Friday, May 6, 2011

A biographical masterpiece!

Book: The Emperor of All Maladies - A Biography of Cancer
Author: Siddhartha Mukherjee
Publisher: Fourth Estate / Harper Collins Publishers
Pages: 571
Price: Rs 499

Eisha Sarkar
Posted on Times Wellness on Friday, May 06, 2011

Had cancer been a man, he would have travelled the world in disguise. He would have killed his gracious hosts, ambushed his enemies, laughed at their feeble attempts to resist him. His conquests - men, women and children - would plead for their lives, but to no avail. He would go on to colonise new territories, subjugate new people. Had cancer been a man, he would have been both loathed and held in awe by the same people he had tried to eliminate.

In many ways, cancer physician Siddhartha Mukherjee’s The Emperor of All Maladies is a celebration of its existence – much like in the case of the biography of a human being. Its polymorphism, its immortality even after it kills its patients and its unchanging ability to grow threatens humanity in a way that no other disease has ever. It has perplexed some of the greatest minds. It has broken its sufferers’ spirits and has forced doctors to think out-of-the-box for therapies. Mukherjee depicts cancer not only as an illness but as a character that grows on you (literally!) He digs into medical journals, library archives, Susan Sontag's books and works by literary greats to come up with a Pulitzer-winning masterpiece - a historical novel, a popular science book and a beautiful piece of literature, all rolled into one. 

Mukherjee writes, "We tend to think of cancer as a "modern" illness because its metaphors are so modern. It is a disease of overproduction, of fulminant growth - growth unstoppable, growth tipped into the abyss of no control. Modern biology encourages us to imagine the cell as a molecular machine. Cancer is that machine unable to quench its initial command (to grow) and thus transformed into an indestructible, self-propelled automation."

But cancer certainly wasn't "born" in the twentieth century. Mukherjee finds the first medical description of cancer by Imhotep, a great Egyptian physician, on a papyrus text dating back to 2500 BC. He discovers that Atossa, the ancient Persian queen, "who swaddled her cancer affected breast in cloth to hide it and then, in a fit of nihilistic and prescient fury, had a slave cut it off with a knife." The sixteenth-century anatomist Andreas Vesalius tried to discover the source of black bile, the fluid thought to be responsible for cancer. Unable to find it, he launched a new search for cancer's real cause and cure. Then there was the nineteenth-century surgeon William Halsted, who chiselled away at cancer with larger and more disfiguring surgeries, “all in the hopes that cutting more would mean curing more." Cancer is not a new disease. It is as old as humanity is. Only, it wasn’t noticed before because people died younger of other causes - plague, tuberculosis, small pox, and cholera killed them faster and before cancer could. But in this modern world, the longer you live the greater are your chances of having cancer. “The question then will not be if we will encounter this immortal illness in our lives, but when.”

Cancer research gained momentum after World War II, primarily because of the contribution and the dogged perseverance of two people - the socialite Mary Lasker and researcher Sidney Farber, the 'father of chemotherapy'. As cancer became the focal point of medical research, scientists in the US and Europe left no stone unturned to find its "universal cure". They tried highly toxic drugs on patients who were left with little choice but to agree. They blasted tumours with X-rays. Later, they opted for a combination of chemotherapy, radiation therapy and non-radical surgery. In the 70s and 80s, scientists started looking beyond the 'cure' to fight off the disease. While it was initially scoffed at by the powerful tobacco lobby, the anti-tobacco campaign finally gained momentum, with an increasing number of reports suggesting a correlation between lung cancer and smoking. After managing to get legislation to force cigarette companies to print warnings on packets, researchers then turned inward, to find out how some cells turn cancerous and others don't. In many ways, the War on Cancer was a battle of ideologies and a riddance of bad habits.

In spite of years of trials, research and documentation, there is no single cure for cancer and the probability of finding one is, well, improbable. The author writes, "Cancer is a flaw in our growth, but this flaw is deeply entrenched within ourselves. We can rid ourselves of cancer, then, only as much as we can rid ourselves of the processes in our physiology that depend on growth - aging, regeneration, healing, reproduction." The War on Cancer did not find a cure, but it did help understand cancer better!

Stringing reports, narratives, anecdotes and case studies, Mukherjee weaves the story of medicine, - of its marvels, its failures, its people, its cultures and its ethos - of life and of death. "Medicine, I said, begins with storytelling. Patients tell stories to describe illness; doctors tell stories to understand it. Science tells its own story to explain diseases. The story of one cancer's genesis - of carcinogens causing mutations in internal genes, unleashing cascading pathways in cells that cycle through mutation, selection and survival - represents the most cogent outline we have of cancer's birth," he writes. 

Brilliantly researched and exquisitely written, The Emperor of All Maladies is a must-read. There are thousands of books on cancers and there will be many more in the future. But there few that relate to students, patients, doctors, researchers, health officials and laypersons to the extent this one does. Mukherjee juxtaposes scientific data with poetry, medical jargon with commonplace vocabulary and slips in bits of conversations and anecdotes to keep the prose interesting. The Emperor of All Maladies is a story not of human suffering but of cancer’s greatness. It is a story not of failures but of trials and smaller triumphs. It is a story not of decay but of growth. It is a story not of despair but of hope.

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