Mukherjee, Siddhartha - The Emperor of All Maladies: A Biography of Cancer

[oyceter]

Mukherjee is an oncologist, and while he was undergoing advanced training at the Dana-Farber Cancer Institute and Massachusetts General Hospital, he decided to keep notes of his year. The notes ended up growing and growing, until he wrote a general overview of cancer, from historical personages who may have had cancerous growths to our understanding of cancer has changed over the centuries.

Understandably, the history of cancer prior to the past two or three centuries is rather fuzzy and involves a lot of diagnosis via speculation. I read this over a month ago, so I don't quite remember if he refers to non-Western-European sources or not. I vaguely feel like he referenced Chinese medicine, but confirmation would be welcome!

Things start to get more interesting when cancer is identified as a single disease, despite how it manifests in different parts of the body's systems. This new understanding of cancer went hand in hand with attempts to move forward on a cure, at least until some scientists and doctors began advocating more research on a practical level to find a cure and less "academic" research to understand how cancer works. Much of this narrative takes place in the US in the 1950s and 1960s.

I tend to enjoy pop science non-fiction, particularly when it comes to medicine, so I'm not sure how well this book works for people who dislike that genre. I do think the writing is particularly good, and I actually stayed up late into the night to finish reading the book, which is not something I usually say about non-fiction. Mukherjee is particularly good at tying together disparate research into a narrative, so that the place of radical masectomies in treatment to research on childhood leukemia to later research on DNA and retroviruses all contribute to the overall story. I felt like I understood most of his explanations, and I was very satisfied to get a better idea of just how cancer works and how there can be vaccinations for cervical cancer by the end of the book.

I also wish I had more Interesting Thoughts about how the cancer narrative and the AIDS narrative interweave; Mukherjee writes a bit on how AIDS research in the 1980s influenced cancer research and vice versa. I have a completely unsubstantiated thought about AIDS as a stigmatized disease, largely from watching Anna Deavere Smith's Let Me Down Easy, telling my sister about it, and having my sister ask, "How come no one talks about AIDS anymore?"

Which is where I go off and theorize that certain demographics now talk more about cancer than AIDS because cancer is largely a disease of age and aging—Mukherjee talks about how cancer rates have risen because of longer life expectancies and better health overall. On the other hand, I feel public perception of AIDS is that it's "someone else's" problem, not "ours," at least given extremely narrow definitions of "ours" that mesh closely with the demographics of populations with more power.

Anyway, back to the book. I really wanted to read more about issues of medical experimentation, human subjects, and consent and knowledge. Mukherjee writes about how AIDS activism for patient access to experimental treatments influenced cancer activism, and I feel like there's an entire book in there about access to treatment, who gets the experimental treatment and why, how treatments are proven safe for privileged bodies with underprivileged populations, and just how thorny and complex these issues are, particularly when they're around life-threatening diseases.

In conclusion: this is a fascinating write up of the personalities involved in cancer research, the main treatments and development thereof within the past century or so, and how our understanding of the disease itself has progressed. And it touches on activism around disease and how cancer started out as something no one talked about and evolved in the public consciousness so that we now have breast cancer walks and frequent magazine articles on the latest medical developments. And it's written in an extremely engaging, easy-to-read voice. (I'd love commentary on the flaws and virtues of Mukherjee's simplification for the lay reader.)

Highly recommended.

On a minor but amusing note, the library put the "Biography" sticker on the spine.

Links:
- rachelmanija's review

Comments

[sara]

I know that I have much more of a perception of cancer as a problem because about half the adults I know over sixty have had it, as opposed to one person I've ever known who was public about his AIDS diagnosis.

But then, every parental figure I've ever really respected has had a cancer diagnosis in the last three years, so I'm sure my perceptions are warped.

[oyceter]

*nods* Yeah, I have the same perception of cancer. And I also think some of that is due to what populations I know? Frex, I wasn't involved in the USian gay scene in the 80s, and people who were are probably much more affected, ditto not having lots of family in countries where AIDS is affecting a lot of people right now. But like I said, a lot of this is speculation on my part....

[via_ostiense]

having my sister ask, "How come no one talks about AIDS anymore?"

Is that true? My impression is that people do, or rather, I see a lot of advertising for the AIDS Walk and for >1. However, the plural of anecdote isn't data, so I'd be interested in hearing your thoughts on the topic.

[oyceter]

I think my anecdotal data is that I see a lot of stuff for AIDS Walk or the whole Product Red thing, but I feel like the advertising is more for AIDS as something that affects "other people" (aka, help Africa!). Whereas I have things like my mom getting on my case to get the cervical cancer vaccination and a bazillion different pieces of advice on how to live a more cancer-proof lifestyle and etc.

Like I said above, I feel a lot of this is because of what demographic I'm in... cancer's more of a concern because AIDS is much more easy to manage if you have money for drug cocktails, and I don't personally know many people who have HIV. I think I am completely randomly theorizing that AIDS is more perceived as "other people's problems" because the death toll is much higher on populations without access to drugs, who don't have much of a say in their own sexual safety, places without good blood screening programs, etc.

[via_ostiense]

I just realized that one reason that I think AIDS is still a topic of conversation is that in rape crisis training, it *was* a topic of conversation, and we covered HIV testing and prophylactic medication as part of the section on rape kits and medical services for survivors at SF General.

[oyceter]

*nods* That totally makes sense. Hrm. How do you think your rape crisis training conversations on AIDS and HIV compare with mainstream USian media's? (I am a very bad judge of media...)

[via_ostiense]

So, aside from people I know participating in >1 (and that person was a gay man, so he falls into the category of people that would be more attentive to HIV/AIDS than the general populace, despite actual rates of incidence) and advertisements for the AIDS Walk, when I think about it, the only conversations I've seen about AIDS were in training. I'm so out of touch with mainstream USian media that it's hard to say -- aside from google reader shares by friends interested in strictly medical/pharma news on the subject, I think the last mainstream discussion I saw was in Queer as Folk US and the S3-ish episode on House where a HIV-positive patient coughs blood into Cameron's face. o_O

In training, the discussion was more practically oriented, i.e. if callers are worried that they've been exposed to HIV, we should tell them that the rape treatment center at SFGH can provide free testing and a free course of prophylactic meds, and the usual active listening skills for listening to their concerns.

[oyceter]

Got it, thanks for the additional anecdotes!

[kore]

I think part of the reason AIDS doesn't get so much of the national media spotlight now is because a lot of treatments were discovered (not cures - treatments) and so it was no longer an automatic death sentence. That said, there was a lot of noise a few years back about a supposed cure for cancer Big Pharma wasn't touching because they couldn't patent it (and, duh, if it cures cancer, that person isn't a moneymaker anymore) but I don't know how good the science behind it was (this was the DCA stuff). And yeah, AIDS does tend to hit marginalized populations much harder.

[oyceter]

I think part of the reason AIDS doesn't get so much of the national media spotlight now is because a lot of treatments were discovered (not cures - treatments) and so it was no longer an automatic death sentence.

Oh, definitely agree! I think that's why it's not seen as much of a USian problem anymore? (At least judging from my completely personal impressions of media here.) A lot of what I see of AIDS now in the media is about Africa (It's all just one big country anyway! *rolls eyes*). Like, I think if you look at media in Botswana, frex, the proportion of media coverage of diseases is probably more skewed toward AIDS and HIV? I guess my speculation is that middle-class USians (het?) probably don't think of AIDS as much because there is much more access to drugs and etc., whereas if you don't have the access to drugs (and during the time there weren't generics), it was probably v. different?

[mercredigirl]

This is one of my favourite non-fiction books :)

[oyceter]

Yay! I really liked it too!!

[applegnat]

No, it hardly refers to any history or current treatments outside the US and UK. I think it's a superb book but hardly a comprehensive one: to be fair, Mukherjee doesn't really say it is.

[oyceter]

*nods* Thanks for the info! I don't think he says it is, but it also makes me wish that the subtitle of the book included something about it being the biography of cancer in the US and the UK. Ah well...

[jesse_the_k]

I love pop-science medicine books, so thanks a lot for this detailed review.

As far as research, consent, racism, and cancer go, I cannot recommend The Immortal Life of Henrietta Lacks too highly.

When the mainstream media no longer address matters of concern, why would we be watching?

[oyceter]

Hope you enjoy this, and thank you for the rec!!

And ahahaha re: mainstream media. Or: reasons why I am so out of touch with it....