Saturday, July 9, 2011

The Emperor of All Maladies, by Siddhartha Mukherjee

The Emperor of All Maladies: A Biography of Cancer, by Siddhartha Mukherjee.  Scribner, 2010.  571 pp.  978-1-4391-0795-9.

... in which we learn of the history of oncology.

This book was one of the most highly praised non-fiction works of 2010; it made numerous top ten lists made by respectable sources, and its author went home with the 2010 Pulitzer Prize for non fiction.  As such, I went in with high expectations.

Written by a doctor who is both a practicing oncologist and a cancer researcher, the book has two separate narratives woven together.  The dominant thread is the story of how scientists' understanding of cancer has evolved.  Beginning with the ancient Egyptians, and moving through time all the way up to current medical practices, Mukherjee does a nice job of showing not only how oncology has evolved, but also how medicine as a whole has changed in the last 4000 years.  In some parts, he focuses on the people who were behind each breakthrough or new practice, and in other parts, he focuses on the science itself.  I haven't had any classes remotely resembling molecular or cell biology since I was in high school, but I found the science parts to be really clearly laid out for readers who are not biologists or doctors by training.

The second thread involves Mukherjee's own patients.  Stories of them are woven into the main narrative, showing how some of them have benefited hugely from centuries of dedicated research, and how scientific knowledge has fallen short for other patients.  Human anecdotes are usually easier reading than scientific history, and in this case, Mukherjee's personal recollections did a nice job of breaking up the long science passages and reminding the reader of the reason for all of the work on the part of scientists and researchers.

Probably the biggest piece of praise I have for the book is related to its accessibility.  Very rarely does Mukherjee assume that the reader knows the definition of a word from biology or medicine; he does a really excellent job of explaining without talking down to the reader.  His explanations of the basics of DNA, cell biology, etc don't interrupt the flow of his story telling, as he works these explanations seamlessly into whatever part of history he is explaining.

The level of detail in this book is astounding.  The last 100 pages or so are taken up by bibliographic notes and the index, which demonstrates how much research went into the creation of this book.  Mukherjee really left no stone unturned when it came to details, leaving me with the feeling that I was really there looking over the scientists' shoulders as they did their work.  In some parts, this detail bordered on the gruesome (particularly in the descriptions of early radical mastectomies), but usually the details worked in the book's favor.

Despite the accessibility of the book, parts of it do feel pretty dry.  For the most part, Mukherjee keeps the story going at a good pace, but every now and then the book gets caught up in long passages about a particular gene or a particular old scientist.  At first when I started reading this book, I thought it could have benefited from more of the personal anecdotes from Mukherjee's years as a practicing physician, since these anecdotes gave the book a bit more life and more of a personal feel.  Further into the book, however, I was convinced that the sparseness of these stories was probably a good thing.  The subtitle of the book is "A Biography of Cancer", so the book isn't intended to be a memoir of the author's professional experiences.  In the end, I thought the author did a pretty good job of keeping the book from feeling too dry and dull.

My biggest complaint is probably that the book is a little too long.  Because some of the subject matter is a little on the dense side, and because it's such a heavy, serious topic, it's not a fast read, though for the most part it's a very interesting read.  Unless you're a doctor or biologist by training, or if you have a really keen interest in the topic, I'd recommend having something else on the side to read when you feel like reading something light.

4/5 stars

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