Mukherjee did a very nice job of combining the history of cancer "treatment" and recent medical developments in the field under one title. I had heard 2-3 podcasts with the author late this fall and added the book to my list because of the way he described his work in these interviews. Mukherjee has the writing talent to take what could turn into an overwhelming work of science and make it accessible to a wider audience by spending the first half of the book on the human side of cancern by looking at its impact and treatment history centered on Sidney Farber in Boston in the mid-20th century.
He then added a great deal of hard science (or at least it was hard science to me as a liberal arts grad) by discussing the medical developments of the last 25- 30 years with the isolation of ocogenes and the pharmaceutical treatments that have come from those developments. Frankly, if the book started with this cell biology, I likely would have put it down and not come back as the density of the science and names of the scientists did pile on for a few sections. However, his plan to engage you in the human story before bringing on the science keeps the reader engaged through the challenging sections.
Overall, the biggest take away from me came from his emphasis that cancer is not a singular disease, but rather an umbrella that encompasses multiple, diverse afflictions that can attack different parts of the body, with different intensities and with highly variable rates of morbidity. That single point re-shaped the way that you react when hearing about a "cure for cancer" by knowing that no single treatment, drug or "cure" will be possible for such a diverse set of diseases.
I was asked if there was a "book" for cancer. If there was not, there is now. Mukherjee's "The Emperor of all Maladies: A Biography of Cancer" is a ambitious and successful book for which there is not yet a clear ending.
Mukherjee is an oncologist and the book does not oversimplify the complexity of cancer. His biography of the cancer focuses on the disease and the people swirling around its vortex. As such, much of the book is filled with scientific language and discussions of experiments and theories. While some of it may be over some readers' heads (and some of it was certainly over mine), Mukherjee always manages to put the discussion into context.
As the father of a child with cancer I'm more familiar than I want to be with many of the terms. It was also surprising to see how much treatment occurring today was still being debated in this decade. The story of cancer is long, it is contentious, and it is depressing. But just when you want to give up, another step is made toward battling some type of cancer.
One clear lesson is that there will not be a "magic bullet" to solve cancer, because cancer is really many diseases. Some types of cancer have seen progress which may be seen as a cure, but really are simply methods to avoid death. The cancer does not go away, but death is held at bay. For other types of cancer there is slow progress marked by ups and downs as new treatments breed new issues, but other treatments show up in the least expected places.
Mukherjee, while clearly respectful of all the people who have made progress in battling cancer, does not glorify his medical profession. He laments the split between researchers and clinicians, the battle of egos which have kept some collaborations apart, the lack of funding from a variety of sources, and the inability of some doctors to understand their patients. However, he avoids the easy target of telling everyone why they are wrong. He shows the scientists in their context, shows how they advance the cause, and celebrates when boundaries are overcome and new hope is created.
And how do you end a biography on a living entity? Mukherjee points toward the future of research and where he sees the next strides in overcoming cancer coming from. He notes the progress that has been made and argues against those who say no real progress is being made. You can play with statistics, but when more people live, live longer, and live healthier lives, the statistics no longer matter.
This should become a textbook not only for future medical professionals, but philosophers and historians of science as well. And all affected by cancer (and that is nearly everybody) will find that their journey, while unique, is not new. And it is not without hope.
Full disclosure: I'm a 20-month multiple myeloma survivor. After all the glowing reviews, I really wanted to like this book. I did, but not as much as I was hoping. On the positive side, we get a lucid history of the War on Cancer; of the much longer war against cancer that was waged, mostly futilely, before it began; and how we got where we are today. The author also does an excellent job of focusing attention on the perennial tension between the desire of scientists to direct resources toward the effort of understanding how cancer works in order to more effectively attack it, and the desire of desperate patients and their families to get treatments -- any treatments -- right away, to keep them from dying today. These topics take up a large majority of the book. But then, toward the end, it kind of falls apart. The train arrives at the end of the line to a mostly empty station. I do think the author oversells the new targeted therapies. He specifically calls out multiple myeloma as a shining example of their effectiveness. There is certainly no denying that the statistical improvements he trots out are real. But as an experienced clinical oncologist, he surely knows that, for myeloma patients who are young enough and strong enough to endure it, the weapon of choice remains the old tried and true -- and quite horrendous -- peripheral blood stem cell transplant. For such patients, the targeted drugs are relegated to the supporting roles of induction and maintenance therapies. He knows this, but doesn't mention it. Nor does he mention the appalling cost of these drugs: Revlimid, which is being used as my post-transplant maintenance therapy, is costing my insurance company $100K per year. Beyond this, there are niggling annoyances sprinkled throughout, that should probably be attributed to desultory editing. There is the occasional howler, such as the one that earlier reviewers have mentioned (if it's male, it can't be breast cancer: check). And there are more than a couple of instances in which the author makes use of a word that doesn't actually mean what he seems to think it means. This problem is endemic to the blogosphere, but this isn't a blog, it's a book I paid the publisher real money to read. So, no fifth star from me.
Enough has been said about the content of this book in numerous earlier reviews; it is a solid read, full of fascinating information, well and clearly presented. Others will have to evaluate further the discussions of omissions around cancer research and treatment.
Comment is due on the Kindle formatting of the book. The appearance of the text I received was so far from the acceptable standards of academic writing - including missing footnotes, spurious links and highlighting, and a muddled and unusable index - that I contacted Amazon about a possible malfunction in my Kindle software. The outcome of several hours on the phone was a replacement Kindle, a text with the identical corruption, and a note and call from Amazon indicating that Simon & Schuster were responsible for the formatting of the electronic edition. I was advised to edit the text of my Kindle book on my own device and to contact Amazon and the publisher with a list of corrections to enable them to do further editing!
Kindle users are (or should be) aware of the limitations of the technology with regard to reproduction of tables, maps,diagrams, and illustrations. Egregious errors in basic notation are not a function of these limitations, and render this text almost unreadable.
Given the huge profit margins in electronic sales, Amazon has a duty to customers to address this problem by establishing clear standards for electronic formatting of any publication sold for Kindle use.
My father in law is an Oncologist, and is notoriously hard to shop for. We bought him the audio version of this book so he could listen to it in his car. He is a big fan of history, and he loved this book. He learned things that he had never known about the history of cancer. While I didn't read this book, it apparently succeeded in captivating the interest of an expert in the field. The only reason I didn't give 5 stars is because it seemed disingenuous to do so when I never read the book myself.
The Emperor of All Maladies is a beautifully written, exquisitely detailed account of the entire history of cancer, even though it's not a subject everyone chooses to learn about. Often I had to stop midsentence to marvel at the precision, the amount of detail and the remarkable evidence of the quantity of research that must have gone into this book. Yet. it is truly a page turner! I regretted having to read it in short segments due to time constraints.
This reviewer decided to read "The Emperor of All Maladies" when his wife was diagnosed with abdominal cancer. EAM has certainly been engrossing, educational and enlightening. That is not to say that the experience was encouraging. It was not.
EAM is a basic and thorough historical survey of cancer. Author Mukherjee has performed prodigious research. There are some 68 pages of endnotes, including a nice glossary that is almost hidden among those back pages. Further to the rear of the text secluded behind the index, is a thorough set of questions and answers. Also, the layout and well-spaced paragraphs make for easy reading with little strain on the eye. The good news ends there.
That is because EAM is negative and pessimistic. The subjest matter is a serious and deadly disease! Consider the following direct quotes:
>"I do not despair of carcinoma being cured somewhere in the future but this blessed achievement will never be wrought by the skill of the surgeon".
>"Few doctors in this country seem to be involved with the non life- threatening side effects of cancer therapy. Baldness, nausea, vomiting, diarrhea, broken marriages, disturbed children, loss of libido, loss of self-esteem, and body images are nurses' turf".
>More drugs produce more toxicity without producing cures, as the radical chemotherapists discovered to their despair in the 1980s".
> (Regarding a cancer patient): "It was like watching someone locked in a chess game"...."The illness acted, she reacted. It was like a morbid, hypnotic game- a game that had taken over her life. She dodged one blow, only to be caught by another". This reviewer is distantly, foggily reminded of the chess game twixt the Knight and Death in Ingmar Bergman's "The Seventh Seal". Those who saw the film know how that one turned out!
Given the amount of scholarship devoted to EAM, a 4 star review is virtually required. So much effort was expended herein. Yet EAM is ultimately sad and disturbing. For all the heroics, struggle, salesmanship, politics, endless research and perpetual fund raising, how close to a "cure" for cancer are we? The answer seems to be-very far indeed. The 470 pages of sometimes searing text were too much for this reader. Pick this one up with your eyes wide open.
I recommend this book to anyone who likes a good read which makes you learn something.
There are a lot of fascinating stories about the history of our understanding of this disease.
The book as at its best when it describes the times when our understanding of cancer was very limited or just wrong; when the search for cures was merely trial and a lot of error.
However, I was not as enthusiastic about the more recent descriptions of cancer research, and in particular about the genetics of cancer. I found myself asking a lot of questions. For example:
- I understand some cancers 'require' mutations in several genes. Do you just need bad luck to get such combination of mutations? Or are there mechanisms that make it more likely that certain patterns of mutations occur simultaneously? The discussion about 'pathways' was mostly beyond me.
- Angiogenesis sounds really fascinating, but the book does not give a lot of details about the extent to which tumours sometimes set up new blood channels.
- The section on smoking was good, and there is also something about asbestos, cell phone use, etc... However, even more detail about the studies on environmental factors would have been welcome.