The immortal illness

by Rebecca Priestley / 07 April, 2011
Siddhartha Mukherjee’s The Emperor of All Maladies is a biography of cancer, “the defining plague of our generation”.


When Fanny Rosenow called the New York Times to place an announcement about a support group she was starting for survivors of breast cancer, the paper’s society editor said that was fine, but she couldn’t use the words “breast” or “cancer” in its pages. Perhaps she would like to call it a support group for sufferers of “diseases of the chest wall”? This was the 1950s: not only was cancer not mentioned in polite society, but the treatments were hit or miss and often brutal, and the causes of the disease were so poorly understood that many doctors, as well as tobacco companies, scoffed at suggestions smoking might cause lung cancer.

By the 1970s, it was okay to talk about cancer. One huge advance was the US National Cancer Act of 1971, which provided a US$1.5 billion budget for cancer research. The lobbying and campaigning that preceded the passing of the Act had broken the ice and cancer was talked about in government, in books like Alexander Solzhenitsyn’s Cancer Ward, in movies like Love Story and, at last, in newspapers. But all this focus on cancer, and some treatment breakthroughs, led to the expectation that the “cure for cancer” was just around the corner; that today we’d be living in a cancer-free world. Instead, as Siddhartha Mukherjee says in The Emperor of All Maladies, cancer is often described as “the defining plague of our generation”.

This book is Mukherjee’s “biography of cancer”, his attempt to “enter the mind of this immortal illness to understand its personality, to demystify its behaviour”. Given that introduction, I was expecting a book that was bigger and broader in its approach to the subject: instead, I found a huge chunk of the book is about chemotherapy and blinkered in its focus on the US. I don’t know enough about the topic to know what he’s missed, but a reference to early use of mammograms being confined to “the far peripheries of medicine” – meaning France and England – raised my eyebrows.

That gripe aside, this is a fine book, and Mukherjee worthy of a science writer’s jealousy: this Rhodes Scholar, Harvard-educated doctor manages to be an award-winning science writer while also working as an oncologist and assistant professor of medicine at Columbia University.

One of the book’s many richly drawn characters is chemist Sidney Farber, who in the 1940s was responsible for a breakthrough in cancer treatment, until then treated with surgery or radiotherapy, when he used an antifolate to force
childhood leukaemia into remission.

This was the first time a chemical drug had been used to treat cancer, and although the remissions were temporary, it made it possible to dream of a cure for cancer.

For decades, advances in chemotherapy were just a matter of finding another poison, or combination of poisons, that killed the cancer without killing the patient, but real advances in drug therapy came once cancer was better understood.

The discovery of oncogenes, genes that predispose a person to develop cancer, led to the first oncogene-targeted drugs – rather than being a general poison, they attacked only the cancer.

For some cancers, like chronic myeloid leukaemia or some forms of breast cancer, the prognosis – with the right treatment – is now so good as to say the diseases are curable. For other cancers, like some forms of pancreatic or gall bladder cancer, medical advances have done little to affect prognosis.

Mukherjee envisages no magic “cure for cancer” in the future, but sees our tools improving, particularly as we better understand the myriad different diseases that come under the banner of “cancer”. And although future physicians might laugh at our use of primitive cocktails of poisons to kill cancer cells, he sees much about the battle against cancer remaining the same, “the relentlessness, the inventiveness, the resilience, the queasy pivoting between defeatism and hope”.



THE EMPEROR OF ALL MALADIES: A BIOGRAPHY OF CANCER, by Siddhartha Mukherjee (Fourth Estate, $39.99).

Rebecca Priestley is the Listener’s science columnist.
MostReadArticlesCollectionWidget - Most Read - Used in articles
AdvertModule - Advert - M-Rec / Halfpage

Latest

The rate of technological change is now exceeding our ability to adapt
71303 2017-04-24 00:00:00Z Technology

The rate of technological change is now exceeding …

by Peter Griffin

A decade on from the revolution of 2007, the pace and rate of change are exceeding our capacity to adapt to new technologies.

Read more
Government tests electric limo for Crown fleet
71520 2017-04-24 00:00:00Z Technology

Government tests electric limo for Crown fleet

by Benedict Collins

An electric-hybrid limousine is being put through its paces to see whether it's up to the job of transporting politicians and VIPs around the country.

Read more
What growing antibiotic resistance means for livestock and the environment
71360 2017-04-23 00:00:00Z Social issues

What growing antibiotic resistance means for lives…

by Sally Blundell

Animals kept in close proximity, like battery chickens, are at risk of infectious disease outbreaks that require antibiotic use.

Read more
The little-known story of Ernest Rutherford's secret anti-submarine work in WWI
71418 2017-04-23 00:00:00Z History

The little-known story of Ernest Rutherford's secr…

by Frank Duffield

Famous for his work splitting the atom, Ernest Rutherford also distinguished himself in secret anti-submarine research that helped the Allies win WWI.

Read more
Book review: Larchfield by Polly Clark
71160 2017-04-23 00:00:00Z Books

Book review: Larchfield by Polly Clark

by Nicholas Reid

Poet WH Auden stars in time-hurdling novel – as a life coach to a lonely mum.

Read more
A Way with Words: Fiona Farrell
71329 2017-04-23 00:00:00Z Books

A Way with Words: Fiona Farrell

by Fiona Farrell

Do I have a routine? Yes indeed. Otherwise I’d never get anything done. I am very distractible. Suggest coffee and I’ll be there.

Read more
The blue zone: Kiwi workers' wage gap trap
71457 2017-04-23 00:00:00Z Economy

The blue zone: Kiwi workers' wage gap trap

by Virginia Larson

For blue-collar workers, the gap between the haves and the have-littles is widening.

Read more
Suitably predictable: Why we're attracted to a uniform
71366 2017-04-23 00:00:00Z Psychology

Suitably predictable: Why we're attracted to a uni…

by Marc Wilson

Why firefighters get the girl more often than the average bloke does.

Read more