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4.7 out of 5 stars
The Emperor of All Maladies
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29 of 29 people found the following review helpful
VINE VOICEon 21 September 2011
Format: HardcoverVine Customer Review of Free Product( What's this? )
The struggle to understand and to cure cancer has consumed medical researchers throughout the twentieth and beginning of the twenty-first centuries. Mukherjee takes a deeply in-depth look at the illness throughout history in this biography of an illness, where cancer is often visualized as a crab scurrying and burrowing away from all reach of therapy. The author adds his own experience to a years-long study of cancer to provide a definitive, insightful book on the way this illness has gripped our modern day lives.

I think almost everyone I know has lost someone near and dear to them to cancer. I have; my brother died at only eighteen from non-Hodgkin's lymphoma. If anything, the fact that we've all been touched by this horrible illness in its many incarnations makes a book like The Emperor of All Maladies an even more important read. Reading this book was always going to be difficult, but it is on a subject I wanted to understand. After it won the Pulitzer Prize, and unending praise from many of my favorite bloggers, I simply had to read it, no matter how uncomfortable the subject matter.

I'm really glad I made that choice, because this book was excellent in so many ways. Mukherjee skilfully weaves together his own years treating cancer patients, ensuring that we get an up close and personal view of what it's like to fight cancer today, with a thorough history of the illness, including its ancient manifestations, early treatments, and continuing right up to the medicines and techniques used to treat various kinds of cancer today. I learned so much from this book, certainly things I never even thought about, like how the War on Cancer got started in the first place, what the Jimmy Fund is, and so on.

I'd also never really understood anything about the biology of cancer. I knew the disease was basically uncontrollable cell division, but Mukherjee goes into depth without becoming confusing or using any jargon that an ordinary reader can't understand.

While doing all this, he also succeeds in matching the struggle against cancer alongside current events, explaining how certain developments happened and why. I felt like I was getting the full story from all possible angles, which I so appreciated, and so thorough a look that I don't think I really need to read another book. Adding in the perspectives of his modern patients just demonstrated the strength of the human spirit and the difficulties of treatment.

This truly is a biography; in many ways Mukherjee makes cancer itself a visible part of the book. In many ways, it is our normal body functions turned inside out and made virulent - and immortal. It's a surprisingly fascinating read which has really enhanced my understanding of everything to do with cancer. I'd highly recommend The Emperor of All Maladies to almost anyone.
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81 of 82 people found the following review helpful
on 17 February 2011
Cancer is an enormous subject: its influence on the history of medicine, on society, on politics... can't be over-estimated. Somebody was bound to take the risk of trying to capture all of this in one book. `I started off by imagining my project as a "history" of cancer. But it felt, inescapably, as if I were writing not about something but about someone. My subject daily morphed into something that resembled an individual - an enigmatic, if somewhat deranged, image in a mirror.' So Siddhartha Mukherjee, cancer physician and researcher, redefined his project: it became `a biography of cancer' - although `a thrilling piece of sublime literary non-fiction' captures the book just as well.

Mukherjee starts off the book on familiar ground: a woman being asked to return to the hospital as soon as possible, because something has shown up in the tests she underwent. This something is leukemia, a liquid cancer, and it catapults us back in time: to 1847, when the term leukemia was coined.
The first chapter is dedicated to the earliest known cases of cancer. We consider cancer a "modern" illness (and it is, because only in the last two centuries have we started to grow old enough for cancer to become the second most common cause of death) but there are some freakishly ancient occurrences. Atossa (550 > 475 BC), queen of Persia, had her breast cut off - a breast cancer that even made an army change direction. (I'm not going to explain this: it's one of the mesmerizing anecdotes you have to read for yourself.) And then there's the Peruvian mummy with a thousand year old preserved cancer. `It is hard to look at the [mummy] tumor and not come away with the feeling that one has encountered a powerful monster in its infancy', Mukherjee observes.
This same chapter also introduces one of the book's "heroes": the pediatric pathologist Sidney Farber, whose research produced the first-ever remission in a leukemia patient. He was the man who realised that, to get the funding for large-scale cancer research, the disease, any disease `needed to be marketed, just as a political campaign needed marketing. A disease needed to be transformed politically before it could be transformed scientifically.'

The second chapter, `An impatient war', focuses on a double war. First battlefield: the political struggle, the perception of science by politicians and the public. Second battlefield: the first attempts at chemotherapy, `near-complete devastation' of a patient, in an attempt to stamp out any trace of the evil.
In the subsequent chapters, Mukherjee writes about patients demanding visibility - as late as the 1950s, the New York Times refused to take an ad for a support group for women with breast cancer, claiming neither the word "breast" nor "cancer" were suitable for print - and a more humane form of care. About the influence of feminism and HIV on cancer treatments. About the slow process of finding the correlation between smoking and lung cancer and the even slower process of accepting this scientific fact.

Finally, we return to cellular level and learn more about the nature and origin of cancer. These last two chapters are a more difficult read, because the more one discovers about the workings of cancer, the more complex it all becomes.

In passing, we learn more about the working of DNA, about the medical definition of the word `cause', about the discovery of X-rays (first thought to be a cure for cancer, but turning out to be a major catalyst of the disease), and much, much more. The emperor of all maladies is an unputdownable piece of medical history, with breakthroughs, competition, pipe dreams and disappointments, Eureka!-moments and the odd incidence of deceit. Reading this book is a rewarding as well as a highly enjoyable experience: here is some excellent non-fiction, with elements of horror, adventure novel and science fiction. Muhkerjee's exploration of cancer - from a factual, historical, biological and poetic point of view - changes your way of thinking about the disease.
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26 of 27 people found the following review helpful
on 9 April 2011
First, I have to declare an interest in the subject - I have been diagnosed with leukemia since 2003, have gone through five chemotherapy regimes and remission for me only seems to last months rather than years. However I am (morbidly) fascinated by the subject and here is a book written by a doctor and researcher in a plain English literary style that does not confuse the general reader with too many scientific names or jargon. Dr Mukherjee is certainly to be congratulated for producing such a lucid and understandable account of the disease. Starting from records of cancer in early history, the book concentrates on the developments of detecting and understanding cancer and its treatment, with special emphasis on the stirling work performed by Sid Farber after the Second World War and the rapid development of treatments to first try to control the disease, up until the last twenty years with the development of specialised monoclonal antibodies to actually target specific types of cancer.

The subject itself is fascinating with such topics as how discoveries of scrotal cancer among boy chimney sweeps in the 19th Century have led to the cause of lung cancer being convincingly stated in the 1950's and the adverse reaction this would have on the powerful tobacco industry. Everyone has probably heard of a "Pap-smear" but who knows where the word "Pap" originated? The book describes the work of George Papanicolaou, over many decades in developing the smear technique but only realised in 1950 that it could not detect cancer - but could find its precursor so allowing cervical cancer to be treated in a preventative manner before the disease took hold. There are far too many highlights to mention in this brief review. However, one particular item that makes this book stand head and shoulder above anything else are the human stories recounted, from the author's own diagnosis of his patient Carla with acute lymphoblastic leukemia and her successful treatment to the description of treatment that Maggie Jencks, a Scottish landscape artist, received for acute myeloid leukemia which she described as being woken up mid-flight on a jumbo-jet and thrown out of the plane with no parachute into a landscape without a map. The author does not overlook the experiences of the patients but keeps them prominently throughout the text.

This book really is a pleasure to read (macabre as that may sound), an unsentimental yet humane book of the worst of all diseases one might suffer.
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5 of 5 people found the following review helpful
on 1 February 2011
I don't know how Mukherjee relates to his patients but if it is anything like the way he writes I would certainly value his qualities were he my physician. Truth, honesty, a commanding grasp of the wider epidemiological picture, leading edge knowledge, a sure feel for the historical narrative, a compassion, hope tempered with realism, a poetry of imagery, ... they are all there, expressed succinctly in only 470 pages. A masterly exposition.

Most people's lives will at some point be affected by one or other form of cancer - whether as a person expressing the disease, a partner of, a carer for ... and the longer the life span is extended the more likely will be its manifestation ... it is impossible to ignore this fact of modern life.

Buy this book. Tell your friends to buy it. If you have cancer, or are in remission or `cured', or in any way touched by cancer, read it. It will probably change your view, or at the very least provide some conceptual clarity in thinking about and dealing with this runaway dysfunction of our genome. It's not something `out there' - it is, quintessentially a part of our genome, a part of our identity as people, our genetic make-up. Get used to it. Only the slow accretion of scientific understanding will be able to dilute its violence and variety and maybe tame its destructiveness.

Mukherjee provides a clear, and clear sighted, narrative of the story so far, the failures, successes, the dead ends, and the breakthroughs and the possibilities to come. Of course it is a depressing book, but then cancer is a depressing ragbag of awesome diseases. But in Mukherjee's skilful hands it is also overwhelmingly uplifting. It is a fine testament to the thrilling human urge to know and to understand and above all, to ameliorate suffering - written by an author who cares deeply for his patients.
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4 of 4 people found the following review helpful
Format: HardcoverVine Customer Review of Free Product( What's this? )
I, probably along with many others, thought that Cancer was a relatively recent discovery as a disease. I mean, I was sure it has been around for a century or two but that its common symptoms and its occurence was only determined recently. How wrong I was!

This book is the culmination of a vast amount of research on the subject of Cancer and its treatment over the years, that being hundreds if not thousands of years.

This really is a biography of a life spanning centuries and with it some intriguing and interesting facts. That life being one of the malignancy of Cancer. I had asbolutely no idea that masectomy was being performed as a treatment for this disease so long ago and was utterly amazed that almost prehistoric medicine could diagnose tumours and attempt to treat them.

It is a story we should all have some idea of as they say that 1 in 3 of the population will suffer from Cancer during their lifetime. This is a frightening prospect and by no means, does knowing more about it make it any less scary but it can help to understand it a little better.

An absolutely incredible historical journey which was one of the best books I have read in a long time. This author is to be applauded for this work.

I just love history and medical history is sometimes very eye opening, how even only a century or so ago, some operations or methods of treatments seemed so niaive and barbaric but then there are cases such as the treatment of a disease like this which shows medical knowledge of the past to be so advanced as to be amazing.

If you are lucky enough to be one of the 2 out of 3 that escapes the clutches of Cancer, you may still have a friend or family member who is not so lucky, this book may help you understand better that which has darkened the doorstep of mankind for many many years.
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3 of 3 people found the following review helpful
on 4 October 2011
A biography? The very idea of writing a `life' of an inanimate entity seems a little odd but, as with Ackroyd's `Biography of London' and others the concept makes a valid point. The human experience of interacting with a city, a building, or in this case a disease that appears to evolve over a period of time seems to endow the subject with a personality that can be explored. Cancer has seemed like a fugitive evading capture by medical science and like an enemy-within for millions of patients over centuries.
Siddhartha Mukherjee's comprehensive history of human involvement with cancer starts from this premise, that cancer is a single entity that can eventually be understood and defeated. Rather than present a linear history from the earliest known recorded cases (though he gives us those), he chooses to trace the individual histories of the different lines of attack. While undoubtedly scientific understanding of cancer has developed considerably, and there is a sense of hope as each foray pushes back a boundary, there is a sense that there have been missed opportunities when different areas of investigation could have cooperated to advantage, and that the ultimate message is that we have to understand that cancer is not a single entity with common cause or solution but myriads of manifestations of the same symptom of growth without control, and that there will probably never be a time when the `war' will be over.
That the author has a passion for his subject is evident, what is pleasing is that in writing in such an accessible manner it is clear that he has not fallen into the trap that so many scientists and clinicians do, of detatching their interest in the subject from the individuals who they are treating. Mukherjee evidently delights in the recovery of patients, and revels in the passion of the scientists in equal measure.
This is a meticulously researched, eminently readable work to recommended to anyone with any interest in cancer. Minor quibbles would be that the author himself refrains from entering into much criticism of individuals or business. It is apparent he knows much more can be done to remove carcinogens (tobacco in particular), and that some beneficial drugs are not being made widely available through purely economic considerations, but he stops short of an overt attack. There is also too little here about the role palliative care can play at the end of patient's lives.
Overall, however, this is an excellent summary of where we are with cancer and how we got here. While it seems unlikely that Dr Mukherjee will write on any other topic, it is to be hoped that he can produce later editions reporting further incursions against the enemy.
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2 of 2 people found the following review helpful
Despite this book being 600 pages long and a rather grim subject, all six of us at our book group were pleased to have read it and felt we had learned a lot. It details the history of cancer and its myriad treatments over the centuries from barbaric operations-without-anaesthetics to modern-day genetics and chemotherapy. We all agreed it was beautifully written and relatively easy to understand.

The author, Siddhartha Mukherjee, lightens the load by giving us heartening case studies. Many more children with leukemia are now cured, as are those with scrotum cancer and breast cancer, although the 'war on cancer' as Mukherjee calls it, is far from over.

In the end, we learned that we all carry cancer genes in our cells and if we don't die because of cancer but because of some other illness, we will nevertheless die with cancer in our bodies. Something triggers it off and we can help ourselves by not smoking and triggering lung cancer; not climbing up chimneys and triggering scrotum cancer, perhaps not eating too much red meat which might trigger colon cancer (although this is still in investigation stage) and so on.

For me, the book is a wonderful story of unsung heroes, those scientists working tirelessly in lonely, windowless basements trying to find the next piece of the puzzle. It reads like a detective novel as the evidence from research is sifted through for clues. Indeed it was so graphic at times, I worried that I might trigger cancer in my own body just by thinking so hard about it!
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2 of 2 people found the following review helpful
VINE VOICEon 26 February 2012
Format: HardcoverVine Customer Review of Free Product( What's this? )
Overall, this is a superb "biography of cancer" which delves into the ancient records of the disease but really begins in depth with the first attempts to find treatments in the early 20th century. The main thrust of the book is a timeline of the scientific insights that produced new therapies but also the growing understanding of how and why cancer develops. The chapter on the epidemiology of lung cancer and the detailed work that showed how central cigarettes are to so many cases of the disease is a highlight, especially dealing with how the large tobacco firms attempted to attack the link.

The book's main strength is in its humanity. The scientific breakthroughs are described with a real feel for the personalities that drove them, the patients perspective is always described well as is the emotional rollercoaster of an oncologist giving tragic news or, increasingly, the good news of successful treatment outcomes to their patients.

If the book has a weakness, it comes from over ambition: trying to capture such a vast story in one volume. Some explanatory information is repeated as it crops up in new contexts, sometimes the end of one chapter and the very start of the next and facts are occasionally mangled to fit the narrative. The most glaring issue is the writing out of history of Goodman and Gilman who developed the first chemotherapy agent derived from mustard gas, mustine, in favour of discussing Sidney Faber's development of antifolates as if they were the earlier invention. The book describes interest in the mustard chemistry originating from observations of troop toxicities in 1943 despite also, accurately, stating that after years of development mustine was first tested in patients in 1942, a year earlier.

Narrative issues aside, the book is still highly recommended, especially for anyone without a medical background as the explanations of complex science are brilliantly done for the lay person.
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2 of 2 people found the following review helpful
Format: HardcoverVine Customer Review of Free Product( What's this? )
This extraordinary book richly deserves its Pulitzer. Showing the book to several workmates elicited the same reluctant, even recoiling response at the mere mention of the word cancer. Yet this book is eminently readable, curiously exciting, written with enormous warmth and knowledge.

There are many fascinating personal histories: One scientist, after whom a common cancer-cell detection test is named and an immigrant to America, made ends meet as a carpet salesman before being able to pursue his true vocation. Another chapter that bears a jaw-dropping significance for health issues today tells of many medical associations and consultants - even the U.S. surgeon general - being completely apathetic and reluctant to fund medical studies into the connection between smoking and lung cancer. Even a revered pulmonary surgeon of the 1940s 'was rarely seen without a cigarette himself'

One junior medical investigator demonstrated his own impatience to fire up treatment of stomach cancer by being his own guinea-pig. He swallowed a glass of water-dispersed bacteria to discover if it provided a link with any form of cancer. There is no sadder indictment of the cavalier attitude of many surgeons and consultants throughout this colourful, often tragic, often magnificent history than the observation from the 1930s that, 'The smiling oncologist does not know whether his patients vomit or not'

I recommend this book without reservation. Magnificent on every level.
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2 of 2 people found the following review helpful
VINE VOICEon 21 December 2011
Format: HardcoverVine Customer Review of Free Product( What's this? )
"A biography of cancer" is the subtitle of this fascinating book, but in fact it is a biography of the fight against it, the history of research into treatment and ways of curing the disease.

It is non fiction but the author starts with a true story, of Carla, a 30 year old working mother with acute leukaemia - of her struggles to get a diagnosis, the news and his first meeting with her. This is a story full of dramatic tension and emotion, as Mukherjee outlines her treatment and her chances of survival (a little under 30 per cent).

He then moves on to writing about some of the big research projects and the scientific breakthroughs of the 20th century, of the War on Cancer pursued by American campaigners and politicians. There are lots of intriguing characters in this story - patients, scientists and the author himself.

The book is packed with research and there are extensive endnotes and a long bibliography. Yet Mukherjee also has the ability to present his scholarship in a way that is as compelling as any best selling novel.

This isn't a manual for how to deal with cancer, but I would highly recommend it to anyone affected by the illness, whether as a patient, a practitioner or someone whose loved one (partner, parent, child, relative, friend) has cancer.
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