Ending the year on serious note

The Emperor of All Maladies, by Siddhartha Mukharjee.

Can a book about cancer really be compelling without being depressing? Um, yeah. The New York Times listed this book as one of the best of 2010, so I figured why not. An biography of cancer--what an intriguing concept. And Mukharjee does recount cancer from its earliest known roots to the present day. It is, as any biogrpahy must be, a recount of history. But more than any biography of a living person, it is the science behind a living cell in which something has gone terribly wrong. Mukharjee recounts the theories over time that have explained cancer, from black bile to the current understanding of a cell mutation. Not surprising, treatment has changed as understading has grown. On the other hand, as much as scientists have learned, there is still so much not known or understood about cancers.

Perhaps the most startling thing is how much of what is conventional knowledge now has been discovered only within my lifetime. For example, until the 1960s, the deforming radical mastectomy was fairly standard treatment for all breast cancers, even though there'd been little to no research to confirm its effectiveness or even its necessity. Indeed, many of the research methods that are fairly common-place have been in use for only a relativly short time. For example, one expects that a cancer diagnosis today means surgery, followed immediately by a cocktail of different chemotherapy drugs and/or radiation. As I learned when reading Death Be Not Proud, chemotherapy had its genesis in WW2 and the experience with mustard gas. But for many years, there was an ongoing rivalry and lack of cooperation between surgeons, whose hubris made them unwilling to consider any other form of treatment beyond surgery, and oncologists. Plus, until recently, different treatments were tried serially, moving to the next one when treatment failed (e.g. surgery, followed by one chemo drug, followed by another chemo drug, etc.) Only recently have scientists really grasped that there is no cure for cancer, but there will have to be many cures for many different cancers.

In short, what becomes abundantly clear is that cancer is daunting. According to the author, 1 in 3 women and 1 in 2 men will be diagnosed with cancer during their lifetimes. Gains have been made towards cure, but many people will still die after suffering through dibillitating treatment. But there is hope that with greater understanding of how cancer works, there will be other successes like Gleevic, used to put victims of chronic myeloma leukemia into permanent remission, and Herceptin, which cures those women with estrogen-dependent cancer.

It was a compelling book. I couldn't put it down.

Currently reading: Sense and Sensibility, by Jane Austen.