The Emperor of All Maladies was written by Siddhartha Mukherjee.
The book opens with a terrifyingly beautiful epigraph from Susan Sontag:
Illness is the night-side of life, a more onerous citizenship.
Everyone who is born holds dual citizenship, in the kingdom
of the well and in the kingdom of the sick. Although we all
prefer to use only the good passport, sooner or later each of us is
obliged, at least for a spell, to identify ourselves in that other place.
I use the verb terrifying here to describe Sontag’s words because both my parents died from cancer. My mum suddenly, and too young. My dad, slowly, the life leeched out of him, as the fear rose in him. Dying more than death defined his life. This, in turn, has caused the fear to rise in me. Each migraine – a brain tumor. Each ache – malignant cells in my marrow. Cancer for me is not a matter of if, but when.
With this in mind, it’s perhaps understandable that it took me awhile to read this book. I’d pick it up and put it down. Stare warily at it from across the room. I stalked it around the house until eventually, I pounced, gave it a good kingfisher’s shake, and set to reading the damn thing.
I discovered that as Siddhartha Mukherjee placed cancer and its accompanying treatments, in their historical context he robbed them of their mysterious power. This was true for me at least. I was greatly heartened to learn of the incongruity of scientific breakthroughs. Why? Perhaps because it stripped the artifice from the pseudo-scientific certainty we demand from the medical profession.
Here are snippets of what I learned.
Accordingly, this is less of a review and more of a birds nest.
It wasn’t until 1838 (1838!!) that a botanist and a physiologist claimed, “…all living organisms were built out of fundamental building blocks called cells.”(15) This idea was quickly extended to an understanding that cells arose from other cells. If this was the case then growth can only occur in two ways – more cells (hyperplasis), or bigger cells (hypertrophy).
What’s the quintessential disease of pathological hyperlasia (more and more cells)? Cancer. Rampant, uncontrolled cell division creates masses of tissues (tumours) > cancer.
When this division occurs in white cells in the blood > leukemia. Where are white cells produced? Bone marrow.
Science begins and ends with counting. To understand a phenomenon scientists must first describe it objectively. To describe it they’ve got to measure it.
How does one measure cancer? By drawing blood from the marrow and looking at it under the microscope. This brings us to Sidney Faber – a formidable physician. If leukemia could be counted, he reasoned, then any intervention (say a chemical sent through the blood) could be measured for potency. He could watch cells grow or die. He could experiment with cancer.
Cold knife or hot ray?
And so the experimenting begins.
I was astonished at the rate of chemical insights and new drugs that emerged in the 20th century. For example, penicillin had to be ‘milked to its last droplet’ in WW2. In 1939 they reextracted the drug from the urine of patients who had been treated with it. In 1942 Merck shipped its first batch of penicillin. It measured a mere 5.5 grams. By the early 1950s it was being produced in thousand gallon vats.
Folks started living longer. Mukherjee notes the hue this brought to American culture on page 22: ‘Lulled by the idea of the durability of life, they threw themselves into consuming durables: boat-size Studebakers, rayon leisure suits, televisions, radios…’. I used to write cultural history. I like that sort of parallel.
But cancer did not fall in step with the advances.
Here we dive into the brutality of surgery. Mukherjee again draws wonderful cultural and personal parallels between surgery style and surgeon. In the 1890s cancer was still a black box – to get rid of it a surgeons= had to cut the whole thing out or burn it with radiation. Cold knife or hot ray.
Cancer is the pathology of excess – it expands, invades, sets up colonies. It’s an EMPIRE.
Where was cancer born?
“Wellness” practitioners would have us believe that cancer is a modern disease, a product of the imbalance of our post-industrial world.
Consider this (consider this); an Egyptian papyrus dated to the seventeenth century BC contains descriptions of cancer. Cancer is quite possibly the oldest disease.
Some context: in most ancient societies people didn’t live long enough to get cancer. eg The odds of getting breast cancer = 1 in 400 for a 30-year-old and 1 in 9 for a seventy-year-old. So in a sense, civilisation unveiled cancer. Also, changes in the structure of modern life have radically changed the spectrum of cancer > increasing some (smoking > lung), decreasing others (refrigeration > stomach).