The problem with radical surgery is that, despite its extreme disfigurement of patients, it doesn’t work. “’Radicalism’,” Mukherjee writes, “became a psychological obsession, burrowing its way deeply into cancer surgery.” He repeatedly remarks on their “hubris” and their zeal for what they proudly called “radical surgery,” which endeavors to cut out as much tissue as possible and which has, since the late nineteenth century, been associated with the American surgeon William Halsted. In fact, as a historian Mukherjee is rather hard on oncologic surgeons. And by page eighty he has all but dispensed with cancer surgery and radiation treatment.

There is no mention of alternative and complementary therapies, for example. Understandably, Mukherjee spends relatively little of his book discussing cancer treatments other than chemotherapy. He explains important scientific innovations using language that is accessible for most lay readers, though he occasionally does so with tedious detail. From Sidney Farber’s earliest experiments treating childhood leukemia with compounds developed in his basement laboratory in the late 1940’s, through recent developments in gene-based cancer therapy, Mukherjee conveys his passion for the subject while artfully weaving his narrative. Mukherjee is a cancer researcher and a medical oncologist (a physician who treats cancer with chemotherapy), and The Emperor of All Maladies is, more than anything else, a history of chemotherapy research. Siddhartha Mukherjee’s Pulitzer Prize winning book, The Emperor of All Maladies, does this too, though not always in the way its author intends. Instead, she wrote, “the most truthful way of regarding illness-and the healthiest way of being ill-is one most purified of, most resistant to, metaphoric thinking.” In seeking to liberate us from this way of thinking, Sontag illuminated something important about us, something that was there all along but that we might not otherwise have seen. But some metaphors-particularly those of battle, with the inevitable outcome of either triumph or failure-are harmful to those living with cancer. We employ metaphor, she noted, to express our prejudices toward cancer and toward those afflicted with the disease. In her landmark book, Illness as Metaphor, Susan Sontag decried the ubiquitous metaphors we use about cancer. In another era tuberculosis or leprosy might have ruled, but in its ability to evoke unmediated responses to our own mortality, cancer reigns supreme over the modern western world. No other disease seems as powerful in this regard. It betrays our most primal fears and leaves us vulnerable, embarrassed.

What is it about cancer that betrays us so? Like a heavy rain that washes the soil from a tree’s roots, cancer has a way of revealing our most basic and heretofore unexamined beliefs.

The emperor of all maladies book review