Sriram's Reviews > The Emperor of All Maladies

The Emperor of All Maladies by Siddhartha Mukherjee
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Sep 02, 11

bookshelves: recos-sep25
Read from July 06 to September 04, 2011

“This book is a history of cancer”. And so it begins! From this rather straight and simple introductory line, 'The Emperor of all Maladies - A Biography of Cancer' unravels the mysteries of the dreadful disease, tracing its path since around 4000 BC until today and the incessant war humanity has waged against it. A war in which for most time the enemy was barely understood; its shape, size, roots, cause, effect, likes and dislikes, lurking as mysteries for most people!
 
As I do with any non-fiction work, I read this book tremendously slowly. Five pages in a sitting over a period of 3-4 months was my pace, with the fear of losing scientific detail if my aging brain were to go any faster or skim through the chapters. A medical book begets even more attention as it also details matters of true lives, deaths, slumps and survivals.
 
As the chapters unfold, in hindsight, one may view Galen's search for the black bile or Bennet simplifying leukemia as a "suppuration of blood" a little humorous - no pun intended. But in the absence of a proper understanding of basic biology, diagnostic tools, surgical methods, antiseptic, anesthesia and a few other essentials in the artillery, it comes as no surprise that the ancient physicians were up against a monster so powerful, looming and unfathomable that Imhotep (around 2600 BC) had to summarize its therapy in just a few words: "There is none!"
 
Mukherjee has begun the first part well with this historic extreme that may leave a reader surprised and troubled at once about how primordial medical therapy was then. In extrapolation and by induction, each era that followed might also justifiably be characterized by this note, as evidenced by the progresses made in cancer research, therapy, molecular biology and so on, each discovery annulling the prior or extending the prior and opening new doors. DNA was referred to as nothing more than a “stupid molecule” after its discovery and we know only too well now what an emperor of its own kind the DNA is!          
 
Galen made a simplistic, debatable but profound statement around AD 160 that "...it (cancer) is caused by bile – of blacke cholor and without boyling...!"  Mukherjee refers back to Galen a few many times in later chapters when he has to drive home the point that cancer has a deep and pervasive basis, so pertinent that a researcher of even recent times could be tempted to liken it to being "humoral" in a sense!
 
Mukherjee elucidates the historical, scientific progress (or the lack of it!) of the fight against cancer with a child's enthusiasm to narrate a story that occurred at school. He knows it really well. He is a player in the field. He is involved. And he entwines it equally well with the endearing stories of several patients - many that remarkably survived and many that gave in. Lachrymal moments for the reader in both instances.
 
Milestone after another achieved in terms of causal, diagnostic, clinical and political breakthroughs stand testimony to human resilience. And equally depressing are instances of human weaknesses listed with examples in this impatient war. Mukherjee has painted these pictures with great skill and knowledge. The eras spanning black bile, radical surgery, discovering cytotoxins, poison trials, Farber, Lasker & Jimmy movement, tobacco wars, mammograms, soot cleaners, Bezwoda enigma, X-rays and radiation therapy, scientific trials, genetic basis of cancer and the prognosis of the war are a true panoramic exposition of the emperor of all maladies!
 
The protagonist of the book is the malady itself and not the innumerable heroes that challenged it. This is an amazing point and full credit to the writing that brought out this intrinsic "feel". To draw an analogy, if someone brings up 'Titanic', my mind would jump to remember DiCaprio or Winslet or the finale in the icy ocean. 'Titanic' the ship per se, comes to the foreground only next possibly! But here, in spite of a few central endearing characters, remarkable soldiers – including patients, scientists and doctors – one is inevitably left brooding about cancer as the dark hero pervading through the book as its indelible core!
 
Ehrlich put it so succinctly and is quoted in the book, Life is... a chemical incident! As the cellular basis of cancer becomes better known, DNA-RNA-protein pathways better understood, agents and anti-agent chemicals synthesized, locks and keys invented, life sinking abysmally in the absence of a molecule and springing back to remission when a new molecule is injected, one is inevitably left with the thought how chemical we are and how whimsical it is to be on this side of the kingdom or the other: the healthy or the ill!
 
Personally, I experienced about hundred "goosebump occasions" as I traversed through this book. A few here (warning - spoilers!):
 
- Ehrlich ranting about the seminal concept of Chemotherapy for the first time in medical history to a dozing audience in a train!
 
- If we didn't kill the tumor, we killed the patient!
 
- A patient admitting her end and the doctors consoled by the ineffectuality of their discipline, hanging their heads in shame!
 
- In God we trust, all others must have data!
 
- Cancer therapy is like beating a dog with a stick to get rid of its fleas!
 
- Cancer - biological mutability gone wild while AIDS - social mutability gone wild!
 
- Our encounter with cancer... has rounded us off and polished us like river rocks!
 
- Both abnormalities - proto-oncogenes and tumor suppressors ("accelerators and brakes") represent the core molecular defects in a cancer cell!
 
- (On cancer therapy...) You change the shape of the key and test it... Does it fit? If not, you change it again!
 
- (For a cancer patient) this is their new normal!
 
- Cancer, as one scientist recently put, "is really a pathway disease"!
 
- Someday, if cancer succeeds, it will produce a far more perfect being than its host!!!
 
- Medicine is fundamentally a technological art. At its core, it intervenes with life. Cancer medicine, at the extreme, intervenes with our genome itself... Perhaps cancer defines the inherent outer limit of our survival!!
 
- And the last line... It was if she (a patient) has encapsulated the essence of a four thousand year war!!
 
Hats off to Siddhartha Mukherjee for this splendid work! This one was a pleasure to read and had the Pulitzer written all over it!!

- Sriram (Sep 4, 2011)
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07/06/2011 page 150
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Comments (showing 1-10 of 10) (10 new)

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message 1: by Sujata (new) - added it

Sujata I badly wanted to read it going by the reviews.Its super, right?


Sriram Awesome!


Geetanjali definitely want to read this one.tell me,how do you find it?


Sriram Awesome... Good blend of core cancer stuff and the historic framework for the fight against it... :)


message 5: by Shwetha (new)

Shwetha Kalyanasundaram Brilliant writing and truly deserved to win the Pulitzer Prize for non-fiction! “The Emperor of All Maladies” is a riveting, thought-provoking, and enlightening work that deserves to become an instant classic.

Must add that your review is impressive! Good going Sriram!!


message 6: by Vishy (new)

Vishy Wonderful review, Sriram! I read the introduction / prologue to the book and read the last page to find out what happened to that teacher :) Cancer being the new normal is a very poignant statement. The paradox of cancer producing the more perfect being is a brilliant piece of prose and a chilling piece of news. I can't believe that Imhotep - who makes an appearance in all Egyptian movies like 'The Mummy' - actually fought against cancer and said that it cannot be cured! I thought Imhotep was an architect, but from your description he seems to be a versatile genius! I have to read this book now :) Thanks for this wonderful review.


Sriram Mikka nandri! Enjoy reading!!


Aswathy Great review Sriram. Makes me want to read it all over again.:)


Vibina Venugopal ur review is insightfull, i loved this book too..Even for a person with no science background this book sounds eqaully great..Mukherjee has waded throughthe difficult waves with ease...


Sriram Thanks. Yes, absolutely!


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