The Emperor of All Maladies
By Siddhartha Mukherjee. It is another one of the books I received in the mail Tuesday. I didn’t plan on reading it before this weekend, but ‘things didn’t go as planned.’ I started out with a few pages Tuesday evening and basically I just couldn’t stop reading. Now I’ve finished the book.
It’s gotten a lot of attention around the web, which was part of why I decided to have a go at it. The attention it has received is not undeserved. I’d have liked more data but then again I always want more data. Here are a few interesting observations from the book:
“In 1870, the per capita consumption in America was less than one cigarette per year. A mere thirty years later, Americans were consuming 3.5 billion cigarettes and 6 billion cigars every year. By 1953, the average annual consumption of cigarettes had reached thirty-five hundred per person. On average, an adult American smoked ten cigarettes every day, an average Englishman twelve, and a Scotsman nearly twenty. […] between 1940 and 1944, the fraction of female smokers in the United States more than doubled, from 15 to 36 percent.”
If you assume they wouldn’t have started in case there hadn’t been a World War, you can probably add another few million people to the list of war casualties right there. How about later on? “By 1994, the per capita consumption of cigarettes in America had dropped for nearly twenty straight years (from 4,141 in 1974 to 2,500 in 1994), representing the most dramatic downturn in smoking rates in history.” But before that point the results of the changed smoking habits were not hard to observe in the data:
“Between 1970 and 1994, lung cancer deaths among women over the age of fifty-five had increased by 400 percent, more than the rise in the rates of breast and colon cancer combined. This exponential upswing in mortality had effaced nearly all gains in survival not just for lung cancer, but for all other types of cancer. […] Lung cancer was still the single biggest killer among cancers, responsible for nearly one-fourth of all cancer deaths.”
A few other interesting bits:
“Prostate cancer represents a full third of all cancer incidence in men — sixfold that of leukemia and lymphoma. In autopsies of men over sixty years old, nearly one in every three specimens will bear some evidence of prostatic malignancy.” (but you already knew that first part, right?)
“Cisplatin was unforgettable in more than one sense. The drug provoked an unremitting nausea, a queasiness of such penetrating force and quality that had rarely been encountered in the history of medicine: on average, patients treated with the drug vomited twelve times a day.”
“The incidence of CML remains unchanged from the past: only a few thousand patients are diagnosed with this form of leukemia every year. But the prevalence of CML—the number of patients presently alive with the disease—has dramatically changed with the introduction of Gleevec [a new treatment option – there’s much more about it in the book and the wikipedia article also covers this]. As of 2009, CML patients treated with Gleevec are expected to survive an average of thirty years after their diagnosis. Based on that survival figure, Hagop Kantarjian estimates that within the next decade, 250,000 people will be living with CML in America, all of them on targeted therapy. Druker’s drug will alter the national physiognomy of cancer, converting a once-rare disease [people just died of it in the past] into a relatively common one”
He doesn’t cover the economics of cancer and cancer treatment in much detail and present problems and developments in this area are not covered at all. Included in the postscript is however an interview dealing with some of the stuff not covered in the book, and after reading that part I’m in a way glad he didn’t write about this stuff – when dealing with the question of the high costs of relatively recently discovered targeted therapies, he does not even mention FDA’s role in driving up costs when answering that question, which is telling me that this is a subject he simply doesn’t know enough about to cover, at least at the present point in time. If you want to know more the FDA’s role in driving up costs of new medical treatments, including new cancer treatments, Megan McArdle has written about that stuff often though I don’t have a specific link at hand; google is your friend.
The book is very USA-centric, but I didn’t consider that a big issue. It’s also ‘popular science’. That was initially a strong argument for not buying the book, but on the other hand the popular science aspect also means that the book is easy to read and won’t take you very long to get through even though the page count is significant.
It’s a wonderful read.
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