Monday, May 2, 2011

Book Review: "The Emperor of All Maladies" by S. Mukherjee

Just finished reading "The Emperor of All Maladies - A Biography of Cancer" by oncologist Siddhartha Mukherjee. The book got excellent reviews, was one of NY Times 10 Best Books of 2010 and scored Dr. Mukherjee a Pulitzer for General Nonfiction. It was heavy, and not just because it's 570 pages of hardcover goodness. Covered in painful detail is the history of cancer - from the first description of the disease by Imhotep in 2500BC to the sequencing of hundreds of cancer genomes, but mostly the countless, gruesome, revolutionary, often barbaric and mostly failed attempts to cure it. In fact I would go so far as to say that this book may be the authoritative text on the history of cancer treatment research. While homage is paid to prevention, causality and, to an even smaller extent, patient care, you will not find anything in this book to alleviate your anxieties or help you avoid joining the ranks of cancer patients (except maybe STOP SMOKING, you fool!). But it does open with this encouraging statistic - "In the United States, one in three women and one in two men will develop cancer during their lifetimes." Fan-fucking-tastick!

Throughout history there have basically been three approaches to cancer treatment - surgery, radiation and chemotherapy. Surgery was first on the field, taking place long before there was anesthetic or antiseptic. In most cases, surgery did you in. I barely made it through the surgical chapters, especially Halsted's radical mastectomies. It must be a testament to the human drive to survive that anyone would consider undergoing such procedures. Radiation on the other hand seems the least intrusive of the three (and also the least discussed) - discovered as a treatment by 21 year old medical student Emil Grubbe who had worked in a Chicago factory that produced vacuum X-ray tubes (he even treated patients in the factory). Chemotherapy, however, takes up the majority of the book. The idea of a poison being used to kill rapidly dividing cells (and it was a looong time still till the biology of cancer was the least bit understood), came to Sidney Farber, a pathologist at the Children's Hospital in Boston, who began to experiment, for a lack of a better word, on children with leukemia, a disease that at the time could be fatal in as little as three days from onset of symptoms.

While interesting, "The Emperor of All Maladies" was a tough read. After I started having nightmares in which I was being diagnosed with cancer, I ended up having to restrict my reading to a few chapters a day. While I learned a lot, my major complaint about this book is it's long-windedness and an overabundance of information and detail. My other complaint, which I feel almost bad stating as it's not the author's fault, is that it's not entirely what I was hoping to read. While a history of research is certainly fascinating, especially after one is done reading about the horrors of cancer treatment, I would have liked to read about how NOT TO GET IT. But I suppose such questions are not yet answered. In fact, I think you will find that most questions are not yet answered about cancer, and we are hardly any better off now than we were a hundred years ago, which is a major downer.