"The Emperor of All Maladies"
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Attached here is an excerpt from the book, "The Emperor of All Maladies" by Siddhartha Mukherjee


Please read...

  1. Create a discussion thread on this page using the 'Add Comment' link below in which you identify and discuss an aspect of the history of cancer as presented by Dr. Mukherjee that you found particularly interesting or surprising, and
  2. Offer your thoughts on at least one other student's original post by replying to that comment (if you're among the first to post, you may need to return to this site later to build on another student's thread).
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  1. The history of cancer as presented by Dr. Mukherjee was intriguingly simple, researchers followed one clue to another in the hope of finding a cure. While the science behind cancer treatments became progressively more complicated, the story of the research waned and waxed with the world around it. Cancer is so often but into its own box and separated from the rest of the medical world but from this excerpt it became clear that cancer research is very much related and reliant on the entire medical world. For example when diseases such as TB and Polio flared up cancer was put on a back burner and only once the epidemics were controlled could research continue.

    In hindsight it is interesting to wonder if WWII had not happened what research could have been accomplished with the 5 million dollar grant from the government. That being said the most fascinating part of the excerpt was the notion that there was a big gap in cancer cases that experts contribute to a general low quality of life. Once simple medicine such as penicillin was introduced to society and the life expectancy started rising so did the number of cancer cases. Simply put people weren't living long enough to get cancer for a long period of time. To me this creates a paradoxical question... Was society better off when people were not living long enough to get cancer or are the extra years worth the high chance of pain and suffering you or your loved ones will most likely have to experience?



    1. Sarah, you raise an interesting question. Although people live much longer today, have more access to health care than any other generation, we face a plethora of problems and overall don't seem to be happier. As society advances it continues to uncover new problems, like the prevalence of cancer. However, in regard to cancer, I believe we are better off today, simply because when people were not living long enough to get cancer they were dying from a hundred other terrible diseases. I think it's worth the extra time, after all, in the end, everyone dies one way or another. I believe it is better to live to 60 and die of cancer than live to 30 and die of the common cold. 

    2. Cancer, medicine, and scientific intervention in general is loaded with complicated questions of ethics, economics, and humanism. A perfect conversation to lead into a 4 year journey in the liberal arts!

  2. I thoroughly enjoyed reading The Emperor of all Maladies. I was interested in learning more about cancer and its history because of my personal experience with the disease. When my father was diagnosed with cancer, I didn't understand much about it. 

    I found the early history of cancer fascinating. Because of how widespread cancer has become in today's society, I had viewed it as a uniquely modern disease. I had never considered factors such as decreasing illness, advancing civilization, and increasing life expectancy in explaining cancer’s prevalence.  Evidence of cancer has been found as early as 2625 BC. It can be discouraging to realize how long doctors have been attempting to understand and effectively treat cancer. Imhotep’s inability to find a treatment for cancer was just the beginning of a long and often unsuccessful search for a cure.

    1. Sophia, you bring up a very interesting thought in that humans have been looking for treatment and cures for cancer for so long. This just goes to show the power of cancer and how in such a long period of time that we have been looking for a cure that we have not been able to crack the code for many cancers leaving so many questions that still can't be answered.

    2. The history is fascinating and offers a helpful perspective for scientists, clinicians, patients, and loved ones of those who fight it.

  3. After reading The Emperor of All Maladies I was extremely fascinated with the history of cancer and cancer research. One thing that specifically stood out to me  and that I was intrigued about was research and treatment of child cancer. Specifically in 1860 when Maria Speyer had Lymphoblastic Leukemia and how baffled scientist and doctors were because adults have five thousand white blood cells circulating per millimeter of blood while Carla had ninety thousand white blood cells circulating per millimeter of blood. So the magnitude in the information that doctors and scientists didn't know when it came to cancer in children compared really stood out to me the most.

    1. And there so much we still don't know! That's the nature of science... every answered question begets many more questions.

    2. I agree. The early history of the study of leukemia was extremely interesting. It is odd to think of researchers using such ancient methods with the resources we have today.

    3. I agree with you. Besides the research results those scientist left to us, the spirit is also a precious legacy for us. They worked really hard with poor technological condition campare to modern labs. This kind of insistence really moved me when I read the book.

    4. This is truly interesting stuff! It was amazing to learn about such rapid growth and development in the field of medicine from that time to now. 

  4. The Emperor of All Maladies made me consider how fortunate we are to have such developed treatments for cancer. It is difficult to even imagine the days when scientists did not even know that living things were composed of cells. It is shocking to read about doctors choosing to study leukemia since they could have some attempt at measuring it versus other cancers they could only guess at, when now there are such advanced research methods employed by cancer scientists. The method of early leukemia research was a piece of the history of cancer that I found particularly interesting. Although theres is a lot more progress that needs to be made, I am grateful that researchers have made great strides and continue to so that patients have a greater chance of survival. 

    1. Margaret, the point that you made regarding that there is still a lot of progress still to be made I found exciting.  I completely agree, with hope in the air for more and more advancement is treating cancer I still believe that there one day will be a cure.  The end of your comment leaves everyone with a sense of hope for the future, that will lead us to success.  

  5. I think the most attractive and moving part for me is the exploring process from nothing to a valuable result.   I love a sentence written by the author, “Incremental advances can add up to transformative changes.” Farber‘s story refreshes my impression of the cancer history. I know more about the stories behind Farber’s first successful chemotherapy for childhood leukemia. In the book, scientist from different historic periods would add their “bricks” to the understanding of the cancer. Those bricks might even be wrong, like Benetto inferred leukemia as “suppuration of the blood”, and Farber thought folic acid could prohibit cancer cell growth, but it accelerated the bad condition. After reading this book, I think the way of finding the right medical treatment is better to describe as thousands of failures than one success. Keep trying and every time walk a little step, we will conquer it in the near future.

    1. That's the beauty of science and the scientific method. In my understanding of science, it is proposing an idea and proving it enough times that it becomes an accepted rule, unless another idea comes around to disprove it of course. We could see this in Faber's experimental chemical treatments for cancer, which had been basically unheard of at the time, but now the idea of cutting off cells from nutrients is prevalent in the form of chemotherapy. Faber's earlier hypothesis had indeed become a brick for this treatment, and will continue to be part of the foundation for a cure for cancer until a better idea comes around.

    2. I agree, the beauty of being able to build on previous generations successes is one of the things that make humans great. Although Farber made several mistakes along his way, in the end he provided some people relief, many hope, and everyone a chance at a cure. Although he didn't cure cancer or even leukemia, he contributed to the ever working machine of human knowledge and helped to make the world a better place.  

  6. What I particularly found interesting is the quote "in Leukemia six months of survival was an eternity" this quote which was written in 1948, over 70 years ago, is still very much in fact relevant today.  This quote goes to show you how deadly cancer has been and still continues to be, after reading this I took a moment and began to re-examine my life up until this point, and realized how much I have taken for granted over the years.  A person one day can be completely healthy and happy enjoying life, or so they thought, and if all of a sudden they discover they have cancer they are now potentially counting their days.  This just goes to show you how important every single day is, and every moment of that day.  Life is precious, make the most of it while you are still here. 

    1. This is a very poignant line. And I'm realizing more and more just how precious everyday is. Just a few days ago, a woman in my hometown died from cancer. I knew her and her family; I can't even imagine what that feels like. You're going about your business one day and the next you're told "you have cancer."  

    2. Indeed. With that in mind, embrace the opportunity to be a student at Colby College with joy and passion!

  7. I think the historical presentation of cancer that Dr. Mukherjee presents is rather interesting. I was particularly fascinated with his research into paleopathology. It's true that we tend to think of cancer as a "new" disease because for so long, the human race was plagued by far more visible diseases, such as the black plague, tuberculosis, and smallpox to name a few. One point in that chapter I found rather controversial though, was that Dr. Mukherjee states that cancer is a disease that tends to appear in older people. I find this rather hard to believe as there seems to be a heavy emphasis on childhood cancer these days. Although, I do suppose that could have something to do with Farber and his "Jimmy Fund." 

    1. Julia,

      It was interesting how concentrated Dr. Mukherjee was on insisting that cancer was more of a problem for old people but then how focused he was on the history of childhood leukemia. It is possible that statistically there was only a small percentage of childhood cancer patients but because of the focus in the passage it seemed like a much larger problem.  

    2. I totally agree with you. I found the research into paleopathology very interesting. I do think Dr. Mukherjee's point on cancer being seen more in older people is very controversial, especially with a lot of the first part of the excerpt being focused on childhood leukemia. 

  8. Dr. Mukherjee presented the problems of cancer throughout this book that I found interesting. One section reads, "To confront cancer is to encounter a parallel species, one perhaps more adapted to survival than even we are" (38). While I came into this read with basic knowledge, I was blown away by the history of this incredibly destructive disease and the countless doctors and researchers that dedicate their lives to finding a cure. 

    1. That's why the title of the book was a "biography" rather than "history" of cancer. Looking at it broadly, it takes on a beastly persona.

  9. As a student with little knowledge on the subject of cancer, I realized how uninformed I was on the topic while reading this excerpt. The thought that cancer is a new disease was a misconception I had formed from my youth. I thought that the cause of its appearance was increased consumption of chemicals commonly found in today's society such as nitrite in preservatives and acrylamide found in McDonald's french fries. However the various mummified bodies from long before a deep fryer was invented disprove this idea, and I am now lead to believe my above mentioned ignorance was my mother's ploy to prevent me from eating too much processed foods. It was an eye opening read, nonetheless.

    1. Before reading the passage, I actually believed the same thing.  My Grandfather was actually an optometrist, which at the time involved working with a lot of very dangerous chemicals, solutions and equipment.  Since his time working however, the industry has made the change to safer work environments in hopes of reducing the risk of cancer.  I always saw this as proving that it was industry and the dangerous chemicals people used, however now I know that is not necessarily true.

    2. I found myself also realizing that cancer has been around way longer than treatment has been available. I was naive to believe cancer has only been around a hundred years or so, and I appreciate how much this article opened my eyes to the struggles mankind has faced over the years. 

    3. I also realized that I had little and misconstrued knowledge about cancer. I did not really know how the tumors and cells affected health and the overall systems of the body until I read about the process of exploration and research. It was amazing to read about the exponential development of diagnoses and treatments because through that, I could take the steps to understand the disease just like the researchers did.

  10. I really enjoyed reading "The Emperor of All Maladies" by Siddhartha Mukherjee.  The thing I found most interesting in the passage we read was the idea that as life expectancy increases in the country and the world as a whole, so dear the prevalence of cancer in society.  Thunking about it, this actually makes a lot of sense, however I never realized it until reading this.  It is an interesting relationship, that's the better care we get in medicine outside from cancer, the more lives cancer ends up affecting.  The book really went into depth about the breathtaking amount of work so many people have done in the attempt to slow such a destructive disease and it is very inspiring to see.

    1. I think it is also worth noting that our global population grows in all areas of the world, but is particularly heightened in countries that are often deemed as "third-world" or "developing." Taking into consideration that these countries may not have access to the same medical resources as "first-world' or "developed" countries, this would exist as one of the many reasons as to why cancer grows in the way it does, in respect to the global population increasing. If the population is growing at higher rates in areas with inferior medical resources than those that are medically-equipped with updated research and technology and are remaining stagnant or decreasing in size, the rate of cancer diagnoses would understandably be rising proportionally. 

  11. After reading the excerpt from The Emperor of All Maladies, I was very interested by the history of cancer and what doctors believed to be the causes of disease. I found it astonishing how quickly Maria's leukemia manifested and killed her. I also thought it was interesting how rapidly new antibiotics and drugs emerged during the late 1940s and how overall public health greatly improved, while the treatment of cancer was at a standstill. When Rosenow tried to tell the New York Times of her experience with breast cancer, the Times turned her down. The media kept silent about cancer. Farber spent much of his life devoted to researching and studying cancer. While researchers have made a lot of progress in cancer treatment over the the last 60 years, there is still a lot to be made. 

  12. It is hard to imagine living in a world where access to medical treatment for something as serious as cancer wasn't an option. It opened my eyes to the challenges living in a time before modern medicine brought, and made me thankful for how far medical treatment has come. This idea was made abundantly clear throughout the passage, but I did not truly appreciate the struggle many went through until I got to page 27, where the New York Times could not publish an article concerning cancer as, the "Times cannot publish breast or the word cancer in its pages." This quote alludes to how little was understood about this horrible disease, and how far both society and medicine have come over the past hundred years. A truly fascinating piece that brought incredible insight to the fact that while modern medicine is not perfect, I am still insanely lucky to be born into a world that was so different just a couple generations ago!

    1. I agree that it was fascinating to learn about how there was little treatment at all for cancer not that long ago but what I also found interesting was how cancer was almost ignored by doctors and medical researchers because back then there were more pressing issues with other diseases that were killing more people. I also thought it was interesting that as life expectancy grew the cases of cancer also did because it is a disease that is more likely to occur later in life.

    2. I think it is also important to note that cancer faced increasing stigmatization even when it was a leading cause of death among Americans. I this this goes to show how stigma can hold back progress towards understanding certain diseases, regardless of how many people it affects. 

  13. What I found most fascinating about Dr. Mukherjee's "The Emperor of All Maladies" was his excerpt pertaining to how "cancer again became the great unmentionable, the whispered-about disease that no one spoke about publicly." (26). In my own personal experience, I have always felt that cancer was, at the very least, a universally discussed subject. Never had I been aware that cancer had ever possessed a stigma that, in the way it had been articulated, appeared reminiscent to something like the conversation surrounding HIV and AIDS diagnoses in the 1980s and 1990s. However, the concept that the "public outcry of the past decade had dissipated," (27) struck me as the most troubling aspect of the passage. The notion of a "politically silent illness" (27) is disheartening, especially considering the progress that, in the context of Mukherjee's writings, had just been recently put into motion.I guess the question that I would pose when faced with the information Mukherjee presents is: do significant medical advancements in cancer research need to be consistently occurring for the public to effectively support the political and economic endeavors that facilitate said advancements in the first place? More so, why is it that efforts to combat evidenced ailments can fall victim to stagnant research projects, regardless of political attention, when the issue still remains prevalent? 

    1. I was also really interested by this and the way that cancer treatment intertwines with society. I was struck by the passage:

      "Fortune magazine published... 'a panoramic survey' of cancer medicine. The report was far from comforting: 'The startling fact is that no new principle of treatment, whether cure or prevention, has been introduced...'... The Fortune article was titled 'Cancer: The Great Darkness,' and the 'darkness,' the authors suggested, was as much political as medical. Cancer medicine was stuck in a rut not only because of the depth of the medical mysteries that surrounded it, but because of the systematic neglect of cancer research." (23-4)

      The fact that we have been aware of cancer for so long yet constantly neglect the research is disheartening. But I think it is also deeply linked to the fact that society doesn't talk about cancer as much as we should. Unlike HIV, Tuberculosis and other contractable viruses and diseases, cancer does not feel quite so relevant. For people who have little personal connection to cancer, it is often disregarded in saying 'that won't happen to me.' It is not a sweeping epidemic in the way that highly contagious diseases are and therefore doesn't warrant an immediate burst of research.

  14. I enjoyed reading "The Emperor of All Maladies" because it was an interesting read and I learned a lot about the history of cancer treatment. I particularly found it interesting how different cancer is in comparison to other diseases. In other diseases it is easier to target the disease because the disease is very different from the cells from the rest of the cells in the body. Cancer is very difficult to target because the cancer cells are so similar to the regular cells which makes it difficult to target the cancer cells without damaging the regular cells. This part really helped me understand why there is no cure for cancer and why it is so difficult to treat even with all the money and research dedicated tp cancer.

    1. I feel like this is the reason why surgeries are rarely performed for cancer treatment because other body cells could also be removed which could lead to a malfunction of body organs. Medicines that could target cancer cells are still the most popular treatment for cancer in the current stage. 

  15. I found the development of cancer treatment very interesting. From the very beginning, cancer was identified as black bile and it is once believed that the best way to cure cancer is doing nothing. Later incision was introduced, but it's not a recommended treatment because it does not cure cancer completely: the black bile always flows back to the body. Looking from today's point of view, people from past times did have the intelligence to use medicines to cure cancer and only perform surgery when medicines fail. It is much like today's cancer treatment, where doctors would suggest surgery as the last method when everything else fails. It is interesting that cancer treatment from so many years ago could have so much in common with today's treatment after years of development. 

  16. Reading this excerpt, I was definitely amazed at how much progress there was in medicine, especially within the 20th century. Each case brought on breakthroughs and I could really see the step by step process of understanding and learning about a disease. It also fascinated me that with penicillin, the status of the drug changed within such a short period of time – it was so precious that they were extracting it from urine, but then there was an abundance soon after. It just amazes me that there are so many developments and progressions within the medical field in such a rapid fashion.

  17. While reading “The Emperor of All Maladies,” I was surprised by the extensive history of cancer and how the disease has stumped doctors ever since ancient times. Before reading this book, I thought of cancer as simply a modern disease, but Mukherjee points out that “civilization did not cause cancer, but by extending human life spans, civilization unveiled it” (44). Even before the rise in average life expectancy that came with improvements in the health of the general population, people such as the woman whose corpse was found at the Chiribaya site showed physical signs of cancer, although these instances were much rarer in comparison to other diseases at the time.

  18. Throughout the article Mukherjee explains the developments of cancer interventions in time. In doing show, she also highlights the response to these interventions. Mukherjee describes a series of radical experiments performed on cancer patients with little to no repercussions for the doctors. However, in modern times, we have laws in place to protect patients from said experiments. However, when Farber administers "folate analogues" (29) to children in Boston, he faces no repercussions except for the disapproval of his colleagues. While this experiment "likely hastened the death of ... children" (29) with Leukemia, it also led to his experiment with aminopterin which could temporarily bring Leukemia into remission.


    The article raises an essential question in medical ethics – how far are we willing to go experimenting for a greater cause or cure? As a society, we many more guidelines in administering medicine. However, it was the absence of these guidelines that allowed doctors to experiment and find treatments for diseases of the past.

  19. I thought the "The Emperor of all Maladies" was a very interesting read. I enjoyed learning about how cancer research has advanced through the years. I think it is very interesting how technology has advanced by scientists continuing to improve others discoveries. For example when Wilhelm Röntgen discovered X-Rays scientists jumped on it and kept looking for new, more powerful, more advanced chemical sources of X-Rays. Scientists continuing to look for improvements is the reason why. we have such advanced technology today.



  20. I would say that one thing that surprised me was the long history of cancer. As with many I always imagined that it was more of a modern disease than anything, but learning that it in fact dates back to the oldest civilization on Earth truly surprised me. Given proximity to radiation is one of the ways of getting cancer the concept of it being an older disease never really occurred to me, so learning of its history helped me better comprehend the full scope of what causes cancer and how the disease works.

    I also found the story about Farber performing untested clinical trials on children without really any barriers incredibly surprising. It caused several deaths and overall more pain for children suffering from leukemia and the only really consequence was a degradation in his reputation and anger from his superiors. Even though restrictions were introduced a month after his experiments, it still struck me that he could do that. It goes to represent how far we have come in the drug review process as well overall medical sciences. Back then one of the top children pathologists was shuttered into a closet to treat what people had considered already dead children, and now we have entire wings of hospitals staffed by the brightest people in medicine working to treat sick children. 

    1. I also found the way research was done hundreds of years ago extremely suprising. It's sad that Farber did costly trials on children even though he did it trying to save them, and change the stigma that people who have cancer are already dead. It definitely makes you thankful for the regulations we have in medicine now. 

  21. I found the history of cancer surprisingly interesting as I read The Emperor of All Maladies. It's extremely interesting to me that cancer was known to exist for thousands of years, but humans only became able to actively fight and cure it when anesthesia was created. It was only 150 years ago that the work being done to fix cancer changed from tearing open cadavers to trying to remove active tumors from live bodies, and it became realistic that a tumor could be removed from the body if caught early enough. Once that breakthrough was made, scientists and doctors were able to use each other's discoveries to rapidly increase the medical technology we use on a daily basis, like x-rays and other forms of radiation.

    1. I also think that is interesting how long it took for humans to start fighting cancer and thought it was very interesting reading how scientists and doctors through the years have advanced medicine and technology to fight it.