An excellent book

For Christmas my brother Steven sent me a book about the history of cancer and cancer treatment. It’s called “The Emperor of all Maladies: a biography of cancer,” by Siddhartha Mukherjee. Steven sent it somewhat hesitantly because, as he warned, “It’s not a light, uplifting read.”

Very true. It’s neither light nor uplifting. It’s a brutal read. But it was absolutely and entirely fascinating; I was completely transfixed. I could barely pay attention to our holiday proceedings (such as they were in a pandemic lockdown) because I was so intent on this book.

It’s not just that I have an obvious interest in the topic. The author is fantastic. Now I want to read everything he has ever written. I like science books, but they can be dry. This one is not dry. I’ve never before been spellbound by the details of drug trial phases (for example).

I’m also going to reread this book. It’s accessible, but dense, and my focus is lacking since my chemo treatments. I would not have been able to make sense of this book during my chemo treatments, and I’ve only barely recovered enough to make some sense of it now.

I’ll warn you though – it’s not pretty. Cancer is a killer. And the treatments throughout history – up until and including now – are only sometimes tolerable. By the way, the term “tolerable”, when used in reference to chemotherapy, doesn’t mean what you would typically think the word means, i.e. “not too bad”. Nope. In this context, “tolerable” means the treatment didn’t kill the patient faster than the cancer was expected to kill them.

The trials were considered successful if it held the cancer at bay for one or two months, even if the patients had catastrophic relapses immediately afterwards. The researchers called the trials “successes” if the drug had any sort of measurable impact, never mind the utter misery of the patients who are being pushed as close to death as absolutely possible, in the wild hope to cure them (or others like them, some many years later, after the drug has been refined).

It’s sad how often researchers have thought they were very close to a cure during this past century, always to find cancer one step ahead. Only very recently have researchers managed to develop a few very effective drugs for a few specific types of cancers.

More generalized, older-style chemotherapies do kill cancer and I’m not recommending against them. Unfortunately chemo can cause enormous collateral damage and it’s too often not a cure. The descriptions of surgeons trying to cure breast cancer with surgery only, before chemo was discovered, were equally brutal. They did not understand how metastatic cancer worked, so they would try to take more and more of the upper body (essentially trying to “get it all”), but in the case of metastatic cancer (stage 4), it would never work. You cannot cure metastatic cancer with surgery alone.

However, as horrifying as that all was, I found the book to be more interesting than depressing. And the detailed knowledge the researchers are gaining just this past decade is encouraging. It’s clear that for the drugs to be truly effective, they’re going to have to be very, very specific to the type of cancer and the genetics of the individual patients. That’s a huge task, and it’s a long road ahead, but it’s a path forward.

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