The day cancer whisper stopped
Fat and fabulous — that is how I would describe The Emperor of All Maladies. At 470 pages (excluding the acknowledgements, notes, glossary etc), this “Biography of Cancer” is certainly not easy, light-hearted, bedside reading. But even those who pick it up with trepidation, like this reviewer, soon join author Siddhartha Mukherjee in
viewing cancer not merely as a disease but as something that envelops our lives fully and becomes an alter-personality. The trick is in the style. Mukherjee is part of that growing, glowing tradition of doctor-writers who approach medicine as a storyteller. Think Anton Chekhov, W. Somerset Maugham, Arthur Conan Doyle and, in recent times, Abraham Verghese, Atul Gawande, the last two with an India-connection like Mukherjee.
Delhi-born Mukherjee started writing the book in 2004 when he was a cancer doctor in training in Boston, US. He was inspired by a single episode. A woman he was treating for a kind of stomach cancer asked, “Where are we going?” Her question was a small question about her prognosis but it set the doctor thinking. “I could not point her to a book, a magazine or a website which would answer her question on where we are going in the war against cancer in the full, longitudinal sense”, he admitted in one of his interviews.
That was the starting point. It spurred the oncologist to delve into the etymology, history, sociology, as well as the politics and pain affecting cancer crusaders waging the long battle against the disease. In his book he stitches together a wealth of this sort of information with his own experience with patients.
The result is as much a history of cancer as about the future of cancer. The story of cancer, as told by Mukherjee, is set mostly in the Western world but it should be of interest equally to Indian readers. Cancer today not only accounts for 12 per cent of deaths throughout the world, it has become one of the 10 leading causes of death in India.
The two characters who thread the book are Sidney Farber, the father of modern chemotherapy, and Mary Lasker, a Manhattan socialite of legendary energy. Farber was a pathologist in a children’s hospital who stumbled upon a vitamin analogue which became one of the main chemotherapeutic drugs against cancer. Farber teamed up with Lasker, who became politically involved in launching the war against cancer. The story of the incredible collaboration between the two and the sense of common purpose and coordination that galvanised the Laskerites who wanted something akin to a Manhattan Project for cancer makes for a gripping read.
For instance, we learn how US astronauts landing on the moon marked a turning point in the cancer crusade. “The cancer crusaders could not have asked for a more exuberant vindication for their own project. Here was another ‘programmatic’ effort — planned, targeted, goal-oriented, and intensely focused — that had delivered its results in record time”, writes Mukherjee.
The book takes us through that exciting moment when Laskerites, transfixed in front of their flickering television sets in Boston, Washington and New York on the evening of the moon landing (July 20, 1969), picked up their cue. The Laskerites in fact coined a phrase to describe this. They called it a “moon shot” for cancer.
And so “on December 9, 1969, on a chilly Sunday morning, a full-page advertisement appeared in the Washington Post”. Richard Nixon was then the President of the United States and the advertisement was pitched straight at him. “Mr Nixon, you can cure cancer… More than 3,18,000 Americans died of cancer last year. This year, Mr President, you have it in your power to begin to end this curse. As you agonise over the Budget, we beg you to remember the agony of those 3,18,000 Americans. And their families…” The advertisement also ran in the New York Times subsequently and marked a seminal intersection in the history of cancer, Mukherjee points out.
That was a game-changer. Cancer was no longer something people whispered about. There was cancer in newspapers, cancer in books, cancer in theatre, and in films, such as Love Story, a 1970 film about a 24-year-old woman who dies of leukaemia and so on. The book shows how Lasker’s goal-driven, aggressive crusade influenced Nixon and eventually led to the creation of a “Panel of Consultants” to advise the US President on how to combat cancer. Politics, science, medicine and finance were thus melded together to craft a national response. The panel came out with its report in the winter of 1970. Its most significant recommendation was an independent cancer agency — something like the Nasa for cancer. Nixon finally signed the idea into law with the National Cancer Act in 1971, authorising the spending of $1.5 billion of research funds over the next three years.
There are many other strands and tales as Mukherjee moves back and forth between timelines, ramping up dramatic energy as the reader is taken on a roller coaster ride through advances in cancer therapeutics, molecular biochemistry, genetics etc and is desperate to find out whether Carla Reed, his patient, will survive.
This reviewer is not going to be a spoilsport and reveal the fate of Carla. But when you have reached the last page, you realise the truth of the Red Queen’s maxim in Lewis Carroll’s Through the Looking Glass — “It takes all the running you can do, to keep in the same place”.
The battle against cancer is long, historic and iconic. Scientists are still trying to get it right. We know so much more about it than we did 100, or even 10 years ago, but there is so much that is unknown. As Mukherjee says, it is only by engaging every single force that we have with us will we be able to cure cancer or, at least, find a way to control the emperor of all maladies.
Patralekha Chatterjee writes on development issues in India and emerging economies and can be reached at firstname.lastname@example.org