The Emperor of All Maladies: A Biography of Cancer
by Siddhartha Mukherjee.
All you really need to know? Get this book. Read it.
Needless to say, however, you guys aren't getting off that easy. I'm writing the full review anyhow. Seriously, though, this is probably one of the best, if not the best, non fiction book I've ever read. It wasn't perfect, but it was excellent.
I've had this book on my list for a while, but my list of "books to read" is now inaccessible to me thanks to the selling out of my library system. I was looking for a good non-fiction book to listen to
and just checking out the shelves at the library when I saw it. Perfect. Reasonably long, I'd been meaning to read it for a while, and by all accounts a good book. Perfect indeed.
Dr Mukherjee writes about cancer, about people with cancer, about people who treat and fight and strive to understand cancer, and about the people who fund the latter. The title of the book, while it could sound like just a clever thing, rings true: it is a biography of cancer, because cancer is intertwined quite tightly with, well, humanity.
And the humanity of cancer and the people involved with it at every level is where this book shines. Dr Mukherjee has a very light touch with emotions, he can convey pain and despair without any maudlin tendencies, only resorting once to a cheap tear jerker comment (though let me tell you... by the time he made that comment, I behaved as Pavlov's dogs would expect me to, and started to sob. It was a false alert, thank goodness, but that is when I realized how deeply he'd made me care.)
The book talks about all aspects of cancer. Where it came from. The historical treatments... or lack thereof. Of leukemia, and breast cancer, and lung cancer. And smoking.
Sidney Farber's crusade, his single minded mission to cure childhood leukemia is detailed. Because he started, others were able to continue and ultimately take a disease that killed almost 100% of its victims to one that kids can, mostly, deal with, treat, recover from. He did that by, really, starting doctors down the path of chemotherapy, and then working on the policies that would allow others to continue work. Farber's story is a phenomenal one, and Dr Mukherjee does an excellent job of interweaving his story with the story or cancer, and the progress being made against the disease.
And that, btw, is one of the most elegantly done things in the book: Dr Mukherjee tells quite a few stories of people, and he touches on each as needed. Carla Reed, one of his patients. Sidney Farber. Mary Lasker. His own story is also told, though so lightly that I was left wanting more about his own personal journey. However, his writing on the people
who make cancer their day to day lives, as researchers, doctors, or patients, is sensitive and profound.
I don't often cry while reading or listening to non-fiction. I did during this book, many times. Not as much at personal stories, but at the gut wrenching ups and downs that human interaction with cancer seems to produce. Research gone nowhere, a dead patient, policy mistakes that kill, treatment that fails despite initial effort. But also, at the victories. Dr Drucker's comment that by helping find the cure to CML, he's actually upped the prevalence of that cancer. Because people are living
with it, normal lifespans. I sobbed.
Dr Mukherjee talks, as I said, about the history of cancer and its treatment, about how in the mid-part of the 20th century, many of the battles being fought were not just the scientific ones, but the political and policy ones. The creation of the NCI, and its work is discussed at length, as well as the creation, and the forces behind the American Cancer Association.
Also detailed in clear steps is the discovery that smoking causes cancer. This broke my heart a bit, to be honest. My dad, really, did not have to die of cancer. The data was there, but he was too hooked to evaluate it logically and it killed him.
A word on the writing itself. The author does tend towards the verbose, but! Even then, the writing was beautiful. Each word felt carefully chosen, but in place for the specific nuance it would impart.
My favourite part of the book, though perhaps the one that got the least in-depth treatment, was the part about the more recent research, medications, and the few decisive scientific victories. The biology of cancer is touched upon, though I'd have loved more detail. However, Dr Mukherjee manages to follow threads of discoveries to their ends, describing, for example, the ins and outs of the cure of chronic myeloid leukemia, without it feeling like he's telling one story after another. The sections feed on each other, and the concepts he delves into (for example, tumour suppressor genes) are revisited in the next ones, so while our understanding of basic cancer biology is never assumed, which is good because it isn't knowledge most of us have on our fingertips, the necessary information is given in detail, and repeated enough to where it doesn't need to be repeated. Which felt like gentle and respectful teaching of difficult concepts to an audience whose level he could not assume. He was thus able, imo, to impart reasonably complex information without ever sounding condescending, without ever talking down at us, because he had laid the groundwork for us to follow his reasoning.
The problems I found with this book....
Like most authors at this point in history, Dr Mukherjee could have used a good editor. I listened to the book on CD, 16 CDs, and there were some repetitions, and some areas that could have been glossed over. He's a bit long winded -ok, fine, verbose- at times, and with that amount of subject matter to cover, this eventually takes a toll.
I get, as I said above, that cancer policy is a major part of the story of cancer, both the medical policy and the political policy. While understanding that, it still seems that a lot of time was devoted to the details of the policy path of cancer, some of which were rather uninteresting and felt almost useless. I'm not talking about science or even medical treatment policy here (for example, while long and sometimes boring, the discussion on radical mastectomy was necessary), but political and lobbying efforts, which, really, YAWN for the most part.
The result, in my opinion of the focus on policy was that there was a short-changing on the science (isn't it always that way?) Dr Mukherjee does talk about many of the breakthrough cancer discoveries of the last century or so, but in very little scientific detail. I'd have preferred more information on that, and less following-the-money.
I could go on and on and not be done. It's a good book, perhaps one of the best I've ever read. I listened on CD, I'm going to be buying the hard copy because it's a book I want to own, to be able to re-visit and reread.
I can't get beyond the fact that this book felt deeply human. That I felt it touched on the very parts of what make us human. I can't quite express it, I don't appear to have quite the words, but reading this book made me acutely aware of our shared humanity. It's cancer's story, but it's also our story, interwoven and entwined, and perhaps the most important part I took away from this book is that this is just the beginning of the story. Cancer's story is our story, and like our story, it is nowhere near being done.