Originally published on Care & Cost here.
The opening page of Siddhartha Mukherjee’s The Emperor of All Maladiesbegins with a quote by Susan Sontag that is so on-point, yet so rare and fresh, that one can’t help being excited by the prospect of what’s to come.
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 as citizens of that other place.
You open the book with great expectations. It is weighty, yes – 570 pages, 100 of which are end notes – but beginning, you immediately find its expansive scholarship wrapped in a writing style so fluid and lyrically engaging that it instantly dispels any hesitancy, and you are captured.
The scope of Mukherjee’s effort is breathtaking. A marvel of organization and narrative flow, Emperor is literary drama, history, mystery, science, with literally hundreds of anecdotes reaching back through the breadth of recorded world history and across an astonishing array of disciplines, each element of content so precisely and vividly drawn that it is accessible to any intelligent lay person. There is Atossa (550-475 BC), the Persian daughter of Cyrus the Great, wife of Darius and mother of Xerxes, whose cancerous breast finally brings her to turn away from court physicians and command her Greek slave to cut it off. She survives.
There is the endless stream of seekers, filled with heroism or hubris, who, step-by-step, uncover truths about the disease and its mechanisms. Some, like Marie and Pierre Curie, pay a steep price along the way, discovering, in their case, that the radiation that can curb cancer can also bring it on. Others, like the Scottish surgeon Joseph Lister, would, in trying to cope with the infections that accompanied so many of his operations to remove cancer, find that carbolic acid can transform all surgeries. Or Sidney Farber and Mary Lasker, who unite in a decades-long campaign to find a universal cancer cure.
Perhaps most awe-inspiring is Mukherjee’s careful descriptions of the unfolding science of cancer, the constant search for silver bullets. In recounting the history of chemo-therapy, he muses:
Every drug, the 16th century physician Paracelsus once opined, is a poison in disguise. Cancer chemotherapy, consumed by its fiery obsession to obliterate the cancer cell, found its roots in the obverse logic: every poison might be a drug in disguise.
The stakes are so great, and this realization so promising, vast and potentially lucrative, that it seeded a strategic shift in the way we attack the disease. Even so, the cancer cell’s remarkable ability to thwart by adaptation has continued to provide transformational revelations, precipitating advance upon advance in both our knowledge and our treatment tactics.
Still, it is cancer’s resilience, its ability to evade, adjust and grow, that causes Mukherjee to observe that cancer cells seem “a more perfect version of ourselves.” But this is always with an awareness that cancer is ultimately about the destruction of life, not its continuance.
And this, his humanity, is one of Mukherjee’s greatest strengths. He never forgets that, at base, cancer is a catastrophic affliction that descends capriciously and violently on unsuspecting patients and families, laying waste to everything. Six hundred thousand Americans and 7 million people worldwide will perish from it this year. It is the attempt to do something, anything, to relieve that suffering, that has motivated efforts for centuries, and that has mushroomed into a mammoth 21st century commercial enterprise that dominates much of the American health care landscape.
Emperor is a great, once-in-a-decade book of unimaginable mission-driven ambition. It succeeds first by painting a kaleidoscope of the dimensions that cancer resides in, including the science that everyone touched by the disease pins their hopes on.
But it succeeds most deeply by rendering an entire universe, located around a pervasive, cruel and brilliant adversary, in which we find the commonalities – strengths, failures, desires, fears, foibles, and very occasional successes – that render us all human.