The Big C: Hitchens lost to the Emperor of all Maladies

THE GREAT Contrarian lost his last argument last night, and in an odd twist he'd doubtless already thought of and enjoyed, he was defeated by himself, but in a more cantankerous, aggressive and determined version.

It was cancer that got Christopher Hitchens: a bunch of Hitch cells, throttle wide open, roaming, dividing and conquering. A case of do or die. They did, so he did.

Sometimes cancer can be swift and hellish, sometimes it's slow and  - as it was for my father - reasonably gentle. And sometimes it's both slow and hellish.

We had a mutual friend, the journalist John Diamond, who died, like Hitch, of what's generalised in the trade as "head and neck cancer". So Hitch saw what nature can do, especially when accompanied by doctors as well-meaning, inventive, skilful and utterly in the dark as any Bronze Age astronomer.

Nature - which Hitch defended against all the gods - is fine, until it all goes wrong. Or so we delude ourselves.

But cancer is just another way of Nature going right. It's just that we don't fancy it. It horrifies us. It's one of the Great Terrors that keeps the dear old Daily Mail going, along with benefit scroungers, so it must have been hard when they found out the other day that a government report proposes that all chemotherapy patients should have to prove that they were too poorly to work.

Imagine. Cancer Horror pitted against Sick Note Britain Horror in the same story. Best for the newsdesk to stick its fingers in its ears and hum. So they did.

A pity Hitch was too busy expiring to smack his great and righteous fist into the pinched mean face of this repugnant idea. He'd have spotted it for the feint it clearly is, unlike the report's author, Professor Malcolm Harrington - CBE, just think! - who fell right into the heffalump trap of one of the oldest political tricks in the book.

You watch. Following the predictable public outrage, in a week or two some frighful schoolboy from the government will announce that they have listened to public opinion and changed their minds. It was all a mistake and a monstrosity. Keep calm and carry on.

Well... it is a monstrosity. But that's why it was chosen.

Of all the hateful diseases jostling around us, cancer (with its seemingly endless stultifying, nauseating, cytotoxic side-show, chemotherapy) is the only one dark and strange enough to fit the bill. We'll all get it or know someone who gets it. It seems to be - and literally is - part of being human. The cure seems worse than the malady, and more often than not is no cure at all, but a stay of execution pending appeal.

And so when Harrington lines up "chemotherapy patients" in his advisory sights, what we hear is "poor bastards who still think they might not die if they feel awful enough".
 
Things have, of course, changed over the years.

We've gone past the age of the monstrous, well-intentioned but gothically insane Halsted "ultramastectomies" where a woman with a small breast lump might wake up from the ether with her chest carved down to the bare ribs and her shoulder and collarbone gone.  

We've gone past the stage of kamikaze chemotherapy, bodies defoliated before the napalm of radiation burns in, then having to be re-planted with their own bone marrow, like a personal Vietnam.

But the sheer magical glamour of cancer remains. For a while, as a student, I planned to become a gynaecology oncologist. I thought that by the time I became a consultant it would all be curable, and, less honourably, because the whole mystery and extravagant staginess of cancer was, and remains, fascinating.

"Glamour" is, I know, an odd word to use. As odd as the oncologist who told a friend that her cancer was like "a magnificent, wild, leaping young animal" inside her body.

Or, as oncologist Siddhartha Mukherjee puts it in his stark, eloquent and beautiful "biography of cancer", The Emperor of All Maladies: "Someday, if a cancer succeeds, it will produce a far more perfect being than its host - imbued with both immortality and the drive to proliferate."

Mukherjee (or 'Sid', as he's apparently known to his friends and colleagues) has written something truly extraordinary. Writing about the puzzle and the glory, the genesis and the genetics and the biochemistry and treatment of cancer, accessibly and with real narrative drive is a hell of an achievement. But this isn't the sort of book you can't put down. It's better. It's one you have to put down, often. To think. To savour. Or just to postpone the end.

Mukherjee recently won the Guardian First Book Award and the Pulitzer Prize for non-fiction. From the first page to the last, you can see why.  If I'd read this as a medical student, I'd be an oncologist now.

• The Emperor of All Maladies: A Biography of Cancer by Siddhartha Mukherjee, Fourth Estate. ISBN 978-0007250929

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