In my read books list, I’ve begun to mark with a (♥) any that I would specifically recommend to people in the healthcare sector. Siddhartha Mukherjee’s The Emperor of All Maladies clearly deserves that badge.
The book, as the subtitle has it, is “a biography of cancer”. From its earliest occurrences in historical texts to recent breakthroughs in science and therapy, Mukherjee tracks the ”life and times” of malignant disease. The history of oncology is fascinatingly intertwined with the development of healthcare in general: antiseptics, surgery, pharmacology, the whole concept of preventive medicine, the discovery of AIDS and genetics…
But the scope of the book is as much societal as it is biomedical. It turns out, for example, that in the 60s and 70s there were hugely influential lobbying groups against cancer in the U.S. – the reasoning being that ”if we can build an atomic bomb and put a man to the moon, we sure can cure cancer”. Science is never only about science, it’s also about PR and being able to sell one’s story to obtain funding.
Mukherjee portrays in a lively way the individuals who played key roles in discovery of oncological therapies. Many of them ring a bell, having lent their names to syndromes or surgical instruments. And many had colorful, quirky careers. Take William Halsted for example, the guy who mastered radical cancer surgery while high on cocaine.
But the writer also makes it clear that science is more about teamwork than individual accomplishments. The ”genii” of oncology also sometimes turned out to be the biggest brakes on the field’s development, having so fallen in love with their theories as to try to prevent any attempts to prove otherwise. The most inspiring cancer scientists opened new lines of thought for the path dependent science and thus laid way to even greater discoveries than their own.
The chapters that describe the clinical trials and medical innovations are actually the less interesting parts of the book (although well-written and not too technical, they still feel more like the stuff of medical textbooks). What I liked especially is when Mukherjee describes the societal and philosophical impact of cancer and cancer research.
Every chapter opens with 2 or 3 quotes that serve to convey the zeitgeist of the past decades’ cancer scientists. It is sobering to realize how quickly attitudes and dogmas have changed. Among other things, The Emperor of All Maladies is a study of medical misconceptions, from the generations of doctors who followed the Hippocratic and Galenic humoral theories without daring to object to these authorities to the 20th-century surgeons who insisted on overly radical, disfiguring operations and even opposed adjuvant chemotherapies before the concept of staging was developed and the evidence for chemo’s benefits too clear to ignore anymore.
All in all, the history of cancer makes up for an unexpectedly good story. The disease first enters history as a vague unknown threat and during the centuries of research becomes an almost anthropomorphic enemy against whom ”wars” are waged. For a serious scientist whose publication history includes Nature and NEJM, Mukherjee’s writing is sparkling. Consider this sentence for instance:
Society and illness often encounter each other in parallel mirrors, each holding up a Rorschach test for the other.
Anecdotes from the Mukherjee’s own practice are interwoven with historical accounts and serve to show that some dilemmas – e.g. when to abandon hopes of cure and settle for good quality palliative care – are still the same than decades ago. The author’s sometimes very personal experiences from the wards are among the most touching parts of the book.
My only grudge is non-continuity. The events covered by the book span centuries and often the story just leaps suddenly from one era and place to another. Many such transitions make sense thematically (and I can see how abandoning the strictly chronological approach might have served the structure of the book) but some of them are confusing and break the rhythm of the story.
Anyway, one of this year’s highlights for me.