‘Cancer: The Emperor of All Maladies’ Battling an Opportunistic Killer by Neil Genzlinger

Early in Monday’s first installment of PBS’s “Cancer: The Emperor of All Maladies,” a statistic about cancer’s toll in the United States is offered to convey the magnitude of the subject. “More will die from cancer over the next two years than died in combat in all the wars the United States has ever fought, combined,” the narration says.

It’s an apt comparison, because what follows, in three episodes of two hours each, is itself the story of a war that has been going on for centuries. This fight has had risk-takers, mistake-makers, heroes and casualties just like any armed conflict, but watch long enough and some specific wars might come to mind — Vietnam, for instance, or the war on terror. The battle has grown more complex as it has gone along, and clear victories have been hard to come by.

This absorbing series, directed by Barak Goodman, has as an executive producer, Ken Burns, who knows something about how to make a documentary about a war and how to make history come alive. It’s a timeline of humanity’s long effort to cure cancer, going back to the preindustrial age but concentrating on the last 75 years or so.

The series is structured as an ever-evolving medical detective story, but the filmmakers give it heart as well by juxtaposing the history lessons with present-day personal profiles of cancer patients — a young child facing leukemia, an oncologist who discovers that she herself has breast cancer. These vignettes are bravely and wrenchingly told, the participants allowing close-up views of the life-or-death decisions they make, and not all of the stories end happily. The patients aren’t the only ones to show their vulnerability; the doctors, too, are exposed, sometimes not really sure if they’ve made the right calls or if the cutting-edge treatments they’re trying will work.

It’s a well-conceived approach to a subject that in other hands might have been dry. Still, be prepared to give it your full attention. The series grows more demanding as the search for a cure advances from the relatively crude — trying to cut cancer out or irradiate it — to the genetic frontier. Think of it as: Part 1, bachelor’s degree; Part 2, master’s; Part 3, Ph.D.

“Cancer” drives home how quickly treatments can go from bold breakthrough to primitive miscalculation. Part 2, for instance, which focuses on breast cancer, reminds us that radical mastectomy was the default treatment until relatively recently. It was an option that, it was thought at one time, had to be administered quickly, as soon as biopsy results were in.

“You would go into the operating room, and you wouldn’t know whether you were going to wake up with a breast or not,” Dr. Susan Love, a cancer surgeon, recalls. “And you know how you found out? You looked at the clock. If it was three hours, it was cancer, and if it was an hour, you were benign. It was just appalling.”

Apparent breakthroughs give way to the harsh reality that cancer is complex and mutable. At one point, the hopeful headline, “A Cancer Vaccine by 1973?” flashes across the screen. The closer researchers looked, the more baffling the cancer cell became, especially once they realized that the disease wasn’t something imposed from outside.

“The vulnerability is already within us,” explains Dr. Siddhartha Mukherjee, on whose excellent book the series is based. “The very genes that make you grow, the very genes that keep you alive, will under different circumstances kill you.”

At times, the program seems too much like a promotional video for cancer researchers and hospitals, and it touches only briefly on the significant issue of costs. As the treatments grow more refined and exotic, they also grow more expensive.

And as with all aspects of health care, advances raise disturbing questions about whether treatments and cures will be available to all or only to those who can afford them. Even with the personal stories interspersed in these six hours, it’s not generally clear how much the interventions are costing or who is paying — matters of urgent interest to any family facing cancer. There also isn’t much about how research is financed or whether a doctor or medical institution’s research interests affect treatment recommendations, a dark side of the medical establishment that needs much more scrutiny.

But the series achieves its main goal, which is to show the human impact of cancer and make you fighting mad that we haven’t been able to beat this sinister, opportunistic killer.

“Cancer wants to live, at the expense of your entire body and your entire being,” says Dr. Suzanne Cole, an oncologist. “It doesn’t care about you. It doesn’t care if you’re a mother, or a husband, or a daughter, or if you have four children. It doesn’t care. It just cares about itself.”

 

Directed by Barak Goodman. Ken Burns, executive producer. A collaboration of Florentine Films, Laura Ziskin Pictures and WETA Washington, D.C., in association with Ark Media. Based on the book “The Emperor of All Maladies: A Biography of Cancer” by Dr. Siddhartha Mukherjee.

By Neil Genzlinger
New York Times
March 24, 2015

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