Fungus Gnat's Reviews > The Emperor of All Maladies: A Biography of Cancer

The Emperor of All Maladies by Siddhartha Mukherjee
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Dec 08, 11

Read in November, 2011

To Mukherjee, it’s a “biography" of cancer, and not a “history,” because he sees cancer as something of an organism in itself, a bit of poetic license from an unlicensed poet that fortunately does not often intrude upon the story. To me, it reads like a history—a history of the disease and our attempts to fight it. It begins with discoveries of prehistoric tumors and the response of the Egyptian physician Imhotep, but takes the topic up in some detail in the mid-19th century, when leukemia was identified. This story is a blend of scientific discovery, therapeutic invention, and the experiences of individual patients. At times, Mukherjee interposes an experience of his own, as a physician interacting with those living with cancer. Even the historical side of the story is not told year by year, or even decade by decade, but by historical theme—surgery, radiation, chemotherapy, targeted genetic interventions. This seems a reasonable approach, but it has the drawback of inviting an inference that these historical phases followed each other in series, whereas there seems to have been a lot of overlap. I felt like creating a timeline that would clarify these overlaps, which Mukherjee seems to want to play down, perhaps because they mess up the plot. On the whole, though, it all works. Mukherjee adroitly synthesizes documentary history, scientific explanation, and personal interviews to create a profile of a disease that will bear on the lives of most of us (if it hasn’t already)—and that realization makes it all rather personal. Mukherjee doesn’t forget that, and his insistence in recognizing the humanity, the dignity, and the courage of cancer sufferers is palpable.

As I say, besides being a history book, this is also a science book. For the most part, the science is clearly presented, although things get a bit muddier as the adventure proceeds into the era of molecular genetics. I have a couple degrees in biology (okay, a long time ago), and I found myself kind of shrugging my shoulders here and there, “okay, whatever.” Am I really supposed to remember what Ras, Mek, and Erk do from 70 pages back? In addition to that timeline, a few diagrams (there are none in the book) might have helped. Notes, though, are copious, and witness well the sourcing.

Curiously, considering this is a Scribner production with care given to design, etc., the editing appears a little sloppy here and there—not in terms of grammar and such, but nobody seems to have read the final through with an eye to continuity. There is the occasional topic (e.g., Kaposi’s sarcoma) that is introduced twice, as if the first mention was forgotten a few pages later, or inconsistencies in where exactly we stood at a given time, e.g., the “triumphant” presentation of bone marrow transplantation results in 1999, when the “end of the transplant era” is stated later to have occurred in 1995.

These are minor glitches, though, in a work that is impressive in its scope and achievement and propulsive in its narrative.
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