A brilliant look at the disease most of us fear above all

A review of The Emperor of All Maladies: A History of Cancer, by Siddhartha Mukherjee

@@@@@ (5 out of 5)

If you’re wondering why the incidence of cancer seems to rise continuously despite all the advances in cancer research and treatment, look no further than the aging of the American population. Cancer, primarily a disease that comes with aging, becomes well nigh inevitable once we get really old.

Now, “really old” is, of course, a concept that has steadily crept up the age scale as the decades have rolled by. The disease was identified as long as 2,500 years ago by the brilliant Egyptian physician, Imhotep, a renaissance man who lived two millennia before the Renaissance, but in that era, when average life expectancy was somewhere in the neighborhood of 40, cancer was a rarity. By the mid-1930s, when Social Security was introduced and Medicare was only a glimmer in the eye of Roosevelt’s social reformers, the average age Americans could expect to see was about 65. Cancer had become more common, but was only the #2 cause of death from illness in our country. Now, as our life expectancy hovers in the neighborhood of 80, cancer has become our #1 killer. So, Dr. Mukherjee’s “history of cancer” is now doubly welcome — and a brilliant accomplishment it is!

Are you wondering why cancer occurs more frequently with age? Mukherjee’s lucid prose, and his masterful command of the field of oncology, make it a snap to understand. Cancer is a genetic disease, and every gene among the 25,000 or so in the human genome is vulnerable to mutation in the course of time. (Mutation is the bread and butter of evolution, enabling homo sapiens and every other species on our planet to adapt to changing conditions.) As the years go by, it’s no wonder that some genes involved in the processes of growth and renewal in the human organism experience mutations — some of which trigger a process leading to uncontrolled cellular growth. We call that condition “cancer.”

But perhaps you’re devoted to the proposition that environmental factors are the “cause” (or at least a cause) of cancer, especially some of those tens of thousands of chemicals that pollute our air, our streams and oceans, and our land. Maybe. We know far too little about the potential for harm in the products of the chemical and plastics industries. And certainly it’s self-evident that alien chemicals introduced into our bodies could possibly play roles in certain types of cancer. Many do in laboratory animals. And, after all, the hormones and proteins that govern the conduct of our biological lives are themselves chemicals. However, if I understand Dr. Mukherjee correctly, those exogenous chemicals could lead to cancer only by interfering in the patterns of growth and mutation that are the controlling factors in the cellular health of our bodies.

For generations now, the consensus has been that cancer is not a single disease but a broad description of a wide range of illnesses. On its face, pancreatic cancer has little to do with testicular cancer or breast cancer, for example — meaning, of course, that a “cure for cancer” is not in the cards. But Dr. Mukherjee leaves the reader with a broad hint that there may, in fact, be common elements that tomorrow’s cancer researchers can suss out — and find that mythical cure after all. To my mind, this is an extraordinarily hopeful perspective.

Dr. Mukherjee, a cancer researcher with clinical experience, surveys the “history” of cancer from Imhotep to the present day but, as he points out, this book more nearly resembles a biography than a history. He combines moving personal experiences, historical vignettes, biographical sketches of some of the fascinating individuals who have advanced our understanding of cancer, and wonderfully articulate explanations of complex scientific matters. The Emperor of All Maladies is this year’s winner of the Pulitzer Prize for Nonfiction, and it deserves every bit of recognition it’s gotten.

The Immortal Life of Henrietta Lacks, by Rebecca Skloot

A review of The Immortal Life of Henrietta Lacks, by Rebecca Skloot

@@@@@ (5 out of 5)

The Immortal Life of Henrietta Lacks is extraordinary on several levels: as a beautifully researched work of medical and scientific history, as a portrait of the profound impact of racism in America, and as a brutally honest first-person account of a writer’s challenging, decade-long struggle to write a serious book. If The Immortal Life of Henrietta Lacks doesn’t win at least one of the major awards for books published this year, I’ll be hugely disappointed.

The text on the cover telegraphs the essence of the story: “Doctors took her cells without asking. Those cells never died. They launched a medical revolution and a multimillion-dollar industry. More than twenty years later, her children found out. Their lives would never be the same.”

Henrietta Lacks, we discover, was an ill-educated African-American woman who died of cervical cancer at the age of 31 nearly sixty years ago. She was a patient at Johns Hopkins Hospital in Baltimore, home of one of the nation’s most prestigious medical schools and of some of the world’s leading researchers in fields such as cell culture and oncology. One of those researchers asked Henrietta’s physician for a sample of her diseased cervix in faint hopes that, unlike every other tissue sample anyone to that date had ever tested, the cells he extracted would divide indefinitely,thus become “immortal,” and open up new vistas for medical research. To his and everyone else’s astonishment, they did. And not only did those cells continuously divide from 1951 to the present, they proved to be so aggressive and so persistent that they contaminated every other cell culture they came in contact with — invalidating years of medical research that was conducted before the contamination was discovered. To this day, HeLa cells, named as a contraction of Henrietta’s name, constitute one of medicine’s most pervasive experimental tools.

The medical history in this book is engrossing. As Skloot amply demonstrates, it’s also scientifically significant. But for me what was most powerful about The Immortal Life of Henrietta Lacks was the unfolding story of Henrietta’s life and of the lives of her many children and grandchildren. Skloot devoted a decade to befriending and later interviewing Henrietta’s daughter, Deborah, Deborah’s brothers, and other influential members of the Lacks family in Virginia and Maryland. Theirs is one of the most dramatic and moving tales I’ve ever encountered of the profound impact of racism in our society. At Deborah Lacks’ insistence, Skloot reported every incident and every conversation precisely as it occurred, with no sugar-coating. The power of her reporting is irresistible.

Rebecca Skloot is an accomplished science journalist, but amazingly this is her first book. If she never writes another one, her contribution to the history of medicine and science will be assured.

ISBN-10: 1400052173

ISBN-13: 978-1400052172