The Emperor of All Maladies: Book Review

Dedicated scientists and suffering patients.  Passionate advocates and expert study groups.  Media reports of impending cures, calls for increased funding, and coordinated national efforts to fight disease.   

These are the ingredients of The Emperor of All Maladies: A Biography of Cancer.  In many ways, they are the ingredients of the Alzheimer’s story as well.

Although The Emperor of All Maladies is a page-turner, you already know how it ends.  Despite many dramatic and real scientific breakthroughs, there’s been only incremental progress in preventing and treating cancer after decades of all-out “war.”  The author, Siddhartha Mukherjee, a cancer physician and researcher, sums up the current situation this way:  “As the fraction of those affected by cancer creeps inexorably in some nations from one in four to one in three to one in two, cancer will, indeed, be the new normal – an inevitability.  The question then will not be if we encounter this immortal illness in our lives, but when.”

It’s hard to say how closely the path to Alzheimer’s prevention and treatment will parallel that of cancer.  But I think aspects of the “war on cancer” might be useful to consider as scientists, policy makers, media and the public participate in the fight against Alzheimer’s.    Of the many themes and stories in this book, three in particular could be viewed as cautionary tales for Alzheimer’s.

1.  A tendency to focus on the search for a cure, and to overlook care.  Dr. Mukherjee describes how work to provide palliative care (comfort and relief of symptoms) came to be seen as an admission of failure that contradicted the success stories in the media.   People who weren’t responding to treatments “had become the pariahs of oncology, unable to find any place in its rhetoric of battle and victory, and thus pushed, like useless, wounded soldiers, out of sight and mind,”  he writes.  He tells how the work of Cecily Saunders, a British physician who helped found the hospice movement, led to the inclusion of palliative care in cancer treatments.

2.  The perception of cancer as a single disease that would have a single cure.  “If the oncologists of the 1960s imagined a common cure for all forms of cancer, it was because they imagined a common disease called cancer,” explains Dr. Mukherjee.  “Curing one form, the belief ran, would inevitably lead to the cure of another, and so forth like a chain reaction, until the whole malignant edifice had crumbled like a set of dominoes.”  We now know that there are many kinds of cancer, and treatment is not “one size fits all.”

3.  The need to address cultural and environmental issues that contribute to cancer.  This social challenge is as urgent as the biological challenge, he writes, but just as difficult.  “It involves forcing ourselves to confront our customs, rituals and behaviors.  These, unfortunately, are not customs or behaviors that lie at the peripheries of our society or selves, but ones that lie at their definitional cores:  what we eat and drink, what we produce and exude into our environments, when we choose to reproduce, and how we age.”

Whether or not you think The Emperor of All Maladies contains lessons for Alzheimer’s research, it’s a great read.

Comments

[Danny]

Mona, thank you for this excellent summary, and for positing such relevant linkages with AD. It is amazing how "Alzhiemer's" can almost be interchanged with "cancer" in these instances.

[Richard Taylor]

hello, i'm just getting around to this post. this slip off my priority page into google mail cyber mail, and it takes a sleepless night for me to catch up. I read this book (as much as I can hold my attention to say I actually read a book), and your summary is mine only 1/10 as long as it would have taken me to do it.
You continue to amaze me. Thankyou for your tireless efforts to be an objective reporter of this highly subjective topic/world...Richard