“The Emperor of All Maladies” and Louis Menand

Rarely does nonfiction approach in a single book the thematic consistency and storytelling verve of Siddhartha’s Mukherjee’s The Emperor of All Maladies.  The subtitle, A Biography of Cancer, is more than a publisher’s provocation.  Cancer is a living entity to Mukherjee, not least because it is his personal, professional, and mortal enemy–he is an oncologist, a researcher and clinician.  In Emperor he recounts, with great narrative economy, the life story of a cancer cell, and, concurrently, our encounters with the disease, from antiquity to the present.  He writes poignantly of the varying fates of his own patients from his years as a fellow in Massachusetts General Hospital’s oncology wards.  And he is at his best on the bitter divisions between cancer specialists (chemotherapy advocates vs. surgeons, clinicians vs. cellular biologists) in the race for short term treatments and a long term cure.

Two traits of Mukherjee’s roundly-admired and Pulitzer-winning book stand out for their unexpectedness.  The first is that Mukherjee views cancer, literally and figuratively, as the quintessential modern disease.  In the literal sense, it is only over the past two hundred years that people have begun to live long enough to succumb in large numbers to cancer in all its permutations.  Carcinogenic activities and habits, from chimney sweeping to cigarettes, are associated with modernity as well.  In the metaphoric sense, cancer, an uncontrollable, unstoppable growth, takes after the imperialist dreams of the nineteenth and twentieth centuries, as well as our modern desire for more of everything (more money, more power, taller buildings, faster computers).

Most modern of all in the story of cancer, though, is our faith in science and in its promise of a cure for everything that ails us; Mukherjee points to the moment in the early twentieth century when patients turned the tables on their doctors, expecting a cure instead of being grateful for what treatment there was.  Later, the so-called War on Cancer became the epitome of the modern response to the disease: inspired by the moon landing in 1969, cancer advocates came to believe that with enough political will and government money, a similar previously unimaginable achievement could be effected in eradicating cancer.  Mukherjee confides that there will never be an outright cure, because cancer has been and always will be a part of us.  Inherent in our cells is the evolutionary tendency to mutate.  These mutations can cause cells to sever their moorings to their own reproductive controls.  The final aspect of cancer’s link with modernity springs from Darwin, in that Mukherjee views cancer as a more evolved, more perfect version of ourselves: tirelessly productive, and so resistant to outside interference that it is often perfectly adapted to survival (if it did not, of course, kill its host).

The second salient trait of Emperor is an extension of the first.  Because Mukherjee thinks about cancer as product and emblem of modernity, his book belongs not just in the literature of accessible science writing, but in another very different and largely nonscientific literature: cultural history.  The book I kept thinking of while reading his was Louis Menand’s The Metaphysical Club, which is similar in scope, goals, and methods.  Menand’s book is, like Emperor, a diagnostic look at a modern phenomenon–in his case, the upheaval of the Northeastern intellectual tradition in the aftermath of Darwin and the Civil War.  Menand discerns connections among new ideas in philosophy, psychology, law, and education.  His thesis is that the modern condition–deracinated, agnostic or atheistic, aware of the savagery of war and the meaninglessness of a suddenly Godless life–brought about a great intellectual fecundity in this country, and a set of ideas that we are still living with and working through.

Where does philosophy meet cancer?  In the medium of biography.  Menand’s book is an intellectual biography of its eponymous club–consisting of, most notably, William James and Charles Sanders Peirce–the members of which did the most to change the way we think.  Mukherjee’s book, ostensibly a biography of cancer, is also a group biography (though one less interested in the particulars of its protagonists’ lives) of those who have campaigned (in the martial sense) against it.  Sidney Farber, the father of chemotherapy, and Mary Lasker, the philanthropist most responsible for politicizing cancer, initiated hostilities.  Many followed their example.  Throughout Emperor, Mukherjee emphasizes that individual researchers and doctors were responsible for most breakthroughs in cancer therapy and prevention.  And it was the visionary risk-takers who achieved the most: the doctors who, with less data than intuition, treated their patients to near-deadly chemotherapy regimens, extending these patients’ lives in many cases and advancing cancer science beyond the expectations and accepted wisdom of their more pessimistic or despairing colleagues.

But still, every bold clinician and scientist relied on the work of his predecessors and contemporaries.  Individuals made the breakthroughs; progress was made by doctors exchanging and fighting over ideas in lectures, during conventions, and in academic journals.  (Indeed, Emperor, like The Metaphysical Club, can be read as a tribute to American higher education.)  This lesson can likewise be extracted from Menand’s book: history in the micro may be made by individuals, but cultural history is made by groups of innovative people in close contact with each other.  And even though we are nearly a half century past the advent of the new social history and the supposed obsolescence of history based on individual lives, Mukherjee and Menand’s lesson seems like a very new one.


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