CureTalk Interview with Dr. Siddhartha Mukherjee, Recent Pulitzer Prize Winner for “The Emperor of All Maladies”
Early on in our conversation, I confessed to Dr. Mukherjee that I thought of him and the other doctor we worked with at the Columbia University Medical Center, Dr. Azra Raza as rock stars. Both have great hair, are incredibly brilliant, are scrupulously dedicated to their work and yet, make time for their patients and staff, speak with them in a friendly tone of voice and listen with a calm demeanor — a feat few research doctors at a busy academic center can perform.
Our Myelodisplastic Syndrome (MDS) team worked tirelessly. Taking care of our patients, ensuring the tests were accurate and ultimately hoping to prolong life is what drove us to work our hardest and to bring our best to the job. A life saving mission is an incredibly motivating one. And no one knows this better than Dr. Siddhartha Mukherjee himself who has dedicated his life to saving others through fighting cancer, in school, at the bench side, in the clinic and now through his new book “The Emperor of all Maladies”. He’s just won the Pulitzer Prize for it and I can tell you it truly is a work of art. Dr. Mukherjee is not only a brilliant doctor, he is a poetic writer. “The Emperor of all Maladies” sweeps through the history, science and the many human stories that cancer manifests through and it couldn’t be more timely — cancer is everywhere. For example, both my mom and dad had it, two of my grandparents, an aunt and uncle, many people I know and have worked with also were diagnosed with it. Statistics tells us that one in three of us will get cancer.
I asked Dr. Mukherjee a few wide ranging questions about his book and about cancer in general that I’ve been curious about. Our dialogue started out like this:
Me: You had described in the introduction to your book that you started keeping journals at some point which amassed into “The Emperor of All Maladies”, but can you describe the moment when you knew you would write the book?
Dr. Mukherjee: Sometime at the end of my fellowship, when my journals were becoming more and more voluminous, I reacted to two kinds of pressures: On one hand, we’ve lost the forest for the trees. In the midst of a clinical setting rushing around from the bench to the clinic, you lose perspective on what that larger project is. On the other hand, if you looked at the media at the time, it was as if the trees were being lost for the forest. There were a lot of global descriptions of what was happening with cancer but I felt it lacked the perspective of the patients as well as some of the dialogue that goes on inside the lab and inside the clinics. So I felt that these two dialogues: the over-granularity and the under-granularity had to be melded so that we could have a real, national conversation on what is going on with cancer. So that began to gel in my mind around the end of my fellowship and therefore I started moving towards the book.
Me: So there was not a larger discussion about the history and scope of cancer.
Dr. Mukherjee: Definitely, I felt it was missing and moreover, my patients kept asking over and over again what the larger history of cancer was and where they fit into that. For instance, “Are we winning or loosing the war on cancer?” This is a question that we can’t answer in less than 600 pages…I think. It is not a yes no answer. It’s a complex answer that includes the history and our current understanding of the present and the future [of cancer]. It’s disrespectful giving patients a simpler answer than that. Plus, patients need that perspective to understand and rebuild a kind of partnership with medicine because there has been a rift in that partnership in the last few years.
Me: I definitely agree, I’ve written a few blogs about that myself. Aside from the larger conversation about cancer and understanding where we are at in a larger trajectory, focusing on the research community, what do you see that is holding the oncology community back? What can we do together to help us all take a step forward?
Dr. Mukherjee: We need to build partnerships between physicians, patient advocates and the pharmaceutical world such that we can bring about new mechanisms to prevent, treat and possibly cure a few cancers. Enrollment in clinical trials remains very threatened today and partly the reason is that there is a real rift between academic medicine and patients and we need to repair that rift and restore a kind of partnership such that we can move ahead. Ultimately the only way we can get knowledge about treatments or prevention is through learning from patients. So patients have to become our collaborators and it’s our job to make them our collaborators.
Me: Do you think that it is because patients are becoming less and less interested in their own health and they just want to be told, “take this or do that”?
Dr. Mukherjee: No actually, just the opposite, I think they are becoming more interested. As a community of physicians we are not doing a good job of communicating with their desire and interest for information. We need to provide them solid, evidence-based information about medicine.
Me: Will the cure for cancer be found in better targeting of cancer-related genes and in finding a cure for cancer, will we unlock the secret to longevity?
Dr. Mukherjee: I think some cures for some cancers will lie in unlocking the genetic mysteries of cancer but we haven’t even begun to fully explore cancer immunology. The role of the immune system in controlling and possibly treating cancer was a dead field for dozens of years and is now revived. Moving outside of the cell into the whole organism is one very key insight. And as far as longevity is concerned, I can hardly comment on longevity.
Me: I admit, that is perhaps my own science fiction, cancer fantasy. OK, moving along, as you mentioned, not all cancers are the same. In Leukemia, based on your own direct experience, what has been a breakthrough treatment or methodology that works and why?
Dr. Mukherjee: In Leukemia, the paradigm that works is to identify the genes that are driving this cancer and use medicines that specifically inactivate the genes themselves or the pathways that those genes utilize. This methodology has been really successful. Particularly the shining example has been Chronic Myelogenous Leukemia [CML]. If you find the right patient who happens to have the right gene and treat them with the right drug, you get amazing responses. That needs to be extended out to other cancers (if that even exists in other cancers remains another story), but once again you need to find the right patient who possesses the right genetic makeup and use the right kind of drug in that patient I think that will be the key for many cancers.
Me: One last question, where do you have the Pulitzer Prize and how much does it weigh?
Dr. Mukherjee: (Laughs) The award ceremony is not until later so I don’t know, but someone told me it is the most precious paperweight you can have so… The Pulitzer is one of the world’s great honors and I am so deeply touched that they recognized more than me but they recognized that cancer is an important topic to address.
Me: The award is well deserved Dr. Mukherjee, for such a brilliant doctor and now award winning author.
Dr. Mukherjee: Thanks very much