A stunning combination of medical history, cutting-edge science, and narrative journalism that transforms the listener's understanding of cancer and much of the world around them. Siddhartha Mukherjee provides a fascinating glimpse into the future of cancer treatments and offers a bold new perspective on the way doctors, scientists, philosophers, and lay people have observed and understood the human body for millennia.
Mukherjee begins the book with the story of Carla Reed, a young kindergarten teacher and mother, who has been ill with vague symptoms for the last month and awakens one day with an ominous sense that something serious is wrong with her. She sees her physician and requests blood work to determine the cause of her illness. The following morning her world is turned completely upside down, as she learns that the complete blood count drawn in the office is highly suggestive of acute leukemia. She is admitted to Massachusetts General Hospital, as she leaves the world of the healthy and enters the realm of the SICK, as technicians, phlebotomists, nurses and doctors swarm to her bedside to ask questions and perform tests. Later that morning she meets Dr. Mukherjee, who oversees her care and shares her story throughout this book.
The story of cancer begins in ancient Egypt, as the famed physician Imhotep describes a malady that presents as "a bulging mass in the breast" amongst other medical conditions. Imhotep provides therapeutic remedies for the other illnesses, but for the breast mass he writes, "There is none." The first definitive treatment of breast cancer occurs centuries later in Persia, as Queen Atossa's cancerous breast is surgically removed by a slave in the first recorded mastectomy, performed without the benefit of anesthesia or antisepsis.
The history of cancer is intimately linked to the history of medicine, and the reader learns about the different types of solid cancers and leukemias as they are understood in the context of history, first as an imbalance in one of the body's four humors, and then as an abnormal proliferation of cells distinct in appearance from normal ones. Mukherjee skillfully portrays the important medical and scientific researchers as sleuths who independently and collaboratively attempt to track down an elusive killer, while also describing the lives of former patients including "Jimmy", the Boston youth whose story inspired millions of Americans to donate to cancer research through The Jimmy Fund, and private citizens such as Mary Lasker, a New York socialite whose tireless efforts transformed the moribund American Society for the Control of Cancer to the powerful and influential American Cancer Society.
Unfortunately, the benefits of most of these advances in medical knowledge throughout most of the 20th century are short lived in most cases, as the majority of patients suffered relapses and recurrences. Mukherjee portrays the despair felt by patients, their families and cancer researchers, contrasted with the hope that significant decreases in cancer mortality would eventually be achieved, through medical research and therapies and, more importantly, from advancements in early diagnostic techniques and in prevention of risk factors such as smoking and excess consumption of alcohol.
The last quarter of the book describes the advances in cancer biology as it is understood on the molecular level to be a disease of uncontrolled cellular growth due to the effect of oncogenes and tumor suppressor genes. Mukherjee leaves us with hope for the future of the treatment of cancer, as it will likely be either curable or a relatively easily treatable chronic disease.
I found [The Emperor of All Maladies] to be as compelling as a well written mystery novel, one filled with interesting characters and unexpected plot twists, along with interesting and understandable discussions of science and medicine. Dr. Mukherjee has done a masterful job in writing this book, and I would highly recommend it to all readers.
This biography traces cancer, from its appearance more than four thousand years ago and the attempts to understand it, control it, prevent it and cure it that continue into this Century. While it is clearly written with compassion, the author doesn't pull any punches with details on the ravages wrought by the vicious disease and some of the drastic attempts at putting a stop to the aggressive invasion of these mutant cells in the human body.
It's fascinating, horrifying, saddening and yet hopeful. It gave me a better understanding of the disease in all its forms, and more importantly, I'm comforted that there are organizations and individuals still determined to find better treatments leading to perhaps a cure in the near future.
By initially grounding the story in the present, Mukherjee is able to jump back-and-forth from the linear history of struggles to understand and treat cancer to the present where Mukherjee is working with individuals who are struggling with this same historic disease. Mukherjee's penchant for summating and outlining unique characteristics of individuals helps make the ravages, successes, and ongoing struggles come to life.
The author's ability to humanize those who have struggled with cancer elucidates the difficulties, nuances, and abstractions of this disease which has so often persisted in a cloak of mystery. What is revealed is not any less terrifying nor does it paint a picture of a disease about to be subdued by the might of ever-heightened scientific advantages. But Mukherjee's story seems more about human dynanicism than that of hero slaying the beast. The word "struggle" dots my review and that ultimately is the testament of this work. It is a story of human struggle against a disease that comes more from within than it does without. It's the struggles of the inability to find a "curative" factor. It is the success of scientific breakthrough and the struggle as one realizes that the breakthrough is limited. More than anything, it is the struggle of the individual coping with a diagnosis that feels at times damning. And from that struggle the attempts to shrug off these fatal bonds and live regardless... even if only for a few months. It is about the struggles of chemotherapy, radiation, and radical surgery that bring the body to the very brink just as they seek to cure. And finally, it is the struggle of Mukherjee and people like Mukherjee. People who try so, so hard to cope with this persistent and tenacious disease. People bright-eyed and eagerly full of hope. But successes are in small increments. This does not make them any less worthwhile. Indeed, it is this element of partial success that seems so very human.
Temple is a great character, and there is a long journey to deliver a body -- in this case a living one -- through a landscape of walking dead, to a family that may or may not still be there. She grapples with her identity, with her baser instincts, with her perceptions of God and duty and right and wrong in a broken world. History is a living, swirling thing, and "The past is never dead. It's not even past." In fact, it's still walking around. Aldon Bell also channels Faulkner when he describes so lyrically the bits of beauty that are always ensconced in decay, and the broad sweeping descriptions of the horizon and the road and the land.
"She raises her gaze and her eyes blur teary in the cool wind and all the lights of the city go wild and multiple, and she wipes her eyes and sits in one of the chairs and looks out beyond the periphery of the power grid where the black rolls out like an ocean."
Despite the fact that it borders on derivative much of the time, I found this book to be enjoyable, thought-provoking, smart, and occasionally really beautiful. I would have never thought that I'd read a zombie novel, but look at that, the pigs are flying.
It felt pretty episodic, which is neither here nor there. And I didn't like the last two sentences. But oh well. It is totally worth reading.
The book covers the history of cancer, and the attempts to understand it's cause and to cure it from ancient times to the present. It is written in a highly readable style for the layman, and even when it gets to the present and into molecular biology, the material is presented in an easy to understand format.
One especially interesting section tells of the controversy that developed when trying to determine if cigarette smoke caused lung cancer. It seems so obvious now, but it took quite a while to prove it. The author makes it a very entertaining story.
I strongly urge anyone to read this book. It's easily one of the best books, fiction or nonfiction, I've read in 2010.
* I won't lie, when I opened up the mail and saw this my first thought was WTF - pulizter prize winner, hello this is not my thing. I am not an overly intelligent women and well quite frankly was thinking dullsville. Well, I was very, very wrong!
* This is brilliantly written and relatively easy to understand -- even for me
* I was so fascinated and learned so much I actually found it difficult to put down
* Medical information is in depth, interesting and written in more layman terms - which very much surprising
* Incredibly well researched & some fantastic notes and detailed index (yes I know its geeky but I am an anal Library Technician
* Fascinating to see the denial through history of the connection between tobacco and cancer -- especially from educated medical personal
* Horrified and disgusted at times of all the research done on unsuspecting patients, even knowing the benefits it had in the medical field
* Actually teared up a couple of times which very much surprised me
* The author has a very honest, sensitive and personal manner which is a rarity in a Dr (Trust me I have spent my whole life surrounded by those in the medical profession)
* The writing is almost lyrical which again surprised me
* Cancer really does suck ass & hopefully one day we will kick its ass
The Not so Good Stuff
* At times it jumps from time frame to time frame which was a little disconcerting
* Some noticeable repetition - better editing would have made it a tighter piece of writing
"As a doctor learning to tend cancer patients, I had only a partial glimpse of this confinement. But even skirting its periphery, I could still feel its power-the dense, insistent gravitational tug that pulls everything and everyone into the orbit of cancer."
"When Wynder presented his preliminary ideas at a conference on lung biology in Memphis, not a singles question or comment came from the members of the audience, most of whom had apparently slept through the talk or cared too little about the topic to be roused. IN contrast, the presentation that followed Wynder's, on an obscure disease called pulmonary adenomatosis in sheep, generated a lively, half hour debate."
"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."
Who should/shouldn't read
* Anyone who has been affected in any way by Cancer
* All medical professional dealing with Cancer
* So yeah, its pretty much required reading for everyone over the age of 16 (Terminology and subject matter might be hard to deal with by those younger than 16)
I received this from Simon and Schuster in exchange for an honest review
The author covers every aspect imaginable, delving into history, and bringing things right up to date. He covers the history of surgical intervention, in particular looking at the extent surgeons went to clear breast cancer. There's also a lot of detail about the development of chemotherapy, and again it's frightening to see how far clinicians were willing to go.
There's a large section covering lung cancer, and the fight against the tobacco companies. It's amazing to read that some doctors explored the evidence and gave up smoking straight away, whilst others had such a strong addiction, they were unable to. There's also a section looking at the discovery of 'pre-cancerous' cells and early changes, and the development of smear tests and mammograms.
There is a lot of medical and scientific detail in the book. I'm a nurse myself, but I haven't worked in the field of oncology. My background did help, but the author does try to make this detail fairly simple to follow and understand.
I think the biggest selling point of this book is that it will appeal to many people, from medical doctors and scientists, to lay people with an interest.
Well written and recommended.
I connected with some of the personal cases, but the constant stream on scientific minutia, tests, studies, etc. lost my interest a few times. Mukherjee opens and closes the book with the case of a young kindergarten teacher, Carla Reed, which provides the perfect bookends to the onslaught of info.
I don’t know how much of the detailed info will stick, but it was so interesting. There were certainly some graphic parts, which is to be expected with a medical topic. I couldn’t believe some of the medieval methods used as treatments for years. Bleeding patients, loping off body parts, acid burns, etc. were all acceptable, which is horrific.
I also couldn’t believe how long cancer has been around. There are fossils and mummies with cancerous tumors. There are even texts describing breast cancer in ancient Egypt and a Persian queen.
It’s unbelievable how many advances have been made in the past couple decades. It wasn’t that long ago that many refused to believed smoking cigarettes could in anyway cause cancer.
One of the most disturbing aspects of the book is learning how common cancer is becoming. The author notes that one day soon we may not wonder IF we will get cancer, but instead we’ll wonder WHEN. As someone who has watched both of her parents struggle with different cancers and losing one to Leukemia, I see his observation in a very real way. To me, this book was incredibly meaningful because it was a chance to better educate myself on the topic and I would recommend it to anyone else interested in doing the same.
This book underscores the fact that there is NO ONE cure for all cancers.It underscores the fact that researchers, molecular biologists, drug businesses, surgeons, oncologists, and even politicians need to work TOGETHER for a cure.
Keep on keeping on, you guys!
This "biography" of cancer, described by the author as a "borderless gulag", is a multifaceted masterpiece. It examines cancer from a historical, personal, and medical perspective, and from the points of view of patients, doctors, researchers, and anyone else affected by cancer. It explores cancer in the context of its treatment, curative and palliative, its causes, and its prevention.
It considers medical ethics--what should researchers do when an experimental treatment is showing strong signs of success? Is it fair to continue the experiment to the detriment of the control patients? Have some of the horrors of previous treatment methods been justified?
It relates how time and again certain advances have occurred after creative thinking has led to a leap of faith by a scientist willing to ignore conventional wisdom, and how time after time advances come as the result of the day-to-day tedium of unnamed scientists following strict protocols.
I am not a scientist, but for the most part I could with careful reading understand the author's clear descriptions of the scientific information, principles and experiments. (Even if I can't explain them to anyone else). This book is by no means dry--it is full of interesting characters and events, and at times reads like a mystery. Highly recommended.
The book is splendidly written -- clear on the facts, and upfront in dealing with the emotions that are inevitably involved in such a subject. That doesn't mean that it is an easy read. As a cancer survivor and a former smoker, I found it at times painful and frightening to read, but I am glad I kept at it. Knowing more about a problem is always a good idea, and the issues around cancer are very much clarified by this book.
Mukherjee expertly shows that better understanding of the disease leads to better treatment. Surgery was the first modern marvel used against cancer. Cut, cut, cut. Then radiation and chemical poisoning. Finally, with the understanding of cellular activities and modern genetics, truly targeted treatments that actually work are possible. What was incurable just one or two generations ago becomes manageable even curable (but at an extremely high cost for the expertise and machinery deployed).
Mukherjee's story is also a celebration of the lab rats (human and murine). The mousy technicians with little to no patient interaction who nevertheless solved the puzzles of cancer are the true heroes of this book. While the book suffers from a US-centricity (whereas cancer research is a global undertaking), it is a splendid work both in the history of medicine and invention. Highly recommended.
This book changed all that.
Siddhartha Mukherjee pulls no punches with his thorough and detailed descriptions of how cancer has been viewed, researched, and otherwise studied throughout the ages.
Both historical and personal viewpoints are shared as the author talks about why people have tried to understand cancer and why people face cancer the ways they do.
Although the book was hard for me to read at times, that is more about my discomfort when it comes to medical detail than it is about the writing. The writing is wonderful both when it delves into the medical detail or when it shapes the emotions ever-present in the history, the patients, the doctors, the researchers, and everyone else involved in fighting the war on cancer.
The author has done the world a great service by writing this chronicle, and definitely deserved all the praise and awards he received for writing this book.
It is strange to say that the history of something so horrible as the "big C" should be that way.
My family, I thought had escaped its deadly spell of caner. In the last few years, one of my cousins died of breast cancer and another cousin has recently completed her treatment against invasive breast cancer also I have what if I am unfortunate could turn into a treatable but not curable cancer. I have learned that cancer is the enemy of everyone's family.
It would be impossible to tell the story of all the cancers because as the book states "cancer is a variety of diseases". But the author does weave in a great variety of different kinds of cancer. And each one must be
treated with its own unique and appropriate treatment. I appreciate the tremendous amount of work it must have taken to pull all that together and to check and double check all the historical references,
Most of the history of cancer is not that old. A lot of what is known about cancer has been in my own lifetime. Siddhartha Mukerjee, a cancer researcher, himself makes this history more personal with stories of the sufferers and the researchers and oncologists.
The history of breast cancer treatment is full of so many controversies and the author corrected some false ideas that I had. The history of the fight against lung cancer includes not only the war with the tobacco companies that most people are aware of but also an unsuspected villain.
I appreciate the tremendous amount of work it must have been to pull all this information together in one book.
I recommend this book to anyone interested in the historical side of medicine and those who want to understand the process of progress in medicine.
Cancer is known to have afflicted the human race at least 4000 years. The understanding of what was happening and how to respond has evolved from crude to complicated. The public has been crying out for a cure to this frightening and isolating monster of death. Though it sometimes doesn't seem it, that cry is being heard and addressed around the world. Mukherjee, an oncologist, has outlined very clearly the advances in our theories, treatments, and results over the centuries. In addition to the science, he has interspersed the sense of human angst and fighting spirit by citing personal cases and touching stories. He is a physician of sensitivity and hope.
The research and critical knowledge of cancer has come slowly for many reasons, e.g., we didn't even have an inkling of what cells were, nevermind how they behaved. There wasn't time to perform scientific studies and save lives at the same time. Many were dying waiting for the answers... and still are. But we have come a very long way and it is obvious as the reader proceeds through this book.
The hope offered at the end of this work is not magical nor unrealistic. We have approached a time where it is possible for some types of cancer to be controlled for a normal life span. The secrets are unravelling. Highly recommended.
Mukherjee is an oncologist himself, and the book begins with a patient of his. The conceit of using a kind of "everyman" narrative to lever the reader into the more factual aspects of science books is a well-trodden path, but Mukherjee quickly heads off into the scrub. Before you can gather breath, he has dived into ancient medical history with Galen, skipped across into a lucid description of leukaemia's ravages, then jumped into the 1950s to chart the evolution of cancer fund-raising and advocacy.
Such a tempestuous approach, leaping across eras and subjects, has the potential to make a dizzying gallimaufry of cancer, but Mukherjee is tracing links with a true biographer's eye. This intuitive, superficially orthogonal approach, gives the book an organic, somewhat free-wheeling approach that both invigorates the reader, and mirrors the chaotic spread of a cancer itself.
It took a while for me to become accustomed to these diverse peregrinations - especially when they occur in the space of just a few pages - but by around the third chapter, I was hooked. Cancer presents such a diversity of symptoms, yet its ultimate conclusion is all too predictable. The wending, stuttering course of discovery left me just as invested in the quest to understand this baffling disease as the heroic scientists working to enlighten the world and save lives.
And there are so many scientists. The Emperor of Maladies didn't just gift me with an understanding and overview of cancer itself, but also a terrific overview of how science is made and built upon. Mukherjee gives everyone their due, and so many fascinating, dedicated - and, yes, noble - people inhabit the pages, making a panoply of discoveries from the 1800s to 2010.
The urgency, brilliance, and dedication of these biologists, oncologists and other researchers is inspiring enough, but the medical riddles they confront - elucidated clearly and with ferocious economy by Mukherjee - represent another source of intrigue and fascination.
But this is not to imply that the patient is elided. On the contrary, the book is peppered with patients - from Mukherjee's own, to the amazing story of the Jimmy Fund and its eponymous mascot. Using patients as a touchstone for readers is by no means an unusual device, but where The Emperor of Maladies really impressed me was with its sociological understanding of patients and the role of sickness in their lives. Mukherjee has clearly given much thought to how science and medicine interact with life outside the test tube, life in the wards, and beyond. His musings on this topic represent the most personal, lyrical, and some of the most emotive in the book. His empathy is obvious, but he refuses to stop there, and places patient and doctor attitudes to each other (and cancer) in historical, social and political contexts; yet another thematic smorgasboard in this embarrassment of riches.
After reading the rhapsody above, you might think the book is perfect, that's not quite the case. With the onset of genetic technology and the explosion of knowledge in the fields of microbiology, the last quarter of the book gets into some pretty full-on science, and the finer intricacies of DNA, RNA, kinases and more may give a casual reader some pause. Of course, I would argue that anyone who has picked up The Emperor of All Maladies - and made it to page 400 - is no longer casual, if they even started out that way, and persevering with the complexity brings its own rewards.
Overall, The Emperor of All Maladies is in someways attempting the impossible. How do you write a "biography" of cancer? It presents the ultimate moving target: mercurial, confusing, as multifarious as humanity itself. The book is staggeringly ambitious when you really think about it. But what is more staggering is that Mukherjee achieves victory over this most difficult and confronting of biographical subjects. By almost any token The Emperor of All Maladies is a success. There are certainly other books as encyclopaedic and rich with information, but there are precious few that present their facts in such a considered, well-written and organic fashion. An excellent book that both challenged me, and taught me so much, above and beyond cancer.
It is a testament to Mukherjee’s writing that I listened to 20 hours and 49 minutes of this audiobook with relatively little discomfort. Billed as “a biography of cancer,” this book is ambitious. Examining cancer from its earliest appearances in medical history to present day developments, Mukherjee takes his complex and wide-ranging subject and breaks it down into understandable pieces. He also manages to make it personal. Using the case history of one of his patients diagnosed with leukemia as a framing device for the book, Mukherjee never forgets that behind all the technological advances, clinical studies, fundraising efforts, legislation and research are real people fighting for their lives. By putting human stories front and center (just like the Jimmy Fund), Mukherjee makes what could have been a dry and incomprehensible book come alive with stories that each of us can relate to.
I was surprised how fascinating the history of cancer turned out to be. So many scientists, physicians, surgeons and researchers have struggled to understand and “cure” this elusive disease. Hearing about the various breakthroughs that led to our current understanding of cancer was almost like reading a suspense novel. Who would figure out the “cause” of cancer? When would they make a link between smoking and lung cancer? When would surgeons realize that radical mastectomies were not a cure for breast cancer? Aside from the medical issues surrounding cancer research, Mukherjee also spends a fair amount of time on the politics of cancer—from the fundraising and advocacy efforts of Mary Lasker to the radical advocacy of groups like ACT UP. One lesson repeated time and time again is that breakthroughs in cancer treatments often happen because of passionate and dedicated people who won’t take no for an answer.
One downside of reading/listening to this book is that you will come to feel that developing cancer of some form or another is an almost inevitable part of being human. If my understanding of this book is accurate, cancer is essentially a part of each and every one of us—built into our very genes and waiting only to be activated by a combination of triggers that may or may not happen in our lifetime. We can take every precaution we want (not smoking, exercising regularly, eating healthily) but might develop a type of cancer. The good news is that many types of cancer can be successfully treated (even vanquished). The bad news, however, is that a universal cure for cancer is a myth. Like people, cancer has numerous different forms and, in many ways, is adapting and evolving along with our understanding and treatment of it. As upsetting as this may sound, I still think it is best to understand the history and nature of cancer and be ready to fight if and when the time comes. And, with any luck, we’ll each have an oncologist as gifted and humane as Dr. Mukherjee heading up our treatment.
A Word About the Narration: The narrator, Simon Hoye, was certainly given a challenge in reading this book, and he did a pretty good job. However, I felt his voice was ill-suited for such a long listen. I needed a little more color and nuance and expression and often found myself longing for a different narrator.
It seems odd to set out on a project where the aim is to write the biography of a disease, but Mukherjee makes the case that as he addressed the history of cancer, it came to have a character unto itself, and it felt more like a description of a person. Indeed, he argues that cancer is in some sense the striving, energetic, evolved form of our cells, just one step beyond who we are now, and it’s precisely that character that makes it so difficult to defeat. Targeting what is essentially a funhouse version of ourselves, our genes with no brakes and a charge to keep going at a feverish pace, makes for perhaps the supreme medical challenge.
That marking of the character of the disease is not new to Mukherjee, but it’s well presented in his prose, and the overall work is magisterial, a lucid tale of haltingly learning the mysteries of a wide-spread disease through the past couple of centuries and trying to work out how to respond. He notes that cancer has been known since ancient Egypt (where the premier physician Imhotep quoted its treatment as “there is none”), and has been fleetingly heard from through history, but it is only comparatively recently that science really took a target on the disease, realizing that diseases that present themselves as differently as leukemia and pancreatic cancer may be underlyingly the same disease. Mukherjee lays out in detail both the scientific drive to work more on cancer – and as always, I’m amazed at how much was known already by the end of the 19th century, even if there was a long way to go – alongside the attempts to raise consciousness of cancer within wider society and gain funding and support.
The tale develops along several threads over the course of the book, generally focusing on different approaches to treatment that came about over time, and pulling the story forward as they did: surgery and radiology, chemotherapy, prevention, and the look for the underlying cause of cancer in genetics. Each section introduces a vivid batch of characters, researchers that crop up repeatedly across the history of cancer like Sidney Farber, Tom Frei and Emil Freireich, William Halsted, and others, alongside the people championing the cause, such as Mary Lasker, and how it tied into the politics of the time. There was a real gung-ho spirit evoked, against the human backdrop of how many the disease ravaged, how fleeting even the successes seemed to be, for the most part. The scientific material is presented in a clear and easily understood manner, and is well-balanced with the stories of the researchers, and of Mukherjee’s dealings with his own patients and their dealings with cancer.
Overall, actually, the writing is really quite well done; Mukherjee doesn’t let things get too heavy, because even when things go wrong, you still have this sense of fervent struggling to work problems out and make people better, to figure out more effective treatments for the future. This is a very solid piece of history, in that you really get a sense of the people and the decisions they made, both for good and bad. To have gotten as far as people did in effective treatments without knowing the underlying cause of cancer is remarkable, for example.
On the whole, this was a very interesting book, one well deserving of the praise it’s gotten, and one that isn’t nearly as scary as it might appear at first glance. You get a new sense of respect for the creativity and variety of science, just as much for the disease at the heart of the book. All that insight is definitely worth the read.
I'm afraid the book did suffer a little bit from over-hype, for me. Some of the things I'd heard about it made it sound like simultaneously a scientific tour de force and an enthralling page-turner as well-paced and exciting as any thriller. Well, it was probably never going to live up to that, but, nevertheless, it is good. Mukherjee writes very clearly, with a good balance between technical precision and accessibility and occasional moments of genuine eloquence. He humanizes what could otherwise be fairly dry material with comments about the lives and personalities of various researchers and other important figures, and with often very poignant glimpses into the lives of his own patients and his encounters with and responses to them. And he provides a lot of information. Just... a lot.
So, OK, it's not a thrilling, fast-paced page-turner. But if you're interested in a deep dive into the subject of cancer that's information-dense but very readable, this is definitely the book you want. (And, let's face it, with the likelihood of being diagnosed with cancer at some point in one's life being about one in four, it's a subject that's pretty much relevant to everybody.)