Dr. Topol: Had you had a history of writing?
Dr. Mukherjee: I had written a little bit, and I was keeping journals and things like that, but I’m a profoundly undisciplined writer.
Dr. Topol: I would never know that. When we first met, you told me, if I remember correctly, that it took 7 years to write the book.
Dr. Mukherjee: It took 6 years cover-to-cover, give or take. I thought it would take a year and it ended up taking 6 years.
Dr. Topol: Along the way, did you think you were going to stay with this thing? That’s a pretty long commitment.
Dr. Mukherjee: There is something about learning medicine and science that really helped me. Medicine, science, and writing are stamina sports: You aren’t judged by how fast you move, you are judged by the capacity to have stamina. It was very important for me to realize that. It’s very important to teach undergraduate and graduate students that it is the length of scholarship that matters. Obviously, great discoveries stand by themselves, but those usually lie at the ends of long processes of scholarship.
Dr. Topol: You have all of this knowledge of molecular medicine but you are writing for laypeople. Is that a difficult transition?
Dr. Mukherjee: It is difficult if you make it difficult, and you can make it not difficult. The most important thing is to learn to respect the autonomy of your reader just as you learn to respect the autonomy of your patients — in other words, if you imagine your readers as brilliant, thoughtful, and compassionate humans instead of abstracting them away. Think of what it is like to read. It is the same as your mentor physicians telling you to think about what it’s like to be a patient.
I don’t want to make an analogy between reader and patient; what I’m trying to say is that there is a profound level of communication that you learn from medicine that involves not oversimplifying topics but allowing the space of conversation, and then very complex ideas can be discussed. It is possible to do that. You just have to be confident that people will be able to rise to that place, and they will.
Publishing Emperor and Winning a Pulitzer
Dr. Topol: I am thinking about you having put this whole book together and sending it off to your editor, and then eventually going through the galleys and getting it published. Did you know this was going to have such an impact?
Dr. Mukherjee: The quick answer is no. When the book was first sent out into the world, it was 3 times its length — it sat at 1800 pages. We had to pare that down to its current size. It was like wrestling a monster to the ground.
Dr. Topol: Can we ever read the outtakes?
Dr. Mukherjee: The Smithsonian has collected some of the outtakes. I have the extra passages. You can imagine that every page is littered with notes because I had a wonderful editor. I chose an editor who wasn’t from the world of medicine. It was someone who was a wonderful writer and editor but could provide a different perspective. She would say, “This is unintelligible.” To be edited by her, my condition was that she should be brutal and ruthless about her commentary. As they say in science, it’s better to be criticized by your friends than to be criticized by your enemies.
Dr. Topol: It’s very different because you are relying on an editor, unlike when you send in a peer-reviewed article and you have multiple reviewers.
Dr. Mukherjee: We invented a kind of peer-review system for this book. I said we should publish a galley copy, and we sent about 70 copies out and received comments back. It’s amazing, the generosity with which people wrote comments back. These galleys were sent out to public health advocates and cancer researchers. [National Cancer Institute director] Harold Varmus was unbelievably generous. I can’t tell you the level of commitment [people made], and it’s because everyone thought that they were helping each other and me to do a public service, which is to dispel some important myths. Let’s get a ground-level view. Let’s get a sober view of where we are, what happens next, and where we’re going.
Dr. Topol: This is amazing. I wasn’t aware of that. Now, let’s fast-forward. The book is out. How were you notified that you had won the Pulitzer Prize?
Dr. Mukherjee: It’s one of those wonderful experiences. I had the luxury of meeting Paul Greengard, who won the Nobel Prize, and we did a taping in which we talked together. It’s an exchange of moments in which you are told this unbelievable announcement. It’s an interesting story. I had gone downtown to meet Tina Brown, who [at the time was] the editor of Newsweek. If you know Manhattan, my laboratory is on 168th Street, uptown. Tina’s office at that time was way downtown. That’s like traveling from Earth to Mars. For some reason, I had forgotten my appointment. I was uptown in my office and was in a foul mood. I said, “Oh my God, I have to travel.” So I went downtown on the train. I had lunch with Tina and it was lovely. My mood was somewhat repaired by lunch. I left and then my cell phone went dead, so I was stranded downtown. I finally got to a place where I was able to charge my phone and I had 12 messages.
I thought, “This is very unusual. Something bizarre has happened.” Someone had left a message saying “congratulations” because “the prizes had just been announced.” I called up my wife and said, “This could be a prank, so can you please check for me?” She logged on to the Web, and of course when the Pulitzers are announced the Website goes down immediately. It’s like the Nobel Prize Website, which inevitably crashes when the prizes are announced. So for 2 minutes I was on the phone and my wife was saying that the Website had crashed.
Dr. Topol: So they don’t contact you directly?
Dr. Mukherjee: They contact you later. Eventually they call you. There is a waiting period during which you don’t know.
Dr. Topol: This was a life-changer for you, I would imagine.
Dr. Mukherjee: Absolutely. How could it not be?
What Comes After a Pulitzer?
Dr. Topol: Now we are going to get into the physician-scientist part of your career. You have written your first book. You won the Pulitzer Prize in nonfiction. Where do you go from there? Are you going to continue writing?
Dr. Mukherjee: I’m writing a book on the history of and the future of the gene. In some ways, obviously, it has some similar elements to this book — the social histories and the intellectual histories; they span time and space.
Dr. Topol: Do you weave patient stories in as well?
Dr. Mukherjee: Absolutely. I will leave a little bit of suspense, but there is a very personal story in the book. My book is subtitled “An Intimate History,” which is part of my project. I’m interested in the structure of knowledge. How do we acquire it? Where does it break down? What are its consequences? What are the cultures that allow us to possess it and to grasp it, and where is it lost? How do we delude ourselves with it?
Dr. Topol: When is it due to be published?
Dr. Mukherjee: In 2015.
Dr. Topol: So this one hasn’t taken 6 years?
Dr. Mukherjee: Well, the time adds up.
Dr. Topol: You practice as an oncologist. How do you balance that with being in the lab?
Dr. Mukherjee: My practice is very limited. It is focused on preleukemic diseases called myelodysplastic syndromes (MDS). They are complex diseases, and I like the complexity. But one way that I manage is by having a very tight intellectual focus in my practice. Essentially, I see only patients with MDS. Twice a year I will go to the wards and do a very general practice. I call it my refresher course. It reminds me of where we are more globally. That’s when I see the entire spectrum of patients: breast cancer, lung cancer, ovarian cancer, everything. For me it’s an experience that grounds me and it’s very important. I keep that. It’s a very precious time for me.
Dr. Topol: In the lab you are studying hematopoietic stem cells to understand MDS.
Dr. Mukherjee: That’s right. Our focus in the laboratory is to try to link steps between stem cells and cancer, focusing particularly on blood cancers because we know those stem cells better than any other cell.
Dr. Topol: There is almost too much overlap between stem cells and cancer.
Dr. Mukherjee: One thought is that cancer arises by co-opting or parasitizing, or pulling out from physiology things that have been maintained in stem cell physiology to make it more concrete. Self-renewal is an idea that is very much part of a stem cell, but if you think about it in a malignant variation, we now think that some cancers have a variant of self-renewal. They are malignant self-renewing cells.
Dr. Topol: I understand that your wife is an artist. What kind of artist is she?
Dr. Mukherjee: My wife does very conceptual, large installation work. Sometimes she does smaller works too. She makes works that are about memory, often using found objects. She inherits a tradition from Rauschenberg and others of trying to understand how we manipulate space and how we ascribe value to things.
Dr. Topol: That’s fantastic. You are a young guy. You are only 44?
Dr. Mukherjee: Yes. I look younger than I am.
Dr. Topol: You have decades ahead in your career. What would you like to achieve?
Dr. Mukherjee: I am really interested in the structure of knowledge and in finding that out as best as I can in various diverse ways. People often say, “How can you wear so many hats?” I don’t see myself wearing many hats. I think I wear only one hat. My interest is in the lineage of knowledge and in discovery, in skepticism, and in being able to integrate all of that with what I call human knowledge. How do we understand more about each other from the way we have discovered things about ourselves in the past? That is my bigger project. Ken Burns is doing a film on The Emperor of All Maladies.
Dr. Topol: I did hear about that. When will it be out?
Dr. Mukherjee: In 2015. It’s an advanced production, a 6-hour film. It is the next flagship, Ken Burns’ project. He will finish Vietnam this year and then move on to what I think is called Cancer. It was announced 2 or 3 months ago. We had begun filming a while ago.
Dr. Topol: Is it basically inspired by the book but not with actual scenarios from it?
Dr. Mukherjee: Both. I’m a co-producer on the film. It follows the structure of the book, but it has a much larger format. We have been able to pour even more resources into very deep archival material. Barak Goodman is taking the frontline in putting this film together, with Chris Durrance and several others. It is an incredible production.
Dr. Topol: It sounds fantastic.
Dr. Mukherjee: Working with Ken made me understand that there is a similarity of method; he is also interested in structuring the archeology of all of these events. It’s been an incredible experience.
Dr. Topol: Would you ever have thought that you would get into something like that?
Dr. Mukherjee: No. With Ken it was a cold phone call. I was sitting in my office and picked up the phone. It reminds you that there still is something very persuasive in talking one-on-one and making decisions. For me it was instinctual. I had watched Civil War and loved it. I told Ken that it was a great public service, and I hope that this will be another great public service.
Dr. Topol: There is no question about that. When you are not in the lab or with patients, and when you are not writing, what else do you do?
Dr. Mukherjee: That takes up most of my time.
Dr. Topol: Do you like to read other stuff, such as fiction or nonfiction?
Dr. Mukherjee: I mainly read fiction. To write, you have to read. The basic structure of storytelling derives from fiction. I don’t think it’s a coincidence that among the greatest fiction writers are physicians — Chekhov being high on that list. I have made a strong argument that one of the reasons that Chekhov originated the short story had to do with his life in medicine.
Dr. Topol: You have had an amazing career in a short span of time. We wish you continued great success. We have this series, “the Dos Equis of most interesting people in the world of medicine.” You fit that to a T. It’s wonderful to get to know you better. For all the folks at Medscape, thanks so much for being with us.
Dr. Mukherjee: It was a pleasure. Thank you for this program.
Dr. Topol: Thank you for joining us for this Medscape One-on-One. We will continue our series with some of the most interesting people in the world of medicine.
SEE PRIOR “1 ON 1” WITH DR. ERIC TOPOL, BELOW