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

The Emperor of All Maladies: A Biography of Cancer Reviews

• 
  David

  Every year there's always one non-fiction book that the entire literate world raves about and that I hate. In 2009 it was Richard Holmes's "The Age of Wonder", the following year it was "The Emperor of All Maladies".
  
  Universally admired, winner of a Pulitzer prize, this book annoyed me so profoundly when I first read it that I've had to wait almost a year to be able to write anything vaguely coherent about it. The flaws that I found so infuriating a year ago seem less important upon a second reading. Though I still think it is a poorly conceived book, executed in a manner that lacks all restraint, it's nowhere near as terrible as I remembered.
  
  As I recall, the aspects of the book that most annoyed me were:
  
  (a) the author's anthropomorphism of cancer -- a stupid, unhelpful, and ineffective metaphor. In general, I detest this practice of attributing personalities to diseases. Perhaps it's a necessary psychological strategy for oncologists. But it's particularly inappropriate in the case of cancer, as it perpetuates the incorrect belief that cancer is a single disease, as opposed to a "shape-shifting disease of colossal diversity". For the same reason, it makes little sense to speak of a "war on cancer", as if it were a sentient villain with plans for world domination, one that can somehow be vanquished if we just find the magic formula. Mukherjee correctly deplores this view as simplistic and reductive, but he then proceeds to adopt it hook, line, and sinker. It's a baffling and unfortunate choice, because its inherent deficiencies lead to a kind of narrative incoherence, as well as a damaging lack of clarity about the nature and scope of the book. It's a symptom of Mukherjee's vagueness of purpose that he often refers to the book as a "biography of cancer", as if that phrase had meaning.
  
  (b) A complete, fatal, inability to leave anything out. There is a certain type of non-fiction writer who seems hellbent on inflicting everything he or she learned while researching the book on the misfortunate reader. No detail is spared. Everyone the author spoke to during the five years researching the book gets a mention, it would seem. As do a bunch of dead folks, some of them very dead, not all clearly particularly relevant.
  
  If, by doing this, the author is trying to impress with the breadth of his research, then he fails. Leaving everything in is the simple, intellectually lazy, option. Where non-fiction is concerned, the reader has a right to expect the author to take the trouble to shape his material into some kind of coherent whole, recognizing that while some details are critical, others are not, and pruning accordingly. All too often, though, authors forget this. Their enthusiasm about the subject leads them to lose perspective: "the reader needs the whole story and will be thirsting for all the gory details; it would be criminal to leave anything out".
  
  Well, actually, NO. We want you, the author, to point out to us what's important and what's not.
  
  (c) The author includes stories of his own patients' experience with cancers of various types. I have nothing against this per se - it's entirely sensible to do so. However, it requires delicacy and finesse to report on his patients' stories without seeming exploitative or emotionally manipulative. Writers like Jerome Groopman and Oliver Sachs regularly navigate this terrain with grace and sensitivity. Mukherjee, a much less experienced writer, repeatedly crosses the line into bathos and melodrama. The language is overly dramatic; one senses also that Mukherjee succumbs to the oncologist's fallacy of believing that cancer is intrinsically "worse", or more serious, than all other ailments. Actually, I guess that's already evident from the book's title.
  
  (d) He has a particularly unfortunate habit of prefacing each chapter with at least one "literary quote", and when the book reaches a new section (there are six in all), he tends to go hog wild and give us a whole page of quotes. These seem like a minor distraction at first, but their cumulative effect is to leave the reader with the impression that (i) it is very important to the author to let the world know that he is a well-read, Renaissance dude (ii) chances are the author is a bit of a poser. The bard, the bible, St Thomas Aquinas, Sophocles, Kafka, Hegel, Voltaire, Plato, Sun Tzu, and William Blake are all mined for a portentous snippet or two about mortality and the evils that the flesh is heir to. Not to mention Gertrude Stein, Jack London, Czeslaw Milosz, W.H. Auden, Hilaire Belloc, D.H. Lawrence, Lewis Carroll, Conan Doyle, Italo Calvino, Woody Allen, Solzhenitsyn, Akhmatova... . Using just the right quote to frame an argument, or introduce a topic, can be an extremely effective device, but its effectiveness diminishes rapidly with overuse. One gets the distinct impression that the author ransacked some quotation website in the mistaken idea that sprinkling them copiously throughout the manuscript would magically confer some kind of gravitas. I reached my eye-rolling moment on page 190, introducing part three, when Doctor Mukherjee felt impelled to quote T.S. Eliot:
  
  "... I have seen the Eternal Footman hold my coat, and snicker.
  And in short, I was afraid."
  
  (e) As I mentioned, I think the structure and organization of the material leaves much to be desired. The writing is generally adequate, if a little verbose, though one tic of the author's drove me nuts. Each of the apparently infinite number of characters in the book is introduced in Mukherjee's characteristically breezy style, then immediately fixed in amber by means of a trio of adjectives. Accurate information about the personality and character of many of these historical characters being limited, one suspects that these adjective triplets may well have been chosen at random from a thesaurus. This kind of thing:
  
  childless, socially awkward, and notoriously reclusive
  wealthy, politically savvy, and well-connected
  wealthy, gracious, and enterprising
  ambitious, canny, and restless
  self-composed, fiery, and energetic
  proud, guarded, and secretive
  flamboyant, hot-tempered, and adventurous
  cool, composed, and cautious
  intellectual, deliberate, and imposing
  charming, soft-spoken and careful
  outspoken, pugnacious, and bold
  impatient, aggressive and goal-driven
  brackish, ambitious, dogged, and feisty
  suave, personable, and sophisticated (impeccably dressed in custom-cut Milanese suits)
  brilliant, brash and single-minded
  laconic and secretive, with a slippery quicksilver temper
  
  Obviously, Dr Mukherjee is an adherent of the "Adjectives are Your Friends" school of writing. If this kind of tic bothers you, be warned that it really runs rampant in this book. In the general scheme of things, it's a minor detail.
  
  Enough caviling. What has the author accomplished in this book? I think he has written an overly detailed*, partially complete**, suboptimally organized*** account of the evolution of our understanding of cancer and the development of treatment options to counteract it. The result is a very readable account, though I imagine some of the second half of the book may be hard for non-scientists to understand. In general, he seems to get things right, though there are a few lapses -- most notably in his discussion of the use of mustard gas in WWI. I can find no corroboration of his statement that "in a single year it left hundreds of thousands dead in its wake"; one wonders if he may have confused 'casualties' with 'fatalities'. His ability to explain biomedical ideas in terms a layperson can understand seems decent, though not exceptional. I don't think the writing is of a caliber that deserves the Pulitzer prize, but what do I know?
  
  *: "overly detailed" - to give just one example, was it really necessary to devote a page and a half to reviewing Lister's introduction of antiseptics? And in a book which appeared to be focused on diagnostic and therapeutic options, why devote 40 pages to the link between smoking and cancer with the emphasis firmly on the legal and regulatory aspects?
  **: eye-glazing detail about kinase inhibitors, but nothing about anti-angiogenesis agents (Avastin was approved around 2003, as I recall, so it's clearly well within the time horizon)
  ***: a person could get whiplash from all the zipping up and back down the historical timeline, for no obvious reason.
  
  
  Thank you. Now that I've got that out of my system, I feel much better.
• 
  Petra loves Miami art everywhere instead of trees

  This book took me over a year to read. I kept it on the kitchen counter and as the left-hand page pile got bigger there was me standing on the right, getting smaller. It was my diet book. A couple of pages and a pound or so every week. What I was doing was either boiling the kettle or making my own concoction of a fat and cholesterol-busting mousse that involved just holding an immersion whisk for a couple of minutes. I have such a low threshold for boredom I had to do something, so I read Emperor of All Maladies.
  
  I had previously tried to read the book in the proper way but failed. It is very heavy and not all of it is equally fascinating, but it all hangs together in the end and has given me a proper education in genes, dna, mutations, what cancer actually is and why it has been so impossible to find a panacea.
  
  It's a bit like fighting a guerrilla war. You can only defeat the insurgents where you find them and where you think they might be. It might seem as if all the rogue cells have been annhilated. But if you didn't find them or one is high in the hills watching, or there are reinforcements coming from abroad in the next few months, then the battle will resume as soon as numbers have built up and the enemy is attacking once again. That is not to say there aren't victories, but they are victories of battles, not of the war, but the war against cancer is one from which we can never withdraw.
  
  One thing struck me that was full of hope, was Mukherjee was talking about a previously rare cancer that is now quite common. It might be assumed that the cancer itself is on the upsurge, but no, it was rare because people died from it, now they live with it, so just like AIDS, it is no longer a killer but a chronic disease.
  
  7-star book. 8 even... it was that good.
  
  
• 
  Riku Sayuj

  Anna Cancerina
  
  What a masterpiece. With beautiful metaphors, poignant case studies, breath-taking science and delectable literary allusions, Siddhartha Mukherjee takes us on a detailed yet panoramic trip spanning centuries. Probably one of the best science books I have ever read.
  
  My favorite parts in the book are the literary allusions that capture the depth and feeling of what is being described so well, such as Cancer Ward, Alice in Wonderland, Invisible Cities, Oedipus Rex and many more.
  
  The most memorable of all is when he encapsulates Cancer with a play on the favorite opening lines from Anna Karenina - "Happy families are all alike; every unhappy family is unhappy in its own way." becomes "Normal cells are identically normal; malignant cells become unhappily malignant in unique ways." This unacknowledged transmutation of the famous lines encapsulates the book for me, in more ways than one.
  
  For a comprehensive take on the influence of cancer as a metaphor in our daily lives and societies,
  go here.
• 
  Always Pouting

  I think this is a really good and accessible book about cancer that traces the history of our understanding of it. I'm not sure if it qualifies as a biography of cancer per se and I only mentioned this because I kind of feel ambivalent about the anthropomorphizing of cancer through out the book. I feel like it wasn't really even anthropomorphizing really, especially not when compared to the way a lot of biologist speak of things like genes, but more metaphorical and a way of relating cancer to a larger cultural feeling and tone. I just found Mukherjee's attention to etymology and to larger metaphorical meaning in terms of the language used and the approach taken to treating cancer a really salient part of this book. I haven't decided how I feel about it though, whether I liked it or not. I enjoyed reading this though and found it really informative. I can see why everyone was recommending it.
• 
  Simon Clark

  I wanted to dislike this book. For personal reasons that I'm not quite ready to talk about yet, I really wanted this book to fall apart, to fail in its communication of the science of cancer. The longer it went on, the harder I looked for reasons to deduct a star from its rating. But I simply couldn't find any.
  
  This is a meticulous account of the multifaceted research to beat cancer. It's quite possibly the best bit of written science communication that I've ever read. In my opinion you can break science communication into a hierarchy: first comes raising awareness, then comes raising understanding, then finally comes raising literacy.
  
  Mukherjee beautifully blends personal accounts of patients that he has treated with a deep review of the existing literature, as well as conducting interviews with the (still living) key movers and shakers. Moreover, he gradually ramps up the complexity of the language used, such that by the end of the book sentences that might once have seemed technobabble are clearly understandable. After reading this book I am more aware of the nature of cancer, understand how (to the best of our current knowledge) it emerges in our bodies, and can parse medical news and reports with new awareness. The Emperor of All Maladies succeeds in all measures of science communication. But more than this, it is a riveting, moving read.
  
  It really is a titanic achievement in written science communication.
• 
  Cait Poytress

  Cancer fucking sucks.
• 
  Diane S ☔

  The author is a cancer physician and researcher,. I don't think anyone else could take on the challenge of writing about cancer, from the first rearing of its ugly head. He gives us a sweeping look at the beginning treatments, trials, operations, and research. Leukemia, breast cancer, Hodgkin's, and other cancers flit in and out throughout this book. Reading about children with this horrible disease always tears at my heart, I think this was the hardest part. Although it was all quite hard, but so informative.
  
  How doctors think at times, when confronted with patients they are not sure they can cure. There is so much included in this book, but it is done well. Written well and definitely kept my interest.
  
  The narrator was Fred Sanders and he was terrific.
• 
  Mark Porton

  Most of us are touched by Cancer at some time in our lives, whether it be via a friend or a family member, or we may suffer from Cancer ourselves. The experience may be fleeting, or our lives may be obliterated.
  
  The Emperor of all Maladies – A Biography of Cancer the Pulitzer Prize winning book by Dr Siddhartha Mukherjee presents an all-encompassing look at Cancer, from how it was considered by the ancients up until the challenges confronting modern medicine. Cancer is the character here, from birth – but not yet to death. Every other biographical subject written either has died or will eventually die – perhaps this biography’s subject will never die.
  
  As a history lover, I was fascinated by stories from antiquity such as Imhotep, a physician plying his trade in Egypt around 2600 BCE. He reported “bulging masses in women’s breasts, spreading under the skin”. He used a whole host of treatments for other maladies, such as balms and poultices, but for this disease all he could write in his notes regarding treatment was “There is none”. Bone tumours have been found in Mummies – it makes one think how that poor person suffered, with no treatment or palliation available. Slow miserable deaths. Cancer is as old as humankind.
  
  One particularly gruelling episode covered was that of the early surgeons, let’s say 1850 to the early 1900s. This is when radical surgery was invented, the words used by our author are “they brazenly attacked Cancer”. If margins were positive, why not extend the margins? Some of the examples cited sounded more like mutilation than surgery, particularly with radical mastectomy procedures. We proceed through various other therapies – the fascinating origins of chemotherapy, experimental radiation, adjuvant therapies and the rise of genetic and immunotherapies.
  
  I really found it worthwhile reading about the stories of the people suffering from Cancer. Even though there was a leaning towards leukaemia in this book, most other Cancers were considered. It’s the patient stories I find the most interesting and indeed the most helpful. I’ll listen to a Cancer story any day – in a café, on a bus, in a waiting room. It doesn’t have to be a good story with a happy ending, in fact – the bad stuff is just as riveting to hear, it’s also just as helpful. But we also need to be mindful that each patient deals with this disease differently, some of us bang on about it, others don’t. I have found Oncology waiting rooms some of the nicest places to be, there isn’t much moaning about not getting a car park, there’s often some smart person saying something a bit odd or funny, but above all there’s a feeling of belonging. I hope that makes sense. One of my fondest memories was the 1,000-piece jigsaw puzzles we all used to do in Radiation Oncology.
  
  Sorry, I digress, one can only admire the clever scientists and doctors who have worked tirelessly, over many years to help find remedies to treat this awful disease. One thing that will strike you if you read this, is the variation in Cancers types, not only the obvious difference between say Breast and Prostate Cancer, but also the differences within the ‘same’ Cancer’ I just makes one think, a single cure for Cancer is just not possible (I don’t think).
  
  The only criticism I have is, it’s quite a heavy book – not so much because the subject matter is Cancer, but the author does go into some detail when describing various advances in therapies, research, genetics and more. It’s easy to get lost – but this book is certainly authoritative. It’s a meaningful piece of work.
  
  We might as well focus on prolonging life rather than eliminating death. This war on Cancer may be best ‘won’ by redefining victory
  
  This is highly recommended, particularly for members of the Cancer club, or for those close to someone who is.
  
  5 Stars
• 
  Vicki

  As someone with a budding interest in diseases- whether chronic, acute, or intermittent- I immediately purchased this book for my library as soon as it was published. I anticipated a similarity to a favorite book of 2010, The Immortal Life of Henrietta Lacks, but this book dives much deeper into the history of cancer, while interweaving personal accounts of patients the author treated. This biography is different from anything I have read this year; poignant, lyrical, accessible- and most of all, real. Living, and breathing along with his patients, Siddhartha Mukherjee dives deep into the dark and the light side of cancer, and explores not only how the diseases spreads within the body, but through the lives of his patients, and the doctors and scientists who strived to defeat this complicated, deadly disease. Great read.
• 
  Christina

  Deep breath. This book is elegant, extraordinarily insightful, and most of all important. Despite the big words and the complicated science, Mukherjee had me riveted from start to finish. I thought I had a knowledge of cancer before this book, but now I understand it, in all of its feverish complexity and horrifying beauty. In the history of cancer research, there have been bright flashes of brilliance combined with truths that are stupidly rediscovered centuries too late (such as the carcinogenic nature of tobacco, which was delineated by an amateur scientist in a pamphlet in 1761 but that was still, somehow, up for "debate" in the 1960s). What sticks with me most is that no one in cancer research really knows what they're doing, but the strength of truly great doctors lies in knowing that, instead of assuming the arrogant position that you've found the only way and other possibilities are laughable.
  
  I did not know that this book won the Pullitzer this year when I read it, but it deserves every piece of praise it gets. I will admit it was very hard to read this book with my 29-year-old sister so struck by (and dying of) breast cancer. On every page are patients suffering through cancer and its treatments, losing their battle only a few chapters before the particular solution they needed is found. Cancer is a formidable foe that, for better or worse, is tightly intertwined within our genes. One of the doctors profiled in the book had a favorite aphorism about how death in old age is not something to be beaten, but death before old age is the enemy to fight. That is what I hope for. Not extravagant medical "advances" aiming for immortality — just the opportunity for each of us to fully experience our mortality for a period of time that does not rob of our best years, or the chance to have children, or the chance to find love and find ourselves. Sigh.
• 
  Warwick

  
  I've been wanting to read this since it first appeared, but I was just too nervous. Call it superstition. This is far scarier than any of your Barkers, your Kings or your Koontzes: there are no such things as zombies or bogeymen, but cancer is out there. Waiting for us.
  
  In
  The Great War and Modern Memory, Paul Fussell talks a lot about the irony of the First World War. Cancer, in the same way, is a deeply ironic disease. As Peyton Rous said, ‘Nature sometimes seems possessed of a sardonic humor.’
  
  The ability cancer cells have to reproduce themselves is the same biochemical magic that normal cells use to self-replicate; it's the whole reason we're alive. Cancer has weaponised our own life force; its ‘life is a recapitulation of the body's life, its existence a pathological mirror of our own.’
  
  Similarly cancer rates have gone up, in historical terms, not because there are more carcinogens but because (more irony) we are living longer.
  
  

  Civilization did not cause cancer, but by extending human life spans – civilization unveiled it.

  
  
  Now that so many people are surviving into their seventies and eighties, cancer has a better chance to pull off its mask – like a Scooby-Doo villain – to reveal that it was lurking there inside us all along. And I would have gotten away with it, too, if it wasn't for you pesky oncologists.
  
  So this book is frightening, and you do have to brace yourself to read endless variants on the phrase ‘unfortunately it had metastasized inoperably into her liver and brain’ over and over again; however, balancing this terror is the very real intellectual thrill of following the generations of doctors and scientists who have tried to understand and fight the disease.
  
  The fight has got a bit more sophisticated than it used to be. Not a lot, but a bit. The prevailing approach for a long time was that pioneered by William Halsted, who insisted on (literally) ‘radical’ surgery to cut out as much tissue as physically possible, in order to maximize the chances of removing all the cancerous cells. One disciple, for instance, ‘evacuated three ribs and other parts of the rib cage and amputated a shoulder and a collarbone from a woman with breast cancer’. Gradually, advances in biochemistry and, latterly, genetics, have allowed for more targeted non-surgical solutions, although so far only really for certain specific cancers.
  
  In fact the most progress has been made not in dealing with cancer, but in avoiding it in the first place. Anti-smoking campaigns, lifestyle advice, along with Pap smears and other screening programmes, have been very successful at least in the West (elsewhere, things are going backwards in many cases). Once it actually develops, your options remain fairly limited, and the metric of success is still often how many years of remission one can hope for, rather than the chances of an outright ‘cure’.
  
  Mukherjee is thorough with his story and writes pretty well, although the focus is very much on the American scene, with researchers from Europe and elsewhere sometimes dealt with in a cursory fashion; at one point he even describes France and England as lying on the ‘far peripheries’ of medicine! He also goes a bit overboard with his literary credentials, bookending every chapter and section with multiple epigraphs from poets and other thinkers. It's not clear how well he understands his sources here, though, especially when you see that he's dated Burton's Anatomy of Melancholy to 1893, when Burton had been dead for two hundred and fifty years.
  
  Still, this is overall a very rich and rewarding book, full of scientific discovery and packed with historical detail. It's a thriller, it's a sci-fi, it's a horror story. Let's just hope that future editions have even more to report in the way of progress.
  
  
• 
  Orhan Pelinkovic

  Reading Siddhartha Mukherjee's biography of cancer evoked buried memories of my experience with the disease.
  
  Cancer is not a single or homogeneous malady but a multiple or heterogeneous disease that shares a common fundamental characteristic; abnormal cell growth.
  
  It seems that during my college years my body's usual self-commanding mechanism, in a distinct area, stopped working properly i.e. my typical cell cycle malfunctioned. Perhaps, the old cells, that my body no longer needed, did not die and grew uncontrollably. Cancer occurs when a copying error of a DNA takes place during cell division, like a typographical error, where the misprinted DNA influences a critical gene. Many cancers are caused by these random unfortunate copying errors but others are caused by environmental effects or inherited mutations. Whichever was the cause in my case the malignant cells incessantly multiplied, by division, to form my tumor.
  
  Similar malignant tumors, leukemia, and lymphoma are all discussed in the The Emperor of All Maladies (2010) but the book focus is more on the history of the evolution and the significant discoveries of cancer treatment and about the notable medical doctors and scientists who were leading the way to better understand the disease and strived to find a cure for it. We also learn that it was not just the individuals who wore the white coats that are to be credited for the accomplishments in cancer research, treatment, and prevention, it's also the activists, philanthropists, and government officials who did their part in advocating the prevention of cancer and securing the funds necessary so we can come closer to finding a solution for this illness.
  
  Even though the surgery to remove my malignant tumor was successful, cancer had spread, hence it required several weeks of therapy, which ended up turning into months that subsequently eliminated my drive and reduced my weight. Since I was even then interested in Darwinism, I remember thinking "natural selection wants me out".
  
  Before my therapy started, I took all measures of fertility preservation. At the time I found it slightly embarrassing as my friends and family knew where I was going. I recall the nurse at the clinic with an expressionless face offering to bring me magazines and videos which I immediately and proudly declined.
  
  Luckily, the efforts of my team of doctors, family, and friends paid off and man-made group selection beat natural selection!
  
  Mukherjee wrote a great book with an enthralling narrative. He smoothly intertwines science, history, and biographical accounts with personal stories as he did with his subsequent book The Gene (2016). The Emperor of All Maladies is over 600 pages but it's worth the effort.
  
  (4.5/5.0)
• 
  Tony

  I knew before I had finished
  The Gene: An Intimate History that I would have to read this earlier work by Siddhartha Mukherjee. Yet I waited over two years, a reading eternity for those who know me. See, I tend to the obsessional in my reading, and I do not need hypnosis to be suggestible. Oh, you can't sway me with your opinions -- I'm too contrarian for that. But if I was drinking Pinot Noir and I offered you a glass of it and you said, no, that Pinot Noir made your mouth too dry, then my mouth would instantly turn to chalk. In other words, should a psychosomatic read a biography of cancer?
  
  And, being both male and American, I have done my share of dumb things.
  
  Demagogues don't scare me, but snakes do. And ageing doesn't scare me. But, cancer does. Perhaps like you, I have seen it up close, and with someone who bequeathed her DNA to me.
  
  ----- ----- ----- ----- -----
  
  Like An Intimate History of The Gene, the subtitle here - A Biography of Cancer - is cutesy. It's actually a mix of things. There's a history of our knowledge of cancer and also a history of the scientific and medical attempts to combat it. It's multiple biographies of the scientists in the lab, the crusaders, and the victims. It's legal fights, as innovative as the scientific research; and it's about prevention. The author's patients are here too, poignantly.
  
  Retroviruses. Cytotoxic chemotherapy. Retinoblastoma tumorigenesis. Words on the right side of the colon are supposed to be illuminating. But here: myc, neu, fos, ret, akt (all oncogenes), and p53, VHL, APC (all tumor suppressors).
  
  And yet, this was a page-turner. Because Mukherjee can write! And he doesn't talk down, and he honors other writers, but just enough not to insult the reader. So he can write a sentence like this: Normal cells are identically normal; malignant cells become unhappily malignant in unique ways.
  
  And he has an ear to quote others. Like Rose Kushner: When doctors say that the side effects are tolerable or acceptable, they are talking about life-threatening things. But if you just vomit so hard that you break the blood vessels in your eyes . . . they don't consider that even mentionable. And they certainly don't care if you're bald. The smiling oncologist does not know whether his patients vomit or not.
  
  But nurses do, and Mukherjee honors them in appropriately subtle ways.
  
  I learned, of course, many things. Trite things, like that the Pap smear was named after George Papanicolaou, who kind of invented them. But also that In autopsies of men over sixty years old, nearly one in every three specimens will bear some evidence of prostate malignancy. Most cases are indolent though, so we tend to die with prostate cancer rather than because of it.
  
  I read with fascination about biases in testing and the perils of statistics. So, a drug 'curing' cancer can actually increase the prevalence of it.
  
  But long after I forget the names of the researchers and the initials of the life-saving drugs, I will remember this one supremely well-crafted sentence:
  
  Old sins have long shadows.
  
  You could start a novel with that.
  
  Or, an autobiography.
  
  Here's the whole thought:
  
  Yet, old sins have long shadows, and carcinogenic sins especially so. The lag time between tobacco exposure and lung cancer is nearly three decades, and the lung cancer epidemic in America will have an afterlife long after smoking incidence has dropped.
  
  The math is that I quit 30 years ago - little cigars, intensely inhaled - a few years after my mother died of lung cancer. That I'm rehabilitated might not matter.
  
  This is a wonderful book, extremely well-written. Nine years old, it might actually be dated. But the messages are timeless.
  
  Old sins have long shadows.
• 
  Jessica

  I am a big blubbery crybaby when I'm reading a book, but I'm gonna have to get over that if I'm going to get through The Emperor of All Maladies. I almost bailed at page five because it was obvious that reading this would involve an intolerable amount of weeping on public transit, but then I realized that what I must do is master myself.
  
  I'm too old to be crying all the time! It's ridiculous! I'm going to read this book and I'm going to put a wrench to the waterworks! I'm gonna save my tears for sentimental nineteenth-century fiction! I hope this doesn't give me tear-duct cancer or something. It's probably dangerous, but it's what I must do.
• 
  Stephanie *Eff your feelings*

  Done!! Phew!!
  
  Everything you've ever wanted to know, and didn't want to know about cancer. While this is not light reading, it's interesting reading.
• 
  David Rubenstein

  This is an elegant, well-written book. Parts of the book read like a detective story, and are very engrossing. However, I really take issue with the short shrift that the book gives to research on cancer prevention. Now, the author readily admits that big strides toward conquering cancer will not occur by only finding cures--prevention is just as important. But, while the book has several chapters on the connection between smoking and lung cancer, no attention is paid to research related to other important lifestyle changes in preventing cancer. For example, a large body of research, both epidemiological and experiments with laboratory animals, have found strong connections between nutrition and cancer prevention. It simply stuns me that in a huge, comprehensive book like this, absolutely zero attention is paid to this very important topic.
• 
  Nick Black

  
  http://www.newyorker.com/arts/critics...
  
  Hyperliterate, scientifically savvy, a hot-boiled detective novel spinning along axes of surgery, chemical and radiative therapy, molecular biology, bioinformatics, immunology, epidemiology and supercomputing -- there's a little bit here for every
  NT (and if you aren't NT*, then to hell with ya!). Suffers noticeably from a lack of editorial quality control -- several passages are repeated almost word-for-word (why does this happen so often in high-grade pop science? what's up with the lack of good, scientifically-literate editors?), and insufficient detail -- the book would have benefited from entire extra chapters detailing pathway-based drug discovery, the physics and mathematics of random mutation (a quick nod is paid to Schrodinger's
  What is Life, of which I fully approve), the use of statistical and combinatorial analyses in drug discovery, etc. Then again, less technically-minded readers are probably thankful for these lacunae. Overall, I'd have appreciated more focus on the past 20 years of oncological research, rooted as they are more deeply in the hard sciences of molecular biology and targeted pharmocology; cancer treatment has, until quite recently, been a story of observation-driven research, which (no matter how complete the collection or analysis of data points) is (and must remain) both fundamentally less effective and less interesting than the ineluctable march of theory.
  
  Then again, one of Mukherjee's major points is that "cancer" is a collection of protean, complex, multifaceted things, evolution in situ possessing its own elegance and beauty, a noble and almost clever opponent. So often thought hovering on the brink of defeat, it has always managed to elude its pursuers, and perhaps the proliferation of pathways hints that protein folding and recombinance will form no more a panacea than did adjuvant radiotherapy forty years ago.
  
  warning, the following are personal conjectures of a precocious computer scientist: The evolution, for instance, of repressed metastasis suppressors or disabled anti-oncogenes coding for "undruggable" proteins -- those lacking differentiated bonding sites along the cell membrane (see breast and ovarian cancer's infamous
  HER2/neu, so efficaciously targeted by Herceptin, for a counterexample), or deeply interwoven with non-renewable, inaccessible host material (eg meningioma, gliosarcoma) -- would require wholly new avenues of treatment (hence the sprezzaturic
  gamma knife -- "
  from the rain of the cobalt, O Lord, deliver us". Hence the radiolabeled polyethylene glycol-coated hexadecylcyanoacrylate nanospheres, in all their evanescent busting of the blood-brain barrier -- and in all their depositive despair). Cancer's accelerated evolution suggests convergence of mortality toward such rough beasts. Pathway-oriented research is critical.
  
  Anyway! This is a pretty goddamn good book. I recommend it.
  
  * Extreme
  ENTP here, of course.
• 
  Kat

  It currently dominates the news in The Netherlands: the suspicious deaths of several people with cancer, who were treated with the drug 3-Bromopyruvate (3BP) in an alternative cancer centre in Germany. It’s likely that those that were treated at this clinic had no other treatment options available in conventional medicine, and so turned to alternative medicine as a last resort. Therefore, a high death rate seems unavoidable either way. Yet, authorities have reason to believe that patients at this clinic died under suspicious circumstances.
  
  The drug in question, 3BP, has shown promising results in early testing and is cautiously referred to as a potential breakthrough treatment for cancer by some researchers. A Dutch boy called Yvar Verhoeven was treated with 3BP several years ago after his dad refused to give up on him. He wrote to over 500 cancer specialists begging for the experimental treatment. Finally, a specialist in Frankfurt was willing and treatment ensued. The drug managed to completely, spectacularly, eradicate Yvar’s liver cancer. As often is the case with cancer, there was no happy ending: Yvar passed away due to related complications a year later. But not before he’d
  toured the States during his short revival to discuss what turned out a miracle drug for him.
  
  Dutch newspaper De Volkskrant ran an article on Yvar’s treatment and the progression of his cancer that’s recommended reading to get the backgrounds, but unfortunately is also in Dutch.
  For multilinguals.
  
  At the time, Dutch professor of medical oncology at the Acadamisch Medisch Centrum, called the mechanism of action of 3BP "very interesting", but warned that a lot of additional research was required before it could be use in humans. Alternative clinics like the one in Germany latched onto the drug anyway. The investigation of the sudden deaths at that clinic is still in full swing, but early reports point in the direction of the clinic possibly carelessly administering manually mixed dosages of (the highly unstable) 3BP. If unprofessional usage is to blame, then hopefully 3BP’s reputation will overcome the bad light it’s now put in.
  
  Indeed it is 2016 now, and still cancer patients look for last-ditch options and visit quacks in their hopelessness. It's 2016 and still cancer is a leading cause of death worldwide, accounting for 8.2 million deaths in 2012 alone.
  
  What even is this "emperor of all maladies", this mysterious killer that in one way or another is a haunting part of everyone’s life? What exactly does cancer entail? I didn’t realize I was so fuzzy on the details myself until after I started reading this book. Mukherjee expertly explains all the what’s, why’s, when’s and how’s when it comes to cancer. He intersperses his book with compelling patient stories and mini-biographies. Just as easily, he throws around in-depth scientific information to explain the difficulties the medical world faces.
  
  And so the unthinkable happened: Mukherjee made me read 600 pages on cancer in a little over a week, and he didn't even hold a gun to my head.
  
  Cancer is a collective noun for hundreds of diseases, and every time we think we have figured out one tiny piece of the puzzle for one of those diseases, cancer races ahead of us, adapting and evolving to wreak havoc again, undisturbed for yet another decade. Or several. Mukherjee will lead you through all those decades, stretching into centuries. Starting with the queen of Persia, Atossa, who somewhere in 400 BC discovered a bleeding lump in her breast in what is the first recorded instance of cancer. With interest and horror I read how Medieval doctors experimented with a wide range of dubious treatments like mercury and lead concoctions and a whack, whack here and a whack, whack there (oh, dark, dark Middle Ages). But as the book crept closer to our modern age, something else happened to me as a reader.
  
  When reaching the late 50’s and early 60’s, I found myself starting to add my own anecdotes to Mukherjee’s timeline. I don’t think there are families who manage to escape cancer altogether, and mine’s no exception. And so when Mukherjee discussed the unfortunate rise of radical mastectomy to beat cancer, I couldn’t help but think of my aunt. She was diagnosed with a tiny lump, breast cancer, in the early 70’s, and like 90% of women with a similar diagnoses underwent what would later be considered a morbid, disfiguring and unnecessary mastectomy.
  
  The increasing popularity of smoking and the campaign against it, too, reminded me of a personal anecdote. My granddad, who started smoking "healthy, doctor-approved" cigs as a boy and steadily smoked for years (even during his years in Nazi-Germany, when “Arbeitseinsatz” forced him to work in a bomb factory) once told me that what made him stop was a TV item in the 60’s in which a doctor showed two pairs of lungs: those of a smoker and those of a non-smoker. Black and white TV did little to disguise the sorry state of the smoker’s lungs. The same day, he went cold turkey. He was in his eighties when he succumbed to lung cancer’s little brother: lung emphysema.
  
  This is an odd book, in the sense that it evokes so many emotions at once. Due to Mukherjee’s engrossing writing style it’s highly entertaining, which I find an embarrassing word to describe a book on this topic. It’s also both a hopeful book (the remarkable, sometimes purely accidental discoveries of scientists and medical professionals throughout the years are encouraging: forms of cancer that used to be 100% lethal can now be treated well) and a hopeless one... Mukherjee points out that when you’re diagnosed with pancreas cancer, you might as well have lived in the Middle Ages: regardless of cancer experts making headlines since the 30’s by claiming that “cancer will be cured within the next 20 years”, pancreas cancer is still as deadly today as it was centuries ago.
  
  Everything considered, this book was incredibly informative and compelling. It might well be the best book I read in 2016. It made me smarter, and I didn’t even have to work for it.;) What’s more, I’m excited to read Mukherjee's 600 pages long book on genetics next, another topic I didn’t think I’d be dying to dive into.
• 
  Carol

  I’m debating whether I should forgo the star system on my reviews. My stars make more sense when you align them with genre or category than title perhaps.
  
  Take a book like The Emperor of Maladies: A Biography of Cancer by Siddhartha Mukherjee. How do the 5 stars I’m going to rate this book stand along side a butcher thriller that I’ve rated this highly too?
  
  This was a book group book and I worried that some would find the topic overally depressing to read or that others, cancer survivors themselves, might be emotionally upset. I was right and yet, I was wrong too. Yes, some of our group just couldn’t read it, but most did, and found it fascinating and informative. None felt it would have made any difference when they were going through their own illness but thought it might have helped if they had read it cancer free. It also would be useful for family members.
  
  Considering there are few of us who will not either have some form of cancer ourselves, or have a love one in need of treatment, this is a book for to equip you with knowledge. Dr. Mukherjee presents a well researched book, though not easy to read, one in layman’s terms and simple to understand. He begins at the beginning, giving us a timeline over many centuries, of what cancer is, isn’t, what we know, what we don’t, treatment tried, treatment failed, treatment success; taking us on a journey in the war against cancer.
  
  Our group learned much, shed a few tears, ate chocolate and marmite (one concoction used for cure long ago), and laughed as all living people must. In the end we felt hopeful that with dedicated doctors, committed researchers, and palliative treatment, we can live longer and better, if not cured, at least, living with cancer.
  
  Dr. Mukherjee won a Pulitzer Prize in general non-fiction for his effort. I highly recommend this book for someone needing to understand the structure of this disease, and for persons interested in science and medicine.
  
• 
  Sonja Arlow

  For me the word CANCER has always felt like that weird little creature in the movie Beetlejuice. If you say its name too often it may just manifest in front if you. Especially because both my parents are cancer survivors and my extended family is also riddled with cancer cases.
  
  And I know I am not alone in my fear of this disease. The stigma around cancer is mentioned frequently in this book.
  
  But knowledge is power, and I was determined to tackle this Beetlejuice head-on. Yet it seems the more we know about cancer the more difficult a cure-all feels.
  
  There is a plethora of cancers out there so the book mainly focuses on leukaemia, breast cancer, but also lesser known ones like Hodgkin’s disease and an eye-opening chapter on lung cancer.
  
  It starts with looking at the history of medicine and advancement of surgery. With the use of ether and discovery of radium, so did cancer treatment advance right along with it. End of life care was only fought for and introduced in the 1950s – before that incurable patients were all but forgotten in the dusty corners of hospitals.
  
  But be forewarned, this is a dense book and not one to just breeze through. Half of the book deals with clinical trials and a good portion of it focuses on quite complex genetic concepts such as mutation genes (ras, myc, rb, neu). I did not find these sections as riveting as I thought I would but at least now I know what retrovirus really means.
  
  I understand that cancer is complicated, VERY complicated so although this extremely well researched piece of work is highly informative it is also at times a little academic and dry.
  
  My rating is based on my personal preference of how scientific work is presented to a layman like me. Books like
  The Immortal Life of Henrietta Lacks,
  When the Air Hits Your Brain: Tales of Neurosurgery, and my favourite
  Pandora's Lab: Seven Stories of Science Gone Wrong presents scientific facts in a slightly more engaging way.
  
  Recommended for readers who have a personal interest in cancer and who will be willing to slog through some complicated concepts to get to the nuggets.
• 
  Michael Perkins

  How other developed countries see the U.S healthcare system (short video)....
  
  
  https://www.nytimes.com/2021/04/28/op...
  
  =============================
  
  “Doctors are men who prescribe medicines of which they know little, to cure diseases of which they know less, in human beings of whom they know nothing.”
  
  This may seem harsh, but diagnosis is a lost art. Primary care doctors spend a mere 11 minutes per patient in an office visit, according to a new analysis. The history of the patient used to be seen as essential in sorting out what's wrong. Instead it's a pill for every ill and insurance companies rewarding procedures over consults. Shotgun blast medicine that's the most expensive in the world.
  
  =========================
  
  Section IV on smoking and the extensive machinations of the Big Tobacco disinformation campaign is worth the price of the book alone. It's become a kind of playbook for other entities. I see some evidence of that in the gun lobby in the U.S. These entities have a lot of money that they put to use in influencing the people they want to. Although I am surprised that the author left out this later phase of the anti-smoking campaign
  
  
  https://profiles.nlm.nih.gov/spotligh...
  
  A note on style: This is not a dry textbook. The style is very fluid. Though rich in information, the narrative moves right along. Even the accounts of research read like engrossing detective stories.
  
  ================
• 
  Rohit Enghakat

  "Cancer changes your life" a patient wrote after her mastectomy. "It alters your habits...Everything becomes magnified."
  This statement is so terrifying that it always rings in your subconscious mind while reading this book. The book is beautifully written and an epic tome on cancer. Full marks to Siddhartha Mukherjee for his detailed analysis and extensive research on the disease. Each chapter starts with quotes by people associated with the disease and about half-way down the book, you realise that it is not a book but a work of art painstakingly brought to life by Siddhartha. A gamut of emotions overwhelm you while reading this book. You feel sad when you read that people who have strived to fight cancer and find a cure themselves died of the disease (ironic isn't it ?). You will be horrified to learn that mastectomies (or for that matter, surgeries) were performed on patients without anaesthesia in the 18th century. You will feel the unbearable and mind-numbing pain of patients undergoing chemotherapy and radiation. You feel happy when patients are cured and do not relapse . You feel a sense of despondency and helplessness when doctors break the news of diagnosis of the disease to their patients, especially so, when it has reached a stage beyond cure. You feel gloomy for patients clamouring for a ray of hope to find a cure.
  
  Folks, it would be apt if you read on kindle. There are medical terms / jargons used which might require a dictionary / wiki to refer to. The book is a heavy read. It took me two months to finish this. It has been a wonderful journey!!
  
• 
  Chandana Kuruganty

  A.M.A.Z.I.N.G
  
  
  " Medicine, I said begins with storytelling. Patients tell stories to describe illness; doctors tell stories to understand it. Science tells its own story to explain diseases. This story of Cancer's genesis- of carcinogens causing mutations in internal genes, unleashing cascading pathways in cells that then cycle through mutation, selection and survival-represents the most cogent outline we have of Cancer's birth."
  
  What stands about the book:
  1. The structuring of the book which tries to ease our understanding of Cancer in its unity amidst diversity.
  2. I loved the analogies and phrases utilised by the author. I am sure I would never see them so aptly fitted in anywhere else- be it pyrrhic victory or Achille's heel!
  3. Attempt made to examine not just history, but bringing in economic, social, cultural consequences along with emphasis at individual level to make us connect to the theme of the book at an emotional level
  
  What were probably missing in the book- global focus or progress in developing world; a specialised & separate index of illnesses mentioned and scientists which would have made it easier to tackle some cross references happening through out the book
  
  The author succinctly summarises the reason why one should know Cancer's story: " As the fraction of those affected creeps.. The question (of cancer) will not be if we will encounter this immortal illness in our lives, but when."
  
  Highly Recommend it! Happy Reading :)
• 
  Lisa Vegan

  I am not sure what to say about this book except that I think it’s a masterpiece. Though I took over five months to read it, I found everything about it fascinating.
  
  I have to say that I felt an urgency to read this book before receiving a cancer diagnosis. My mother died of cancer before my twelfth birthday, and ever since then I’ve enjoyed reading books about cancer (fiction, biographies, general non-fiction, medical textbooks, all of them) and have been terrified about getting it. In fact, with my genes and some of my behaviors/environments, it’s amazing I’ve made it at least this far cancer free. I have a feeling if/when I get cancer, I won’t be as addicted to cancer themed books, at least not for entertainment purposes.
  
  In 1965 my uncle, a doctor, said he thought that in a decade there would be a cure, and that nobody would die from cancer. Was he ever wrong! And the author of this book does a masterful job of explaining why, and why cancers are so complicated.
  
  I enjoyed the quotes that started off each chapter, and how they stem from both science and literature. I admired how cancer is covered from the very personal (the author’s thoughts and perspective, and stories of a very few patients he’s known), the historical all the way through history, the research and its successes and failures, to date, the science, the various cancers touched on, so many aspects, and that’s very fitting for this subject, a biography of cancer. I would have liked a bit more on the individual patients, but since I wouldn’t want any cuts in the other portions, we’d most likely be talking about a 1,000 page book; actually, that would have been fine with me.
  
  This book is definitely for laypeople, but for me it helped to have a bit of medical/oncology background/experience; it’s not necessary though. I often love books by doctor writers and I’ll definitely read (almost) all other books this author writes. He’s an excellent writer, I love his writing style, and he made every aspect of this subject so interesting.
  
  I didn’t thoroughly read the notes pages 473-532 or the index pages 545-571, but I read everything else.
  
  Highly recommended for anyone interested in cancer.
• 
  Julie

  This is an incredibly moving book filled with an amazing blend of science and humanity. The scientists who are driven to find cures and the patients who endure the cures with courage in the hope of extending their lives. I became truly invested, humbled and enthralled. I hoped and cried for them all.
  
  One thing that struck me is that, "A disease needed to be transformed politically before it could be transformed scientifically." Politicians had to be persuaded that cancer research was worth the investment of millions of dollars. The scientists were determined and succeeded in their cause.
  
  Research is vital in understanding how to treat cancer, a wily enemy of health and vitality. "Basic research leads to new knowledge, it provides scientific capital, it creates the fund from which the practical applications of knowledge must be drawn. Basic research is the pacemaker of technological progress."
  
  "The emergence of cancer from its basement into the glaring light of publicity would change the trajectory of this story. It is a metamorphosis that lies at the heart of this book."
  
  It is good to remember that scientists are human also and that knowledge is gained over time and experience. One example is the discovery of the importance of DNA. "What scientists had formerly disregarded as a form of cellular stuffing with no real function, "a stupid molecule," as the molecular biologist Max Delbrück once called it dismissively, turned out to be the central conveyor of genetic information between cells. The least stupid of all molecules in the chemical world."
  
  It was fascinating to read about the process of coming up with treatments and how scientists would conduct research and problem solve. Indeed, scientists would mull on these things when they weren't in their laboratories and even during quiet moments at home. In fact, "chemotherapy, the use of specific chemicals to heal the diseased body was conceptually born in the middle of the night." I think of this scientist as having this flash of inspiration, possibly writing down a note or two, then, falling back to sleep. Were they aware of how monumental this discovery would prove to be and how life changing for people?
  
  Then WWII intervened and laboratories that might have been dedicated to further research into chemicals for healing were used instead to make chemical weapons such as mustard gas which caused great suffering and even death.
  
  The author writes of the annihilation of life caused by a cancer diagnosis as being similar to the experience of existing in a concentration camp. It strips the person of their past, their present, their identity and their personality, and worst of all their hope of a future. "It negates the possibility of life outside and beyond itself. It subsumes all living. The daily life of a patient becomes so intensely preoccupied with his or her own illness that the world fades away. Every last morsel of energy is spent tending to the disease."
  
  Finally, when we consider cancer we often think in terms of statistics. We consider family history, we calculate how likely we are to get certain cancers. When someone we know is diagnosed we talk in terms of prognosis and how much time we/they have left or our odds of beating it. However, when it comes down to it we are all individuals and I understand that chemotherapy is now tailored very specifically to individuals. So, I will leave you with this final quote: ""Statistics," the journalist Paul Brodeur once wrote, "are human beings with the tears wiped off.""
  
  
• 
  Cee

  Informative. The first hundred pages trace cancer's history, even way back to the Egyptian civilization. The next two hundred pages are about the long struggles in surgery, radiation and chemotherapy to fight cancer. Then the last two hundred pages launch into prevention, genetics and more pharmacology.
  
  With the scientific terminology toned down and explained as best as the author could, I felt I was reading a quasi-textbook. Before the topic would become monotonous there were breaks in form of stories, whether heartwarming or heartwrenching. And when not being technical, Mukherjee's writing can also be lyrical.
  
  I really like how the more common cancers: leukemia, breast, lung, etc. came into the picture one at a time as the account traveled through discovery, treatment, prevention and palliation. And then each cancer's backstory, current status and future is written about.
  
  Mukherjee used the word serendipitous several times. I think I understand. We may never know the cure for cancer but everything we now know and may learn to fight it with is serendipitous.
• 
  María Alcaide

  A great compilation on all cancer related, from history to biology, treatments, future perspectives and clinical cases. Though a big dense book, with tons of information, it is greatly written and explained in a way everyone can understand. For those not much into science or medicine it can be a bit hard. As said, it is huge and tells so many things, but worth reading anyhow. From my point of view, the view of a trained scientist with some cancer knowledge, and a lover of medicine, science and history, this book is fantastic. Absolutelly recommended. One of the best non-fiction I've read so far.
• 
  Moumeeta

  I first heard about this book a year back and was sure I would never read it. Medical non-fiction is not something I want to wrap my head around. So finally when I did pick it up from the library it was because a young acquaintance was undergoing chemotherapy and I thought it was perhaps "important" to understand cancer.
  
  I am surprised at what a gripping read the book turned out to be. I ran through the initial 100 or so pages that chronicle the first instances of cancer in history. Mukherjee's ability with words is obvious from the very first page. He makes the whole guided tour of cancer a fascinating one. At the same time, there is an emotional undertone to the whole story. There is the evil enemy cancer and there are the good guys........a mixed bunch of chemists, biologists and doctors who are fighting valiantly against a seemingly undefeatable evil. The personality of each of these contributors to the fight against cancer, is charmingly analysed by the writer and is one of the things I especially liked about the book.But after a fortnight and with more than half the book left, I realised I was losing the thread because of the numerous people and events that had been explained. So I actually (and geekily) made notes at the back of the book in pencil so that the basic developments would be clear to me. It still took me another month or so to complete the book. I cried, felt triumphant and figuratively bit my nails as I waited for some sort of denoument. The cure of course was never coming but I still felt there SHOULD be something. Mukherjee makes this whole labyrinthine journey seem like some Greek adventure. In the end, a basic understanding of the disease was all that decades of research arrived at. However, with an opponent as formidable as that described by the writer, this was as good a climax as those I have come across in any good thriller.
  The book reads like a dedication to all those who lost their lives to the disease and to those who made it their live's purpose to vanquish it. There is a strong "personal" sense to the writing that elevates the book. It is definitely among the most significant books that I have ever read.
  
  quotes from the book:
  "I explained the situation as best as I could.......And it is - I paused here for emphasis, lifting my eyes up - often curable. Curable. Carla nodded at that word, her eyes sharpening..........We spoke for an hour, perhaps longer. It was now nine thirty in the morning. The city below us had stirred fully awake. The door shut behind me as I left, and a whoosh of air blew me outward and sealed Carla in."
  
  "Nature," Rouss wrote in 1966 "sometimes seems possessed of a sardonic humour." And the final lesson of Rous sarcoma virus had been its most sardonic by far. For nearly six decades, the Rous virus had seduced biologists - Spiegelman most sadly among them - down a false path. Yet the false path had ultimately circled back to the right destination - from viral src toward cellular src and to the notion of internal proto-oncogenes sitting omnipresently in the normal cell's genome.
  In Lewis Carroll's poem, when the hunters finally capture the deceptive snark, it reveals itself, not to be a foreign beast, but one of the human hunters sent to trap it. And so it turned out with cancer. Cancer genes came from within the human genome. Indeed the Greeks had been peculiarly prescient yet again in their use of the term oncos. Cancer was intrinsically "loaded" in our genome, awaiting activation.We were destined to carry this fatal burden in our genes - our own genetic "oncos".
  
  
  
• 
  Rebecca

  This magisterial history of cancer won a 2011 Pulitzer Prize, though not for History (that went to a new book about the Civil War) or, as Mukherjee more whimsically categorizes his own book, Biography (that went to a biography of George Washington); instead, he won in the General Nonfiction category, which, though prosaic, is certainly appropriate for a work of scientific journalism. The Emperor of all Maladies reminded me most of The Immortal Life of Henrietta Lacks, the previous year’s popular science blockbuster, with both focusing on bringing complicated science to laypeople through the life stories of ordinary individuals.
  
  What Mukherjee has achieved in less than 500 pages is truly remarkable: a fairly comprehensive history, from ancient Egypt to the present day, of the discovery of cancer, its different manifestations, its causes, and the development of treatments ranging from radical surgery to sophisticated pharmaceuticals. That he manages this without alienating people who come to the material with no more knowledge than one could glean from newspaper articles and high school biology is impressive. Only in the last third of the book did I find the science stretching the limits of my imaginative capacity and my memory of AP Biology and Genetics classes, as he goes into details of oncogenes, tumor suppressors, retroviruses, etc. I managed to stay just the right side of comprehension, but I can guess that others with less patience or brain power to devote to their chosen leisure reading might have started skimming or, worse, given up.
  
  When meditating on cancer there is a fine line between depression and hope, and Mukherjee proceeds carefully to prove that there is reason for both. On the negative side, it seems likely that in the near future one in two men and one in three women in America will suffer from some form of cancer in their lifetime. All the 1950s talk about a ‘magic bullet’ to cure cancer has fizzled; there are so many disparate types of cancer that it seems impossible that there could one day be a panacea. Furthermore, the search for environmental and manmade carcinogens faces ongoing resistance from lobby groups. The most discouraging sections of the book were about smoking and the nation’s reluctance to warn of the high risk of lung cancer. And it wasn’t just the tobacco industry that opposed measures such as strongly-worded warning labels on cigarette packets; doctors, politicians, and smokers in general (who formed more than 40% of the population at the height of smoking’s appeal in the 1940s-1950s) denied the truth that was in front of their eyes.
  
  However, this book offers the reader plenty of reasons to be hopeful. Mukherjee follows the treatment trajectory of a number of his patients, including Carla Reed, a young mother with leukemia. Her story opens the book and, as Mukherjee reveals in the last chapter, he assumed his book would also finish with the end of her story – her death. But this was not the case; instead, he comes to a close with an anecdote about going to visit Carla on the fifth anniversary of her remission, to celebrate her new chance at life. My overwhelming sense from this book is that most cancers are indeed treatable, and new medications and procedures are being developed all the time. When cancer affects us – because, for our families if not for ourselves, it is a question of when, not if – there should be no cause for despair. The ‘biography’ of cancer probably does not have an end point, but there is every chance that we can live long lives alongside it.