Friday, May 11, 2012

Siddhartha Mukerjee: The Emperor of All Maladies

Best read when neither you nor anyone close to you has cancer, and so you can enjoy the story dispassionately, this is really good read. If only it were fiction. It's a biography of an enemy, its first appearances, its identification, and then the millennia-long human quest to find ways to kill it -- a story of knife-attacks, poisoning, irradiation, prevention, and now the subtle mapping of proteins and pathways in the cell, and the design of exquisitely shaped molecules to block them.

It's also a human story of politics, hubris, self-experimentation, and luck, all lashed into a froth by the deadly urgency of the task.

The author, himself a cancer doctor who clearly rides the rough road alongside his patients, left me with two conclusions.

First, like driving terrorists out of a city, cancer is being pushed back, block by block, though with many casualties. Survival rates increased by one percent per year for many years from the mid-1990s. No magic bullet here, then, just the patient accumulation of fine medicine.

Second, though, cancer does what living things do: multiply, mutate, adapt, innovate, fight on, refuse to die. Its strengths are life's strengths. In cancer, it's as if our own life-force slips its bonds and turns on us. Surveying current medical horizons, this book suggests that we may largely conquer cancer in the sense that perhaps one day few people will die young of it; but it will conquer us in that, in old age, even when everything else can be healed, it will be waiting for us.

My only criticism? One gets the impression that only in the United States has anyone fought cancer at all, with that collectivity of wusses known as 'Europe' just throwing in some not-much-needed logistical help now and again -- rather like the Iraq war.

Pulitzer prizes (unlike, in my view, many other prizes) are a reliable indicator of a good book. This super book puts all the dread things we see when people enter cancer wards--the chemo, the surgery, the remissions --into their proper places within a coherent, constantly interesting and rather gripping account.