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I like big books.

The Emperor of All Maladies: A Biography of Cancer

The Emperor of All Maladies: A Biography of Cancer - Siddhartha Mukherjee Mukherjee is incredibly well read and like all great science communicators seems to have an endless ability to connect highly technical subjects to cultural, social and historical issues to ground us in the familiar. The Emperor of All Maladies is a pretty epic journey through the history of a disease - cancer personified as the adversary and obstacle to the perpetual human dream of immortality. Along the way Mukherjee masterfully draws in supporting characters and narrates a litany of discoveries and set backs that place the reader in the room of great and base scientists and doctors alike. Patient, handholding, he manages to explain and demystify for the lay reader, making highly complicated genetic science accessible. Sometimes this goes a bit too far and the book borders on the repetitious, especially in latter chapters, but if reading Maladies at a stretch, the reminders could be helpful.

The most interesting parts of the book to me were the social and cultural aspects of medicine explored throughout the book. Frequent references to Susan Sontag's Illness as Metaphor are insightful explications about why certain diseases capture the imagination of certain ages. Western preoccupation with tuberculosis, or consumption, in the 19th century as a disease of wasting, its ties to the mechanical age and the byproducts of mechanization are all enlightening and put disease in a historical context that, as a historian, I found enlightening - a new angle and lens through which to view history and the actions of human beings. As an example of such elucidation:

"There is, in retrospect, something performed in that magnification, a deeper resonance - as if cancer had struck the raw strings of anxiety already vibrating in the public psyche. When a disease insinuates itself so potently into the imagination of an era, it is often because it impinges on a n anxiety latent within that imagination. AIDS loomed so large on the 1980s in part because this was a generation inherently haunted by its sexuality and freedom; SARS set off a panic about global spread and contagion at a time when globalism and social contagion were issues simmering nervously in the West. 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."

Such powerful and fresh analysis is enough to warrant a five star review in my opinion, but there are a few things I'd have liked to see that never really materialized in the fullest. The biggest oversight: a richer and more nuanced discussion of the roll big pharma and insurance companies play in the delivery of treatment historically and how the delivery of treatment and its accessibility has changed over the past two centuries. There was indeed some discussion of insurance and affordability, but it was a localized example tangential to the main story of the development of a drug. There was rich potential to delve into some type of judgment or casework about the efficacy of insurance programs, whether hinderances or proponents in the delivery of drugs, but perhaps that would have lent a political air to the book he was trying to avoid. After all, the goal was a biography of Cancer, not advocacy so maybe I'm guilty of wanting the book to be something other than what it professes to be. Still, there are, on occasion, segments of narration that tended to carry value judgments about accessibility - subtle, like they were trying to be covered or avoided, but still present.

Anyway, all in all, worth your time. I feel like what I knew about cancer turned out to be not much at all and with life-spans increasing, the natural tendency among the American population will be toward higher rates of cancer incidence - it's a byproduct of longevity that it gives our genes more time to mutate. But even so, the future is not completely bleak. While we really haven't made significant progress toward a universal cure, changing expectations around intervention and treatment have made the disease livable, which, in the author's opinion is a monumental advance nut just over the previous century, but over the previous three decades. Chances are we all know someone afflicted with some form of this disease. Do yourself a favor and open a window upon their world. This is as good a place to start as any.