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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After immersing the reader in Carla Reed’s plight, Mukherjee flashes back to the 1940s Boston laboratory of Sidney Farber, a chemotherapy pioneer, and then to the writings of the Egyptian physician Imhotep. In a manuscript dating from about 2500 BC, Imhotep describes a case of breast cancer; in regard to treatment, he writes simply: “There is none.”

This is the first record of cancer in the medical literature. Over the centuries, Mukherjee says, cancer seemed to be something of a bit player. Though it can strike children and young adults, cancer, a disease of cell division run amok, is strongly correlated with age. In the past, infectious diseases decimated large swaths of the population before cancer could emerge. It follows that, as our population ages, the prevalence of cancer will increase, and the need for effective treatments and preventive measures will grow even more urgent. 

Mukherjee is keenly aware that as cancer cases escalate, cures have not kept pace. While he tends to see cancer researchers as heroic, he is less sanguine about practitioners who have too readily employed radical surgery and radical chemotherapy. 

A cancer diagnosis has historically inspired fear not just because of the disease’s painful course and high mortality rate, but because of the arduousness of treatment. Cures, often of dubious efficacy, entailed surgical disfigurement, the ingestion of highly toxic chemicals with crippling side effects, potentially damaging radiation, or some combination of the three. (My mother’s oncologist, describing her decline into semiconsciousness, attributed the blame jointly to her cancer and the drugs she was taking to combat it.) 

Mukherjee compares cancer treatment to the conundrum of Lewis Carroll’s Red Queen, with both doctors and patients “stuck pedaling furiously just to keep still in one place.” And yet, only a few decades ago, the situation was markedly worse. Some once-fatal cancers, including childhood leukemia, are now highly curable. And the armamentarium of remedies has expanded. William S. Halsted’s late-19th-century radical mastectomy, which excised lymph nodes as well as breasts, has mostly been replaced by the simple mastectomy and, in some cases, a breast-sparing lumpectomy. High-dose chemotherapy cocktails are being supplemented — if not yet eliminated — by less toxic and more targeted drugs, including Herceptin (for breast cancer) and Gleevec (for leukemia). 

In these more subtle remedies, along with better prevention against carcinogens, lies oncology’s future, Mukherjee suggests. “No simple, universal, or definitive cure is in sight,” he writes. But as the science of cancer grows more sophisticated, it will spawn more sophisticated oncological medicine, a constantly evolving array of specific treatments and cures. 

Mukherjee shies away from utopian predictions. “Technology,” he writes, “dissolves its own past,” complicating any such forecasts. But neither human nature nor the nature of cancer, is likely to change. So, he writes, “the relentlessness, the inventiveness, the resilience, the queasy pivoting between defeatism and hope, the hypnotic drive for universal solutions, the disappointment of defeat, the arrogance and the hubris” that have characterized the battle against cancer to date will surely be part of its future, too.

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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.



Seattle, WA

School of Law 1967

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