By Chet Yarbrough
The Emperor of All Maladies, A Biography of Cancer
By Siddhartha Mukherjee
Narrated by Fred Sanders
Dr. Siddhartha Mukherjee examines the history of cancer in “The Emperor of All Maladies”.
The Centers for Disease Control and Prevention reports heart disease and cancer are the two leading medical causes of death.
At first glance, one thinks–so what? We are living longer, and everyone dies of something. However, Mukherjee notes a study showing cancer deaths are rising: i.e. they decrease in one age group only to be offset by increase in another. The net effect is a rising number of cancer cases.
In researching the history of cancer, Mukherjee exposes the arrogance of medical specialization. Mukherjee shows early attempts to cure cancer were led by surgeons who removed cancerous growth.
“The Emperor of All Maladies” reminds one of the saying—”To a hammer, everything is a nail”.
Cancer is a slippery killer. The hammer, in the early days of treatment, is a scalpel wielded by surgeons who cut deeper and deeper into the body until the patient is physically disabled, in limited remission, or laboring toward death. The surgeon believes he has removed the cancer only to find it returns in weeks or months later.
Surgery works but the scalpel is a hammer that only works when cancer is localized and non-systemic.
The next specialty is radiation. Here the physician replaces the scalpel with focused radiation; another hammer. Radiation cannot kill systemic cancer without killing or diminishing a patient’s health.
Next up is the internal medicine specialist, the oncologist. This specialty argues that cancer can best be treated with designer drugs to specifically attack or starve cancer cells. The problem is medicines that kill cancer cells are generally toxic; i.e. they kill both good and bad cells.
The final specialization is immunotherapy which ranges from bone marrow and blood antigen enhancement to bone marrow transplantation. The purpose of immunotherapy is to make the body more resistant to cancer cell growth.
Though each specialization advances cancer remission, specialists lauded their own treatments and ignored each other’s accomplishments.
Specialists were historically proprietary about their treatments. Some went so far as to distort their results with false clinical studies. They felt their treatment was the best way of attacking “The Emperor of All Maladies”.
Specialists exclusively pursue their singular research, treatment, and reporting until a few physicians argued all disciplines should be enlisted to cure cancer.
The cure begins with physician attention and empathy for the patient. Mukherjee infers cancer therapy is not for physician self-congratulation. Hubris is a failing in physicians; just as it is in all human endeavors. Cancer is an eternal war. It changes with the environment and life’s evolutionary laws.
Mukherjee’s history explains how the chain of discovery for a cancer cure can be broken at different levels.
There is physician self-delusion about how effective their treatment is for cancer. There is the integrity of research studies and how they are conducted. There is industry and government support of industrial waste production that is proven to be carcinogenic.
The door is opened to interdisciplinary research by philanthropists who created foundations to clinically study causes and cures for cancer. Mukherjee addresses the continuing need for funding to expand cancer research. He is not Pollyannaish about the need. He acknowledges cancer research is not going to be like America’s race to the moon in the 1960s. There is no definitive goal. The goal is not fixed like a mission to Mars. Cancer’s etiology evolves. It is unlikely for there to be a single-bullet solution that will cure cancer.
Mukherjee expands on the difficulty in curing cancer because of capitalist resistance to scientific research, and discovery.
Mukherjee recalls the battle with the cigarette industry when research clearly shows a correlation between cancer and smoking. The cigarette industry lies to the public about their own studies correlating lung cancer with smoking.
Cigarette industry lobbyists influence legislation that delays concerted action by the government to curb the addictive characteristics of smoking. Money talks, cancer proliferates. (This reminds one of the gun lobby and their insistence that guns designed only to kill people are a right that should not be infringed upon. Though gun use may not be addictive, there is a distinct correlation between the number of deaths in one incident and the proliferation of fully automatic weapons designed only to kill people.)
Mukherjee also recounts the incidence of cancer in England for chimney sweeps that inhaled carbon and asbestos from cleaning chimneys. Today’s confrontations are carbon, other cariogenic, and environmental contaminants created by industry.
The National Institute of Health reports an estimated 1,735,350 new cancers will be diagnosed in the United States in 2018. Of that number, 609,650 will die. Worldwide, NIH reports 14.1 million new cases were identified in 2012. 8.2 million died. The only killer more prolific than cancer is heart disease, and only by a small margin (In 2009, the CDC reports 610,000 people die every year from heart disease.)
Mukherjee implies all physicians need to step back, abandon their professional bias, and pursue treatments that are based on scientific research, symptoms, and reports of their patients.
Physicians need to listen, do no harm, and when necessary, offer palliative treatment—until, hopefully, a lasting cure is found.
Cancer research and experimentation is costly. Mukherjee’s history shows the weakness and strength of capitalism and human nature in supporting what humanity needs to defeat cancer. His history should be required reading; particularly for physicians, and researchers, but also for the general public.