Criticism & Features

Year 2010: 30 Books

Karen Long on Siddhartha Mukherjee’s “The Emperor of All Maladies”

By Karen Long

Each day leading up to the March 10 announcement of the 2010 NBCC award winners, Critical Mass highlights one of the thirty-one finalists (to read other entries in the series, click here). Today, NBCC board member Karen Long discusses nonfiction finalist Siddhartha Mukherjee's Emperor of All Maladies: A Biography of Cancer (Simon & Schuster).

World Cancer Day was February 4. An outfit called the Union for International Cancer Control urged people to visit a web site and sign the World Cancer Declaration.

Here is a better idea. Find a copy of The Emperor of All Maladies, Siddhartha Mukherjee's small miracle of insight, scope, pace, structure and lucidity. Reading it provides essential context, and a critical dose of humility.

Cancer is an old disease; it appears on the papyrus of the earliest written human records. In the Egypt of 2500 BC, the physician Imhotep had a hieroglyph for cancer. He could diagnose it but, he wrote, “there is no treatment.”

“Even an ancient monster needs a name,” Mukherjee observes. “To name an illness is to describe a certain condition of suffering––a literary act before it becomes a medical one. A patient, long before he becomes the subject of medical scrutiny, is, at first, simply a storyteller, a narrator of suffering.”

The literary threads in this book glint with evocation. In an ambitious survey volume like this, we hope to meet Susan Sontag's essays and perhaps a snippet from Alexander Solzhenitsyn's novel Cancer Ward. But Mukherjee also mines Tony Judt's Postwar and Lewis Carroll's poems. He repeats Anna Deavere Smith's zinging line: “Cancer therapy is like beating the dog with a stick to get rid of his fleas.”

Indeed, individuals with cancer begin and end this book. Mukherjee, an oncologist, researcher, and professor at Columbia University, is rigorous about keeping our eye on the people here, even as he distills a science, politics, history, and culture of cancer that makes it feel less like a “thing” and more like an individual. Pointedly, he subtitles his book “a biography.”

“To confront cancer,” he writes, “is to encounter a parallel species, one perhaps more adapted to survival than even we are. This image––of cancer as our desperate, malevolent, contemporary doppelganger––is so haunting because it is at least partially true. A cancer cell is an astonishing perversion of a normal cell. Cancer is such a phenomenally successful invader and colonizer in part because it exploits the very features that make us successful as a species or an organism.”

As elegant as the expository writing is, Mukherjee doesn't shirk on the science. Expect to digest a few pages on statistical innovations that galvanized drug-treatment trials, to get a refresher on RNA's dance with DNA, and to grasp, finally, why it's so difficult to assert that mammograms before the age of 50 do a woman any good.

This year, a quarter of all American deaths––some 600,000––will be from cancer. Worldwide, the figure tops 7 million.

Reading this book excavated my own proximity to cancer: Both my mother and grandmother died from the ovarian form, and a beloved sister-in-law succumbed to recurrent leukemia. Mukherjee's explanation of the blood-brain barrier in chemotherapy made my mother's demise newly explicable. My sister-in-law's bone-marrow transplant bought her another year, but the politics and aggression that exported this near-death technique into breast-cancer treatment left me shaken, angry, and drained.

Yet another section found me circling this sentence for my friend Michele: “Between 1970 and 1994, lung cancer deaths among women over the age of fifty-five increased by 400 percent, more than the rise in the rates of breast and colon cancer combined.”

I don't expect a statistic to separate her from her cigarettes, but the 334 preceding pages of The Emperor of All Maladies just might. It is the antithesis of a self-help book: a text rich with complexity, irony, and, yes, humor. (The Nixon White House routinely called medical scientists “nuts” and “bastards,” and the chief executive repeatedly wanted them to “shape up.”)

Such pithy detail makes the short chapters fly, and the 98 pages of footnotes indicate that Mukherjee put in many thousands of hours panning up the nuggets.

Some readers, I fear, will shun a scholarly book about cancer. But to those willing to engage it, let me say that this profound, clarifying and moving book amounted to one of the best reading experiences of my life.

To read an except from Siddhartha Mukherjee's The Emperor of All Maladies: A Biography of Cancer (and to access the author's website), click here.