Rebecca's Reviews > The Emperor of All Maladies

This magisterial history of cancer won a 2011 Pulitzer Prize, though not for History (that went to a new book about the Civil War) or, as Mukherjee more whimsically categorizes his own book, Biography (that went to a biography of George Washington); instead, he won in the General Nonfiction category, which, though prosaic, is certainly appropriate for a work of scientific journalism. The Emperor of all Maladies reminded me most of The Immortal Life of Henrietta Lacks, the previous year’s popular science blockbuster, with both focusing on bringing complicated science to laypeople through the life stories of ordinary individuals.

What Mukherjee has achieved in less than 500 pages is truly remarkable: a fairly comprehensive history, from ancient Egypt to the present day, of the discovery of cancer, its different manifestations, its causes, and the development of treatments ranging from radical surgery to sophisticated pharmaceuticals. That he manages this without alienating people who come to the material with no more knowledge than one could glean from newspaper articles and high school biology is impressive. Only in the last third of the book did I find the science stretching the limits of my imaginative capacity and my memory of AP Biology and Genetics classes, as he goes into details of oncogenes, tumor suppressors, retroviruses, etc. I managed to stay just the right side of comprehension, but I can guess that others with less patience or brain power to devote to their chosen leisure reading might have started skimming or, worse, given up.

When meditating on cancer there is a fine line between depression and hope, and Mukherjee proceeds carefully to prove that there is reason for both. On the negative side, it seems likely that in the near future one in two men and one in three women in America will suffer from some form of cancer in their lifetime. All the 1950s talk about a ‘magic bullet’ to cure cancer has fizzled; there are so many disparate types of cancer that it seems impossible that there could one day be a panacea. Furthermore, the search for environmental and manmade carcinogens faces ongoing resistance from lobby groups. The most discouraging sections of the book were about smoking and the nation’s reluctance to warn of the high risk of lung cancer. And it wasn’t just the tobacco industry that opposed measures such as strongly-worded warning labels on cigarette packets; doctors, politicians, and smokers in general (who formed more than 40% of the population at the height of smoking’s appeal in the 1940s-1950s) denied the truth that was in front of their eyes.

However, this book offers the reader plenty of reasons to be hopeful. Mukherjee follows the treatment trajectory of a number of his patients, including Carla Reed, a young mother with leukemia. Her story opens the book and, as Mukherjee reveals in the last chapter, he assumed his book would also finish with the end of her story – her death. But this was not the case; instead, he comes to a close with an anecdote about going to visit Carla on the fifth anniversary of her remission, to celebrate her new chance at life. My overwhelming sense from this book is that most cancers are indeed treatable, and new medications and procedures are being developed all the time. When cancer affects us – because, for our families if not for ourselves, it is a question of when, not if – there should be no cause for despair. The ‘biography’ of cancer probably does not have an end point, but there is every chance that we can live long lives alongside it.