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In Sickness And In Strength

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There is a new doctor in the literary world. And the prognosis is all good.  Atul Gawande and Abraham Verghese have some distinguished company. The Emperor Of All Maladies is an ambitious work aiming to be a biography of cancer, (going by its subtitle) by the accomplished cancer physician and researcher, Siddhartha Mukherjee.

The book, which won the Pulitzer Prize for Non-Fiction in 2011, is written brilliantly and traces the history of cancer from the times of the ancient Egyptians, almost four thousand years ago, to present day multi-drug chemotherapies combined with radiation and surgery. It provides ample illustration of the talent of its author who quotes and switches effortlessly from works as diverse as Lewis Carroll's Alice In Wonderland the writings of philosopher Karl Popper and Susan Sontag's Illness As Metaphor.

Mukherjee uses the backdrop of the case of one of his patients, Carla Reed to tell the tale of cancer from its earliest descriptions to those of the various personalities that dot its history over the last two centuries. The reader becomes a virtual tourist whose somewhat unsettling journey through the history of cancer is curated by the author. Not for a moment is the reader bored during the reading of this rather long commentary thanks to Mukherjee's well-chosen figures of speech; sometimes borrowed, sometimes original. Sample this, about Syphillis: One night with Venus, a thousand nights with mercury or the comparison of the remission from cancer to a bad trip to a foreign land.

The author's empathy for his patients as well as those engaged in the war on cancer is perhaps the hidden glue that holds the tale together. And his occasionally reckless enthusiasm, on display when he rushes to Maine to meet a cancer survivor from the 60s whom he has managed to trace after nearly a year and half's search, lends some much needed colour to his book.

The book is divided into six parts with a prologue and an epilogue. In the first part, Mukherjee discusses the history of cancer from ancient times to the uncertain but sometimes aggressive initial treatments in the late 19th and early 20th century including radical surgery led by the surgeon Halsted and the precursor to chemotherapy initiated by Sidney Farber, soon to be one of the central characters in the story. The second part is really where the book acquires its biographical tone, profiling numerous characters from the indefatigable Laskerites to the various researchers who each lent a hand to the battle against cancer. It is in the third section that Mukherjee details how the struggle against cancer is not straightforward and between the second and third section, it becomes clear, how most of the participants in the war on cancer, didn't really have a grip on their enemy. Against the backdrop of various efforts including a concerted campaign against tobacco, the author outlines how prevention has been one of the planks of resistance and advance against cancer. He elegantly describes the myriad issues confounding the medical profession not least of which are quirky mutations in the human body as well as cancer cells in the fifth section, which also marks the somewhat optimistic note that the book takes through to the sixth final section as he documents the numerous milestones in understanding the many-headed monster that is cancer. The change in tone of the comments by James Watson, (one half of the celebrated DNA duo) from 1969 to 2009, shifting from scepticism to cautious optimism on the progress in the combat against cancer underlines not only how much has changed, but also how much more needs to be done. As the author explains, using the landmark studies in the 1970s and 90s on the efficacy of various treatments, even interpreting the data is open to fervent debate.

The book is a must read for various reasons which may appeal differently to different audiences. The colourful characters who occupy the pages of the book: from the researcher who ended up stomaching a potentially lethal brew of germs when there was no alternative to legally testing his theory using patients to the dazzling statisticians, who found elegant solutions on more than occasion to research problems, are just one of the many reasons. While there have been other works on cancer in the past, perhaps none has been as non-partisan, with the author maintaining an almost invisible role in the entire narration. Of course, the book should perhaps become compulsory reading for anyone whose life has been confronted by cancer; be it a patient, doctor, medical student or researcher. For the sheer broad sweep of topics that Mukherjee has managed to cover, the book is a mandatory read for anyone who plans to study cancer in the future or perhaps, even just write a ‘biography' of that other scourge of humanity, AIDS, whose origins are briefly documented in this book as well. The author does pay some tribute to the activists against AIDS in the 80s and 90s whose relentless dogging of pharma companies and the authorities led to some much needed changes in the pharmaceutical world. One might just read the book for the simple reason that it is so magnificently written.

When one finally finishes Siddhartha Mukherjee's weighty tome, a quote which comes to mind to sum up his magnum opus is Walt Kelly's famous remark on an Earth Day poster in the 1970s, "We have met the enemy and he is us."