Dr. Siddhartha Mukherjee
Dr. Mukherjee’s Pulitzer Prize–winning book, The Emperor of All Maladies: A Biography of Cancer, was named one of the 100 best nonfiction books of all time by Time Magazine and was developed into an Emmy-nominated television documentary series by Ken Burns.
Since that book’s publication, Dr. Mukherjee has published The Laws of Medicine: Field Notes from an Uncertain Science and The Gene: An Intimate History. The latter, named one of The Washington Post’s 10 Best Books of 2016, maps the history of the human genome and “its surprising influence on our lives, personalities, identities, fates, and choices.”
Dr. Mukherjee brings this perspective to the 2017 ASCO Annual Meeting, where he will serve as the guest speaker at this year’s Opening Session. He sat down with the ASCO Daily News for an interview before this year’s Annual Meeting.
ASCO Daily News: Can you describe your Opening Session address?
Dr. Mukherjee: I have tentatively chosen to speak about four patients: one of the first patients to receive trastuzumab for breast cancer, a patient who received one of the first successful targeted therapies, one patient treated with immunotherapy, and lastly someone who has benefited from secondary prevention.
I will use these four cases and talk about the human stories behind them to illustrate the advances and also the challenges of cancer care. I will use these four cases to talk about one idea: how to detect cancer at the earliest possible phase without risking overdiagnosis and treatment, which is the major challenge of cancer care.
ASCO Daily News: You recently authored a piece in The New Yorker about ‘deep learning’ systems and the future of cancer diagnosis. How is deep learning impacting cancer care? How will it influence oncology in the future?
Dr. Mukherjee: The New Yorker piece on artificial intelligence was meant to be provocative. One reason that deploying personalized therapies may not work well at times is that by the time we deploy them, we may be too late. At such late points, tumors might have become highly evolved. So one place that deep learning can be helpful is to diagnose cancer at an earlier stage. Deep-learning tools might be able to pick up a breast cancer lesion at an earlier stage, or a melanoma before human eyes could easily diagnose it. That said, we need to ensure that there is no overdiagnosis and overtreatment-—both major pitfalls of attempts to detect and treat early-stage tumors.
Another area that computational tools might be helpful is in the arena of cancer genomics—or cancer biology in general. Are there patterns within cancer cells, or their microenvironments, that standard learning techniques are failing to detect? We now have hundreds of thousands of cancer genomes and an abundance of gene expression data from cancers. Could new computational techniques help identify deeper patterns in the data?
ASCO Daily News: The Emperor of All Maladies: A Biography of Cancer was first published 7 years ago. What aspect of cancer from the last 7 years would you be interested in writing about?
Dr. Mukherjee: When the book was finished in 2010, immunotherapy was in its infancy. That’s obviously an area that has been remarkably successful. Our understanding of the tumor microenvironment, including interactions between tumors and stroma, have also advanced enormously.
ASCO Daily News: Your writing often explores complicated scientific topics in a way that is accessible to a non-scientific audience. How do you communicate with a broad audience?
Dr. Mukherjee: The larger question there is ‘Who is the audience?’ How do you appropriately communicate important information about cancer and oncology to the largest audience possible?
The question I am interested in is the history of our knowledge about science. I actually don’t think of myself as a science writer. I think about tracing the history of ideas. Obviously if you write, you have to choose for yourself what you think is the right level of detail. If there is too much detail, people won’t read it. They don’t understand jargon; they don’t understand terminology.
In the books and in the Ken Burns documentary, we tried to trace an idea without getting into the weeds, because as soon as you get into the weeds you lose the audience. Then the outcome is worse because they will never read about the subject again. It’s a balance. Not everyone agrees on what the appropriate balance should be—but as a writer and a scientist, I am always thinking about how to achieve that balance.
ASCO Daily News: You gave an address to the recipients of the 2017 Whiting Awards about combating ‘numbness’ in life. Is this a concern in medicine?
Dr. Mukherjee: It is always a concern. The burnout level in medicine and the burnout level in cancer medicine is particularly high. One of the ways that people cope is by desensitizing themselves to patients. You have to remind yourself why what you’re doing is crucially important. If you don’t remind yourself of the importance of it, you could lose sight. I try very much to be engaged with patients on a day-to-day basis.
ASCO Daily News: Your new book, The Gene: An Intimate History, focuses on the history of scientific knowledge related to the human genome. What interested you about this topic?
Dr. Mukherjee: I have talked about the three strands that come together. One is the very personal history of mental illness in my family, specifically bipolar disorder. The second is I am a cancer biologist, a cancer geneticist. My laboratory has been involved in defining and understanding several genes involved with stem cells in cancer. The understanding of cancer has been deeply influenced by the advancing front of genetics.
Third is the astonishing way we were beginning to manipulate and read and write genetic information in cells, especially with new techniques such as CRISPR-Cas9 and others that we were beginning to use in the laboratory. We don’t know what we’re going to do next, but the central question and theme is ‘What happens to a machine that begins to decide on its own code of instructions?’