November 2010

A better understanding of cancer

By Siddhartha Mukherjee
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Cancer, a disease with tens of millions of faces, will require many biographers. But those future biographers and historians of the disease will labor from deep within the long shadow cast by Siddhartha Mukherjee’s remarkable The Emperor of All Maladies.

Starting with the teachings of the Egyptian physician Imhotep (circa 2625 B.C.), Mukherjee’s “biography of cancer” offers a sweeping “attempt to enter the mind of this immortal disease, to understand its behavior.” It is a vivid and profoundly engaging read.

Mukherjee, an assistant professor of medicine at Columbia University and a former Rhodes Scholar, is both a cancer physician and a cancer researcher. He is also extraordinarily good at explaining complex medical and scientific issues and controversies. He devotes most of his pages to developments in laboratory research and clinical treatment since the 1950s, as cancer medicine moved from a gruesome regimen of radical surgeries, through the development of radiation treatments, into chemotherapy and combined therapies and, finally, to the present era, in which research and treatment have finally come together and biotechnology has given rise to targeted therapies that attack cancer cells and the genes within those cells.

Science and medicine, like all human endeavors, are driven by the knowledge, intelligence, ambitions and egos of the people involved, and Mukherjee presents lively thumbnail portraits of doctors and researchers and of the battles that engaged them. He writes vividly of the political struggles to fund cancer research and to limit known carcinogens like tobacco. He quotes poets, philosophers and writers, particularly Susan Sontag, and he writes with empathy about the experiences of his own patients. All of this makes The Emperor of All Maladies not just an exceptional work in the history of science but a fine example of literary nonfiction.

Cancer, as Mukherjee writes in his epilogue, is “the scrappy, fecund, invasive, adaptable twin to our own scrappy, fecund, invasive, adaptable cells and genes.” This means that we may never completely defeat this many-headed disease. But, he suggests, with a greater understanding of cancer, we may at least be able to forestall its fatal effects until old age. With The Emperor of All Maladies, Siddartha Mukherjee makes a large contribution to a better general understanding of this dread disease.


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