A view From the Bridge

The Emperor of All Maladies, redux

Posted on behalf of Boer Deng

One of the remarkable features of Siddhartha Mukherjee’s Pulitzer Prize-winning history of cancer, The Emperor of All Maladies (2010), is its philosophical acuity. “Science embodies the human desire to understand nature; technology couples that desire with the ambition to control nature,” he writes. Cancer treatment is at the very edge of technological possibility, intervening in a disease that is our “desperate, malevolent, contemporary doppelganger”. To Mukherjee, cancer was not something, but someone.



Cancer: The Emperor of All Maladies, a three-part documentary, adapted from Mukherjee’s “biography” and directed by veteran filmmaker Barak Goodman, airs on PBS (the US Public Broadcasting Service) starting 30 March. It stands witness to the achievements of cancer research, but is also visceral and emotional.  Executive producer and co-writer Ken Burns, best known for his documentary series on the American Civil War and the Roosevelts, is adept at evoking empathy for those who feature — parents with sick children, wives learning of husbands’ prognoses, doctors faced with unspeakably difficult choices.

The structure hews closely to the book’s. Part 1 traces the disease to an ancient Egyptian record telling of an illness for which “there is no cure”, to rudimentary treatments that evolve from antiquity to modernity, to the mid-twentieth-century US “war on cancer”, for which pathologist Sidney Farber and socialite and philanthropist Mary Lasker galvanised support. Part 2, “The Blind Men and the Elephant”, looks at the shift towards piecing together the still-muddled puzzle of cancer genomics. It is proof of the progress over the past few years that immunotherapeutics, which Mukherjee’s book did not discuss, closes the series’ finale, “Achilles Heel”.

Yet as medicine advances on the screen, a subtler kind of progress can be detected in the voices of those whom cancer has touched. In 1978, essayist Susan Sontag, diagnosed with leukaemia, wrote in Illness as Metaphor of a peculiar sociological phenomenon — the “magic power” even the diseases’ names seem to hold. Until the AIDS epidemic of the 1980s, cancer evoked a uniquely potent dread. Some oncologists even avoided telling patients they were ill, a practice that still goes on in some parts of the world. When cancer could not be fully understood and confronted, it demoralized.

The most profound aspect of Burns’s visual rendering of Emperor of All Maladies is that it allows us to see the clarity that cancer research has brought about. We can now read the mutations of an oncogene, and look with astonishing precision at where a tumour has formed. In the last two years, as the series shows, work by Steven Rosenberg on T-cell therapy and James Allison on targeted tumour recognition has revealed how harnessing the immune system can combat cancers.

Such advances have divested cancer of some of its slippery, amorphous capacity to invoke terror. “Cancer, we have discovered, is stitched into our genome,” writes Mukherjee. “Perhaps [it] defines the inherent outer limit of our survival.” Burns’s documentary ends with “tempered optimism”, speculating that one day soon the disease will be managed “like any chronic illness”. For now, at least we have reclaimed our agency in facing it.

Cancer: The Emperor of All Maladies runs from 30 March to 1 April on PBS.


For Nature’s full coverage of science in culture, visit www.nature.com/news/booksandarts.


  1. Jo Moore

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    Jo Moore said:

    The truest “philosophical acuity” about Mukherjee’s The Emperor of All Maladies that is never mentioned in the mainstream culture’s praise of it is that the work is mainly a one-sided account glorifying the conventional allopathic medical system (and how that industry views cancer) and its “advanced” technological cancer modalities.

    You can see this type of politically/medically-correct “thinking” of Mukherjee in action in his perspective of cancer as a person (“To Mukherjee, cancer was not something, but someone.”) which is just about the same as the medical business’ view of cancer as some mutated genetically deterministic “alien thing” that needs to be destroyed. It’s a erroneous dogmatic perspective of allopathic medicine, instead of science (read “The Mammogram Myth” by Rolf Hefti – see TheMammogramMyth dot com). But… the dogmatic ideology is highly conductive to, and aligned with, their ridiculously profitable business model using expensive technological cancer interventions all of which are geared to eradicate the alien“someone.” Mukherjee’s dogmatic hope into gene therapy-medical solutions to cancer is also right up the big money-alley of the allopathic business.

    The real fact is that the orthodox “war on cancer” has been an almost complete failure (read ‘War on cancer” by Guy Faguet or Samuel Epstein’s work), and it’s mainly glorified medical propaganda (and more “sophisticated” versions of that like Mukherjee’s work) and mainstream media and the cancer “charities,” obvious allies of the medical industry, that keep convincing (=hoodwinking) the public otherwise.