March 28, 2020
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The Epic Of Malignancy

A US-based physician tackles the fecund life of one of our bitterest enemies with lyricism, insight and rigour

The Epic Of Malignancy
Jitender Gupta
The Epic Of Malignancy
The Emperor Of All Maladies: A Biography Of Cancer
By Siddhartha Mukherjee
Fourth Estate\HarperCollins | Pages: 592 | Rs. 499

In many ways, the opposite of life is not death, but cancer. Death is after all an event, singular in its occurrence and emphatic in its finality. The process of living, of building our bodies from tiny seeds, and of using an intricate network of complex systems to stay alive, is perhaps most graphically mirrored by cancer. Arising from within it turns the idea of life against itself, in dizzyingly varied ways, using the power of evolution to stay one step ahead of our attempts to still its inexorably malignant journey, eventually overwhelming us with its seeming omniscience. Siddhartha Mukherjee’s book is an epic attempt to tell the story of this “expansionist disease” that “invades through tissues, sets up colonies in hostile landscapes, seeking ‘sanctuary’ in one organ and then immigrating to another”. Tracing its journey from its earliest mention in the writings of Imhotep, an Egyptian physician, dated around 2500 BC, to the modern understanding of the process by which ‘accelerator’ oncogenes interact with ‘brakes’ tumour suppressants, the story of cancer is, in Mukherjee’s hands, a deeply engrossing tale of the dogged human pursuit to name, discern, document and fight a bare-knuckled war against an enemy that knows us too well.

While the book may not exactly be a biography of cancer as the title claims, for that might well be a project too ambitious to attempt and too tedious to read about, it is much more than a mere history of the ailment. Interwoven in the story of the search for a cure lie at least three compelling narratives: a rich description of the larger ecosystem in which this quest operated—the clinicians and researchers, hospitals, governments, advocacy groups and pharmaceutical companies; intimate stories of individual patients that cover the spectrum of emotions from heartbreak to quiet, burning hope; and, in the most beautifully written part of the book, an understanding of the idea of cancer, a peep into the soul of this dark cousin of life.

The heart of the book, the story of the relentless search for a cure, reads like a detective saga without an ending, full of episodic victories but without a grand denouement, as it details the advances and the setbacks, the inspirational leaps and near-misses, the false hopes and fortunate serendipities that mark this journey. Particularly interesting are the stories of how two of the world’s most powerful anti-cancer drugs, Herceptin and Gleevec, almost did not make it because of insufficient support from the companies that were developing them. There are many protagonists in this quest, but the two that serve as the pivot for the book are the unlikely pair of Sydney Farber and Mary Lasker, the former a doctor who was the first to convert the dream of an anti-cancer chemical into reality with his use of antifolates, and the latter a socialite who teamed up with Farber to bring cancer on the top of public agenda. There are many others—William Halsted, remembered today for his advocacy of radical mastectomy, an influence that has taken years to wear off; Emil Frei and Emil Friereich, who pioneered the combination drug therapy for leukemia; Richard Doll, whose work on the effect of smoking on lung cancer marked the beginning of anti-tobacco activism;  George Papanicolaou, the discoverer of the pap smear; and Dennis Slamon, the prime mover behind Herceptin, the first drug that worked by inactivating oncogenes, to name a few.

For the most part, Mukherjee pulls off an almost impossible task he has set himself—he writes beautifully and explains the technical bits with clarity. He manages to keep a tight grip on the narrative, in spite of its vast scope. There are times when science slips into poetry, and storytelling into profound human insight. There are some quibbles—the book drags a bit in the second, partly because he diverges into surrounding terrain, such as the arrival of aids, with a little too much detail. The bits about the genetics of cancer get a little too technical for the lay reader and a surfeit of detail clouds the bigger picture.

The book begins with and follows the story of Carla Reed, a patient of Mukherjee, who is diagnosed with leukemia and succeeds in taming the disease. Perhaps fittingly, it ends with the tale of Germaine Berne, who, after apparently beating a gastrointestinal stromal cancer, succumbed to it, embracing death with grace. For all the advances made in our understanding of cancer, there is something about it that poses a fundamental philosophical challenge to the idea of life itself. Mukherjee takes us through the heart of this darkness into some light, but it is clear that it is not day yet.

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