The Emperor of All Maladies: A Biography of Cancer


If you or anyone you love has had cancer, you must read The Emperor of All Maladies by Siddhartha Mukherjee, MD, PhD, an oncologist and assistant professor at Columbia University. What sounds like it could be the most boring book this year by its title is actually a page turner and has won a Pulitzer Prize. It also gives those of us who have tangled with this vicious disease just a glimpse of its history and the men and women who have made an impact.I had a chance to meet Dr. Mukherjee at a company event last month, and he was every bit as interesting as his book, which captures the imagination as it looks at where cancer fits in a 20th century timetable of those who have tangled with the crab. Of course,I may be a bit biased because when I introduced myself he immediately reminded me that he had used a piece of reporting I did on Larry Einhorn,MD, and the first patient Einhorn treated with the chemo combination that eventually cured Lance Armstrong. Mukherjee takes us into the lives of the researchers - men and women who were often idiosyncratic and often driven by ego, but who solved a piece of the cancer puzzle. He introduces heroes of cancer research such as Sidney Farber, MD, who took on leukemia when it had been "abandoned by internists, who had no drugs to offer for it, and by surgeons, who could not possibly operate on blood," Mukherjee writes. Farber's first efforts to treat leukemia were met with "skepticism, disbelief, and outrage," but his determination led Farber to partner with philanthropist Mary Lasker who taught him how to use the media and the power of advertising to draw public attention to the disease. Lasker is credited with shaking up the ACS and turning it into a powerhouse for cancer. Mukherjee also adds moments of high drama, including the day when patients gathered for the first study of Herceptin (trastuzumab). All 15 of the trial's initial women had exhausted their efforts for treatment for metastatic breast cancer. Metastatic cancer patient Barbara Bradfield's cancer had metastasized to the lymph nodes near her collarbone and was clearly palpable. As Mukherjee writes:"On the morning of the first intravenous infusion of Her-2 antibody, all the women came up to feel the lump, one by one, running their hands across Bradfield's collarbone. It was a peculiarly intimate ritual that would be repeated every week. Two weeks after the first dose of the antibody, when the group filed past Bradfield, touching the node again, the change was incontrovertible. Bradfield's tumor had softened and visibly shrunk."I think this vision is haunting for me because I know of so many women whose tumors who could be felt, and I could almost feel the joy as those women understood from touching Bradfield's tumor what must be happening to their own. Most haunting in terms of today's needs is Mukerjee's discussion of the pressure brought to bear on the government after the first man walked on the moon. Cancer activists wanted a "programmatic" effort to cure cancer, just as there had been a concentrated effort to build the atomic bomb in Los Alamos and to put a man on the moon in Houston. It's an intriguing thought. What if all the cancer researchers moved to a remote location and worked in collaboration on the cure for cancer? And this is one place where the book stops short. When activists demanded action from President Richard Nixon in a full page advertisement in the Washington Post in December 1969, they used the number of Americans dying each year from cancer as their proof that that the nation had to declare war on the disease. The figure then: 318,000. Today, it's more than 500,000 -- an estimate of 1,500 Americans a day. More people are being cured, but more are dying. Is that progress? Where are we failing? What needs to be done to speed the process? My other issue with the book is that nurses aren't present or even mentioned. Oncology nurses have become a critical part of the healing of cancer patients in this country and it didn't happen overnight. It's time they are brought out of the shadows of patient care and their professionalism, research and commitment to cancer is recognized and applauded. Perhaps that will be Mukherjee's next book.

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