The Emperor of All Maladies: A Biography of Cancer

I enjoyed this book because it gives an in-depth look at cancer from the side of the patient, the oncologist, and the activist. The author breaks each bit down into a story - a story of one scientists struggle, a story of one treatment, a story of one patient - in order to build up a narrative about cancer and its treatment (or lack thereof) overtime.

Although I enjoyed the book, and I feel that I have benefitted from reading it, I did not fly through the story. I had to read it in measured bits. At points, I bored with the text as the author labored over details that weren't interesting enough to me, but perhaps would be to others. But, generally, I appreciated that the medical terminology and approaches were broken down for the reader, so I could follow along.

My advice to folks who don't have time to read the book: Still read the thought experiment of Atossa's treatment over time (pp 463-465). It shows (less poignantly than the stories in the book) that diagnosis, treatment, and outcomes of treatment of cancer has changed substantially over the last 2500 years or so for some cancers but not at all for others. Sober indeed.

I am not a medical professional, and I assume that folks with knowledge of cancer may not appreciate this book.

The book starts out rooted firmly in the human experience, told through the stories of patients, doctors, and discoverers from the ancients up through the modern era. I found these stories fascinating and often incredibly sad; I could relate to them. Around the 1960s the book shifts into a more technical vein, which makes sense because this is when so many innovations in cancer research and treatment began, but I found myself disengaging from the story. The author does a laudable job of keeping the human experience a part of the story, but this is a biography of cancer - not humans - and at some point the story becomes less about “us” and more about “it”. Or rather, “them”, because one of the most fascinating parts of the book was seeing how heterogenous cancer is in the human body. Lymphomas are completely different from breast cancer, which is completely different from sarcoma, etc. I truly had no idea.

Also fascinating was how breast cancer was the focus of cancer research for literally hundreds of years. This seems like a woman-positive situation until you discover the devastating surgeries and experiments that doctors inflicted on the female body. Would they have been so quick to carve out literal pounds of flesh if these were male bodies? Would male patients have had more authority over their own care, and been fully informed about what was about to be done to their bodies? Kudos to the author for explicitly calling out the medical industry on its historically cavalier treatment of women, and acknowledging the women of the 1970s who refused to be sidelined in their own treatment, and thus forged the patients' rights movement out of the second-wave feminist movement.

Sigh. I love Mukherjee's New Yorker pieces, but don't seem to be intelligent enough to appreciate his books; this one makes two for two.

I found the first half engaging despite the frequent timeline jumping: valuable history, insights into the personalities of researchers and the challenges they faced, compassionate reflection on the lives of those afflicted. I never really got the “biography of cancer” angle—it felt jarring every time he brought it up, gimmicky—but ok, whatever.

Somewhere midway, he just lost me. I found myself reading pages over and over, not understanding even a tenth of the content; deciding to press on, understanding even less on the next pages. It doesn't feel quite fair for me to assign a low rating over something that's my own stupidity... but I kept feeling like this was stuff he was really excited about, really into, and when I get into that mode I have to be especially careful to calm down and remember my audience. I think he got carried away. So, mostly me, but partly him too. Recommended only for very smart educated people.

You know the feeling that you get when you're done reading a book on the subject and realize how it changed your understanding of the field dramatically? Such as Feynman's Lectures on Physics, A Brief History of Time, or The Emperor's New Mind? This magnificent treatise on cancer is just what the subject needed - a meticulous, no-holds-barred treatment that reveals a plethora of information on cancer, and our ancient, never-ending war with it - a constantly shape-shifting enemy whose root is ourselves.
Mukherjee describes in eye-watering detail how our understanding of cancer has changed in around four thousand years, and how the landscape of the ‘War Against Cancer' has undergone multiple paradigm shifts - from the witch-doctors who thought the best cure for the then-unnamed disease was crab soup; to current efforts, which are a mixture of chemotherapy and targeted drugs, some of which can almost erase certain cancers from its roots.
Absolutely no detail is withheld from the reader - the politics, the money, the legal battles over potential cures and clinical trials, the innumerable doctors involved, the patients whose lives were altered with the onset of the disease, and how each potential drug worked (or why it stopped working).
Mukherjee also focuses on how patients embrace their sickness as the new normal, and how some patients accept death easier than doctors - his work is, above all, a testimony to the tenacity and resilience of the human spirit.
In conclusion, although this might not be the most readable book, it is definitely one of the most sobering books I have ever encountered. A must-read.