Still Looking For a Cure

It’s pleasant to think that we’re long past the time when illness was attributed to divine retribution. Nowadays, we understand that most disease has an external cause. We eat right, take care of ourselves, avoid dangerous activities (unprotected sex, malarial-zone sunbathing), and expect, in return, relative safety. If we go take a walk and catch Lyme disease, well, it’s not a personal curse from the gods; it’s bad luck. And modern medicine is there to set things right with whatever’s needed: antibacterials, antibiotics, or other treatments.

It doesn’t always work this way, of course. With some sicknesses, the cause and the cure can be frustratingly hard to pin down, leading even the staunchest Rationalist to ask, “Why me?” Despite years of research, cancer has maintained this elusiveness in spades. Avoiding the activities we know can cause it, such as smoking, does not entirely protect us. Sometimes the cause is environmental, sometimes it’s hereditary, and sometimes it isn’t clear why the cells in a person’s body have started to grow explosively. Or how to stop them. Here come the gods, casting their mysterious judgments.

Thank goodness, then, for Dr. Mukherjee’s Emperor of All Maladies, which throws a little more light for the layperson on cancer: its history, as well as what it is and how we’ve learned about it in 2,500 years of written history. And he delves into why some iterations especially are so nearly impossible to cure—and why, depending, to cure it may not be the best option to pursue.

Emperor of All Maladies begins with a difficult literary conceit: Cancer is like a personality—its multifarious displays are akin to the vagaries of human behavior. Mukherjee introduces the book as less a history than a biography. Fortunately this conceit is not carried too far, and Mukherjee avoids overplaying it by attempting to anthropomorphize the disease. It would be difficult to sustain for any real length of time. Instead, after a brief chronology of humanity’s earliest knowledge of cancer through the 18th century Enlightenment’s attempts to create a methodological basis of understanding, Mukherjee focuses primarily on the 20th century, in which the first attempts to actually cure a cancer through surgery appeared, which prompted Sidney Farber’s efforts through the Jimmy Fund to provide a national organized assault on cancer, which led to advancements in chemotherapy, hormone therapy, and finally the beginnings of a genetic understanding.

Dr. Mukherjee does a commendable job of explaining many highly technical discoveries and processes in a way that is not only understandable, but readable. His prose stretches toward captivating as he uncovers the stumbling in the dark of many doctors and researchers looking for cures, the political machinations that aided and prevented research, and the sheer flukes that often led to important advancements. But he’s at his best when he pauses for occasional interludes with actual patients. Halfway through a chapter on the setbacks and discoveries that led doctors to begin treating leukemia with an intensely toxic combination of regimens, called “total therapy,” Mukherjee breaks into a personal narrative:

Carla Reed entered this form of hell in the summer of 2004. Chemotherapy and radiation came back-to-back, one dark tide after another. Some days she got home in the evening (her children already in bed, her husband waiting with dinner) only to turn around and come back the next morning. She lost sleep, her hair, and her appetite, and then something more important and ineffable—her animus, her drive, her will.

It would be easy for Mukherjee to affiliate the reader only with the researchers’ late nights, brash decisions, and bold successes. Their story is the primary focus, and the struggles of plucky doctors, suspense of new methods, joys of successful trials, and gloom of setbacks are all compelling. But it’s easy to forget that success means patients’—people’s—lives have been lengthened, and failure often means drawn out, painful deaths. These moments with actual patients temper the book with a human element, reminding the reader of what’s at stake.

By the end, it’s clear not just what we’ve learned in the 20th century, but how much we still have to learn about cancer, and why this disease—which isn’t exactly a virus, or a bacteria, but the body’s own cells, which have stopped working correctly and begun to rapidly reproduce—may not ever be cured. But there are indications that many cancers eventually will be palliated, managed, or otherwise kept under control, meaning that, though we many never have the “cure for cancer” that has been so highly touted, the disease may still stop being the death sentence it once was.

The book is not all hopeful, and the strongest single sense imparted to readers by the end is just how intractable cancer really is for the human condition. But Mukherjee shows us that for all we still have to learn, and for as stumbling as the learning has been, we have still gained an awful lot of knowledge since the beginning of the last century. Given the uncertainty that comes with this mysterious, mercurial disease, Mukherjee’s clear-spoken candor makes for excellent therapy.