Review of The Emperor of All Maladies

A physician at work recommended the book or documentary The Emperor of All Maladies: A Biography of Cancer to me, and that seemed like a good reason to pick this title out of the many books and films about cancer that I might put on my list. I chose the 6-hour 2015 PBS documentary over the Pulitzer-winning 2011 book by Siddhartha Mukherjee simply because I have more things on my to-read list than on my to-watch list, but honestly, the documentary whet my appetite to read the book. Mukherjee appears frequently as one of the series’ many very articulate interviewees, and it’s clear there’s material in the book the documentary didn’t cover.

The PBS version ran in three episodes of two hours each. It’s lengthy and not nearly long enough to cover all of the social, medical, surgical, and preventive aspects of cancer. Each episode has some overarching themes and stories that form a bit of an arc, but I think it could have worked just as well with six one-hour episodes. The film largely focuses on the story of competing and shifting paradigms in cancer research, especially in research around cancer treatment, although prevention is also mentioned. The series also touches on shifting cultural attitudes towards cancer, from a time in the mid-twentieth century when cancer was mostly a taboo topic to the vocal fundraising, activism, and patient advocacy of today, but this topic is primarily presented in the context of the research. 

In addition to the ups and downs of cancer research,
the documentary discusses various public initiatives for
 fundraising and awareness, including the Jimmy Fund,
founded in 1948.

I could imagine some viewers feeling that the documentary was incomplete because of the comparatively short time it spends discussing environmental and consumer goods regulations (or lack thereof) and other attempts at preventing cancer that have grown as we as a society have learned more about carcinogens. I didn’t know what to expect going into the series, so I wasn’t disappointed, but there’s still more I’d like to know. One aspect that did frustrate me was that the story was very centered on the United States -- for example, it talked about surgeon general’s warnings against tobacco use, but not about the very large “Smoking kills” warnings that many countries have require on cigarette packages for decades. 

The series shows the personal impacts of cancer by following a number of patients and their families through the course of their treatment, and in some cases, through the end of their lives. Personally, I found the balance of modern individuals’ stories with historical and research information (which also includes patients’, researchers’, and advocates’ stories) to be just right. A lot of the history is within living memory, but within such a fast-moving field of study, memories of a treatment breakthrough twenty years ago can feel very much in the past.

It’s not the first documentary I had seen on illness, but especially with the sick kids being profiled, I was struck by the weird intimacy of having film crews follow people in the hospital.In my work at a medical museum, I have coworkers in the department that handle news and public affairs for our hospital, so I’ve had a very small inside look at that process. From them, my understanding is that there are stringent requirements for ensuring the camera crews have the permission of the patient (or their family for minors) and the care team, and most importantly, that they all understand that the patient can revoke permission at any time in the process. This made me feel better as I watched the heart-wrenching stories, with and without uplifting endings.

Perhaps my favorite of the personal stories was in episode two. A surgical oncologist became a patient when she learned that she had breast cancer. She is an attending surgeon, and she supervises residents as well as performing surgeries, and I imagined that sharing this intensely personal journey in a high-profile documentary was something that she did with the spirit of an educator. She did additional interviews about her experience, many of which are available online. Her own mentor from when she was training performed her double mastectomy.

Overall, I would recommend this film to anyone interested in the scientific or cultural progress we have made in addressing the complicated mess that is cancer. It's hopeful without being overly idealistic about the potential breakthroughs and roadblocks in the future.