Review of Emperor of All Maladies A biography of cancer

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Review of Emperor of All Maladies A biography of cancer

Postby rickyemanuel » Sun Feb 08, 2015 9:59 pm

Review of the Emperor of All Maladies by Siddhartha Mukherjee

This book is a revelation.

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It is written by a sensitive oncologist with a great name, and it won the Pulitzer prize for non fiction in 2011. Dr Mukherjee said he wrote the book as a very long answer to a question posed to him by a patient as her oncologist to try and address the question “what am I battling?. .

He writes the book as a “Biography of Cancer”, as if cancer is a person whose life story he is recounting. He shows how cancer is thought of throughout history and how the way it is conceived of changes the way it is treated. He calls it “a portrait of an illness over time”. It makes fascinating reading as he manages to convey complex information in a simplified way which only someone who knows their subject well can do. His own humanity and compassion shine through reflected in his first name as the book is full of the “stories” of his patients and researchers including successes and failures. The most interesting part of the book for me was how he described how seeing Cancer as an enemy to be defeated in the "war against cancer” formulated by Richard Nixon had profound effects. Although it drew attention to the disease and with it a lot of research funding, the treatments like radical mastectomy were often brutal in the way an army may approach a dangerous enemy. Only by knowing the adversary or ceasing to see it as an adversary but as something to be understood and related to based on this understanding, so treatments changed.

It is particularly fascinating to read how serendipitous so many discoveries were. This includes how the smear test was discovered by a Greek doctor unable to find any other work in the USA other than looking at the ovulation cycle of worms. The techniques he developed there in staining cells and looking for the first signs of cell changes gave rise to the smear test for women. There are far too many accounts like this to mention but luck or the absence of it certainly runs through the book.

Recent publicity in the press confirms this that most cancers are due to bad luck although of course life style diet etc all play their part. He debunks the myth that people are responsible for their cancers by the way they live. Of course they contribute to the getting their disease in some cases like lung cancer and smokers, etc but mostly they only contribute and not cause. This is crucial since he shows how modern gene research in cancer demonstrates how there needs to be two events not one which trigger cell changes to cause cancer. The first sets the propensity for the cancer to occur and the second sets it off. So smoking may predispose you to get lung cancer but not all smokers get it. This is because it takes a second genetic event to set it off and this is often due to bad luck like a mutation which may preexist smoking or later environmental exposure etc. The complexity of the subject shines through. Cancer is not one thing but a family of diseases , “each with a different face” and cannot be defeated in this simplistic manner.

I was particularly interested in his bald statements in a Q&A at the end of the book about the mind/brain role in cancer. He writes that there is no “correct” response to a diagnosis of cancer and warns sternly about how how patients may feel they are not getting better or got ill in the first place because of their mental attitude ( Too negative, not positive enough etc). He calls this type of thinking correctly in my view “medieval” as it some how blames the patient. He cautions against psychic therapies for cancer. This does not mean that there is not a role for psychological therapies for managing cancer related pain or anxiety but the causal link must be debunked. For my work in a hospital with cancer patients, or children of cancer patients, this is profoundly true. He does think that there is a promising future in looking how hormones in the brain may modify cancer cells.

This is such a rich and rewarding book which educates about the disease, the history of medicine and the anthropology of illness. It also looks at group processes and rivalries between research teams or surgeons and oncologists and pays homage to those dedicated men and women who study processes in the body right down to cellular or genetic levels to uncover the complexity of this set of diseases which touch all our lives in one way or another. I cannot recommend it highly enough.
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Ricky Emanuel

And here are three two hour links to the book, on You Tube:

Episode 1:

Episode 2:

Episode 3:
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