Friday, January 24, 2014

Review: The Emperor of All Maladies

If cancer doesn't strike fear in you, it should. I've had a friend die of cancer, and it was scary to watch and difficult to forget. Dr. Murkherjee subtitled The Emperor of All Maladies "the biography of cancer,: and that's as descriptive a name as any.

It discusses the history of cancer discovery and its remedies, from the primitive (early surgeons worked without anesthesia, so you can imagine how horrifying it is) to the modern (like Genentech's invention of Herceptin). Along the way, you get all the fascinating stories of heroes and villains that aren't just interesting to read about, but as fascinating as any exciting adventure novel.

For instance, early anesthetics were cocaine and morphine. Doctors frequently experimented on themselves, and as a result, many surgeons were themselves addicted to cocaine and morphine. In fact, the history of cancer research seems full of doctors who bravely experimented on themselves, including a much more recent account of a doctor who swallowed a glass full of bacteria he suspected of creating an inflammation that could eventually lead to cancer!

Since it was written by a research oncologist, the book is strongest when it discusses recent research, where details about how new targeted cancer drugs are developed and how they attack the cancers they target. Dr. Mukherjee also does not flinch from describing cancer prevention and its villains, chiefest of which is the tobacco industry. The account of the fight between the medical profession and the big tobacco companies is detailed, and exposed many things I didn't know about. For instance, smoking was so prevalent in the 40s and 50s that no one thought to consider smoking might be a cause of lung cancer. When the researchers involved made the connection, they immediately stopped smoking, but in at least one case, it was too late. The researcher had already developed metastatic cancer. Even so, the tobacco companies won reprieve after reprieve by using the familiar phrase, "correlation is not causation."

The creation of the National Cancer Institute and the politics involved is also thoroughly explored. I generally find politics less interesting, but Mukherjee did a great job tying the cancer movement with what went on later with regards to the AIDS epidemic, as well as the consequence of approaching cancer via a directed "therapy first" project as opposed to the traditional vision of government funding basic research without particular goals in mind. I wasn't excited to read it, but in the end was glad the author saw fit to cover it.

The genetic origins of cancer is thoroughly explored, and provides a great discussion of how our genes operate, and why cancer is fundamentally part of our genome and a consequence of evolution.
If there's any flaw in this book, it's that the book flinches away from discussing detailed statistics behind cancer survival rates. There are references to statistics showing that the survivor rates for cancer is still abysmally low, despite the new therapies. If the new therapies are so good, why does it not affect the population of cancer patients statistically?

In any case, the book well deserves its Pulitzer prize, and is well worth the time spent reading it. Recommended.
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