Siddhartha Mukherjee Archives

The Emperor of All Maladies

The Emperor of All Maladies, Siddhartha Mukherjee. Scribner (ISBN: 9781668047033) 2025 (My review is of the 2010 edition).

Summary: A biography of the disease, our understanding of its nature, and approaches to treating it.

Excuse my bluntness. Cancer sucks. I’ve watched friends and beloved relatives die cruel deaths from it. The survivors I know, including those in my own family, while grateful to be alive, bear the marks of their experience. The fear of recurrence is never far away. I’ve had my own brushes with cancer with skin lesions and precancerous polyps. Early detection and treatment made these just brushes. The truth is, all of us will have some form cancer or know someone close to us who does. And for anyone with a serious cancer diagnosis, life changes irrevocably on the day they receive that diagnosis.

The marvel of Siddhartha Mukherjee’s The Emperor of All Maladies is to write beautifully, elegantly, clearly, and honestly about this ugly fearsome disease. The title recognizes the powerful adversary cancer is. It arises when the normal cellular mechanisms that check growth and multiplication go haywire. Also, additional changes allow it to spread and resist our own defenses as well as external agents.

Mukherjee also calls this a biography of cancer. He chronicles a four thousand year history of the disease from the Egyptian physician Imhotep, who first described it to the Persian Queen Atossa, who had a slave remove a breast to fight breast cancer in 440 BC, futilely as it turned out because the cancer had spread. He traces that history down to the present discussing both our slowly growing understanding of the disease and key figures in the history of its treatment. Mukherjee also personalizes it with Carla, one of his patients, whose journey he traces at various points of the book.

He begins with when cancer was thought to be “black bile.” Yet doctors found no such substance, even in cadavers. Early on, a cancer diagnosis simply was a death sentence. Apart from quack remedies, there was no treatment. Only palliative care was possible. With the advent of antiseptic measures, surgeries were used to remove cancers, such as William Halsted’s radical mastectomies, often quite extensive and disfiguring. But quickly, doctors learned that if cancer was not local, surgery was futile. Another blunt instrument was radiation, again effective with local cancers (although it could also cause cancer).

Mukherjee introduces us to Sidney Farber, who moved from the laboratory to the clinic to fight childhood leukemia and other cancers. Antifolates and other early chemotherapies extended the lives of children. Farber teamed up with Mary Lasker to lead an effort to secure funding for research into other chemotherapies. They created the Jimmy Fund, named after a young boy, Einar Gusfson, with leukemia who was dubbed “Jimmy.” A baseball fan, he won the hearts of Boston’s baseball teams, and money poured in.

From the 1950’s to the 1970’s, Mukherjee chronicles burgeoning, hubristic efforts to win the “war on cancer” with chemotherapy. More and more extreme combinations of drugs resulted in both victories and a lot of failures. But something was missing. While throwing all these therapies at cancer, clinicians gave little time to understanding how cancer worked. Not only that, but those who researched the cellular mechanisms of cancer weren’t talking to the clinicians who treated it.

Then, beginning in the 1980’s, there was an explosion in understanding the nature of cancer, and the genetic mechanisms behind its uncontrolled multiplication and spread. Just as the human genome has been sequenced, so are cancer genomes, tracing pathways by which normal cells turn cancerous. This has been accompanied by advances in both prevention and therapeutics, including identifications of mutations like the BRCA gene that leads to some breast cancers.

Since 2010, there have been an avalanche of advances in cancer biology, prevention, and treatment. So in 2025, Mukherjee released an updated edition of the book with four new chapters detailing these advances.

Despite the heartbreaks and latent fears I’ve known, I found Mukherjee’s account fascinating. Mukherjee weaves into the history and the science real people, both those who die and those who survive. His book stands as a warning against hubris in announcing “cures for cancer.” He helps us understand why cancer is such a difficult to conquer emperor and what has been and is being done. He reflects the realistic hope of every cancer survivor who speaks, not of cures, but of “no evidence of disease” that allows one to live another day. Mukherjee also reminds us of the army of people working to prevent cancer and treat it, not giving up on conquering the emperor.

The Song of the Cell, Siddhartha Mukherjee. New York: Scribner, 2022.

Summary: A history of the advances of cell biology including the cutting-edge innovations that allow for the modification or implantation of cells, creating in essence, a new human.

There was a time when those who studied organic life did not understand that a fundamental component of all living things was the cell. And then Hooke in England and van Leeuwenhoek in Amsterdam used their primitive microscopes to look at water droplets and tissue and saw–cells. Not only that, these early cell biologists realized all living organisms were constituted of one or more cells that are the basic structure on which all of life is organized.

Siddhartha Mukherjee, a cancer researcher, takes his readers on a step by step narrative unpacking the basics of cell biology (and pathology) for a lay audience. He takes us through the different structures within the cell and the incredible phenomenon of cell division. He traces how cells develop into living organisms from a tiny clump to a blastocyst to a living human being or other creature.

Perhaps the most fascinating section of the book is that on the nature of blood. He describes the different components of blood–red cells, how blood clots, and the intricacies of the immune cell and how self recognizes non-self, and what happens when self fails to recognize non-self and when self thinks self is non-self. Later, we learn that all the different components of our blood arise from a single type of stem cell.

Amid the story (and the writing) came the pandemic. Mukherjee remarks that it came at a time when cell biologists were celebrating breakthroughs in understanding immunology. And COVID-19 unraveled so much of what we thought we knew, once again showing us how much we’ve yet to learn. Here as in the rest of the story, Mukherjee intermixes personal narratives, sometimes tragic, with the science.

He takes up how cells work together. There are the “citizen cells” of the heart muscle, pulsating in rhythm for decades. There are the “contemplating cells,” the neurons, and the fascinating role of microglia in pruning away unused connections, creating the particular ways we are “wired.” Then there are cells within key organs that maintain homeostasis, those in our pancreas our metabolism, in our kidneys, our salt levels, and our liver, metabolizing harmful chemicals like alcohol.

An underlying theme that Mukherjee draws to a focus at the end are the ways we intervene to modify cells. It may be the interventions to halt and destroy cancer cells, runaway cells that cannot turn off their multiplication and trick the body to not recognize the foreign, yet non-foreign, invader destroying it. We’ve pioneered IVF techniques and, in the case of one researcher at least, genetically edited and embryo (and went to prison for it), resulting in the first gene-edited baby. The use of edited stem cells to reverse sickle cell anemia, to reverse osteoarthritis and a host of other therapies suggest the possibility of “new humans,” or at least renewed ones.

There are always the questions of how far to go with such things, questions that often arise only after we realize something is possible. Mukherjee explores the boundaries between maintaining and restoring health and the enhancements that somehow change who we are. What is most troubling about the latter augmentations is that they reflect a certain privilege not open to all, creating the potential for two races, those of super-humans and then ordinary humans. How long will it be before they are viewed as sub-human?

Aside from these sometimes fascinating and sometimes vexing questions is the sheer wonder Mukherjee describes, aptly called the “song” of the cell. Often, his writing sings and soars, and one finds oneself saying, “how wondrous.” Sometimes the song descends as well, as we learn of the microbes that invade us or the cancer that consumes and wastes us. Sometimes the song is beautifully complex, like a baroque fugue, and other times chaotic, difficult to make sense of, as are many of the intricacies of various cancers. This was a stunning work, leaving me in a state of wonder, even with all the mysteries of the cell yet to be unraveled.