The Emperor of All Maladies
by Siddhartha Mukherjee

A river sifting and winding backwards, into the history and the unglamourous cruft of cancer treatment. This non-fiction novel chronicles a journey on how we’ve developed cancer medicine.

Each chapter starts with a litany of quotes cited from literature and news. Some chapters expound on the emotional impact that a cancer diagnosis brings upon individuals, while others analyze societal forces that accelerate or impede research for cures.

An oncologist viewpoint brings into consideration many details that a non-expert would miss. Tools of the trade, types of treatment philosophies, a label for a research methodology, and anecdotes of how collaboration and communication among scientists can become a turbulent contest fraught with human weakness and human ingenuity.

I find it hilarious that, if you take what doctors say out of context, they really do sound like mystical priests:

…a young oncologist, drunk with the arrogance of power, personifies the divide as he spouts out lists of nonsensical drugs and combinations… “Hexamethophosphacil with Vinplatin to potentiate. Hex at three hundred mg per meter squared. Vin at one hundred. Today is cycle two, day three. Both cycles at the full dose.”

Finally, Mukherjee includes an observation on the power of the “network effect” as it relates to smoking and to genetic mutations which cumulate into cancer:

When the epidemiologists juxtaposed smoking behavior onto this network and followed the pattern of smoking over decades, a notable phenomenon emerged: circles of relationships were found to be more powerful predictors of the dynamics of smoking than nearly any other factor.

The book starts to drag near Part 4 when it talks about lobbying for clinical trials, patient activism, implications of genetic engineering, and post-1980 modern attitudes and speculation of our present and future. These are territories that none of us, not Mukherjee, can describe confidently, but I don’t blame him for trying.

I liked how the final part, “Atossa’s War,” summarizes the book by casting Atossa, an Achaemenid queen, as a time traveler, and the author ends the saga with anachronism.

Overall, considering the subject matter, the book was smooth. Not a breezy read; it took me 2-3 months to finish. Sometimes the recollections and stories plod slowly, and the author loves name dropping. The prose is clear enough for a layperson. If you want to dip into the Styx River, pick up this book.

Fun Stats

Word Count: 212000
Average Readability (US Grade Level): 12
Percent dialogue: 9.89%