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Dr Siddhartha Mukherjee is the Pulitzer price winner for his book, 'The Emperor of All Maladies'. It is a lucid and griping account of this complex disease and our ongoing battle with it.
Dr Siddhartha Mukherjee is the Pulitzer price winner for his book, "The Emperor of All Maladies". It is a lucid and griping account of this complex disease and our ongoing battle with it.
CNBC-TV18's Anuradha Sengupta caught up with Mukherjee to find out more about his work.
Below is a verbatim transcript of the interview. Also watch the attached videos.
Q: The Pulitzer price has really propelled this book into limelight. It has got a lot of attention. Has it done what you wanted to do for the subject of the book, which is the discussion on cancer and the way we are dealing with the disease?
A: Well I hope so. Part of the reason of writing the book was to demystify something that was very mysterious to many people. Cancer is not one disease but many diseases and there was a huge amount of mythology around cancer. People feared the word and they didn't want to read about it.
So, in a way, writing a book allowed me to explore my own history and the history of this disease but also allowed me to understand what people feared.
Q: In the book at one point you say and I am quoting from the book, ďThis image of cancer as a desperate, malevolent, contemporary doppelganger is so haunting because it is at least partly true. A cancer cell is an astonishing perversion of the normal cell. Cancer is a phenomenally successful invader, colonizing part because it exploits the very features that makes as successful as a species or as an organism.Ē Would I be right on saying this is at the heart of the entire perspective you want to bring on this?
A: Exactly right. I mean if you really bestial down and ask the question: what is cancer? The quick answer is there is not one cancer. Breast cancer is very different from brain cancer. But that said, there are very deep fundamental principals that cross all forms of cancer.
What are those principals? Well, ultimately, cancer results from cells that donít know how to stop growing. Its pathological growth of cells and the crux is that you could ask, ďWhat makes cells grow pathologically?Ē Well, it turns out that the very genes that allow cells to grow normally, if you distort those genes, you get pathological growth.
Unlike really any other disease cancer is fundamentally linked to normalcy. In other words, the very genes that allow our embryos to grow or our hands to grow, if you distort those genes, you get cancer. So cancer is growth distorted and you can't do away with growth. Therefore its part of our genetic inheritance.
Q: There are different kinds of cancer and yet your book the starting point at least and the sort of underpinning is leukemia, which is blood cancer. Itís rarer isnít it than the other forms of cancer. When then did you pick that?
A: Even though leukemia represents a very rare form of cancer, it still lives at the cutting edge of cancer. So, itís a very peculiar series of historical instances that allow this to happen. One reason is that unlike most forms of solid cancer, by solid cancer I mean things that grow in lumps like breast cancer or lung cancer, leukemia is a liquid cancer. Itís a cancer of white blood cells.
So by its very nature it spread throughout the body and so you can't go to a surgeon and say take my leukemia away. By its very nature, if you treat leukemia as if itís a disease thatís already spread throughout the body and therefore you have to use things like chemical therapies or chemotherapy.
So leukemia, therefore, launches a very different mechanism to look at cancer. It changes the imagination of cancer. Itís a very interesting story that a rare variant can really drive the research of the more common variants. Interestingly, itís present in other fields of science too.
Q: You have dedicated your book to Robert Sandler who is this young boy who lived for just three years because he was suffering from leukemia in the 1940s. Your patients have been one of the triggers for you coming out with this book, isnít it? I find something very interesting that you have said in one of your interviews about how hope is malleable and how as a doctor who deals or treats cancer, itís not about cure so much as about coping with death. Would I be right?
A: Yes, I mean you are right in one sense. I donít think that coping with death is the only outcome. I mean we are living in times where people can live 10-15 years with breast cancer for instance. Now that doesnít mean that they have been cured. They are living with cancer as a chronic disease. Just that idea to say that there are conversions of come cancers into chronic diseases would have been considered hubristic and crazy in the 1950s Ė but thatís happened with some cancer. People are living with prostate cancer.
You meet dozens of survivors of breast and prostate cancer. So that transformation has been very central to all of these but not true for all cancers. For some cancers, and as I say this in the book, that pancreatic cancer, in fact, if you had metastatic pancreatic cancer in 1850 you would be so would be the same place in 1950 and so would be the same place in 2011. Some medicines have changed but really in many fundamental senses itís remained the same.
So my point is when I say hope is negotiable, hope is malleable, what we are trying to do now in oncology is trying to convert as many cancers as we can into these chronic forms because then people can live with it instead of dying of it. And thatís an enormous transformation.
Itís a little bit like diabetes. We still can't cure diabetes. We often can't cure heart diseases but there are survivors who live with diabetes. Imagine the moment of time when insulin was discovered. Insulin converted a disease that was very lethal, in fact, you die of diabetes in the 1920s into a disease that was manageable chronic.
So thatís the kind transformation thatís happened for some cancers.
Q: I think you have said that this bookís the ultimate aim is to find out is cancers end conceivable. You have also said is it possible to eradicate the disease from our bodies and societies forever. Where is cancer research when it comes to these questions today?
A: The first question, can cancer get completely eliminated from human society? The answer is very unlikely. Unlike for instance polio, unlike for instance smallpox, and the reason has very deeply to do with the first point that I just made, which has reason to do with, the reason that cancer develops in the first place and that cancer is a distortion of normalcy and you can't do away with normalcy.
In order words again the very genes that allow cells to grow, if you distort those genes you get cancer but you can't get rid of growth. You can't say that I am going to stop growing because growth is what repairs our tissue, growth is what repairs our wounds. Cancer is an intersection between what we inherent as genes and the environment.
We can reduce the environmental impact on our bodies, carcinogens, and reduce the rates of cancer. We could delay the appearance of many forms of cancer using prevention or treatment techniques ó a mammography not a very good one but at least one of them. But the idea that you can completely eliminate it is very unlikely.
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