The Emperor of All Maladies: A Biography of Cancer (original 2010; edition 2010)

Excellent read. The topic coverage is very dense; there are a lot of dates that fly around; and there isn't a linear progression to the book. I came away from the book believing that there will never be a cure for cancer (as in the disease as a whole); but that doesn't mean there isn't hope. Some cancers are very treatable, others are not. ( )

A mammoth and ambitious undertaking and well worth reading. Parts are somewhat depressing and parts are enlightening. I also found the book pretty frightening because it confirmed what I have observed; that incredible progress has been made in just a few types of cancer. Researchers have pretty much figured out what causes a few kinds of cancer and have developed highly successful treatments for them. Those cases account for the cancer statistics getting better. There are also some cancers that can be put into remission for a while. But there are still some cancers that remain unexplained and incurable.

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I'm on page 355 with more than 100 pages to go. The book starts in ancient times and moves along more or less chronologically addressing different discoveries about, and treatments for, cancer. Leukemia was particularly interesting; lung cancer, not so much. Sometimes the author takes longer than necessary to tell about some discovery. I fell asleep twice during the lecture on DNA. On page 375 the clinicians and the biologists went to a dinner where they separated and talked among themselves. I can relate. I was very interested in the clinician part of the book and had a hard time following the biologist part of the book, even though I realize how significant their work is. The author describes the biologist's search for cancer genes "a slow, frustrating time" and that's how I felt about that part of the book.

On page 337 the author had gotten up to 2005 and then he flashed back to 1914 and I was like OH NO!

This book was recommended to me when it came out by the nurse who coordinates our cancer patients' support group at the hospital. I didn't get around to reading it until now. Probably because the last thing I want to read about is cancer. One of my chemo drugs is covered on page 203 and I can vouch for the author's total accuracy on that. I bought my barf bags in bulk.

I laughed at the hospital that put up wire mesh on the balcony to prevent their chemotherapy patients from jumping because my hospital was smart enough to put chemo on the ground floor.

On page 328 the author says "Another patient record, tracked back to its origin, belonged to a man -- obviously not a patient with breast cancer." Maybe there weren't supposed to be any men included in that study but certainly men can get breast cancer. The American Cancer Society statistics for 2013 say that about 2,240 new cases of breast cancer will be diagnosed in men and about 410 men will die from breast cancer. Admittedly, that's a drop in the bucket compared to the numbers for women but a man can still be a breast cancer patient.



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Review TK

Quotes:

Epigraph: Illness is the night-side of life, a more onerous citizenship. Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place. -Susan Sontag

Pierre and Marie [Curie]...had met at the Sorbonne and been drawn to each other because of a common interest in magnetism. (74)

Doctors are men who prescribe medicines of which they know little, to cure diseases of which they know less, in human beings of whom they know nothing. -Voltaire (143)

Every era casts illness in its own image. Society, like the ultimate psychosomatic patient, matches its medical afflictions to its psychological crises; when a disease touches such a visceral chord, it is often because that chord is already resonating. (182)

The search for magic bullets needed to begin with an understanding of cancer's magical targets. (210)

"We shall so poison the atmosphere of the first act that no one of decency shall want to see the play through to the end." -biologist James Watson, 1977 (223)

"The death rates from malaria, cholera, [etc.], and other scourges of the past have dwindled in the US because humankind has learned how to prevent these diseases....To put most of the effort into treatment is to deny all precedent." -biologist John Cairns (229)

"A causal relationship between heavy cigarette smoking and cancer of the lung is stronger that for the efficacy of vaccination against smallpox, which is only statistical." (Evarts Graham, c. 1956, 254)

The last cigarette commercial was broadcast on television on January 1, 1971. ("proportional airtime" clause, 266-267)

...old sins have long shadows, and carginogenic sins especially so. The lag time between tobacco exposure and lung cancer is nearly three decades... (272)

"You caused the health crisis; you pay for it." -Michael Moore. June 1998, Master Settlement Agreement (MSA) signed by states and tobacco companies (272-273)

Tobacco smoking is now a major preventable cause of death in both India and China. (273)

"All photographs are accurate, [but] none of them is the truth." -Richard Avedon (context: mammography screenings, 303)

"If a man die, it is because death / has first possessed his imagination." -William Carlos Williams (306)

"Like so many doctors, he spoke to us as if we were children but without the care that a sensible adult takes in choosing what words to use with a child." -David Rieff, Susan Sontag's son (306)

In an essay entitled A View from the Front Line, [Maggie Keswick] Jencks described her experience with cancer as like being woken up midflight on a jumbo jet and then thrown out with a parachute into a foreign landscape without a map... (329)

Retroviruses...shuttle constantly out of the cell's genome: RNA to DNA to RNA. During this cycling, they can pick up pieces of the cell's genes and carry them....Viruses did cause cancer, but they did so, typically, by tampering with genes that originate in cells. (362)

[He] epitomized the afterlife of cancer - eager to forget the clinic and its bleak rituals, like a bad trip to a foreign country. (400)

[T]he therapuetic advances that had led to the slow attrition of cancer mortality made no use of this novel biology of cancer. There was new science on one hand and old medicine on the other...."Our knowledge of...molecular defects in cancer has come from a dedicated twenty years of the best molecular biology research. Yet this information does not translate to any effective treatments not to any understanding of why many of the current treatments succeed or why others fail. It is a frustrating time." (cancer geneticist Ed Harlow in 1994, 403)

"Cancer is complicated, everyone kept telling me patronizingly - as if I had suggested that it was not complicated." (Brian Druker, 435)

446-447?

Normal cells are identically normal; malignant cells become unhappily malignant in unique ways. (echo of first sentence of Tolstoy's Anna Karenina: "Happy families are all alike; every unhappy family is unhappy in its own way." p. 452)

One of the most provocative examples of a cancer cell's behavior, inexplicable by the activation of any single gene or pathway, is its immortality. (comparison to stem cells; 458)

Science embodies the human desire to understand nature; technology couples that desire with the ambition to control nature. These are related impulses - one might seek to understand nature in order to control it - but the drive to intervene is unique to technology. (462)

"There are far more good historians than there are good prophets," [NCI director Richard] Klausner wrote [in 1997]. "It is extraordinarily difficult to predict scientific discovery, which is often propelled by seminal insights coming from unexpected directions." (465-466)

History repeats, but science reverberates. (466)




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Mukherjee spent nearly 7 years researching, compiling and writing this biography of cancer. While he was in medical school. Say what? Dude, apparently, wasn't busy enough.

This book is stellar. We are given a detailed history of the disease, but also of the research and the doctors and scientists who have spent their lives trying to understand cancer and find a cure. Interspersed, we are introduced to patients - both those who lived and those whose malignancies were just too fierce. Mukherjee manages to distill complex information into a format that not just readable, but un-put-down-able and humane.

This is one of those books everyone should read. ( )

This book took me over a year to read. I kept it on the kitchen counter and as the left-hand page pile got bigger there was me standing on the right, getting smaller. It was my diet book. A couple of pages and a pound or so every week. What I was doing was either boiling the kettle or making my own concoction of a fat and cholesterol-busting mousse* that involved just holding an immersion whisk for a couple of minutes. I have such a low threshold for boredom I had to do something, so I read Emperor of All Maladies.

I had previously tried to read the book in the proper way but failed. It is very heavy and not all of it is equally fascinating, but it all hangs together in the end and has given me a proper education in genes, dna, mutations, what cancer actually is and why it has been so impossible to find a panacea.

It's a bit like fighting a guerrilla war. You can only defeat the insurgents where you find them and where you think they might be. It might seem as if all the rogue cells have been annhilated. But if you didn't find them or one is high in the hills watching, or there are reinforcements coming from abroad in the next few months, then the battle will resume as soon as numbers have built up and the enemy is attacking once again. That is not to say there aren't victories, but they are victories of battles, not of the war, but the war against cancer is one from which we can never withdraw.

One thing struck me that was full of hope, was Mukherjee was talking about a previously rare cancer that is now quite common. It might be assumed that the cancer itself is on the upsurge, but no, it was rare because people died from it, now they live with it, so just like AIDS, it is no longer a killer but a chronic disease.

7-star book. 8 even... it was that good.

*Recipe *
1/8 tsp of xanthan gum (negligble calories, lots of soluble fibre) whisked at high, long and boring speed into 1/4 cup of skim milk (21 cals) until thick like a meringue.

Add another 1/8 tsp of xantham gum and whisk more. Add flavouring and sweetener - yoghurt, apple sauce, mashed banana, sugar-free kool aid (makes the texture chunky, very odd) or for an ersatz cay lime pie, some lime juice. Not chocolate, dissolves the whole thing.

For chocolate mousse, 2 tsps of cocoa powder (20 cals and has soluble fibre) to some sugar-free syrup (10 cals) and stir. This is very nice with a bit of ginger and cinnamon added and pour over vanilla-flavoured mousse.

Xantham gum remains bulky in your stomach and fills you up for a short while, but 1 and a half cups of a fluffy mousse are a nice ending to a diet meal as it can be under 25 cals (and then I can have another one and read some more Emperor of All Maladies.

(I lost 55lb and 30 points off my cholesterol.



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