Reviews: 1. The Emperor of All Maladies: A biography of cancer, Siddhartha Mukherjee
From this January onward, the Hive writing team produces a monthly review on a key text. First in the series is the 2011 Pulitzer non-fiction winner – a vivid biography of humanity’s greatest mortal dread.
At the conclusion to his extraordinary history of cancer, Siddhartha Mukherjee, an Indian-born, US-based cancer specialist, posits that ‘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 will not be if we will encounter this immortal illness, but when.’
That Mukherjee’s book is so compelling isn’t due solely to the drama of the story he tells, but because he is alive to the efficacy of art as well as science. ‘Normal cells are identically normal,’ he writes, ‘malignant cells become unhappily malignant in unique ways.’ His repurposing of Anna Karenina’s opening line is more than a rhetorical flourish: it’s indicative of the intelligent and illustrative way he approaches his material. Like all well-executed ideas, the question it raises is “Why hasn’t anyone done this before?”
The Emperor of All Maladies follows cancer from the palaces of ancient Persia to the R&D campuses of modern pharmaceutical companies. The majority of the story, however, takes place in the mid-to-late 20th century, when increased life expectancy in the western world saw the prevalence of cancer skyrocket (in third world countries cancer doesn’t even make the top 10 causes of death).
Mukherjee’s story centres on two figures who defined the post-war struggle against cancer. Sidney Farber was a paediatric pathologist who became the father of chemotherapy. Mary Lasker was a wealthy socialite and fearsome lobbyist who believed that if enough money was aimed at it, cancer could be vanquished. In 1971, after nearly 20 years of their campaigning, President Nixon declared the ‘War on Cancer’: legislation that devoted millions of dollars in federal funds to finding a cure.
Farber and Lasker’s achievement was of mixed worth. ‘Cancer,’ Mukherjee writes, ‘a shape-shifting disease of colossal diversity, was recast as a single, monolithic entity’. Scientists competed to find cures, theories of prevention were all but non-existent, and misguided treatments such as megadose chemotherapy did more harm than good.
Mukherjee’s recreation of the ambitions, disappointments and, occasionally, triumphs at each stage of the fight against cancer is one of his book’s greatest achievements. He successfully places the reader in whichever era, lab or ward he describes. He also renders cancer itself in a way that’s both horrifying and gripping. Of leukaemia he writes, ‘Its pace, its acuity, its breathtaking, inexorable arc of growth forces rapid, often drastic decisions; it is terrifying to experience, terrifying to observe, and terrifying to treat.’
The book’s final section is its most optimistic and most complex. Harold Varmus and J. Michael Bishop won the Nobel Prize in 1989 for proving the link between cancer and genes, which led to the subsequent identification of many oncogenes (genes with cancer-causing potential). ‘Having wandered in the darkness for decades,’ writes Mukherjee, ‘scientists had finally reached a clearing in their understanding of cancer. Medicine’s task was to continue that journey toward a new therapeutic attack.’ This came with development of drugs such as Herceptin, which targets an oncogene in a particular type of breast cancer.
But Mukherjee is too knowledgeable about cancer to be swept up in an optimism that has, time and again, proved false. Other gene-targeted therapies like Herceptin and Glivec may emerge over time, but that’s a forecast quite different to the ‘cure for cancer’ that has been dreamed of for so long. ‘This War on Cancer,’ he cautions, ‘may best be “won” by redefining victory.’
Mukherjee says the idea for his book was hatched when a patient asked him the simple question, ‘“What is it, exactly, that I am battling?”’ His answer, all 500 pages of it, is fascinating, depressing and exhilarating, and his writing on lung cancer is so affecting that, after 24 years of smoking, I haven’t had a cigarette since finishing the book six weeks ago.
Have you read this book? We’d love to have your comments.
Around 2,000 teenagers and young adults in the UK are diagnosed with cancer every year. These vulnerable patients often feel isolated, bitter, confused and afraid as they struggle to come to terms with and overcome a life-threatening disease.
