Throughout history, there have been a surprising number of doctors who were also great writers.
For some of these physicians, writing was, apparently, a diversion. William Carlos Williams, for instance, used to scribble his terse poems on prescription pads between patient visits.
For others, time in the hospital seems to have stimulated their imaginations. When Arthur Conan Doyle was in medical school, he had a professor who could walk into a waiting room and diagnose people just by looking at them. Those uncanny powers of observation inspired Conan Doyle’s most famous creation: Sherlock Holmes.
And then there are the doctors for whom writing seems to be a form of thinking, a way to process the lives they lead when they’re wearing white coats. In this camp, you might think of Oliver Sacks, who wrote about his patients not only as a way to make sense of their pathologies but also to expand his readers’ understanding of science, medicine, and the human condition.
Another writer working in that vein is our guest today on The Next Big Idea, Dr. Siddhartha Mukherjee.
Born and raised in Delhi, Sid attended Stanford for undergrad and then earned a Ph.D. at Oxford as a Rhodes Scholar. After that he got his M.D. at Harvard, and in 2009 he joined the oncology department at Columbia, where he teaches and manages a lab that is developing new cancer drugs. He also runs four different biotech companies.
And, of course, Sid is not just a doctor. He’s also a writer—a gifted one. His first book, The Emperor of All Maladies: A Biography of Cancer, won a Pulitzer Prize and was turned into a documentary by Ken Burns. His next, The Gene: An Intimate History, shot to the top of the New York Times bestseller list and also received the Ken Burns treatment. His latest is called The Song of the Cell: An Exploration of Medicine and the New Human.
That song—or story—begins three-and-a-half billion years ago when the first cells emerged. It accelerated in the 17th, 18th, and 19th centuries as a colorful cast of scientists and hobbyists discovered that all living things are made out of the same cellular building blocks. And it culminates in the present as researchers (Sid among them) use their modern understanding of cells to design game-changing treatments for cancer and other diseases.
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On the elements of great science writing.
Rufus Griscom: Your first book, The Emperor of All Maladies, was about the quest to cure cancer, and it won a Pulitzer Prize. Your second, The Gene, was a number one bestseller. And your latest, The Song of the Cell has spent 12 weeks on the New York Times bestseller list. I find this really encouraging because while your books are beautifully written, they’re also full of dense, complicated science—and dense, complicated science is not something one typically associates with success in publishing. Why do you think your work has resonated with such a large audience?
Siddhartha Mukherjee: I think that it has resonated because people are curious. A lot of science writers foolishly underestimate how curious the broader public is about what’s happening, and I think that’s a terrible mistake. That underestimation leads to a kind of paternalism, which I cannot stand.
I’ll tell you two anecdotes that are important. A very important mentor of mine said to me, “If you cannot explain to someone who is curious and interested in one sentence why what you’re doing is important for human beings, then you’re in the wrong.” That should be one exercise that every scientist, every doctor, every person involved in the sciences should be able to perform.
Point number two is someone else said to me, “We underestimate the interest people have in entering a completely new cosmos.” Think of Alice in Wonderland. Think of Tolkein. Think of Dune. Think of Hunger Games. What people want to do, as readers, is enter a new cosmos with you—a new world. And once you’ve brought them into that world, they’ll trust you. In my case, that world happens to be genetics, cell biology, cancer, and longevity.
On scientists, tinkerers, and crackpots.
Rufus: One of the things you do in The Song of the Cell is you bring to life dozens and dozens and dozens of early scientists and tinkerers who made critical discoveries about how cells work, and built on one another incrementally. Who among them were you most fascinated by?
Sid: I’ll give you some examples, but they’re all so crazy that it would be interesting to meet all of them. There’s Robert Hooke. He’s a cantankerous guy. He is a bit of a polymath. He is a microscopist, a physicist, an architect, a designer, an illustrator, an engineer, a tinkerer. So Robert Hooke would be a fun character to visit, partly because he was such a cantankerous madman. At one point of time, he said that it was he who thought about the laws of gravitation, and this made Newton so angry, the story goes, that when the Royal Society moved its offices from its old office to its new office—so Robert Hooke used to be the president of the Royal Society, and then Newton was the next president—Newton was so pissed that he took the one portrait of Robert Hooke that ever existed in the world, and he purposefully neglected to move it to the new office. And that portrait has been lost. And so the man who invented, or partially invented, optics, the art of seeing, does not have an optical visual representation of him. We don’t know what he looked like.
“What people want to do, as readers, is enter a new cosmos with you—a new world.”
But there are others. There’s crazy Leeuwenhoek, the inventor of the microscope. He’s as crazy as they come. He’s not a scientist. He refuses to let other people examine his microscopes. He’s living in Delft. He’s a cloth trader, never trained in science. It would be fun to meet him and say, “Why didn’t you just let someone from the Royal Society look down your microscope?”
Rufus: And he did these beautiful drawings, didn’t he?
Sid: Incredibly beautiful drawings. And the last person I’ll say is Frances Kelsey, an administrator in the FDA who looked at the evidence and said thalidomide was not safe for pregnant women. I’d love to meet Frances Kelsey and just shake her hand and say, “You know what? You did a great service. Thank you. You were pushed by drug companies. You were pushed by the FDA. And you said, ‘No thank you, because I have my standards. I’m not going to bend. You have to prove to me that this drug is safe, and I’m not sure that it is.’” She saved hundreds of thousands of lives.
So it’s a range from Robert Hooke to Frances Kelsey.
On recent breakthroughs in stem cell treatments.
Rufus: Let’s talk about stem cells. They’ve been a buzzword in medicine for the last several years, and a source of some political controversy. Now we have new techniques, and there’s been a real explosion of exciting applications of those stem cells. Is that right?
Sid: So there’s a special kind of stem cell called an embryonic stem cell. This is a cell that you can grow and it makes copies of itself. You can grow it in a lab, in culture, like you can grow any other cell type, but under the right circumstances, you can make that stem cell give rise to all the necessary tissues that are in the human body—cartilage, bone, most tissues you can derive from stem cells. (I should say blood is an exception, but that’s a side story.)
“Not far in the future, we will have cures for sickle cell anemia based on all these technologies. It’s more exciting than flying cars.”
These are extraordinary cells. They’re derived from embryos and they have extraordinary capacity to give rise to other cells. And for a while, there was a moral outrage about the fact that these cells were being derived from embryos and therefore were in the gray zone for some people who thought that they should not be used in laboratory research. But then, in a series of astonishing experiments, Japanese researchers, Shinya Yamanaka and some others, discovered that you could actually bypass deriving these cells from an embryo and use any cell in the body, like a skin cell, and make it into cells that are like these embryonic stem cells. They’re called iPS cells. They behave, for the most part, like embryonic stem cells. And by genetically manipulating these skin cells, you can make them behave like embryonic stem cells. It’s almost as if you took a cell from your body, you know, a cell from your skin, and made it into one of these embryonic cells, thereby bypassing some of these religious and other concerns that these cells were derived from embryos and could give rise to embryos.
Rufus: It seems like the potential implications of this and the range of diseases that could be treated are almost endless.
Sid: Absolutely. There’s enormous potential. It’s unrealized potential, but that’s how science works, right? You advanced an idea. It seems mad to start with, and then slowly it seems less and less mad. And then finally, all of a sudden, you’re taking a gene therapy, a chemical therapy, a medicine that seemed mad 10 years ago. This is how science works.
Not far in the future, we will have cures for sickle cell anemia based on all these technologies. It’s more exciting than flying cars. These are cures for deadly diseases that humans have had since the birth of humanity.
Can cancer be cured?
Sid: I see some cancers as curable, some as preventable, some cancers as detectable. I think the solution to cancer is going to be a mix. We’ll prevent some, we’ll detect some early and cut them out, and some we will treat based on new therapeutics.
Breast cancer is a good example. There is preventative stuff in breast cancer. We know some of the risk factors—some genetics, some non-genetic. We can identify people who are at high risk and we can tell them what to do in order to help prevent breast cancer. We can do early detection. It helps a little bit. And finally, if you were to have breast cancer, we have now, not one, not two, not three, not four, not five, but tens of medicines that work for the majority of the variants of breast cancer. These medicines will extend your life, not one, not two, not five, but up to 15 years. So we do have life-changing paradigms for cancers, they’re just not there for every cancer.
The advice Sid gives dying patients.
Rufus: You opened the book with the story of your friend Sam, who was diagnosed with a malignant melanoma in 2016. Initially, he responded well to treatment. He went into remission. But the cancer came back and, as you write, “the melanoma won.” Do you think that today would have a better chance at fighting that cancer?
Sid: Oh, I think today we’d have a better outcome. I think that there are a series of new drugs since 2016 and 2017 that allow us to have much, much more control on cancer. Maybe this time we would’ve won, but that’s just a hope.
Rufus: Well, boy, it sure creates a kind of urgency around the work that you and many others are doing. I was really moved by the passage where you said the last time you saw Sam, he asked you what happens at the end, and you thought back to all the patients you’d been with near the end of their lives, and you gave him some advice. I wonder if you could share that with us.
Sid: The advice I give people is this: Think about forgiving someone, think about being forgiven, and think about something that you’d like to do that you haven’t done yet. I can’t stop time—no one can—but I can slow time, and I can correct time.
“Think about forgiving someone, think about being forgiven, and think about something that you’d like to do that you haven’t done yet.”
I say to people, “What’s hankering you?” And the answer is often that they haven’t told someone that they love them; they haven’t forgiven someone; and they haven’t been forgiven by someone. Just three simple things. And I say, “Okay, there’s a phone next to you. Pick up the phone. And say to someone that you haven’t forgiven, ‘I forgive you.’ Or pick up the phone and say to someone, ‘I’m really sorry I did something. Can you please forgive me?’ Or pick up the phone and say to someone, ‘I love you.’”
There is a spiritual burden that’s lifted from you when you say those three things and you make yourself ready to die. You can crash a plane or you can land a plane. I want people to land a plane.
Edited and condensed for clarity. For a closed-captioned version of this episode, click here.
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