The Emperor of All Maladies, by Siddhartha Mukherjee

Many medical histories follow the same arc. A disease or condition appears. It is named and scientifically described (more or less—less if the humors are involved). Doctors through the ages attempt to cure the disease or condition with everything from what sounds like a marinade recipe (Pliny the Elder) to pseudo-scientific procedures or remedies up until modern medicine figures out what’s going on and a real cure is found. This is exactly what happens in Siddhartha Mukherjee’s The Emperor of All Maladies: A Biography of Cancer, but saying that damns the book with faint praise. This book is full of human stories, heart, curiosity, and stellar science writing.

Mukherjee began this book during his oncology fellowship. Cancer fascinated him. It’s been with us so long and it’s only recently (since the 1950s) that medical science has been able to cause lasting cures and remissions. After introducing his interest in the topic, Mukherjee goes back to the earliest records of cancer in ancient Egypt and Middle East, through Galen and the humors to William Halsted and his ultra radical surgeries to Sidney Farber‘s experiments with chemotherapy and the present era of gene targeting drugs. Throughout, Mukherjee shares stories of people he treated during his fellowship. These stories serve as a reminder that all of this science is in service to patients, to cure them.

What fascinates me about the history of cancer research and treatment are all the epiphanies that brought us to where we are now. So many men and women were able to make intuitive leaps about genetics and chemistry that I am in awe of their brains. Mukherjee writes:

Science if often described as an iterative and cumulative process, a puzzle solved piece by piece, with each piece contributing a few hazy pixels of a much larger picture. But the arrival of a truly powerful new theory in science often feels far from iterative. Rather than explain on observation or phenomenon in a single, pixelated step, an entire field of observations suddenly seems to crystallize into a perfect whole. (362*)

There were times, Mukherjee tells us, that theories were rejected out of hand because they contradicted established wisdom. Other times, discoveries were prevented from going into practice because they were so radical no one was sure they could work. After all, the challenge of cancer treatment is killing off cells that are terrifyingly similar to normal human cells; doctors have to kill the cancer without killing the patient. If these men and women tried something, they ran a real risk of killing people.

The Emperor of All Maladies is packed with tales of scientific experimentation, dead ends, miracles, rivalries, compassion, bravery, stubbornness, and some truly great science writing. Mukherjee has a gift for relating tons of scientific and medical information without ever condescending to his readers. He weaves together the “biography of cancer” from the fields of medicine, physics, chemistry, biology, and psychology into an amazing epic. I feel like I’ve been through a college course in oncology after reading it. (I am also exceedingly grateful to be alive now, when many cancers can be treated. If I had been born even a few decades earlier…the mere thought makes me shudder.)

* Quote is from the 2010 hardcover edition by Scribner.


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