The Emperor of All Maladies

The Emperor of All Maladies by Siddhartha Mukherjee

With age comes sickness. Now that I think about it, I’ve been dealing with some sort of nontrivial health problem ever since I moved to SF. Is it age? Or is it just that I actually have the time and mental bandwidth now to care about my health? Anyway, it all culminated with an ER visit where it hit me how little we know about how our bodies work. Modern medicine can solve a lot of problems but still has so far to go. One day, I hope the final verdict won’t be “take tynenol and drink more water.”

1) Sidney Farber specialized in pediatric pathology and is considered the father of modern chemotherapy.

I never really registered just how much of a medical powerhouse Boston is.

2) Penicillin was so valuable during WWII that it was recycled from the urine of patients to be used again on other patients.

In half a century, we’ve gone from lacking antibiotics to fearing resistance from overuse.

3) Hippocrates introduced the concept of the four humors: red, black, yellow, and white. Galen then attributed cancer to black bile.

Is Galen closer to our modern understanding of cancer, or are we closer to the truth?

4) Halsted popularized the concept of radical mastectomy, in which surgeons removed large parts of the patient’s body in an attempt to cure cancer.

The main storyline of the book is the evolution of cancer treatment. It’s amazing to see all the breakthroughs and wrong turns. Maybe iterate isn’t as empty a buzzword as it seems.

5) Marie Curie died from anemia that she got from prolonged exposure to radiation.

Radiation cures and radiation kills.

6) Jimmy of the Jimmy Fund, whose actual name was Einar Gustafson, was a child patient with lymphoma.

Farber was trying to find a way to raise money for cancer research. Back in those days, he found the Boston Braves, not the Boston Red Sox.

7) The NSF was founded in 1950 to promote basic scientific research.

When I did my DC internship, I think we visited the NSF. I can’t see our government pulling through and creating institutions like this anymore. Or maybe we just need a crisis, like how the 2008 economic crisis gave us the Consumer Financial Protection Bureau.

8) Mary Lasker was an influential figure who kickstarted the War of Cancer in 1971 by pulling strings to get the National Cancer Act passed in 1971.

She was instrumental in getting political and popular support for cancer research. She recognized that curing cancer was not only about science. It was also about fundraising and advertising.

9) Chemotherapy can generally be split into cytotoxic, hormonal, or targeted.

Early chemotherapy (and maybe still the majority?) involved using chemicals that killed cell growth in a blanket manner. The way the book describes these treatments, doctors found a bunch of chemicals that worked and tried to combine as many of them as possible. The more toxic it was, the better the remission rate, but also the more painful.

10) Major tobacco companies released an ad in 1954 called “A Frank Statement” to discredit science claiming that smoking caused cancer.

FUD never fails.

This was a very well written book that made me once again appreciate how hard science is. We take so much for granted now and don’t recognize how difficult it is to measure, test, and prove something. Without science, none of us would be here.


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