The Emperor of All Maladies by S. Mukherjee

By Brian Wolf


In The Emperor of All Maladies, Dr. Mukherjee, a specialist in cancer medicine, discusses how cancer dates back to ancient Egypt and yet still remains a part of modern life. Since the first mention of cancer in 2500 B.C., the disease has been linked with our need to prolong life and prevent illness. The term “oncologist” relates to the Greek word onkos, which means “mass” or “burden.” As Mukherjee writes, “Cancer is… the leaden counterweight to our aspirations for immortality.” The study of cancer has vastly improved since ancient times, yet we are still fighting a battle with this indomitable opponent.

A grasp of the mechanisms by which cancer acts is helpful in understanding the destructive path that cancer creates. Cancer occurs when a single cell, among the trillions in which make up a human body, starts to grow out of control. A simple mutation in one cell can lead to various cancers such as lymphomas, malignant melanomas, leukemia, and sarcomas. Without cell growth, living would not be possible, since a continual supply of cells is required to adapt and repair our bodies. Yet cancer cells use growth to rebel against the body’s normal cells. As scientists discover more about the mechanisms of cancer, we learn that its goals to grow and multiply resemble our own. Cancer, however, does not know how to stop. Mukherjee states, “Cancer cells are hyperactive, survival endowed, scrappy, fecund, inventive copies of ourselves.” The cancer cell has been deemed a worthy opponent by numerous researchers who both admire and want to destroy this disease.

Some scientists have called cancer a “modern disease” not only because we understand it in radically new ways, but also because of the rise of various cancers not seen before modern times. In the beginning of 1900s, the life expectancy at birth in America was 47.3 years. In the 1850s, the life expectancy was less than forty. Now, the median age at diagnosis for breast cancer in the United States is 61 and for prostate cancer is 67. Additionally, about fifty percent of men and about a third of women will contract cancer in the U.S. in their lifetime. Cancer is the second leading cause of death. As humans begin to live longer lives, we become more susceptible to diseases ,such as cancer that usually express themselves at older ages.

In the summer of 2003, the author, Dr. Mukherjee, began writing this book while a resident in oncology at the DanaFarber Cancer Institute in Boston. He begins the book with one of his patients, Carla, tracing and exploring her journey with cancer. When Carla finds herself constantly visiting the hospital for treatments, she says, “Cancer is my new normal.” As a clinician, Mukherjee always appears to be suspiciously optimistic about this patient and the various patients he encounters. While Dr. Mukherjee has seen many patients succumb to this disease, he has always seen patients fight back vigorously and return victoriously from their battles. For most patients, cancer becoming a manageable chronic condition is success.

One of the main focuses of this book involves the relationship between a cancer researcher and a philanthropic socialite who, together, brought cancer to the forefront of science in the 1940s. Mary Lasker needed a philanthropic cause, and found one in harnessing the tremendous power of medical research to cure all manner of disease. Sidney Farber, a cancer researcher, desperately needed funds to support his research in methods such as chemotherapy. Farber believed that, for example, radical mastectomies were not necessary in many situations and other treatments should be utilized. However, Farber needed the funds to discover these other methods and Lasker would be the person to provide him and other researchers with the necessary funds.

During this period of time ,there was a conflict between whether cancer medicine should focus on finding cures or taking care of patients. A balance between these fundamental needs was required to help treat cancer patients with the knowledge and treatments that were available during that time. Sidney Farber focused mainly on the idea of the “War on Cancer” and the increasing need for present care. Despite Farber’s desire to have patient care at the forefront of this war, the mechanisms behind cancer needed to be studied before treatments could be constructed and implemented. Farber believed that cancer could possibly be cured without the ability of physicians to specify the mechanisms of curative action, similar to how aspirin could be used to cure headaches without knowledge of why and how this occurs. With a limited knowledge of fundamental mechanisms, cancer medicine in the 1960s and 1970s pushed the patients’ bodies to the brink of death in order to rid them of cancerous cells.

Book Information
The Emperor of All Maladies, Siddhartha Mukherjee, Simon and Schuster Press, 573 pages

Subject: Global Health, Biomedical Science
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