Reflections on The Emperor of All Maladies: A Biography of Cancer

Because I have recently been writing a book, in order to obtain more detailed material I have been reading many more medical monographs on cancer, among them The Emperor of All Maladies: A Biography of Cancer by Siddhartha Mukherjee (Chinese translation: Zhong Bing zhi Wang—Aizheng Zhuan).

Siddhartha Mukherjee is an Indian-American physician, scientist and writer. Besides The Emperor of All Maladies, he has another celebrated work, The Gene: An Intimate History, which is also very well written.

Many American physicians write beautifully. A solid foundation in the natural sciences, combined with a broad vision in the humanities and social sciences, makes the works of these authors—who are at once physicians, scientists and writers—impressive.

Unlike Chinese physicians, who mostly come from science and engineering backgrounds, many American physicians hold both a humanities or social-science doctorate and a medical doctorate. Some American M.D.s also hold doctorates in other fields, such as literature, anthropology, philosophy or psychology.

This educational background is the first thing that makes us envious. Such a knowledge structure gives these physicians both high humanistic attainment and high scientific attainment. I truly hope that China's medical education can undergo bold reform, drawing outstanding talent from every field without constraint, so as to strengthen the medical research workforce.

Siddhartha Mukherjee was born into an Indian family whose genes carried defects. In The Gene he describes the psychiatric illness in his own family. Because he was troubled by family illness from childhood, Mukherjee came to love medicine and eventually took up cancer research; his main research direction is leukemia.

After graduating from medical school, Mukherjee entered Massachusetts General Hospital as a resident. After witnessing with his own eyes the arduous struggle for survival of so many cancer patients, the seven future oncologists who entered Massachusetts General Hospital with him grew humbled one by one—because malignant tumors shatter any physician's arrogance. No matter how outstanding you are, in the face of a malignant tumor your intelligence and talent are not enough.

After two years of residency, Mukherjee and his fellow residents went their separate ways—some stayed on in the hospital as clinicians, some entered specialized cancer research centers for basic medical research, and one was utterly broken by cancer and vowed to stay away from medicine.

The graduation ceremony was unusual. A colleague of Mukherjee's softly read out the names of every cancer patient who had died under her care, praying for them. Mukherjee was moved and followed her example, softly reading out the names of every patient who had died under his care, praying and blessing them. As he read, tears streamed down his face.

During his residency Mukherjee resolved to write a monograph on cancer. To write it well, in his spare time he read a great many tumor-related monographs. After extensive reading and research, his original wish changed, and he eventually wrote a biography of cancer.

Precisely because he had accumulated rich expertise in oncology, Mukherjee was able to write such an outstanding Emperor of All Maladies. He sought to lay before the reader, in full, humanity's understanding of tumors and the history of our struggle against them; and he achieved his aim.

Reading this book raised my overall understanding of cancer. I am very grateful to the author for devoting so much effort to helping readers like me sort through the history of humanity's understanding of cancer. At the same time I genuinely learned much from this book that I had not known before; it deepened and broadened my understanding of cancer and has been instructive for my own cancer research.

On humanity's road of struggle against cancer, the heroic devotion of many fighters is moving. I used to think that only medical workers were silently contributing on the anti-cancer road. But in fact many people outside the medical profession have also made enormous contributions.

For example, the American science writer Rachel Carson, through her personal influence, broke through the arrogance and prejudice of surgeons and ended the enormous, futile bodily damage that radical surgery inflicted on breast-cancer patients. And the lawyers, scientists, journalists, writers and volunteers who joined together to corner the tobacco companies finally forced them to admit that tobacco causes cancer, advanced the whole-of-society smoking-cessation movement, and lowered the incidence of lung cancer.

But at the same time I also saw the evil power of bloodthirsty capital. Though American tobacco companies met setbacks in developed countries, with their vast capital they bought lobbyists and politicians, changed the laws and regulations of developing countries, and caused the number of smoking citizens in developing countries to rise rapidly. Ultimately this of course led to a sharp rise in lung-cancer incidence in those poor, backward countries and regions.

Meanwhile, the various chemotherapy drugs of unstable efficacy developed by the U.S. National Cancer Institute were supplied in an endless stream to cancer patients in those poor, backward countries and regions, draining their wealth and destroying their bodies.

The dream of preventing cancer has been blocked by greedy human nature. Many factors that induce cancer are man-made. As Adam Smith summarized, consumption determines production. Ever since humanity entered a rapidly developing industrial society, the whole world simply cannot stop; our desires keep expanding in the endless cycle of consumption and production.

This ever-expanding desire makes humans disregard everything for their own benefit. We manufacture carcinogens, we pollute the environment in which humanity lives, and the food we produce is full of toxic components. Politics colludes with interest, and all of this is determined by human weakness; it is hard for us to see where all this ends.

There is a famous saying in the Bible: "There is nothing new under the sun." Looking at worldly affairs from the perspective of human nature, this saying from the Bible is truly an unshakable truth. An awakened individual cannot wake up an addicted human multitude. Cancer is like a punishment that nature has inflicted on humanity as a group. Nature inflicts many punishments on us humans, yet no matter how it punishes us, the human collective remains what it is.

The anti-cancer road is extremely arduous—not only for patients and their families, but also for physicians and scientists. Many physicians and scientists who study cancer have exhausted a lifetime of effort, only to end up with nothing. They have merely told later generations, with their life's effort, that they were walking a wrong road.

Mukherjee wrote out the many setbacks and achievements in humanity's understanding of cancer. Those cancer patients who suffered and died in medical experiments paid with their lives, turning page after page of human anti-cancer history: surgery, chemotherapy, radiotherapy, bone-marrow transplantation, and ever-renewed new cancer therapies, all ultimately proved to have very limited effect—though the public placed great hopes in them.

As scientists explored, humanity began to realize that food, air, tobacco and alcohol, bacteria, viruses, chronic inflammation, and even an old scar can all induce cancer. Many factors can cause mutations in human genes; the cause of cancer is not single.

After the initial fervor, cancer specialists began to grow more rational. Everyone began to realize that every idea of curing cancer was overly optimistic; and every idea that cancer is untreatable was overly pessimistic. Oncologists' goals shifted from curing the patient to the more realistic care of the patient.

Patients and their families, who gained nothing from radical surgery and high-dose chemoradiotherapy, also began to realize that curing cancer is an impractical dream, and that we need to look for ways to cope with cancer from another angle. Ruining a family to pursue a cure for cancer is very irrational, because to this day no oncologist has found a way to definitively cure cancer—objectively speaking, most of the time everyone is merely trying to prolong the patient's survival.

While reading this book, I myself happened to be going through the same transition from fervor to rationality in the anti-cancer dream. So as I read, I deeply empathized with the author's feelings in writing it. After struggling against cancer for more than ten years and watching tens of thousands of cancer patients pass away, I have gradually slowed my pace.

By the lakeside, in the library, under the tree-lined paths of the park, I have countless times thought about how to root out cancer, but fulfilling that wish is too difficult. Now I have adjusted my goal to studying how to prevent cancer and prolong cancer patients' lives and improve their quality of survival. This has relaxed me greatly—because it is a more realistic goal.

My own pace of life has also begun to slow down step by step. I have greatly reduced my use of the phone. Though I cannot completely escape modern life, I can minimize the place modern life occupies in my life.

My life grows ever simpler and more rustic. I once again have plenty of time to read books, to stroll by the lake and under the trees, to play my seven-string qin, to accompany my child in a game of chess or to play the games he likes.

As Mukherjee put it at the very beginning of The Emperor of All Maladies, an oncologist must have a life beyond cancer, or he will sooner or later collapse. After making a series of de-cluttering adjustments, my life finally has many themes beyond cancer; I do not want to suffocate in cancer either.