Emperor of All Maladies

2012-06-06 01:37:14

Last week, I finished reading the outstanding Siddhartha Mukherjee book The Emperor of All Maladies: A Biography of Cancer. This was a New York Times top 10 book for 2010, and it won the 2011 Pulitzer Prize for general nonfiction. Mukherjee is an oncologist at Columbia University, and he frames his history of efforts to cure cancer with his own experiences as physician. He tells many fascinating stories, from the earliest medical description of cancer (by the ancient Egyptian Imhotep, writing 4,600 years ago, who indicated that there is no treatment for the disease), to recent discoveries of drugs that target specific genetic defects underlying cancer and which are capable of switching off certain cancers indefinitely.

One of these new drugs is Gleevec, which targets a certain kind of leukemia. Several years ago, I met a young fellow in Portland who was on this drug, who seemed to be completely healthy. I was fascinated to read Mukherjee's account of the discovery of the drug; it turns out it was tested in Portland. One curious effect of Gleevec is that it will result in a substantial increase in the number of people living with this kind of leukemia, because it will extend life expectancies in patients from 30 months to 30 years. Mukherjee reports that the drug's discoverer, Brian Drucker, jokes that "he has achieved the perfect inversion of the goals of cancer medicine: his drug has increased the prevalence of cancer in the world."

Other interesting stories Mukherjee tells include the origins of the American Cancer Society and the first high-profile fund-raising campaigns against cancer; in the 1950s, a pioneering childhood leukemia clinic was funded by a campaign whose poster child was named Jimmy.

Mukherjee also describes the work in the 1950s to show that cigarettes cause lung cancer; he gives a crystal clear explanation of the statistical difficulties in doing this (most adults smoked in that era). He also sketches the efforts of the tobacco companies to hide the dangers from their products.

Much of the book is grim and unsettling. But it is deeply fascinating, and it ends on a hopeful note, describing the "fruits of long endeavors," and the survival against long odds of certain of his own patients. Mukherjee mentions that it was learned in the late 1990s that 'Jimmy' was still alive, living quietly in Maine.