At BenchSci’s latest fireside chat with our users, we had the privilege of being joined by the renowned oncologist, researcher, and author, Dr. Siddartha Mukherjee, perhaps best known for his 2011 Pulitzer Prize-winning book, The Emperor of All Maladies: A Biography of Cancer. His second book, The Gene: An Intimate History, won international awards and was recognized by the Washington Post and the New York Times as one of the most influential books of 2016. He has been featured in the TIME 100 poll as one of the most influential people in the world and has written for both The New Yorker and The New York Times Magazine. His third book, Song of the Cell, will be available on October 25th.

I had the privilege of asking Dr. Mukherjee about his unique perspective on communicating scientific information to the general public, the future of cancer treatment, and more. Here are a few of the fascinating insights he shared.

MA: You started your writing career a few years after you started practicing medicine. What was your writing motivated by, and why was it so important for you to communicate your scientific knowledge to the public? 

SM: I think the pivotal moment for me as a writer was when a cancer patient I was treating asked me a very simple question: What would her journey look like? What was coming next and why? This was back in 2008, and to my astonishment, I found that there was no journey mapped out. So really, my first book, The Emperor of All Maladies, was my answer to that issue.

MA: Can you elaborate a little bit more on why it's so important for patients to understand what they're fighting? How does that knowledge help them through their incredibly tough journey?

SM: It's difficult to articulate why; there’s just no other option. You can’t undergo a journey as a patient without knowing what’s ahead. Medicine has long been a black box, but no longer. For years, patients were treated in an entirely paternalistic manner. They didn’t know what was happening and didn’t ask questions. Now, patients want information. They want to know where they are, what's happening next, and why. Most importantly, they want autonomy. I see autonomy as a breath of life; to deny a patient that is to deny them an essential thing in their time of need.

In medicine, we talk a lot about outcomes and data, But as a doctor, the first thing you learn is that your job is to heal. Healing isn’t about numbers. It’s not about data or statistics. It’s about giving the patient autonomy, power, and direction. It’s an art, not a science. Somewhere in between the art of healing and the science of healthcare is where real medicine lies.

MA: Your second book, The Gene: An Intimate History, focuses on genetic history and the connection between genetic predisposition and mental illness. With rising rates of mental illness, this book is even more relevant today. Can you elaborate on your motivation for writing on this topic? 

SM: The Gene: An Intimate History is a story of how and why we explore genetic histories. It’s also a story of my own family history, which is where the “intimate” part comes in. While the first book was about my growth as an oncologist, this book is about my growth as a young man, exploring my own genetic history.

I write my books in a way that I think science history hasn’t been. I take science, and I make it mine. Which is to say that I make it everyones’. Part of the focus is on the science, but it’s also about the reader. Who are they, and what’s their part in this story? You might have a family with mental illness. You might have a family with cystic fibrosis. You might have a family with Huntington's disease. In The Gene, I explore that. 

MA: You’ve also worked on several startups during your career. For example, Vor Biopharma and Myeloid Therapeutics focus on CAR T-cell therapy to target malignant cancer cells. Can you give us more insight into recent developments regarding that type of work?

SM: Vor is one of the most radical ideas I've had in my life. Killing cancer cells in leukemia, lymphomas, and other cancers is challenging because cancer cells and normal cells share almost everything in common except for mutations. So, instead of targeting cancer cells, Vor targets the normal cells, making them immune to a certain therapy while leaving the cancer cells susceptible. It’s like making grass immune to a chemical so it can be used as a weed killer. Rather than changing the weeds (the cancer), in this case, you change the grass. 

I'd also like to highlight that we just made a massive, public release on the first use of CAR T therapies in a phase 1/phase 2 trial in India through a company called Immuneel Therapeutics. We are delivering CAR T therapies to patients with leukemia, lymphoma, and myeloma. We've cured a seven-year-old girl, a four-year-old boy, a thirty-year-old woman with two kids, and others. Those are some of the proudest moments that I have ever experienced in my life.

MA: New AI-driven technologies are developing every day. What’s your perspective on the impact these technologies can have on advancing healthcare and even potentially treating cancer?

SM: AI stands for artificial intelligence, right? I find that people focus a little bit too much on ‘artificial’ and focus too little on ‘intelligence’. Intelligence requires data. It requires analytics. It requires an understanding of what it means to be intelligent.

Say you have a great doctor; she is intelligent and understands who you are, your goals, and your understanding. To convert her into AI, you have to capture her intuitions, her understanding, her experience, and her empathy. I think the word artificial is incorrect in some ways. In medicine, we need empathetic intelligence: EI. We need to capture empathy and intelligence at the same time.

MA: RNA has received attention following mRNA COVID vaccines. Do you foresee an emphasis on cancer patients’ transcriptomics—which are non-coding RNAs—and so on moving forward?

SM: The quick answer is that we've been looking at cancer transcriptomics for several years, so yes, we’re absolutely looking for coding and non-coding RNAs moving forward. The question becomes, how do we manipulate them? How do we treat them? How do we move forward with non-coding and coding RNAs as part of a cancer patient's diagnosis, prognosis, and therapy?

We certainly want to create vaccines against cancers caused by viruses, such as human papillomavirus. I would love to see an RNA-based vaccine along these lines. That said, while explorations of coding and non-coding RNAs in cancer have helped us in prognosis and diagnosis, they haven’t created new therapies. The challenge for cancer researchers that’s yet to be solved is how to convert the coding and non-coding RNA information we get from cancers into therapeutics.

MA: Someone in our audience has a family member whose biggest struggle was finding the right cancer treatment for her young body. They want to know what you think about demographic restrictions and their impact on cancer research.

SM: It's an essential question, which is partly addressed in my upcoming book Song of the Cell. We have a lot of demographic information for some cancers (young, old, ethnic groups, men, women, et cetera), but for most cancers, we’re lacking this information—so, there's a kind of one-formula fits-all thinking that goes into treating cancer. But we can do better than that. The more data we have, the more we know, which is why every person in my clinic enrolls in a clinical trial. 

MA: What is the main piece of advice you have for science professionals? Where do you think we need to improve ourselves?

SM: My answer is simple: have a new idea. Change the world by devising novel ideas and pushing the frontiers of those ideas to create something that wasn't there before.

MA: What drew you to oncology over other areas of medicine and research in your career specifically early on?

SM: I saw oncology as the most interesting area but also the most troubled. Going back to the previous question, it was where new ideas were most urgently needed. I wanted to bring new ideas to cancer research, and I’m proud I was able to with the idea of looking not only at cancer cells themselves but also the surrounding cells. That’s the basis of Vor and our T-cell therapies. Don’t look at the cancer cell itself; look at how immune cells and the microenvironment interact with those cancer cells. My entire career was built around the importance of non-cancer cells in cancer research.

MA: How can a patient learn more about their path or trajectory if medicine doesn't speak their language?

SM: The quick answer to the question is that medicine should speak their language. It's not like we're talking about some alien language here. In writing my books, I always strive to speak using plain language—real language that people can understand. So, if you’re having trouble understanding something, tell your doctor to speak your language! If they can't or won’t, it’s their problem, not yours. You’ll be better off finding another medical professional who is willing and able to speak on your terms.

MA: How would you like to see the patient's journey transform in the future as our understanding of disease and treatment evolves?

SM: I'd like to see a patient's journey mapped out upfront as opposed to being reactive as it is now. As medicine evolves, I think it will become more proactive so that patients can know what to expect or watch out for in the future, rather than being surprised by it.

MA: Is there a particular experience, job recognition, or award that you think of as the moment you realized you were truly contributing to life-changing work?

SM: I've been struggling to find a cure for myeloid leukemia for a long time. And right now, I think Vor has the best shot of achieving that. The idea that we could change a person's bone marrow and then attack the cancer cells is so deeply radical. It's something that I had never imagined before. I can only say that this journey has been the most fascinating journey of my life.

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