With epic scope and passionate pen, Siddhartha Mukherjee’s The Emperor Of All Maladies: A Biography Of Cancer boldly addresses, then breaks down the monolith of disease and its public face from ancient Egyptian care to gene-resistant trial therapies. The oncologist author cuts across history, psychology, and medicine to develop a timeline of cancer’s evolving treatment and the struggle to prevent, not just to treat.
While mistaken in his mechanics, the Roman scientist Galen—who theorized that an overflow of black bile caused cancer—still correctly recommended a systemic cure for a problem that was most often diagnosed locally. Advances in commercial lab technology in the 19th century prompted physicians who strayed outside palliative care for more advanced cases to look beyond the standard tumor removals to attacking cancer with targeted treatments. At the forefront of this effort was a Boston-based pathologist named Sidney Farber, who used his basement lab at a children’s hospital to test experimental protocols on live pediatric patients diagnosed with leukemia (an ideal test cancer because of the measurable effects in the blood), and was instrumental in coordinating the first joint trials of combination treatments. As drug cocktails yielded progressively better results via months or years of remission, physicians rushed to give hope to late-stage patients and test new combinations in a research free-for-all, even as geneticists struggled to find the causes of common cancers in mutations that multiplied in complexity.
Unsurprising considering his training, Mukherjee is preoccupied with the curiosity and drive of doctors who led the medical establishment toward a better-organized attack on cancer. (One standout: William Stewart Halsted, who pioneered the radical mastectomy, but whose cocaine-fueled zeal over the operating table led him to order surgeries that were often far too aggressive for the patient’s stage.) Mukherjee incorporates strands of patient histories, including the history of the poster child for Farber’s “Jimmy Fund,” but his extensive knowledge of the disease and exuberance for the scientific developments on the path sometimes blots out the human cost of such experimentation; his sensitive treatment of activism among metastatic breast-cancer patients gives their struggle a platform as well as a historical justification for their protests.
Aligning medical trends with public policies that either raised cancer researchers on a pedestal or disregarded their work—as with the rising profile of breast cancer in the 1980s—is Mukherjee’s key brushstroke, adding texture to his portrait of medical derring-do. A biography without an ending by the author’s own admission, The Emperor Of All Maladies does provide a tempered hope for advances in understanding that will fuel future discoveries.