on November 11, 2010
You remember the scene in the film "Butch Cassidy and the Sundance Kid"? From the top of the bluff looking into the distance at dusk, Butch sees the lights of the pursuing posse which doesn't stop tracking them even at night and says "How many are following us? They're beginning to get on my nerves. Who are those guys?" In the same threatening way cancers have been dogging human beings since the dawn of time, and although we now know quite a lot about cancer we still don't really know "who are those guys" or how to shake them. And they sure are "beginning to get on our nerves" as Butch said. Almost one out of four of us will eventually wrestle with cancer -- the defining illness of our generation -- and lose our lives in the process. Until it catches up with us most of us will try to ignore this fact, just as when we were very young children alone in our bedroom trying to go to sleep at night we tried to ignore the monster that we sometimes feared might be lurking in our bedroom closet.
Enter oncologist Siddhartha Mukherjee who almost parentally takes us by the hand to give us the courage to open with him the door to that dark and foreboding closet in order to see what is really lurking inside. Since eventually most of us are going to have to wrestle with this monster anyway -- either as a victim or as a loved one of a victim -- looking intelligently and closely into that dark closet does diminish fear and enhance wise perspective. And on this incredible journey into the depths of that darkness, what an absolutely marvelous guide is this modern day Virgil called Siddharta Mukherjee as he leads us on this long and often harrowing journey through the swarth that cancer has cut through mankind throughout time.
Mukherjee is a veritable kaleidoscope. Turn his writing one way and you experience him as an exciting writer of page-turning detective stories or mystery stories; turn him another and he's a highly effective communicator of cellular biology; turn him a third and you get superb science writing; turn him a fourth and he has the grandeur and broad sweep of an excellent historian. It's hard to believe that this one book, combining all of these appealing characteristics, is the work of just one man. And underlying it all is his sterling medical training and credentials which have been enumerated often elsewhere.
The book itself is a tour de force. It is the first book of such extraordinary scope regarding cancer. Its architectural structure brings to mind Melville's Moby Dick and how effectively and artfully Melville braided together the three strands of his great classic: a grand adventure story, the technology of whaling, and a treatise of humanity and philosophy. Equally effectively does Mukherjee weave together all the various facets of this iconic disease throughout history, from describing cancer from the patient's perspective, to viewing the never ending battles of physicians and medical researchers with cancer over the centuries, to examining the mysteries of the cellular nature of cancer itself and what really goes on in there, to the pro and con impact of this never ending plague on the spirit of the individual human and on our race as a whole, to peering into a crystal ball for a glance of cancer's and our future together. While doing all of this the alchemy of Mukherjee's writing continually turns science into poetry and poetry into science.
Simply put, it is so good, and so incandescently clear and lucid, and so powerful, and so engrossing, and so easily consumed that you will not lay it down without someone or circumstances forcing you to.
Had I read this book in my teens I would have found my life's career. I can only imagine that while you are reading this book, somewhere there will be some very young teenage girl or boy who will also be reading it at the same time you are, and who will become totally hooked by this book just as you will be, and who will go on to make a career in cancer research, a career that might provide the breakthrough that humanity has been searching and hoping for all of these many centuries. Thus although you will never know it, you will have "been there" at the initial motivation of that person and thus indirectly present at the earliest genesis of the eventual great idea.
This book has THAT potential. It is THAT good.
Kenneth E. MacWilliams
**I am pleased that Dr. Mukherjee has won the Pulitzer prize in general non fiction for this book, 4-18-11
In the United States one in three women and one in two men will develop cancer in their lifetime. Dr Siddhartha Mukherjee, a medical oncologist, has written a definitive history of cancer. It may be one of the best medical books I have read. Complex but simple in terms of understanding. A timeline of a disease and those who waged the wars. In 1600 BC the first case of probable breast cancer was documented. In the thousands of years since, the Greek word, 'onkos', meaning mass or burden, has become the disease of our time. Cancer. The title of the book, is "a quote from a 19Th century physician" Dr Mukherjee had found inscribed in a library book that "cancer is the emperor of all maladies, the king of our terrors".
As a health care professional and as a woman who is six years post breast cancer, Cancer has played a big part in my life. I used to walk by the Oncology clinic, and quicken my pace. I used to give chemotherapy to my patients, before it was discovered that the chemo was so toxic that it needed to be made under sterile conditions and given by professionals who specialized in Oncology. Dr Mukherjee, wisely discusses cancer in the context of patients, those of us who suffer. After all it is because of the patients, the people who have gone before us, who have contracted some form of cancer, they are the base of this science.
Dr Mukherjee started his immersion in cancer medicine at the Dana Farber Cancer Institute in Boston. He relates the beginning of the study of ALL, Acute Lymphocytic Leukemia, by Dr Sidney Farber in 1947. Dr Farber, a pathologist at the time decided to change his focus and start caring for patients. He was given a medication to trial for ALL, and though most of his patients died, some survived to remission. This opened his world and with the help of Mary Lasker, and Charles E Dana, philanthropists, they opened one of the first clinics that specialized in cancer care and research, The Dana Farber Cancer Center. Dr Mukherjee gives us the timeline of ALL and lymphomas and the medications that turned into chemotherapy. The development of specific care for blood cancers and the emergence of AIDS and patient activism. He discusses the surgery for breast cancer. It was thought that the more radical the surgery the better the outcomes. We now know that lumpectomies have an excellent outcome. But, women before me had a radical removal of breast, chest tissue, lymph nodes and sometimes ribs. The lesson learned is that breast cancer is very curable now and all those men and women, the patients who suffered, gave us the answers and cancer care has moved on.
The onslaught of chemotherapies changed the face of cancer, and the 1970's served us well. In 1986 the first outcomes of cancer care were measured. Tobacco emerged as an addiction and soon lung cancer was a leading cause of death. Presidential Commissions ensued, politics entered the world of cancer, the war against cancer and the war against smoking. The Pap smear was developed, and prevention came to the fore. The two sides of cancer, the researchers and the physicians at the bedside, who often thought never the twain shall meet, recognized the importance of research to bedside.
The story of the boy 'Jimmy' from New Sweden, Maine, became the face of childhood cancer. The Jimmy Fund, a Boston Red Sox charity in Boston, is still going strong today. 'Jimmy' opened the door to the public for the need for money and research, and care for those with cancer. We follow Dr Mukherjee with one of his first patients, Carla, from her diagnosis through her treatment. He has given a face to cancer. We all know someone with cancer, those who survived and those who did not. Cancer prevention is now the wave of the future.
"Cancer is and may always be part of the burden we carry with us," says Dr Mukherjee. He has now written a "biography of cancer" for us, those without special medical knowledge. However, he does go astray in some discussions such as genetics. I have an excellent medical background, and found I was floundering at times. As I discovered,and Dr. Mukherjee agrees, our patients are our heroes. They/we withstand the horrors of cancer, and the horrific, sometimes deadly treatments. The stories of his patients make us weep, and the complex decision making about their care make him the most caring of physicians.
The 'quest for the cure' is the basis of all science and research, and Dr Mukherjee has written a superb tome in language that we can all attempt to understand. The biography of Cancer. Cancer may always be with us,Dr Mukherjee hopes that we outwit this devil and survive.
Highly Recommended. prisrob 11-13-10
Jimmy Fund of Dana-Farber Cancer Institute, The (MA) (Images of America)
Early Detection: Women, Cancer, and Awareness Campaigns in the Twentieth-Century United States
on November 12, 2010
The brilliance of this book is the effortlessness with which the author draws the reader into the world of cancer and keeps him there as a tourist or witness. Dr. Mukherjee's engaging style, precision of prose and overwhelming compassion imbue this work with an energy that carries the reader along a ride like none other.
Whether the reader is a basic scientist or sociologist, a patient or healthcare provider, a philosopher or philanderer, this book will appeal, entertain and educate.
A remarkable achievement.
Siddhartha Mukherjee's monumental "The Emperor of All Maladies" meticulously outlines the trajectory of cancer (derived from the Greek word "karkinos," meaning crab) over thousands of years, starting in ancient Egypt. In 2010, seven million people around the world will die of cancer. Many have experienced the horrors of this disease through personal experience. The author provides us with a global view of this "shape-shifting entity [that is] imbued with such metaphorical and political potency that it is often described as the definitive plague of our generation."
In "The Emperor of All Maladies," we meet a variety of patients, doctors, scientists, and activists. We also hear the voices of such iconic figures as Susan Sontag, author of "Illness as Metaphor," and Alexander Solzhenitsyn, whose "Cancer Ward" is a desolate and isolating "medical gulag." Cancer is such a complex subject that it can only be understood by examining it in all of its facets: through myths, the anguish of its victims, and the untiring efforts of its adversaries, both past and present, some of whom were well-meaning but horribly misguided. Mukherjee says in his author's note that he has made an effort to be "simple but not simplistic." In this he has succeeded.
Ancient physicians thought that such invisible forces as "miasmas" and "bad humors" caused cancers. Many years of experimentation, studies of human anatomy, laboratory work, and clinical trials have shown cancer to be a "pathology of excess" that originates from the uncontrolled growth of a single cell. Cancer is "unleashed by mutations--changes in DNA that specifically affect genes that incite unlimited cell growth." What treatment to use--surgery, radiation, chemotherapy, or a combination of these approaches--is rarely an easy decision. Equally significant are the efforts of public health officials, who seek to reduce cancer's mortality through early detection (mammography and colonoscopy, among others, are screening methods in use today). In addition, cancer may be prevented by encouraging people to avoid environmental carcinogens such as cigarette smoke.
This elegant and heartrending narrative is far more than a biography of a terrible malady. It is also a story of paternalism, arrogance, and false hope, as well as inventiveness, determination, and inspiration. We meet Sidney Farber, who pioneered a chemotherapeutic approach to leukemia in children during the 1940's and helped launch "the Jimmy Fund"; William Halstead who, in the nineteenth century, disfigured women with radical mastectomies that, in many cases, were not curative; Paul Ehrlich, who discovered a "magic bullet" to combat syphilis from a derivative of chemical dyes; Mary Lasker, a powerful businesswoman and socialite who zealously raised money and political awareness in what would become a national war on cancer; and George Papanicolaou, a Greek cytologist, whose Pap smear "changed the spectrum of cervical cancer." Mukherjee constantly moves back and forth in time, showing how the past and the present are closely interconnected.
Throughout the book, Dr. Mukherjee's keeps returning to one of his patients, Carla. In 2004, she was diagnosed with acute lymphoblastic leukemia, a cancer of the white blood cells. She would have a long road ahead of her, filled with pain, fear, and uncertainty. We look to the future with cautious optimism that even greater progress will be made in our never-ending battle against a treacherous and multi-pronged enemy. Mukherjee is a brilliant oncologist, gifted writer, scrupulous researcher, and spellbinding storyteller. "The Emperor of All Maladies" is a riveting, thought-provoking, and enlightening work that deserves to become an instant classic.
on November 17, 2010
There seems little left to say so I'll take a different tack, look to another facet of this book and its author.
Today I heard Dr. Mukherjee interviewed on the Terry Gross show (Fresh Air - NPR), where the topic, the book, was biased in favor of the author ... and a wonderful treat it was. While I am interested in cancer and progress toward cure, the fascinating aspect of today's experience was the man himself. In all the interviews of all the interviewers I've listened in on - mostly literary in nature - I've never heard a more articulate responder than Mukherjee. He's a poet. His choice of words slice in toward meaning like the scalpel itself. He avoids vagueness and ambiguity, courts acuracy and precsion like no one I've heard. He is a treat just to listen to, never mind his insights into the disease, it's history and possible future.
I ordered this book today in order to get more of his artistry but I wouldn't discourage those seeking the phycician's prowess - that is there too. If I should be in that 25% that ends up with cancer, I would hope Dr. Mukherjee would be there to consult with me and console.
on March 1, 2011
At one time or another, it is likely that most of us will bow down before "The Emperor of All Maladies", the title of Siddhartha Mukherjee's epic account of the history, politics, and and biology of cancer. He is clearly in the company of other outstanding contemporary physician-writers, including Atul Gawande and Abraham Verghese, with a gift for being able to distill complex medical issues into managable parcels, all the while celebrating the joy and anguish of caring for patients in their most vulnerable hours.
In the mid 1970s I worked as a lab tech in the Division of Investigational Chemotherapy at Sloan Kettering. My boss was Dr. Joseph Burchenal, an indefatigable pioneer of modern cancer research, who assembled an array of antimetabolites to transform childhood leukemia from a uniformly fatal disease to one in which prolonged survival was the norm. We were foot soldiers in Nixon's recently declared "War on Cancer", equipped with the crudest of weapons to undermine the enemy's ability to replicate DNA, while inflicting substantial collateral damage among innocent cellular bystanders.
Our laboratory was on the ninth floor of the research building, and Burchenal, who regularly scaled peaks from the Adirondacks to Nepal and New Zealand, never took the elevator. Though 40+ years our senior, he would regularly embarass his young entourage with his athleticism by ascending stairs 2 and 3 at a time. His drive and determination were no less apparent in the lab, where he sytematically evaluated every compound he could get his hands on for the greatest benefit, and the least toxicity against mouse leukemias in vitro and in vivo.
Thirty five years later, the heroic legends of early cancer research are mostly gone, but new stars are shining in the field as science marches on, now with the mapping of the human genome and a better understanding of the biology of specific tumors. Newer cancer therapies such as Herceptin,Avastin, and Gleevec are more like laser guided weapons, relative to the chemo, radiation, and surgical trebuchets of the 1970s.
Yet, the enemy hardly presents a fixed target. Mukherjee alludes to the admonition of the Red Queen, in Lewis Carroll's "Through the Looking Glass", who tells Alice that the world is shifting so quickly that she has to run briskly just to keep in place.
We might think that we are gaining the upper hand, but cancers are constantly evolving by virtue of both predictable and random mutations. Modern oncology is akin to great chess matches played out every day, pitting modern science against the ancient and devious foe that is cancer. Each side is pondering several moves in advance. The era of early "blitzkrieg" victories is past, but Dr.Mukherjee urges us to stay in the game. We are seeing more and more cancers yield to sheer persistence, and a draw may be no less a victory than checkmate.
on July 24, 2011
While Dr Mukherjee is to be commended for an encompassing history of the disease we call "cancer," for a strong sure handed writing style, for making an abstruse subject readable (I have a graduate degree in molecular genetics) and for a bedside manner that I can only infer as compassionate he is less to be praised for what too often comes across as an optimistic, we're all but to the finish line benediction to his scientific field of study. Too often he unjustly dramatized marginal accomplishments as great victories, "response rates" ( a surrogate for a more damming term, survival) in the teen percentages, for instance. What for example, is one to make of "...In 1971, about half the patients diagnosed with multiple myeloma died within twenty-four months of diagnosis, the other half died by the tenth year. In 2008, about half of all myeloma patients treated with the shifting armamentarium of new drugs will still be alive at five years." Huh? (I can only assume that he meant something more felicitous than that specious phrase.) And what are we to make of a drug, first administered in clinical trials in 1999 that is claimed (in 2009) to extend survival by an average of thirty years after diagnosis? For too long we have given oncologists the benefit of the doubt as they threw one poison after another at their patients in the benighted hope that they could cure, well, perhaps delay a rampaging malignancy. Is it only in a world inured to Zyklon B that poisoning ninety nine to bestow a marginal improvement on one is regarded as rational?
The history of cancer medicine is one of futile, poorly-guided, but savage attempts to save doomed patients, too often ignoring the basic science that might provide a more enlightened therapy.(Dr Saunders who resuscitated the humane treatment of dying patients with the hospice movement and palliative medicine is deservedly praised here.) To the author's credit he acknowledges this as well as the many horrific therapies that failed. He details the problems that interfere with performing well designed clinical trials - the academic and economic self-interests, and the interests of dying patients willing to try any therapy no matter how slender the promise of that therapy. His forays into molecular biology are clear and easily read but deceptively incomplete, an enthusiast's account. Medicine has suffered from a tendency to explain anything and everything in terms of the latest mechanistic discovery - it was "humors," hormones,vitamins, calcium, prostaglandins, interferons, now oncogenes - it was never "we don't know but we're trying to understand." It is absolute folly to think that we've reached the core of the problem, that we finally understand nature's workings. It was the hubris of the early oncologists that allowed the use of WWI nerve poisons on cancer ridden patients, it was the refusal to see that the emperor had no clothes that led to allogenic bone marrow transplants and for that those clinician should be roundly condemned. I remember hearing that the university I was working at was administering whole body radiation (an LD-50 if I recall correctly) to a young woman in an attempt to "prepare" her for a bone marrow transplant, wiping our her whole system in a lead-lined basement room - one needn't be an medical ethicist to imagine the horror of that approach, one needn't much imagination to feel revulsion at that scene. As epimethylation adds to the complexity of a nucleic acid biology we thought we understood this book should have counseled a more humble approach, and, to be fair, the author did near the end touch on the possibility that we may never conquer the disease, that it may, in fact, be our biologic destiny, it may actually be how we are designed and not to be avoided. But too much of the book reads as a triumphalist''s version, look what we've done, look what we've accomplished. An honest retelling would conclude, not much.
on December 9, 2010
I am in treatment for aggressive, inflammatory breast cancer. I received this as a present from a physician relative and began reading with some trepidation. Instead of being depressing or discouraging, this is the most incredible and beautifully written book I've read in a long time. The sheer breadth and scope of the book, when combined with its elegant, lucid writing, make it an amazing undertaking.
The biography of cancer is complex: it borrows from surgery, anatomy, engineering and physical sciences. Events as different as the lunar landing and pharmacology for birth control have had profound impacts on the knowledge of cancer and its research and treatments. The book includes insights on scientific revolutions and the ongoing quest for knowledge, the craft of experimental design, the practise of medicine, research turf battles and more.
On a deeply personal level, it makes me feel, not like a victim of cancer, but like one of the new line of combatants in this ongoing hand-to-hand struggle. Please get it, then settle back to read, savor and enjoy.
on November 29, 2010
This is a spectacular book. I read 100 books a year and this is definitely in the top 10. It is very, very well written and, in some ways, it is like a mystery. The way the book is written, we follow the stream of research and clinical medical treatment over 150 years. It's like feeling around in the dark for a bomb that we know will go off. It is simultaneously horrifying and compelling. I am a doctor and think I am compassionate towards my patients. This book increased my compassion 10X. What surprised me the most was the politics involved in attempting to cure a disease that potentially affects everyone. Surgeons want to cut and oncologists want to drug. They each have their turf and don't want to give it up. The fact that 50% of all men and 33% of all women will get some form of cancer before they die is a very sobering one. The section on the evilness of the tobacco industry was particularly illuminating. I can't put the book down and will truly be sad when it is finished.
on February 5, 2011
I was asked if there was a "book" for cancer. If there was not, there is now. Mukherjee's "The Emperor of all Maladies: A Biography of Cancer" is a ambitious and successful book for which there is not yet a clear ending.
Mukherjee is an oncologist and the book does not oversimplify the complexity of cancer. His biography of the cancer focuses on the disease and the people swirling around its vortex. As such, much of the book is filled with scientific language and discussions of experiments and theories. While some of it may be over some readers' heads (and some of it was certainly over mine), Mukherjee always manages to put the discussion into context.
As the father of a child with cancer I'm more familiar than I want to be with many of the terms. It was also surprising to see how much treatment occurring today was still being debated in this decade. The story of cancer is long, it is contentious, and it is depressing. But just when you want to give up, another step is made toward battling some type of cancer.
One clear lesson is that there will not be a "magic bullet" to solve cancer, because cancer is really many diseases. Some types of cancer have seen progress which may be seen as a cure, but really are simply methods to avoid death. The cancer does not go away, but death is held at bay. For other types of cancer there is slow progress marked by ups and downs as new treatments breed new issues, but other treatments show up in the least expected places.
Mukherjee, while clearly respectful of all the people who have made progress in battling cancer, does not glorify his medical profession. He laments the split between researchers and clinicians, the battle of egos which have kept some collaborations apart, the lack of funding from a variety of sources, and the inability of some doctors to understand their patients. However, he avoids the easy target of telling everyone why they are wrong. He shows the scientists in their context, shows how they advance the cause, and celebrates when boundaries are overcome and new hope is created.
And how do you end a biography on a living entity? Mukherjee points toward the future of research and where he sees the next strides in overcoming cancer coming from. He notes the progress that has been made and argues against those who say no real progress is being made. You can play with statistics, but when more people live, live longer, and live healthier lives, the statistics no longer matter.
This should become a textbook not only for future medical professionals, but philosophers and historians of science as well. And all affected by cancer (and that is nearly everybody) will find that their journey, while unique, is not new. And it is not without hope.