"Well, in our country," said Alice, still panting a little, "you'd generally get to somewhere else--if you ran very fast for a long time, as we've been doing."
"A slow sort of country!" said the Queen. "Now, here, you see, it takes all the running you can do, to keep in the same place. If you want to get somewhere else, you must run at least twice as fast as that!"
-Lewis Carrol,
Through the Looking-Glass
One of the chapters of Siddhartha Mukherjee's The Emperor of all Maladies begins with this very apt quote that describes the pursuit of hundreds of clinicians and researchers worldwide to know more about and overpower this deadly disease that we call cancer. Do we know of a time before cancer came to existence? Probably not. If we do not have proofs of its existence since the beginning of life, it is only because no records are available or we may not have come across (or understood) them. What we do know is that this monster is an ancient one and it has caught the attention of humans as early as 2500 BC; however, the name 'cancer' came into being during the time of Hippocrates in 400 BC. Mukherjee's historical account of cancer begins with the first recorded medical description in an Egyptian text and builds the story one significant development after another till the year 2010.
I borrowed this book from a friend almost three years ago, and it remained buried under the pile of other books that I needed to finish urgently. The reason why I finally picked it up one evening was not because I had finished reading every other book on my list. It was because I needed to delve deeper into knowing this monster inside out; it had crawled and come closer than I had ever imagined. It was no longer just any other disease.
If one needs to identify the point in time that marks the beginning of the quest to eliminate cancer, it has to be in 1947, the place being Sidney Farber's basement laboratory at the Children's Hospital in Boston. A trained pathologist, Farber took up studying the effect of certain chemicals on childhood leukemia, which gave birth to the idea of chemotherapy as we know today. He found an ally in Mary Lasker, a health activist and a philanthropist, and together they began a campaign for public awareness of cancer and to raise funds for cancer research. Today, we may not realize how difficult it was to secure funds to conduct large-scale, well-designed, randomized clinical trials on patients with different types of cancer. Mukherjee touches upon the process of fundraising as well as the politics of it. Once you get the complete picture of struggles of early researchers and clinicians who tried everything to ease the pain of their patients and give them a few more pain-free months to live, you realize how far we have come in just a few decades.
As it happens in case a fire breaks out, rapidly engulfing everything around it, the focus remains on dousing the fire with little information about how it began. The initial approach to control this complex group of diseases was somewhat similar. Radical surgeries and cocktails of toxic chemicals were tried by different clinicians worldwide, but the results and success rates varied. It was only in 1990s and early 2000s, when there was a surge of information owing to developments in molecular and cell biology, advanced visualization and surgical techniques, that the attack on cancer became more focused, more informed. The most interesting accounts narrated by Mukherjee in this section are about the development of two wonder drugs that we know of today, Herceptin (Trastuzumab) and Gleevec.
'The fruits of long endeavors'--the concluding part of the book-- summarizes the long story of this 'emperor of all maladies' and brings us to believe that what we are reaping today are indeed the fruits of endeavors of everyone who accepted the challenge posed by this ancient monster and jumped in the battlefield with whatever resources and expertise they had at that point of time. We owe them more than we could realize.
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