The Emperor of All Maladies

The Emperor of All Maladies: A Biography of Cancer - Siddhartha Mukherjee

Did the ancients describe cancer? What early cancer treatments gave hope that cancer could be beaten? Is “war” the best metaphor when the adversary is cancer? What do cancer patients want to know?

These are the questions that Mukherjee tries to answer in this long chronicle of research and treatment defeats, dead-ends, and progress against this relentless disease. It can also be read as the story of women who were injured, disabled, disfigured, and killed by not only cancer itself but by aggressive treatments  against it by doctors, surgeons, and chemotherapists. The main thing that I took away from this book is that a memorial should be erected to the women that died during treatment and in clinical trials that compared treatments for cancer. A plaque in a garden would be the least we could do in order to commemorate their courage and patience in the face of unimaginable suffering.

But Mukherjee tells stories about selfless researchers, too. For example, in 1984 Dr. Barry Marshall experimented on himself to convince skeptics that H. pylori was the cause of gastritis and peptic ulcers. No animal study had proved the point and Institutional Review Boards would never have approved the study be conducted on living human beings (I know: I've worked on such a board for 10 years).

Marshall decided to establish the disease in his own body.  He reduced his stomach acid with an alkaline cocktail, drank a bacterial culture, and fasted for the rest of the day. He developed bloating, nausea and vomiting with night sweats and halitosis after three days. The subsequent biopsy clearly and indisputably established the bacterial presence on stains and cultures. After 14 days, his own immune response successfully fought the symptoms. Marshall had fulfilled the standards for identifying the causative agent of a disease and proven that the bacterium was a cause of gastric inflammation. And this is only one hero discussed in this book.

Mukherjee also narrates tales of victories, goals and courage among doctors, researchers, and patients in the wards of the children's hospitals, university laboratories and even basement labs, where great scientific revolutions sometimes take place. So, this is a serious book, sometimes frightening and sometimes demanding on the non-expert reader. But the style is very readable with clear terminology, explanations and digressions that makes it generally accessible to the lay audience.

This book won a Pulitzer Prize in 2011. It should be read by any reader who wants to understand why, after billions of dollars and five decades of (mostly) well-designed research, there is still no single cure for all forms of cancer and why, even while increasing the effectiveness of the treatments, more and more people will continue to get sick in the years to come.