A strong intuition is much more powerful than a weal test. Normals teach us rules; outliers teach us laws. For every perfect medical experiment, there is a perfect human bias.
— Siddhartha Mukherjee
Because I work on leukemia, the image of cancer I carry in my mind is that of blood. I imagine that doctors who work on breast cancer or pancreatic cancer have very different visualizations.
We know cancer is caused ultimately via a link between the environment and genes. There are genes inside cells that tell cells to grow and the same genes tell cells to stop growing. When you deregulate these genes, you unleash cancer. Now, what disrupts these genes? Mutations.
Science is among the most profoundly human of our activities. Far from being subsumed by the dehumanising effects of technology, science, in fact, remains our last stand against it.
We may have to learn to live with cancer rather than die of it. It means a big change in our mindset and how we do research. We haven't quite reached there yet.
We now have poured in an enormous amount of resources into cancer. The National Cancer Institute Project, you know, runs about $5 billion a year. That's a large amount of money, but let's not be grandiose about the amount of money we're actually spending on a problem that is attacking us at the most fundamental level of the human species.
If something is good, more is not necessarily better. Not always.
Why did I write 'The Emperor of All Maladies?' A 56-year-old woman with an abdominal sarcoma, having undergone two remissions and a relapse, asked me to describe what she was battling. By the time I had finished answering her, I realised that I had written 600 pages.
Robert Sandler is a child who died when he was three years old, and he is a child who was the first child that we know of to be treated with chemotherapy.
The idea that cancer genes are sitting inside each and every one of our chromosomes, just waiting to be corrupted or inactivated and thereby unleashing cancer, is, of course, one of the seminal ideas of oncology.
In a spiritual sense, a positive attitude may help you get through chemotherapy and surgery and radiation and what have you. But a positive mental attitude does not cure cancer - any more than a negative mental attitude causes cancer.
Pharmacology is benefited by the prepared mind. You need to know what you are looking for.
I am a scientist and I am a physician. So I write papers.
I had seen cancer at a more cellular level as a researcher. The first time I entered the cancer ward, my first instinct was to withdraw from what was going on - the complexity, the death. It was a very bleak time.
I left Delhi in 1989 and remember very little of how life used to be then. Increasingly, in my recent visits to Delhi, I've started to realize that the city has become intellectually very lively. It makes me want to discover the city over and over again.
I think when we use 'stress', we are often using a kind of dummy word to try to fit many different things into one big category.
Most days, I go home and I feel rejuvenated. I feel ebullient.
I could write a thesis on the physiology of vision. But I had no way to look through the fabric of confabulation spun by a man with severe lung disease who was prescribed 'home oxygen', but gave a false address out of embarrassment because he had no 'home.'
The gene that enables birds to learn songs can become cancer-causing. There is no normal physiological process that can't be bastardized by the disease.
There is an enormous amount of options that a physician can provide today, right down from curing patients, treating patients, or providing patients with psychic solace or pain relief. So, in fact, the gamut of medical intervention is enormous.
My memory of my household is of one immersed in books and music. I have a very intimate relationship with Bengali literature, particularly Tagore, and my interest besides reading then was music.
Each of us knows a few or several young people whose lives have been devastated by cancer. I don't mean to be nihilistic about it, but it is very much an active killer of people now.
Mary Lasker was an entrepreneur; she was a socialite. She was kind of a legendary networker. She became interested in saying, 'Well, you know, if these diseases don't have political support we'll never conquer them.' And she made, really, cancer her special cause.
I once set myself a deadline: half a chapter a week, 20 minutes a day. The thought froze me instantly, like literary Botox. I returned to my non-schedule: sleeping, writing 20 minutes, and then back to sleep. Breakfast in bed, with juice congealing on the sill: pages and pages began to pour out again.
I'm human, we all are - all doctors are - and grieving is a natural part of medicine. As a doctor, grieving is a natural part of medicine. If you deny that, again, you'd get into this trap of curing and victory. I think grief is very important.
It turns out that the very genes that turn on in cancer cells perform vital functions in normal cells. In other words, the very genes that allow our embryos to grow or our brains to grow, our bodies to grow, if you mutate them, if you distort them, then you unleash cancer.
Cancer is not just a dividing cell. It's a complex disease: It invades, it metastasizes, it evades the immune system.
Every era casts cancer in its own image.
We don't know why, but pancreatic cancer has a very interesting physiological link to depression. There seems to be a deep link, and we don't know what it is.
What we do in the laboratory is we try to design drugs that will not just eradicate cancer cells but will eradicate their homes.
Good physicians are rarely dispassionate. They agonize and self-doubt over patients.
I believe the biggest breakthroughs on cancer could come from brilliant researchers based in India.
Probably the most important reason we are seeing more cancers than before is because the population is ageing overall. And cancer is an age-related disease.
What does it mean to be an oncologist? It means that you get to sit in at a moment of another person's life that is so hyper-acute, and not just because they're medically ill. It's also a moment of hope and expectation and concern.
If you take 100 breast-cancer samples, 100 types of cancer have 100 different hallmarks of mutated genes. You could be nihilistic and say, 'Oh, God, we'll never be able to tackle this!' But there are deep, systematic, organizational principles at work in all that diversity.
Nearly every one of the genes that turns out to be a key player in cancer has a vital role in the normal physiology of an organism. The genes that enable our brains and blood cells to develop are implicated in cancer.
Some cancers are curable, while others are highly incurable. The spectrum is enormous. Metastatic pancreatic cancer is a highly incurable disease, whereas some leukemia forms are very curable. There is a big difference between one form and another.
Unlike other diseases, the vulnerability to cancer lies in ourselves. We always thought of disease as exogenous, but research into cancer has turned that idea on its head - as long as we live, grow, age, there will be cancer.
I think you would have to be a nihilist to say that we are not making progress on cancer, just like you'd have to be hubristically optimistic to say that we have conquered cancer.
Sidney Farber was a pathologist. He was called a doctor of the dead. He was a pathologist who sort of lived in the basement of the children's hospital in Boston, and he became very interested in childhood leukemia. And Farber began to inject this drug, aminopterin, into young kids, in order to see if he could get a remission.
The trick to my writing, it turned out, was doing so exclusively in bed. The minute I even dared to discipline myself and write at the desk, I produced mounds of nonsense. Yet, sitting in bed, I wrote easily, effortlessly, fluidly. I became the master of perfect indiscipline.
The history is important because science is a discipline deeply immersed in history. In other words, every time you perform an experiment in science or in medicine, what you're actually doing is you're answering someone, answering a question raised by someone in the past.
One day, I had a patient who was going through chemotherapy who came to me and said, 'I'm going to go on with what I'm doing, but I need you to tell me what it is that I'm fighting.'
Cancer is not one disease but many diseases.
Most discoveries even today are a combination of serendipity and of searching.
There is a very moving and ancient connection between cancer and depression.
Postwar U.S. was the world's leader in science and technology. The investment in science research was staggering.
Cancer has enormous diversity and behaves differently: it's highly mutable, the evolutionary principles are very complicated and often its capacity to be constantly mystifying comes as a big challenge.
I think the way we think about cancer, the way we treat cancer, has dramatically changed in the last century. There is an enormous amount of options that a physician can provide today, right down from curing patients, treating patients or providing patients with psychic solace or pain relief.
There's a rising cancer trend and, as I said, one of the major contributors is the overall ageing of the population - we aren't dying of other things, so we're dying of cancer.
