Siddharta Mukherjee on the Emperor of All Maladies

Siddharta Mukherjee is a cancer researcher, a physician and the author of the upcoming book The Emperor of All Maladies: A Biography of Cancer. A Rhodes scholar who teaches and practices at Columbia University, Mukherjee is often asked why he wrote this particular book. He’s explanation begins with the story of a single patient of his who had an especially aggressive form of abdominal cancer. She had been undergoing various intense treatments and at one point told Mukherjee that she was willing to go on with the treatments, but asked him “What is it that I am fighting?” He didn’t have a good answer for her and nor were there any existing resources to refer her to. He wondered: how old is cancer? When did it begin? How did we get to this moment in time with cancer and where are we going?

Siddharta Mukherjee

The stark reality of cancer is that 600,000 Americans and 7 million humans globally will die of cancer in 2010. One out of every three women and one out of every two men will develop cancer in their lifetime: cancer will cause 1/4 of all American deaths. But all of the books Mukherjee could find were about cancer prevention, not history. He wrote the book, he said, “because it was not there”.

The book, which he describes as a biography, features a main character named Sidney Farber. Farber was a scientist known as “the doctor of the dead” at a Boston hospital. As a pathologist, he saw only the bodies of dead children. But in 1947, he grew more interested in trying to treat them. He became specifically interested in leukemia, since it was a disease that could be tracked by following blood samples of patients.

Another character in the story is Lucy Mills, who was studying anemia and pregnancy. She noted in her research that anemic pregnant women who ate the thick brown spread known as Marmite seemed to recover. Chemists following her work broke Marmite down and discovered that it contained folic acid.

Could an anti-folic acid drug help block the growth of cancer? One chemist began treating children with an anti-folic acid. Scientist Farber eventually found a critical ally in Mary Lasker, who was known as “The fairy godmother of biomedical research”. An independently wealthy entrepreneur, she teamed up with Farber to help put cancer research on the map and even began putting pressure on President Nixon to help find a cure for cancer.

Mukherjee became obsessed with finding the first child who had been treated with the anti-folic drug. Initially, he knew the child only as “RS” and that he was a two and a half year old living in 1948 in Boston. He was also a twin. Mukherjee began searching for this child’s history and through serendipity, connected with the biographer of the chemist while he was traveling in India. The biography had a roster of all the patients who had been treated, including the formerly mysterious RS, who turned out to be a child named Robert Sandler. Shortly after learning this patient’s name, he found his entire family history and even located the house where he had lived.

Mukherjee showed a chart to the audience that displayed how the number of cancer deaths is still rising due to the aging population, but that the rate of death has actually plateaued. The goal, he said, is to turn it around so that the number is decreasing. He’s not yet sure how we will do it, but says we now have the data to be able to it. He likened the current situation with cancer to “knowing Newton’s law, but needing to figure out how to land the rocket on the moon”.

He closed his session with a reading from his book. The passage shared one women’s experience with cancer and one of his final conversations with her. He described how objects in room seemed like symbols, the patient herself like an actor. After she died, he reflected on the conversation and realized that her cheerfulness was really a decoy, as were the flowers, the bright jewelry, her “studied casualness”. Her illness, he noted, tried to humiliate her, miles away from her family, but she always moved to be one step ahead of it until she no longer had the internal resources to do so.

In this moment, she captured something essential about our struggle against cancer: learning and unlearning new strategies on a strange and limitless journey. Mukherjee closed by noting that we are in this battle for a very long time, but an enormous amount of resources are being deployed to fight it.

(Photo credit: Kris Krüg)

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