Review » The Emperor Of All Maladies, by Siddhartha Mukherjee

Full Title: The Emperor Of All Maladies : A Biography Of Cancer
Author: Siddhartha Mukherjee
Year: 2010
Genre: Medicine, History
Publisher: Scribner
ISBN 978-1-4391-7091-5
Wikipedia page
Author’s Wikipedia Page

Summary

I picked up this book on a whim while browsing in a bookstore — the “Pulitzer Prize” note on the front cover grabbed my attention. I hadn’t heard of it, or the author, previously. Siddhartha Mukherjee, I later learned, was named by Time as one of the world’s most influential people, and this particular book was selected as one of the 100 most influential books of the past 100 years.

The Emperor Of All Maladies is, as the subtitle suggests, an attempt to detail the history of cancer, from its earliest historical descriptions (by Egyptian doctor Imhotep) to the most current — as of 2010 — advances in cancer-related research. Mukherjee weaves anecdotes from his personal oncology work into his steadily advancing historical prose in this powerful book.

What I Liked Least About It

As usual, I will list my dislikes first to get them out of the way.

There were a few places where I felt he let history get away from him. For example, on page 267, Mukherjee notes that Rose Cipollene “tasted her first cigarette as a teenager in 1942”, but then on the very next page, he moves the story along with: “But as the economy soured and dipped in the 1930s, she dropped out of school... and her habit escalated.” Clearly, she was only a child in the 1930s and hadn’t yet had her first smoke, so she couldn’t possibly have “escalated” her habit at that time. I don’t know whether one of these dates was a typographical error, simply missed by editors, or if Mukherjee added parts later without remembering what he’d already said about her. Either way, I kept coming across items like this.

Another example of this is on page 348, where we read that Hermann Muller tried to kill himself in Texas in 1932. “He survived, but... his scientific productivity lapsed in his later years.” Just a few sentences later, it turns out Muller won the Nobel Prize in 1946. While both of those sentences can be true, they appear constructed with the intention of confusing the reader.

There were also times when it looked like he was either confused about what words mean, or perhaps some editing process moved paragraphs around until they didn’t make sense to me. For example, on page 298, he says “The Canadian trial, meanwhile, epitomozed precision and attention to detail”, but then the following paragraphs explain how it was actually the opposite of that — the trial was undone due to failures to randomize participants and poor bookkeeping procedures.

What I Liked Most About It

The scope of the book is what I liked most about it. Mukherjee clearly did his research, not only on cancer and its related medical fields, but on the men and women who researched it, treated it, discovered (often unintentionally) either new cancers or new treatments, and pushed it to the forefront of American medicine during the 20th Century.

This is a personal jab, but I love that the book uses U.S. spelling rules. Several recent reads had a lot of “grey” and “mould” (the extra “U” in words that only need the “O”). I always stumble on these words because they look like they should be pronounced hilariously — “greh” and “moe-oold” is how I assume they must be said.

I was fascinated by how little anyone knew about any form of cancer just a couple of generations ago — even after many decades of surgeries and treatment by chemical had found some success, no one knew why some treatments failed and others succeeded, because the world knew very little about genes, DNA, and cellular processes. Reading the dates on which certain bits were discovered, I was struck by how primitive everything was, even through parts of my own lifetime. (And, by extension, how primitive everything today will seem, if you’re in the distant future looking back at 2018.)

Despite my complaints above, these instances were relatively minor and few. The vast majority of the book carries the reader along, wondering what the next discovery will be or how the researchers will solve the newest puzzle they’ve uncovered.

Further Discussion

One question I hoped the book would answer, but didn’t even approach, is something I’ve wondered about for several years: How has cancer, especially the type(s) of cancer that tends to strike children, survived evolution? Anyone can understand how “old-age cancer” traits survived in our gene pool — these never kill anyone until after we’ve reproduced. Any cancer traits I carry might kill me someday, but they’ve already been passed on to my kids. What I don’t understand is how the genetic tendency to develop childhood cancer has survived.

In the U.S., cancer is the leading cause of death among children who survive infancy. These cancers include leukemias, brain and central nervous system tumors, lymphomas, soft tissue sarcomas (like rhabdomyosarcoma), neuroblastoma, kidney tumors, gonadal (testicular and ovarian) germ cell tumors, thyroid cancer, and melanoma. No, it’s not widespread, but I can’t help but wonder why such a tendency hasn’t died out in the human race — if it’s always killing people before they’ve had a chance to reproduce.

Conclusion

In the end, this book was not perfect, but I think it could be with just a few tweaks (see the dating/factual issues I mentioned above). Mukherjee manages to take the lay reader into labs and clinics around the world, and we see cancer through the eyes of the doctors and scientists who steadily unraveled its mysteries for generations. He also tells it with a passion, careful to remember that real humans are fighting these battles, suffering from this powerful scourge.

The major downside is that you can’t read it without occasionally checking for odd lumps — just in case.

UPDATE, 2018.11.10: Just a day after I posted this review, I found this article, showing that science is still proceeding rapidly toward fighting cancer.

Note: A shorter version of this review is available on Goodreads, here.