The emperor of all maladies

I’ve recently finished reading Siddhartha Mukherjee’s Pulitzer Prize winning book “The Emperor of All Maladies – A Biography of Cancer”. The book documents the history of cancer treatment, starting around 2500BC and rapidly advancing to cover the story up to the modern day. The author was well placed to produce such a work as he is both a cancer researcher and cancer physician, he also happens to be a very capable writer.

I began reading this book in the spirit of “know thine enemy”, indeed Mukherjee’s stated aim with the book was to answer the questions asked by his patients. In places “The Emperor of All Maladies” is both upsetting and rather frightening but it is also always compelling and informing. Most of the book focuses on the last hundred years, the story of the treatment of cancer in this period is one of false starts and wrong roads followed, ego triumphing over the scientific method, misplaced optimism about the proximity of a cure and tremendous suffering by patients. On an intellectual level the heterogeneity, resilience and adaptability of the disease is something to marvel at as well as being something that explains why this illness is so difficult to treat.

There is hope in the book too as it details how, over the last twenty five years, cancer prevention and treatment has advanced making inroads and improving patient outcomes across a range of different cancers. Mukherjee explains how research has provided scientists with a much greater understanding of how cancer occurs and develops, particularly at the genetic level. This understanding has led to the development of new drugs like Herceptin and Gleevec which have had close to miraculous results against some cancers. These drugs are targeted therapies, attacking particular forms of cancer on very specific and narrow chemical fronts. Unfortunately drugs of this type have been created for only a very few cancers so far.

Mukherjee is cautious about the future rate of progress in cancer research, perhaps this is not surprising given the history of cancer treatment as recounted in his book, however whilst he does not foresee a comprehensive cure he does foresee ongoing advances across the field leading to stepwise improvements in care.

This book has given me a much better understanding of cancer and cancer medicine and provides a useful context within which to understand my own treatment. For anyone interested in cancer or for anyone who enjoys popular science books, I highly recommend “The Emperor of All Maladies – A Biography of Cancer”. Mukherjee does a terrific job of weaving a coherent narrative from many historical threads and despite my initial expectations his book is a real page turner.