Siddhartha Mukherjee


American Physician, Biological Scientist and Author, Awarded Pulitzer Prize for his book, The Emperor Of All Maladies: A Biography of Cancer

Author Quotes

A protein is a gene realized?the machine built from a gene?s instructions. But proteins are not created directly out of genes. In the late 1950s, Jacques Monod and Francois Jacob, working in Paris, discovered that the genesis of proteins from genes required an intermediary step?a molecule called ribonucleic acid or RNA. RNA is the working copy of the genetic blueprint. And it is RNA, not the gene, that is translated into a protein. This intermediary RNA copy of a gene is called a gene?s message. Genetic information is transmitted from a cell to its progeny through a series of discrete and coordinated steps. First, genes, located in chromosomes, are duplicated when a cell divides and are transmitted into progeny cells. Next, a gene, in the form of DNA, is converted into its RNA copy. Finally, this RNA messages is translated into a protein. The protein, the ultimate product of genetic information, carries out the function encoded by the gene. This unidirectional flow of genetic information?DNA->RNA->protein?was found to be universal in living organisms, from bacteria to slime molds to fruit flies to humans. In the mid-1950s, biologists termed this unidirectional flow of information the central dogma of molecular biology.

A static picture cannot capture this qualitative growth. Seeing a small tumor and extracting it from the body does not guarantee our freedom from cancer?a fact that we still struggle to believe. In the end, a mammogram or a Pap smear is a portrait of cancer in its infancy. Like any portrait, it is drawn in the hopes that might capture something essential about the subject?its psyche, its inner being, its future, its behavior. All photographs are accurate, the artist Richard Avedon liked to say, [but] none of them is the truth.

A ward nurse recalls, was so deep that doctors would not even look us in the eye when we recommended that they stop their efforts to save lives and start saving dignity instead?

Activating or inactivating any single gene, he postulated, produced only the first steps toward carcinogenesis. Cancer?s march was long and slow and proceeded though many mutations in many genes over many iterations. In genetic terms, our cells were not sitting on the edge of the abyss of cancer. They were dragged toward that abyss in graded, discrete steps.

After decades of musing, have we reached the conclusion that fate is, well . . . fate? That being happens through . . . be-ing? I find that formulation illuminatingly beautiful.

All cancers are alike but they are alike in a unique way.

A breast cancer might turn out to have a close resemblance to a gastric cancer. And this kind of reorganization of cancer in terms of its internal genetic anatomy has really changed the way we treat and approach cancer in general.

Allogeneic transplantation (i.e., transplanting foreign marrow into a patient) was temperamental?tricky, mercurial, often deadly. But in some cancers, particularly leukemias, it was potentially curative. Once could, for instance, obliterate a marrow riddled with leukemia using high dose chemo and replace it with fresh, clean marrow from another patient. Once the new marrow had engrafted, the recipient ran the risk of that foreign marrow turning and attacking his or her own body as well as any residual leukemia left in the marrow, a deadly complication termed graft-versus-host disease or GVHD. But in some patients, that trifecta of assaults?obliterative chemotherapy, marrow replacement, and the attack on the tumor by foreign cells?could be fashioned into an exquisitively potent therapeutic weapon against cancer. The procedure carried severe risks. In Thomas?s initial trial at Seattle, only twelve out of a hundred patients had survived. But by the early 1980s, doctors were using the procedure for refractory leukemias, multiple myeloma, and myelodysplastic syndrome?disease inherently resistant to chemotherapy. Success was limited, but at least some patients were eventually cured.

A cancer cell is an astonishing perversion of the normal cell. Cancer is a phenomenally successful invader and colonizer in part because it exploits the very features that make us successful as a species or as an organism.

Although cancer is not universally caused by viruses, certain viruses cause particular cancers, such as the human papilloma virus (HPV), which causes cervical cancer.

A cancer patient today has a team that works around him or her, including nurses, psychiatrists, psychologists, and, in some cases, pain and palliative medicine experts.

A major hindrance to cancer effort has been a chronic, severe shortage of funds?a situation that is not generally recognized.

A model is a lie that helps you see the truth.

A nation which depends upon others for its new basic scientific knowledge will be slow in its industrial progress and weak in its competitive position in world trade, regardless of its mechanical skill.

A numerical measure of intelligence was also particularly suited to the demands of the First and Second World Wars, during which recruits had to be assigned to wartime tasks requiring diverse skills based on rapid, quantitative assessments. When veterans returned to civilian life after the wars, they found their lives dominated by intelligence testing.

A Pap smear would give a woman a chance to receive preventive care [and] greatly decrease the likelihood of her ever developing cancer.

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American Physician, Biological Scientist and Author, Awarded Pulitzer Prize for his book, The Emperor Of All Maladies: A Biography of Cancer