Thursday, July 19, 2012

The Emperor of All Maladies: A Biography of Cancer

This book caught my eye at an airport bookstore, but I waited until i was home and could check it out of the library before reading it. Initially, it was a bit of a slow go and I had a hard time getting into it. I put it down for a week or so and when I picked it up again it was with a renewed enthusiasm for what was both a hopeful and depressing read (also fascinating, but I'll focus on that last).

Siddhartha Mukherjee does an admirable job of making the history of cancer, and especially cancer research, accessible to a non-medical audience. Not only is it accessible, but generally this is an engaging read, particularly before the 1970s, at which point the book does focus more on research and becomes more technical by turns. As Mukherjee winds his way through the history of cancer and treatments, I was taken by the progress that has been made in the past few decades. He describes what amount to cures for several, admittedly rare, cancer types, and the progress being made to treat and ultimately cure many other types of cancer. 

So why did I say The Emperor of All Maladies is also a depressing read? Three big reasons: 1) because the more scientists learn, they more they discover that each type of cancer is different and requires different combinations of drugs for treatment, thereby complicating the process of finding effective treatments; 2) as with so many diseases now, there exists the very real risk of drug resistance, rending existing treatments moot; 3) as our environment changes (by which I mean anything as simple as the introduction of the cell phone to the complex phenomenon of global warming), so does our exposure to potential carcinogens, making cancer "prevention" a moving target.

My primary takeway, however, is the fascinating bit. Mukherjee's work is at its finest when he is describing real cancer cases, particularly those from the past. For example, early in the book we are introduced to ancient mummies whose bodies still bear the tumors of the cancer that ravaged their bodies thousands (or, in one case, even millions) of years ago. We also "meet" William Halsted, he of Johns Hopkins fame, who pioneered some of the earliest mastectomies while also nursing and hiding addictions to both morphine and cocaine. The mastectomies, by the way, were truly disfiguring, horrific operations that bear little resemblance to the current-day procedure. Also, for any UM people out there to whom the name CC Little rings a bell (yes, the big bus stop is outside the building named for him), we meet the former-UM president twice in this book. The first time, he is the director of the American Society for the Control of Cancer, the precursor to the American Cancer Society. The second time he is a stooge for the tobacco industry itself, asserting at every turn that there is no relationship between smoking and cancer. Alas.

On the whole, a great read, particularly for those with an interest in science and/or medicine.

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