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The Emperor of All Maladies: A Biography of Cancer
The Emperor of All Maladies: A Biography of Cancer
The Emperor of All Maladies: A Biography of Cancer
Audiobook22 hours

The Emperor of All Maladies: A Biography of Cancer

Written by Siddhartha Mukherjee

Narrated by Fred Sanders

Rating: 4.5 out of 5 stars

4.5/5

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About this audiobook

Winner of the Pulitzer Prize and a documentary from Ken Burns on PBS, this New York Times bestseller is “an extraordinary achievement” (The New Yorker)—a magnificent, profoundly humane “biography” of cancer—from its first documented appearances thousands of years ago through the epic battles in the twentieth century to cure, control, and conquer it to a radical new understanding of its essence.

Physician, researcher, and award-winning science writer, Siddhartha Mukherjee examines cancer with a cellular biologist’s precision, a historian’s perspective, and a biographer’s passion. The result is an astonishingly lucid and eloquent chronicle of a disease humans have lived with—and perished from—for more than five thousand years.

The story of cancer is a story of human ingenuity, resilience, and perseverance, but also of hubris, paternalism, and misperception. Mukherjee recounts centuries of discoveries, setbacks, victories, and deaths, told through the eyes of his predecessors and peers, training their wits against an infinitely resourceful adversary that, just three decades ago, was thought to be easily vanquished in an all-out “war against cancer.” The book reads like a literary thriller with cancer as the protagonist.

Riveting, urgent, and surprising, The Emperor of All Maladies provides a fascinating glimpse into the future of cancer treatments. It is an illuminating book that provides hope and clarity to those seeking to demystify cancer.

Editor's Note

A microbial adversary…

Acclaimed science author Mukherjee tells the story of humanity’s most formidable adversary with the passion of a biographer in this Pulitzer Prize-winner.

LanguageEnglish
Release dateDec 15, 2015
ISBN9781508214243
Author

Siddhartha Mukherjee

Siddhartha Mukherjee is the author of The Gene: An Intimate History, a #1 New York Times bestseller; The Emperor of All Maladies: A Biography of Cancer, winner of the 2011 Pulitzer Prize in general nonfiction; and The Laws of Medicine. He is the editor of Best Science Writing 2013. Mukherjee is an associate professor of medicine at Columbia University and a cancer physician and researcher. A Rhodes scholar, he graduated from Stanford University, University of Oxford, and Harvard Medical School. In 2023, he was elected as a new member of the National Academy of Medicine. He has published articles in many journals, including Nature, The New England Journal of Medicine, Cell, The New York Times Magazine, and The New Yorker. He lives in New York with his wife and daughters. Visit his website at: SiddharthaMukherjee.com.

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Reviews for The Emperor of All Maladies

Rating: 4.402635286969253 out of 5 stars
4.5/5

1,366 ratings124 reviews

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  • Rating: 5 out of 5 stars
    5/5
    This was the most comprehensive examination of what cancer is, why it doesn’t occur more frequently, how various treatments try to eliminate it, and why treatments that work initially become ineffective.
  • Rating: 5 out of 5 stars
    5/5
    Extremely informative and terribly tragic. Definitely worth a listen, more for people engaged in the topic.
  • Rating: 5 out of 5 stars
    5/5
    Well written and well presented. The stories told of the highs and lows in the battle against cancer are emotional moments that are articulated in a way where you feel the moment as acutely as if you were there. The presentation is also very informative. great book for all levels.
  • Rating: 5 out of 5 stars
    5/5
    A fascinating book. I left oncology nursing in 2000 after 20 years to go into hospice nursing because oncology felt hopeless and dishonest in the promises offered in the name of hope. This book both confirms my decision and gives me hope for those in the field now. His statement about " our goal is not to prevent death but to extend life" would have influenced my decision to leave the field. Funny how a few words can influence how one feels about a life's work. Thank you to the author.
  • Rating: 5 out of 5 stars
    5/5
    Takes your fear of cancer and cranks it up by 1000. Amazing information. Very informative.
  • Rating: 5 out of 5 stars
    5/5
    A gripping intersection of history, biography, and detective story repeat with heroes and a most sinister villain!
  • Rating: 5 out of 5 stars
    5/5
    If there’s one disease these days that still has the power to really frighten people, I’d say it’s cancer. There’s no shortage of diseases that no one wants to contract, certainly, but it’s cancer that seems the most dramatic, cancer that represents the inward turning of the body against itself, cancer that is the subject of test upon test upon test, of our bodies and the things we surround ourselves with, cancer that seems somehow emblematic of our times. Where so many of the diseases of the past have been kept at bay for a long time now, cancer largely continues unabated.It seems odd to set out on a project where the aim is to write the biography of a disease, but Mukherjee makes the case that as he addressed the history of cancer, it came to have a character unto itself, and it felt more like a description of a person. Indeed, he argues that cancer is in some sense the striving, energetic, evolved form of our cells, just one step beyond who we are now, and it’s precisely that character that makes it so difficult to defeat. Targeting what is essentially a funhouse version of ourselves, our genes with no brakes and a charge to keep going at a feverish pace, makes for perhaps the supreme medical challenge.That marking of the character of the disease is not new to Mukherjee, but it’s well presented in his prose, and the overall work is magisterial, a lucid tale of haltingly learning the mysteries of a wide-spread disease through the past couple of centuries and trying to work out how to respond. He notes that cancer has been known since ancient Egypt (where the premier physician Imhotep quoted its treatment as “there is none”), and has been fleetingly heard from through history, but it is only comparatively recently that science really took a target on the disease, realizing that diseases that present themselves as differently as leukemia and pancreatic cancer may be underlyingly the same disease. Mukherjee lays out in detail both the scientific drive to work more on cancer – and as always, I’m amazed at how much was known already by the end of the 19th century, even if there was a long way to go – alongside the attempts to raise consciousness of cancer within wider society and gain funding and support.The tale develops along several threads over the course of the book, generally focusing on different approaches to treatment that came about over time, and pulling the story forward as they did: surgery and radiology, chemotherapy, prevention, and the look for the underlying cause of cancer in genetics. Each section introduces a vivid batch of characters, researchers that crop up repeatedly across the history of cancer like Sidney Farber, Tom Frei and Emil Freireich, William Halsted, and others, alongside the people championing the cause, such as Mary Lasker, and how it tied into the politics of the time. There was a real gung-ho spirit evoked, against the human backdrop of how many the disease ravaged, how fleeting even the successes seemed to be, for the most part. The scientific material is presented in a clear and easily understood manner, and is well-balanced with the stories of the researchers, and of Mukherjee’s dealings with his own patients and their dealings with cancer.Overall, actually, the writing is really quite well done; Mukherjee doesn’t let things get too heavy, because even when things go wrong, you still have this sense of fervent struggling to work problems out and make people better, to figure out more effective treatments for the future. This is a very solid piece of history, in that you really get a sense of the people and the decisions they made, both for good and bad. To have gotten as far as people did in effective treatments without knowing the underlying cause of cancer is remarkable, for example.On the whole, this was a very interesting book, one well deserving of the praise it’s gotten, and one that isn’t nearly as scary as it might appear at first glance. You get a new sense of respect for the creativity and variety of science, just as much for the disease at the heart of the book. All that insight is definitely worth the read.
  • Rating: 5 out of 5 stars
    5/5
    Excellent,spellbinding, indeed unable to put it down
    A great narrative of the history of cancer, it’s discoveries and treatments
  • Rating: 5 out of 5 stars
    5/5
    I wish it included a chapter about preventive measures like exercise and diet.
  • Rating: 5 out of 5 stars
    5/5
    This is a magnificent treaty about cancer, the evolution of knowledge and in the war against it. It covers from the earliest attempts to cure cancer to the latest techniques based on the intimate knowledge of the genetic mechanisms that trigger and empower cancer cells. At the same time the book is very humane and humbling and made me develop a stronger appreciation for oncologists and scientists from many disciplines working in the war against trials. My determination at the end of my reading is to support in any way possible the war against cancer through activists and associations rather than through colder and less empathetic government organisations.
  • Rating: 5 out of 5 stars
    5/5
    Listening to this book, with the voice of Fred Sanders and Mukherjee's style of writing, was like watching a BBC documentary narrated by David Attenborough, scientific but still emotional. I was expecting a scientific history of cancer medicine and instead got a human biography of humanity's struggle with this disease, the low and high points in this relationship but with so many individual examples that it almost feels that this is a personal battle for each and everyone of us and for us all together, at the same time. I recommend this book to anyone, like myself, who wants to start understanding cancer and breaking some of the misconceptions we have regarding this disease, such as the fact that it is a new disease.
  • Rating: 5 out of 5 stars
    5/5
    Very interesting book. A bit technical at times. Enjoyed it very much.
  • Rating: 5 out of 5 stars
    5/5
    A complete history of cancer from the time of an ancient Egyptian physician who could recognize cancer in his patients but offer no remedy to an imagined time in the future when you can walk into your doctors office with your DNA sequenced on a thumb drive and your doctor will come up a cancer therapy targeted to your genome. I found this book to be absolutely fascinating. We travel from a time when cancer doctors tucked away their children leukemia patients in the back of the hospital to die to the dawn of real hope with the advent of chemotherapy. My interest in the subject was peaked my own cancer diagnosis. As grueling as treatment has been, it is hard to feel sorry for yourself when you are tucked snuggly into your heated, massaging infusion chair and you read about a boy who endured some of the first chemotherapy treatments, without anti nausea medication, getting to his treatments by riding into Boston in the back of whatever neighbors pick up truck was heading that way. I stand in amazement at the strength of all of the people who have battled this disease before me. It was their stories that moved me so deeply. Often people are mentioned so briefly and I longed for more information. Sadly when it was provided the update was often a brief they passed away. I also loved the stories of the scientists who were always trying to stay one step ahead of the disease, sometimes suffering from the very cancer they were looking to cure. I was somewhat less interested in the heavy scientific sections that dealt with DNA sequencing. Those parts were a little dry but still readable. It was the patients and doctors who really brought the book to life for me. Whether the year is 1716 or 2016 the outcome of stage IV cancer is inevitably terminal. What has changed is that people are living longer with cancer. The new focus may not be a cure but a better quality of life for those living with cancer. Even if you aren't a cancer patient chances are you know someone. Cancer is in all of us and one in three of us will develop it in our lifetime. This book gave me the push to join the research arm I was asked to participate in order to write the next chapter in my kind of cancer treatment. The story of cancer is far from finished and I for one am looking forward to the future that Mukherjee envisions and the chapters of triumph yet to be written.
  • Rating: 5 out of 5 stars
    5/5
    Brilliantly structured survey of the history of humanity’s effort to understand and cure cancer. The science of that effort and the human stories of the medical researchers and the patients are artfully interwoven through masterful storytelling.
  • Rating: 4 out of 5 stars
    4/5
    Excellent A to Z book from beginning of time but very technical a lot of the time. Amazing to see the the progression of studies and tests and the evolution of doctor/scientists methodology.
  • Rating: 5 out of 5 stars
    5/5
    Incredibly well written and inspiring! Mukherjee illuminates our changing perceptions of the disease and the truly astounding advances that have been made in its identification and treatment. I can't imagine anyone, unless you have absolutely zero interest in biology/medicine/cancer, not finding this book fascinating.
  • Rating: 4 out of 5 stars
    4/5
    It is an absolutely fascinating book. It covers the history of cancer understanding of through the centuries. There is a lot to cover so it is a rather long book, but well worth the time investment. As our knowledge about the disease, or should I say diseases, has grown, treatment has become more targeted. Initially the only treatment was surgery, which became more and more extensive and disfiguring in an attempt to stop spread, before then becoming more specific and localised again. With the discovery of anti-folate drugs chemotherapy was born. I was particularly interested to discover the type of cancer I had (choriocarcinoma) was the first to be cured by chemotherapy. From that modest beginning more and more toxic combination regimes were developed before also becoming less extreme and more intelligently targeted again. Similarly the use of radiotherapy has changed as our understanding of the mechanisms involved has developed. The more recent developments are of course the most promising. Geneticists are working on the cancer genome project to catalogue the genetic abnormalities in different types of cancer. This has already led to the development of targeted therapies which can block the action of single protein pathways within certain types of cancer cell. The more is discovered the more these types of drugs will take over treatment. The other topic considered is cancer prevention, through the avoidance of carcinogens and lifestyle risk factors, and through screening to provide treatment at the pre- or early cancerous stages. Of course one of the biggest causes is smoking so there is a long section on the history of that discovery and the despicable behaviour of the tobacco companies.As I said, I found it a fascinating book. My only complaint is that it is very much centred on the United States. Even where progress elsewhere in the world is referred to, it is through the lens of how this impacted treatment in America. All the information about campaigning and fundraising is entirely American even on topics where the Americans trailed significantly behind the rest of the world (such as on tobacco). Where doctors and scientists from other nations are mentioned it is in the context of their interaction with American researchers, or their visits to American laboratories, as if little of significance happened elsewhere.
  • Rating: 4 out of 5 stars
    4/5
    Mukherjee traces human understanding of cancer from earliest recorded history to the present day. A mixture of epidemiology, sociology, history, bio textbook and personal stories should be a disjointed mess, but instead it's a nearly perfectly cohesive "biography" of cancer. I'm astonished at how ambitious Mukherjee was--and how successful. I want do re-read this someday, to refresh my memory of all the interesting tidbits and theories he shares.
  • Rating: 5 out of 5 stars
    5/5
    This Pulitzer prize winning expansive history of the disease(s) known as cancer is a pretty epic reading challenge, but well worth the effort. Mukherjee dives into his subject chronologically (from ancient and medieval treatises on the disease up through current genetic discoveries), thematically (by treatment -- surgery, radiation, chemotherapy, targeted agents; political advocacy and funding; research and clinical trials; prevention -- particularly in the context of anti-smoking campaigns), and personally with stories of his own medical training and experiences with cancer patients. The scope is so broad that you would think the approach would feel scattered, but Mukherjee has an ability to control the many threads of his narrative and dig deep into the background of individual researchers, discoveries, and treatments which grounds the reader in a narrative foundation and keeps the whole thing from running off the rails. As a breast cancer patient I was particularly fascinated with the history of the embrace and then rejection of ever more radical mastectomy surgeries, the dashed promise of scorched-earth chemo followed by a bone marrow transplant as a treatment for metastatic breast cancer, and the fascinating history of patient advocacy clashing (and then cooperating) with the pharmaceutical industry in the development of Herceptin, a wildly successful targeted treatment for Her-2 positive breast cancer. The book also helped me get my head around how clinical trials are designed and how the medical profession approaches oncology. And he FINALLY explained what kinases are and how they work in a way that clicked with my brain (as a person on her second flavor of a cyclin-dependent kinase inhibitor, this is news I could use). While his prose can sometimes be a bit florid and I didn't love every one of his patient characterizations, this was still a great read and I am very interested in reading his new book, The Song of the Cell. Human bodies are so complicated, and cancer uniquely harnesses this complexity to do its thing. Mukherjee really brings this all home in an understandable and comprehensive way.
  • Rating: 5 out of 5 stars
    5/5
    I've had this on my tbr since before my 3 year old was diagnosed with cancer. I'm glad I waited to read this till I was on the other side of her treatment.This is an immense chronicle of what we know of cancer and how it's been treated over the decades. It's crazy that we haven't improved cancer treatment in any meaningful way since chemotherapy regimens were first discovered. The cocktail of drugs they started with is largely what was used in 2020.I hate that new drugs targeting more specific cancers aren't funded because they aren't profitable. We experienced a shortage of a vital drug due to it not remaining profitable during her treatment. For profit healthcare is evil.Despite pediatric cancer receiving very little funding, it was a large focus of this book. I am thankful for all the oncologists and patients who have come before. As the Green brothers have just said, this is the best time in history to be diagnosed with cancer. Though a year from now would be better. (John & Hank Green).
  • Rating: 5 out of 5 stars
    5/5
    Great medical history of the disease of our times ... except, of course, it isn't. Cancer has been traced back to the ancient Egyptians. Mukherjee relays the trials and triumphs in the pursuit of this killer in a way that reads like a medical thriller. Did I understand all of the medicine? No. Will I remember the details of successful drugs and treatments? No. Does it matter? No. My take-away is that we are making progress against a very complicated enemy whose weapons include altering our very DNA and reacting to certain chemicals in our environment ("carcinogens").
  • Rating: 5 out of 5 stars
    5/5
    This is worth all 472 pages. It was easy to follow, very educational, and it made me appreciate how far cancer treatment has come and the lives that contributed to this progress. Cancer is the world's oldest disease, but it wasn't until vaccines and civic improvements raised the life expectancy that cancer was finally studied. Early attempts at treatment included x-rays, radical surgery and even mustard gas, but until the 1950s it was an unspoken death sentence.Sydney Farber, a researcher in Boston, decided to tackle leukemia. Why? Leukemia, as a blood disease, can be measured without surgery. Farber performed several unsuccessful tests with antifolates on (unconsenting) children. Eventually his research attracted the attention of the Variety Club of Boston and Mary Lasker, a driven socialite and philanthropist. With Farber in tow, the Variety Club finds a poster child, Einar Gustafson, to exploit for funding. Meanwhile, Lasker runs a much more successful campaign through Reader's Digest, balls and benefits creating the American Cancer Society. But Dr. Min Chiu Li, a Korean immigrant, was the first to cure a cancer with antifolates. He dosed an adult choriocarcinoma patient even after visible symptoms had vanished. A high dose 4-drug combo for leukemia was finally launched in 1961 followed by a series of toxic chemo cocktails of the 1970s, i.e. MOMP for Hodgkin's Disease. It wasn't until the 1980s that the whole system was turned on its head, with the idea of "prevention" being the cure, rather than treatment. Radical surgeries became unnecessary, DNA is tested for mutations, anti-smoking campaigns are run and occupational diseases are finally investigated.There's so much to unpack for a small review, but it's 5/5 and I've recommended to friends and coworkers as well!
  • Rating: 4 out of 5 stars
    4/5
    I was pleasantly surprised by how good this book was. Not sure how I came up on it, might have been the Freakonomic MD Podcast that I listen to by Dr Bapu Jena. I like some many have had close family members taken by Cancer and wanted to learn more about its history and this book does a great job of relating mostly in chronological fashion the developments through the years of the battle against cancer from the earliest references all the way till the 80s/90s. Yes is has a primarily pan American view point and yes it does seem repetitive at times but overall one comes away feeling inspired by how far we have come and also knowing the realities of the situation right now how far we still have to go. It is really interesting to read and learn about the different players over the years and how they have contributed to the body of knowledge surrounding cancer as well as how the political, fund raising and marketing aspects of the organizations that were setup. The stories of the patients involved was a great counterpoint to all the technical information shared in the story. Read the book you will not forget it.
  • Rating: 4 out of 5 stars
    4/5
    Depending on where you live, if you're in the western world chances are you're looking at a pretty high chance of getting cancer in your lifetime. In the UK it's now 1 in 2, and my nearest geographical neighbour - Ireland - has the third highest rate of cancer per 100,000 people in the world (behind Australia at #1 and NZ at #2). We all know people who have survived it and people who have died from it, and sadly that's often just within our own immediate families. Given that there's no getting away from it I was interested in learning more about it, and this Pulitzer prizewinner from 2011 seemed as good a place to start as any.It does what it says on the tin, taking us from the earliest known examples of cancer (breast) in BC times to savage surgery in the 1800s, the first use of radiation in the early 1900s, the introduction of the first chemotherapy in the 1940s (nitrogen mustard) and the critical discovery of the first identified oncogene in the 1980s and pursuant biological and clinical strategies in the fight against the disease. Mukherjee is thorough in relaying this history to us. Although some patient stories are included that area was a lighter touch than expected, but in retrospect I appreciate that. This book is not an emotive, personal account of cancer (although it's clear that patients are front and centre in Mukherjee's mind during his day job as an oncologist) but rather a biological and clinical focus (with the emphasis on the former). It's a complicated subject area, and although a book for the layman Mukherjee doesn't overly dumb it down so some chapters are harder going than others. Overall, however, it was a hugely informative read, and my big takeaway was a much better understanding of the complexity of the cancer war, with not only stark differences between cancer types but also hugely different personal cell mutations even within the same cancer type.Given that there are so many different types of cancer, this book concentrates especially on leukaemia, breast cancer and lung cancer, where perhaps there have been most marked changes in survival rates over time.Would I recommend this if you're currently dealing with cancer, either personally or with a close family member? I'm not sure. It's not a depressing read and mostly is a chronological account of development in surgical and biological advancements, but there is the odd line here and there that's pretty sobering. This isn't a book like Atul Gawande's Being Mortal - I don't think there's anything in here that would hugely influence any decisions you'd make around treatment. Not being from a medical background this book did raise a number of questions in my head. There seemed to be quite a chasm of missed opportunity between biologists and clinicians at various points in this history of cancer, and I wonder if this is still true today (sadly I expect it is). Also, given the advancements that were made in treatment at the cost of early patients' lives, I wondered in this modern day of medical governance and ethics just how free today's oncologists are to try out new ideas with patients, or if the fear of litigation hampers that.All in all a dense but interesting read. Sorry to be the one to deliver a spoiler, but it appears that the notion of a magic bullet for cancer is the stuff of fairytales, and the best we can hope for are personal therapies that adjust throughout our lifetimes as personal cancer mutations change trajectory.4 stars - a fascinating journey through what is indeed the emperor of all maladies.
  • Rating: 5 out of 5 stars
    5/5
    nonfiction/medical science. a fascinating comprehensive history of oncology that treats cancer not as a discrete medical phenomenon but as a human condition that touches so many of us personally.
  • Rating: 5 out of 5 stars
    5/5
    An excellent read if you have ever wondered about causes, treatments, and understanding how cancer takes over a body or you have someone close to you that has suffered through this nightmare. This book is written in more of a biography style since as the writer puts it, Cancer acts more like a biological being that can adapt to it's surroundings. It also explains the technological advances that have occurred over the past 100 years and how there is hope for future treatments in the future. The war on cancer may never be won, but science and medicine are slowly winning the battles with new treatments. DEFINITELY recommended reading!
  • Rating: 4 out of 5 stars
    4/5
    The author covers the history of cancer. Well detailed, and for the most part, very readable.
  • Rating: 4 out of 5 stars
    4/5
    I learned so much! A few parts of the newer, genetic science were a bit beyond me, but the author did a good job with analogies and examples to help the non-scientist reader. His research is comprehensive and the story is fascinating.My biggest take-away from this book is the sense of gratitude and awe I have for the researchers who never give up. The kind of people who search tirelessly for cures or treatments and the kind of people whose sense of curiosity and love of knowledge give us the basic research which others can apply.
  • Rating: 4 out of 5 stars
    4/5
    I don't quite buy the conceit that this is a "biography" rather than a more prosaic work of history. But it's very informative and not difficult to read, at least once one gets past the hypochondria-inducing initial chapters. Captures both the thrill of scientific discovery and the agony as each discovery ends up proving inadequate.
  • Rating: 5 out of 5 stars
    5/5
    This highly acclaimed work (winning a Pulitzer Prize) deserves every one of its adulations. It is not only personal, erudite, and interesting; it is also inspiring and well-written.

    Mukherjee attempts to present “a biography of cancer,” starting from its first mention in the historical record (a Queen of Persia). A practicing oncologist, he also ties in patient stories to advance the narrative in appropriate places.

    Generally, he tells the tale of how humanity and science has wrestled with cancer over the past several millennia. Obviously, he pays special attention to the twentieth and twenty-first centuries as this is where most of the action lies. In truth, with infectious diseases well countered with antibiotics and vaccines, cancer looms as one of humanity’s greatest menaces. And as Mukherjee admits, cancer has indisputably won the war thus far.

    He does provide hope because research has provided much insight in the last thirty-or-so years. With an acumen as only a practicing physician can offer, he summarizes the progress of research with personal insights and stories. He divulges the basis for cancer in DNA and what this insight provides in terms of therapy. While doing all this, Mukherjee maintains a basic narrative with the skill of a studied historian. This is a great work to read for anyone interested in healthcare and medicine.