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.