medicine was as profound as it was misplaced. About nine months after her diagnosis, just after we had decided to enroll her in a hospice program, she asked me, heartbreakingly: “Julia, when do we go to the doctor?” A week later, she was dead. 

It was with this dismal personal history as context that I picked up Siddhartha Mukherjee’s much-praised The Emperor of All Maladies: A Biography of Cancer. Mukherjee, an assistant professor of medicine at Columbia and a staff physician at Columbia University Medical Center, writes that he originally intended the book to be a journal of his two years as an oncology fellow at Massachusetts General Hospital in Boston.

He ended up producing something considerably more ambitious: an eloquent and indispensable history of cancer. (The “biography” conceit of the subtitle is clever without being particularly illuminating.) The Emperor of All Maladies tracks the first historical glimpses of the disease, the development of treatment regimens, the role of prevention, and the biological mechanisms by which cancer wreaks its various forms of havoc. Anchoring the narrative, and giving it a human face, are case studies of patients who lived to tell their tales — and of others who did not. 

By dint of its subject matter, The Emperor of All Maladies can at times be difficult to read. The vividly depicted suffering of patients such as Carla Reed, in the grip of an aggressive leukemia, or Barbara Bradfield, battling metastatic breast cancer, might evoke painful associations. (It did for me.) And Mukherjee’s elegant exposition of the science of cancer — which touches on retroviruses, proto-oncogenes, tumor suppressors, genetic mutations, biochemical pathways, and more — will prove challenging for readers without a decent background in biology. 

It’s worth persisting. This is a remarkable book: cogently written, impressively researched, and animated by a sensibility that is at once skeptical and empathetic. Mukherjee relates cancer’s story as if it were a thriller, and his narrative command is as thorough as his scientific expertise. This isn’t a full-fledged cultural history, but it is enriched by Mukherjee’s literary proclivities. He begins each chapter with epigraphs, and names such as Czeslaw Milosz, T. S. Eliot, and Jack London turn up alongside quotations by cancer researchers. 

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Julia Klein's review of the Emperor of All Maladies was right on point. Some of us are old enough now that we think we know about cancer. But we do not. This was driven home to me this last year when we lost our # 1 daughter after a 5 year fight.
I am now half way through the book. I wish I had read it 5 years ago. My advice: Don't wait. Read it now.



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