Tuesday, 24 April 2012

Book: The Emperor of all Maladies by Siddhartha Mukherjee

(Image courtesy of Indigo.ca)

Score: 4.5 / 5

I first got interested in cancer when in elementary school my parents brought me to visit a dear family friend with leukemia in the hospital.  She looked thin, pale, and our conversations were interrupted by sudden onsets of vomiting.  Mom said she has cancer, and the chemotherapy made it hard to keep food down.  This first encounter with the disease left a big impression on me.

Intrigued by cancer, in grade 7 while browsing in the library I picked up a book about cancer and went through it.  Though it explained that cancer is characterised by uncontrolled cell division, I still had many questions.  Why are there different kinds of cancer?  Why are they so difficult to treat?  What is chemotherapy?

Fortunately, Dr. Mukherjee found it worthwhile to write this book to help answer those questions for a layman like me.  This book is one of the best books I have read.  It tells the history of cancer discovery, treatment, and care through the stories of doctors, scientists, politicians, activists, and patients.

Cancer is a family of diseases, characterized by the frenetic and uncontrolled division of cells.  Unlike other diseases that originated with foreign bacteria, cancer cells are normal cells with normal functionalities gone haywire.  Conventional medicine targeted cells or organisms by recognizing their differing enzymes.  Cancer and normal cells have very similar enzymes, thus making it notoriously difficult to target.

Cancer has been around for a long time.  The first possible case was documented in Egypt around 2500 BC.  The examiner carefully documented the observations of the tumour but could offer no treatment.  Since that time, a lot has changed.  Thanks to the efforts of many before us, a series of notable innovations occurred to give us what we have today –

  • How Chemicals in mustard gas used in wars were discovered to have dried up the bone marrow cells in those exposed and would later become a drug for chemotherapy
  • How multi drug chemotherapy (a norm now) was heavily resisted but eventually proven correct
  • How radical mastectomy, a procedure excavated huge amounts of a woman’s body in hopes of curing breast cancer, took nearly a century, the quality of life of five hundred thousand women, and many brave surgeons willing to challenge the status quo to prove wrong
  • How the public became aware of cancer and public movement on the war on cancer was formed
  • How, slowly, the medical field learned that caring for patients’ quality of life (for example, by developing antinausea drug and dispensing opiates as a measure for pain management) is as important as curing the patient
  • How cancer biology finally turned the descriptive symptoms of the disease into functional actions and gave birth to targeted therapy (though still in its infancy) that is turning a deadly disease into a chronic condition with minimal side effects for certain cancers
  • How scientists achieved the difficult task of proving cigarette as a carcinogen when smoking was so pervasive (it’s like proving sitting down causes cancer – everyone sits, so how can you prove that “non-sitting” helps in the long run?)
  • How scientists, surgeons, and chemotherapy doctors stayed in their silos and tried each to understand and attack the disease alone, but finally came to find a jointed effort was more effective
  • How there are hype and disappointments with each types of therapy at various points in history

Ultimately, Mukherjee had written a book rich with historical context, filled with the zeitgeist and hopes of the public and medical community at various points in time, and full of the interplay between different industries and medical disciplines.  The book is beautifully written and is a balanced account of humility and optimism.  To me, it is also a history of innovation in the medical field, and shows the totality of human effort in the face of this ancient disease.  I highly recommend this book.

I will end with an excerpt from the book about Germaine, a patient in Mukherjee’s care:

Germaine seemed, that evening, to have captured something essential about our struggle against cancer: that, to keep pace with this malady, you needed to keep inventing and reinventing, learning and unlearning strategies.  Germaine fought cancer obsessively, cannily, desperately,fiercely, madly, brilliantly, and zealously – as if channeling all the fierce, inventive energy of generations of men and women who had fought cancer in the past and would fight it in the future.  Her quest for a cure had taken her on a strange and limitless journey, through Internet blogs and teaching hospitals, chemotherapy and clinical trials halfway across the country, through a landscape more desolate, desperate, and disquieting than she had ever imagined.  She had deployed every morsel of energy to the quest, mobilizing and remobilizing the last dregs of her courage, summoning her will and wit and imagination, until, that final evening, she had stared into the vault of her resourcefulness and resilience and found it empty.  In that haunted last night, hanging on to her life by no more than a tenuous thread, summoning all her strength and dignity as she wheeled herself to the privacy of her bathroom, it was as if she had encapsulated the essence of a four-thousand-year-old war.

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