Table of Contents
About The Book
Now includes an excerpt from Siddhartha Mukherjee’s new book Song of the Cell!
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.
Reading Group Guide
Introduction
In The Emperor of All Maladies, Siddhartha Mukherjee offers a sweeping and erudite history of cancer—from its earliest incarnations in ancient texts up to recent and long-awaited breakthroughs in treatment. Populated by captivating characters, from the Persian Queen Atossa, who instructed her servant to cut out a malignant tumor in her breast, to Sidney Farber, whose tireless research into children’s leukemia ushered in the modern era of cancer research, and written in Mukherjee’s artful prose, The Emperor of All Maladies reads like a thrilling novel, with scientific triumphs and setbacks, personal rivalries and alliances. But set against the backdrop of changing politics and social values, it is also a history of human civilization seen through the prism of cancer, the world’s most pervasive, tenacious disease.
Questions and Topics for Discussion
1. Cancer is often described as a “modern” disease—yet its first description dates from 2500 B.C. In what sense, then, is cancer a disease of modern times? How does knowing its ancient history affect your notion of cancer?
2. Mukherjee frames the book around the story of his patient, Carla Reed, a teacher who is diagnosed with leukemia. What did you find interesting or important about Carla’s experience? How do you think she shaped the author’s life and thoughts?
3. Mukherjee writes how in the early 1950s The New York Times refused to print the word “cancer” (or “breast”). Compare this to how we view cancer today. Is there any difference in the way you discuss cancer as a political or news topic and how you discuss a cancer diagnosis among family and friends?
4. Looked at one way, Sidney Farber’s early clinical trials with antifolates in 1947 and 1948 were a failure, with all of his young leukemia patients eventually dying of the disease. But with the results of these trials, Mukherjee writes, Farber “saw a door open—briefly, seductively” (p. 36). How so? Why do Farber’s trials mark a turning point in the history of cancer research?
5. “The stories of my patients consumed me, and the decisions that I made haunted me,” Mukherjee says about working in a cancer clinic (p. 5). But in the 1970s, during the height of aggressive combination chemotherapy trials, Mukherjee paints a different picture of doctor-patient interaction: “The language of suffering had parted, with the ‘smiling oncologist’ on one side and his patients on the other.” How have the relationships between doctors and patients evolved along with cancer treatments? What could be done to restore some of the lapses in this relationship?
6. “‘Li was accused of experimenting on people,’ Freireich said. ‘But of course all of us were experimenting… To not experiment would mean to follow the old rules—to do absolutely nothing.’” Review the case of Min Chiu Li (pp. 135-138), and explain Emil Freireich’s quote. Do you think Li’s actions were ethical? How can doctors and scientists draw the line between reckless, unproven treatment and necessary experimentation for drug development?
7. How did Mary Lasker borrow from the worlds of business, advertising and even the military to build a nationwide effort to combat cancer? How might Lasker’s vision be invoked today to generate funding and national attention for breast or ovarian cancer?
8. So many of the scientific breakthroughs that impacted cancer research, such as Wilhelm Röntgen’s discovery of the X-Ray in 1895, occurred by accident. What other “chance” discoveries appear in the text?
9. Numerous advances in cancer research would have been impossible without patients willing to submit themselves to grueling experimental trials—experiences from which they did not benefit, but future cancer patients might. How would you counsel a friend or relative about submitting themselves to such experiments?
10. How is the early history of chemotherapy linked to the histories of colonialism, the Industrial Revolution, and World War Two?
11. Was the War on Cancer a failure? Why or why not?
12. How did the tobacco industry react to studies in the 1950s about the link between cigarettes and lung cancer? How did the industry’s reaction differ to that of the general public? Do you think cigarette companies should be legally liable for cancer and other health problems likely caused by smoking?
13. The 1980 Canadian mammography trial (see pp. 298-300) was possibly flawed because technicians disproportionately steered women with suspected breast cancer to get mammograms, likely out of compassion. Put yourself in the technicians’ shoes. Would you have allocated your friend to the mammogram group? If so, how can trials ever be randomized? Should a trial with a promising new drug be randomized—even if it means forcing some patients to be in the non-treatment group? What if a new treatment emerges for a deadly form of cancer? Should half the enrollees in the trial be forced to take sugar-pills to document the efficacy of the treatment?
14. On page 316, Mukherjee argues that “the trajectories of AIDS and cancer were destined to crisscross and intersect at many levels.” Do you agree with Mukherjee’s comparison? What did Susan Sontag mean when she said AIDS and cancer had both become “not just a biological disease but something much larger—a social and political category replete with its own punitive metaphors?”
15. Review the case of Nelene Fox (pp. 322-324), whose HMO, Health Net, refused in 1991 to pay for an expensive bone marrow transplant to treat her diagnosis of advances breast cancer, citing the procedure as “investigational.” In your view, was it appropriate for Health Net to refuse reimbursement? Should patients pay for expensive experimental treatments out of their own pocket? What if these experimental treatments turn out not to extend survival—as with Fox’s transplant?
16. The author says that he was motivated to write this book after a patient asked him, “What is cancer?” Mukherjee could not think of a book that would answer her question. So he wrote it. Does “knowing your enemy”—knowing cancer—bring some kind of comfort?
17. On page 459, Mukherjee writes, “As the fraction of those affected by cancer creeps inexorably in some nations from one in four to one in three to one in two, cancer, will indeed, be the normal—an inevitability.” Mukherjee makes this assessment despite the approval of oncogene-targeting drugs like Herceptin, which have given new hope to cancer patients, as well as promising efforts to sequence the cancer genome. At the end of The Emperor of All Maladies, do you come away with optimism about science’s efforts to combat cancer? Why or why not?
18. In the final chapter of the book, Mukherjee creates a fictional journey for Queen Atossa through time to demonstrate how cancer treatment has changed over the centuries. How might you have summarized this book? What image, or metaphor, emerges most powerfully at the end of this book?
19. Germaine Berne’s story, which ends the book, is not superficially a story of hope, since she ultimately dies from relapsed cancer. Yet Mukherjee portrays her as a symbol of our war on cancer. In what sense does Germaine epitomize the battle against cancer? How is her story a story of hope?
20. Mukherjee calls this book a “biography.” Can a “biography” be written of an illness? How might such a biography differ from the traditional biography of an individual? Are there other diseases that demand biographies, or is this project unique to cancer?
21. In what sense does history “repeat itself” in cancer research? In science, where new discoveries keep altering the landscape, what is the worth of reliving the past?
Enhance Your Book Club
1. Learn about cancer prevention. Before your book club meeting, have each member choose a type of cancer to research and prepare a brief presentation about warning signs and prevention. Learn more on the website for the American Cancer Society: http://www.cancer.org/Cancer/index.
2. Prepare for your next doctor appointment. In today’s health care system, patients often complain about doctors spending too little time with them or providing unsatisfactory explanations of medical conditions. Make a list of facts you learned from The Emperor of All Maladies with practical implications for your own healthcare, or questions that the book provoked. Discuss what you learned as a group, and then, during your next appointment, ask you doctor to clarify any topics you found unclear or confusing.
3. Get involved. The Emperor of All Maladies mentions several cancer charity organizations, such as The Jimmy Fund and St. Jude’s Children’s Research Hospital. Research local cancer charities in your area, and find out how you can donate time or money to their cause.
4. Read science news: The Emperor of All Maladies describes powerful stories that directly affect our lives: mammography, breast cancer treatment, cervical cancer prevention. Read updates on these in The New York Times, or other newspapers, and bring stories to the book club meeting to discuss.
About The Author
Siddhartha Mukherjee is the author of The Song of the Cell,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.
Product Details
- Publisher: Scribner (November 16, 2010)
- Length: 592 pages
- ISBN13: 9781439181713
- Lexile ® 1240L The Lexile reading levels have been certified by the Lexile developer, MetaMetrics®
Raves and Reviews
“Mukherjee brings an impressive balance of empathy and dispassion to this instantly essential piece of medical journalism.”
—Time
“A meticulously researched, panoramic history . . . What makes Mukherjee’s narrative so remarkable is that he imbues decades of painstaking laboratory investigation with the suspense of a mystery novel and urgency of a thriller. . . . He possesses a striking gift for carving some of science’s most abstruse concepts into forms as easily understood and reconfigured as a child’s wooden blocks.”
—The Boston Globe
“Riveting and powerful . . . Mukherjee’s extraordinary book might stimulate a wider discussion of how to wisely allocate our precious health care resources.”
—San Francisco Chronicle
“Remarkable . . . The reader devours this fascinating book . . . Mukherjee is a clear and determined writer. . . . An unusually humble, insightful book.”
—Los Angeles Times
“Extraordinary . . . So often physician writers attempt the delicacy of using their patients as a mirror to their own humanity. Mukherjee does the opposite. His book is not built to show us the good doctor struggling with tough decisions, but ourselves.”
—John Freeman, NPR
“Now and then a writer comes along who helps us fathom both the intricacies of a scientific specialty and its human meaning. Lewis Thomas, Sherwin Nuland, and Oliver Sacks come to mind. Add to their company Siddhartha Mukherjee.”
—Elle
“Rich and engrossing . . . With the perceptiveness and patience of a true scientist, [Mukherjee] begins to weave these individual threads into a coherent and engrossing narrative.”
—The Economist
“A brilliant, riveting history of the disease . . . Threaded throughout, and propelling the narrative forward, are the affecting tales of Mukherjee’s own patients.”
—Entertainment Weekly
“Ambitious . . . Mukherjee has a storyteller’s flair and a gift for translating complex medical concepts into simple language.”
—The Wall Street Journal
“Cancer has never been as fully explored as in Dr. Siddhartha Mukherjee’s fascinating and moving history.”
—The Daily Beast
“With epic scope and passionate pen, The Emperor of All Maladies boldly addresses, then breaks down the monolith of disease.”
—The Onion A.V. Club
“Informative, elegant, comprehensive, and lucid.”
—Pittsburgh Post-Gazette
“Mukherjee’s elegant prose animates the science.”
—Bloomberg News
“Brilliant and riveting.”
—Associated Press
“[A] brilliant book.”
—Larry King
“A magnificent book.”
—Sanjay Gupta, M.D., CNN
“An ambitious scientific, political, and cultural history.”
—Slate.com
“Intensely readable.”
—New York Post
“Impressive.”
—The Philadelphia Inquirer
“Mukherjee . . . writes with supreme authority.”
— The Seattle Times
“Mukherjee makes us understand that along with our terrible losses, great gains have been made.”
—Newsday
“Eminently readable . . . A surprisingly accessible and encouraging narrative.”
—Booklist (starred review)
“A beautifully written account of the ingenuity, hubris, courage, and utter confusion humankind has brought to its attempts to grapple with cancer.”
—Maclean’s
“Future biographers and historians of the disease will labor from deep with the long shadow cast by Siddhartha Mukherjee’s remarkable The Emperor of All Maladies. . . . A vivid and profoundly engaging read.”
—BookPage
“Sweeping . . . Mukherjee’s formidable intelligence and compassion produce a stunning account.”
—Publishers Weekly (starred review)
“Siddhartha Mukherjee’s The Emperor of All Maladies left me shaken, fascinated, and not depressed, because he gives a face to our old enemy, cancer.”
—Emma Donoghue, author of Room
“Sid Mukherjee’s book is a pleasure to read, if that is the right word. . . . His book is the clearest account I have read on this subject. With The Emperor of All Maladies, he joins that small fraternity of practicing doctors who cannot just talk about their profession but write about it.”
—Tony Judt, author of The Memory Chalet
“Rarely have the science and poetry of illness been so elegantly braided together as they are in this erudite, engrossing, kind book.”
—Andrew Solomon, National Book Award–winning author of The Noonday Demon
“At once learned and skeptical, unsentimental and humane, The Emperor of All Maladies is that rarest of things—a noble book.”
—David Rieff, author of Swimming in a Sea of Death
“A magisterial, wise, and deeply human piece of writing.”
—Adam Hochschild, author of King Leopold’s Ghost and Bury the Chains
“The Emperor of All Maladies beautifully describes the nature of cancer from a patient’s perspective and how basic research has opened the door to understanding this disease.”
—Bert Vogelstein, director, Ludwig Center at Johns Hopkins University
“A labor of love . . . as comprehensive as possible.”
—George Canellos, M.D., William Rosenberg Professor of Medicine, Harvard Medical School
“An elegant . . . tour de force. The Emperor of All Maladies reads like a novel . . . but it deals with real people and real successes, as well as with the many false notions and false leads. Not only will the book bring cancer research and cancer biology to the lay public, it will help attract young researchers to a field that is at once exciting and heart wrenching . . . and important.”
—Donald Berry, Ph.D., MD Anderson Cancer Center, University of Texas
Awards and Honors
- Pulitzer Prize
- Carnegie Medal Honor Book
- ALA Notable Book
Resources and Downloads
Freshman Reading:
UCSD School of Medicine (2013/2014)
High Resolution Images
- Book Cover Image (jpg): The Emperor of All Maladies eBook 9781439181713
- Author Photo (jpg): Siddhartha Mukherjee Photograph © Deborah Feingold(4.6 MB)
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