The Emperor of Pop Medicine

Here’s my review of The Emperor of All Maladies: A Biography of Cancer, by Siddhartha Mukherjee. I really liked this one, so be warned: Superlatives ahead.

Goodreads tells me that I started reading this book in August 2014. It took a long time to finish, even considering that I was juggling office and studies at the time, and took extended breaks for fiction. It’s a 600 page, detailed epic that is well worth the effort. It received the Pulitzer Prize for general non-fiction in 2011.

Mukherjee begins with a story from his days as a medical student specializing in oncology. He takes a personal interest in one patient, and some philosophical musing leads him to conclude that cancer is different from other diseases- striking a variety of organ systems, it is multifaceted; and it arises from within rather than from an external invader, making it seem like a betrayal by one’s own body. He then dives into a metaphorical biography of cancer, beginning with a Persian queen who ordered her own mastectomy when faced with a rapidly progressing breast cancer.

I was initially put off by the use of metaphors- it seemed melodramatic. Later, though, the verbosity grew on me. (I won’t lie, reading this book with an Oxford Pocket Dictionary at hand helped me boost my vocab at a time when it was very helpful). Nowhere else will you see a quote from Lewis Carroll’s Through the Looking Glass used to describe the state of modern cancer research: “It takes all the running you can do, to keep in the same place,” said the Red Queen. Nor will you see puns on Anna Karenina in the context of cell biology. “Normal cells are identically normal; malignant cells become unhappily malignant in unique ways.” These analogies make sure the book never descends into dry textbook territory, and keep you emotionally involved.

This book stands out from other pop science non fiction by virtue of its well-researched data. Every statement is backed up with statistics, which are in turn supported by references. This gives it a ‘hard science’ feel that puts books like Freakonomics or Blink to shame. Of course, unlike the relatively new ideas on behavioural science or social psychology discussed by Malcolm Gladwell, Mukherjee has literally centuries of doctor’s notes and clinical research to fall back on.

Some general ideas presented in The Emperor of All Maladies, as understood by an bio-n00b engineer:

  1. One of the reasons cancer has become more prevalent today is because of the lengthening of life expectancy. A disease like prostate cancer, that affects mainly those aged 60-70, would be uncommon in a population having an average lifespan of less than 50 years.
  2. An American socialite, Mary Lasker, was instrumental in bringing cancer to the (American) public’s attention and raising funds for cancer research in the 1940s. The fact that she used influence and social events to make a charitable cause trendy was a real eye opener for me. ‘Networking’ and socializing are very powerful tools when used with good intentions. (cc: Bangalore Times Page3 personalities)
  3. Statistics are misleading. Pre-screening for cancer (for example Pap smears for cervical cancer) often appeared to lengthen the survival period of cancer victims. In reality, it was because a person with early stage cancer usually lives longer than someone diagnosed with late stage disease. Simply put, people with cancer weren’t living longer, they were just finding out about the cancer earlier.
  4. Clinical trials are not as straightforward as they seem. From participants who cheat, to scientists who manipulate the numbers (see point 3 above), there are many many ways in which a trial can be jeopardized. This makes double blind, or even triple blind studies extremely important. Many trials are ruined when the person in charge takes pity on a particularly ill patient and switches him/her out of the control group.
  5. Conventional wisdom about health was not always, well, conventional. It took quite a while for the link between smoking and cancer to be established, due in part to the efforts of cigarette manufacturers to prevent studies on the occurrence of lung cancer in habitual smokers.

There’s a lot more information in the book, mostly about the history of cancer research and how major breakthroughs were made, but these points in particular caught my attention. All in all, definitely worth a shot. Life changing (or at least career-path-changing) stuff for sure! 5/5

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