As I waited to speak with Dr. Siddhartha Mukherjee on a cold December morning in New York City, I found myself staring at the last of the leaves that pressed into my window from a Callery Pear tree below. In summer, its branches had offered its foliage as a canopy for all those who walked beneath it. But it is winter now. A whole life cycle—from tendrils to senescence—had gone by and it was only at this late hour that I had begun to notice them carefully. Outside, the sun continued to lend its faint golden-yellow to those branches, all of which were now emptied of leaves. It is a relentless cycle of life and death—one that has played out for millions of years and will continue to do so long after we are all gone. Driving this unceasing set of actions and transformations were cells—those billions and trillions of microscopic entities that come together to form living beings, their organs and body parts, and in the case of humans—you and me. Perhaps my observations were inevitable—‘cells’ were on my mind as I had been thinking about Dr. Mukherjee's latest book, ‘The Song of the Cell’. It follows his extraordinary debut—a biography of cancer—titled ‘The Emperor of All Maladies’; and the fascinating second book titled, ‘The Gene’. This third book, while being about cells also straddles the worlds of cellular therapy, the history of medicine, the politics of science, and so on.
Born in India and educated at Stanford, Oxford, and Harvard, he is a cancer physician and researcher, a professor of medicine, a Pulitzer Prize winner, and a writer of reflective and scrupulously researched books on medicine and, arguably, the human condition itself. Dr. Mukherjee’s world has a ring of permanence and heaviness to it. He spends his days among the sick and those suffering from random mutations—each of whom is looking for a life of normalcy, even if the word ‘normal’ is complex and defies easy characterization. This world of disease and cure, suffering and alleviation, is both intimate and yet forbiddingly alien. Viewed thus, Dr. Mukherjee's books are like lighthouses that scan and shine light upon sections of the great unknown, as a result of which the reader forms some intuition about the contours of what lies out there.
When we spoke that morning, he had recently returned to New York and had gotten up very early to talk to his medical team in India. His voice was measured, perhaps a bit tired, but there was no impatience in it. That exhaustion had steadily caught up to him was not surprising because he had been traveling across the Atlantic for the past few weeks—California, New York, London—as he spoke to a diverse group of audiences all of whom must have come to hear him describe the farthest horizons of modern biological sciences. Despite so much else going on, he had generously agreed to speak to me. Somewhere at the back of my head was the constant sense that I was infringing on his time which, at the very least, he could have used elsewhere for more productive or personal purposes, including to spend it with his family—his two daughters and his wife Sarah Sze, who is an artist of much renown.
In the conversation that follows, there are many topics which we don’t speak of: from the usage of new CRISPR technology to edit genes, to the 19th century German scientist Rudolf Virchow who resisted political pressures, and even his adventures as a singer of Hindustani classical music in a music band. Perhaps some other time. On that day as we spoke, even as he calmly went about untangling my questions with the practiced detachment of a man who had learnt over the years to look at the question and not the questioner, I heard in his voice a melancholy nobility that was neither hurried nor soporific. While asking him questions, I watched the manner in which his answers emerged: in lucid and complete sentences, filled with a minor flourish here and an elegant turn of phrase there. There was nothing forced about it—rather, it slowly dawned on me that what was on display was a kind of archival intelligence married to a presence of mind which noticed the shifting registers of my questions. His answers weren’t a display of some sterile technical virtuosity but a steady and patient effort to communicate ideas that he had lived with for years, if not decades, in a manner that I understood. After our talk finished, I thought about it all when it dawned on me that while much of human communication is a matter of knowledge and content which we exchange, it is also as much about composition. How we articulate things, how we edit and remove words, how we pause amid the frenzy of expression, how we translate non-verbal cues, and how we let silences speak. It is from this marriage of content and composition that meaning eventually froths outwards. Perhaps we ought not to be surprised that the structure of our world is encoded in this specific manner. As I learnt from Dr. Mukherjee’s latest work, our cells do something similar in a chorus where they sing songs marked by beauty, beatitudes, and silences throughout our lives until they belt out one mysterious dirge at the end. By then, the leaves will have yellowed, the branches will have gone bare, and the tree of life outside my window will have to wait another iteration of this cosmic play. This lila of life.
Keerthik Sasidharan (KS, hereafter):
Let us start at the end of your book where you talk about the title of your latest book, ‘The Song of the Cell’ – what does the word ‘Song’ mean here?
Dr. Siddhartha Mukherjee (SM, hereafter):
There are really two reasons that this book is called The Song of the Cell. And I should tell you that I came up with the title very late in the book. This book had a different title initially. The first song is an internal song. And that refers to the idea that comes very early in the book, which is that if you think about genes, which has captured human imagination as sort of symbols of life. The irony is that genes themselves are lifeless. DNA is a molecule. DNA, which encodes genes, is a molecule. And that molecule is lifeless. It's a chemical, and it's only the cell that enlivens that molecule. So in some ways there's a comparison between DNA being a score, a musical score and the cell playing out its music. And that's the internal song of the cell that comes very early in the book.
But there's a second song that cells play. That comes much later in the book, which is much less known. And that's the song that cells play when they communicate with each other when there is a system of cells. And I think that is an external song. A song between cells. A song of the cellular civilization that we live in, as we're made of trillions of cells. And they are communicating with each other in ways that we don't know yet. They are creating ecologies. They're creating interactions and communications that we don't yet know. And that's the second song: that’s the unknown song. And that comes very late in the book because of course, that's much less discovered. So these two ideas basically form the title of the book ‘The Song of the Cell’.
KS:
If a common reader without any medical training were to ask you what is your book about, how would you describe it? Is it a history of ideas which have led us to the present. Or is it like a map from the16th century about what humanity has discovered and we don't know about the great unknown out there. And some of what we think we know today could be wrong eventually, say 30 years from now.
SM:
You’ve read my other books so you know I don't write in a genre. I write outside genres. Or I don't believe in a sort of genre writing. So this book if you twist it one way—sort of like a kaleidoscope, it reads in one manner. If you twist it another way, it reads in a different way. In some ways, it’s a medical history. There is personal history and memoir in it. There's the history of my becoming a physician. There are case histories which sort of mimic or resemble Victorian case histories. There is a lot of, you know, deep science. That goes into the book, some of which is very new. Some may or may not survive our explorations in time. So it's a mix of all of these and different readers come to the book in different ways, and they come to the book in ways that are unique to what they're looking for. This is a book as much for cell biologists as it is for someone who's just interested in learning about the world. It brings you into, I think, a new world, which is the world of cells. And there's a very specific reason for that. And that is because if you think about biology— biology is based on three grand unifying theories.
One, of course, is the Theory of Evolution. The second is the universality of genetics and the genetic code. And the third is cell theory. The fact that all living organisms are made of cells. Now there are a thousand books about evolution and thousand books of our genetics—I’ve written one of them myself—but cell theory got [little] in this. And, even though arguably from the standpoint of medicine, it's probably the most important of all of these theories. If you want to call this book an intellectual history of the cell, [the fact is] there are very few intellectual histories of the Cell. And that's why this book; and the scope of the book is so large because of that reason.
KS:
There is a wonderful line in the book which moved me greatly: about returning home after long alien days in a foreign university. What awaits you at home is a father’s love that is both quiet and deep, a mother’s abiding presence. You write about arriving in India on that occasion: ““The man at Customs [in Delhi] asked me for a small bribe, and I felt like hugging him; I was home.” When I read that it made me laugh. You obviously know India in a very intimate kind of way. In the last three decades, you must have seen India evolve in good and bad ways. What does India mean to you today as somebody who lives here and travels the world over? Or do those boundaries not really matter because you're living and thinking about something so universal as the human body?
SM:
I think to a large extent those boundaries [of nation-states] don't matter to me. I've always lived multiple lives and allowed myself to travel in space and time in my mind, in different ways in different places. So I think that [national boundaries] itself doesn't matter to me. That is not really of consequence. I think there's particular challenges in terms of medicine in India that I feel acutely. As you know, I’ve launched clinical trials in India which are still very active. Part of the reason I have to wake up really early is that I still am very deeply involved in those trials. It’s not like I've run those trials and set them free. I collaborate with an incredible team of physicians and scientists. And I can tell you that the quality of care and discussion and thinking that goes into this very radical clinical trial that we're doing in India, could be anywhere in some ways. It could be I could be speaking with my colleagues at Columbia [University], or I could be speaking with my colleagues anywhere in the world. And in fact it is a collaboration between India and Spain which itself is interesting.
So, in some ways, I feel totally at home—in both contexts. But in other ways I feel, there's some very foreign elements that I can't quite fathom and I'm not sure what it would take to fathom them. The trial is being run out of Bangalore. It takes me 3 hours to travel from Delhi to Bangalore, give or take, and then it takes me another 3 hours to go from Bangalore to the hospital—from the airport to the hospital. And when I reach the hospital, having passed by roads piled up with garbage. I all of a sudden encounter a place that is—because we are harvesting and culturing T-cells—one of the cleanest environments conceivable on the planet. There's not one single pathogen that's allowed to enter. You have to wear a [sort of] hazmat suit—not a real one, but you have to gown and suit and glove yourself. Every surface is sterilized and polished to look like a mirror. And the contrast [between the road to the hospital and the hospital itself] is just shocking to me. I've learned to deal with it over time. I don't feel any difference in a fundamental way between one place and the other as far as the science, the technology, the clinical care is concerned.
KS:
If you were to write a sort of a history of modern India through human bodies—as you know, Indians were shorter, weighed less in 1947 compared to today. We have new types of diseases—you write about the emergence of heart disease in America in the 1930s, the rise of a sedentary lifestyle, and so on. Is it possible to write such a book which tracks the history of the Indian Republic on one side and a history of Indian bodies on the other. And marry the two into one narrative.
SM:
Yes, I think it would be a very interesting history. I'm not sure I'm the right person to write it, but I think it would be a very interesting history. I mean, I think this is true for the world in general. This is not specific to India, but across the world—hypertension is now a major cause of death in Tanzania, which we think of as a country where you would imagine that infectious diseases would be so predominant that they would really wipe out all other causes of death. Everywhere in the world, the epidemiology and the face of Epidemiology is changing. And so again, I don't think I would make a distinction between India and other parts of the world. I think you can write such a book. I think it would be interesting to write such a book more globally. Given body and changes in the human body over time. And what does that mean for medicine? What that means for epidemiology etc.
And I think it has very much to do with very broad global shifts. In nourishments. In what food we eat, how we eat the food, how we process the food, what chronic diseases we're exposed to, the changes in our lifestyles, the changes in how much food we are given and how we store that food, how our metabolism has changed. That I would imagine that if I were to do—a corner of my life that works on metabolism. How metabolism has changed between the centuries. I suspect that that book would be better written not just from an Indian perspective, but from a global perspective.
KS:
In everyday life, when we think of depression, it is the heart as an organ that we assume, metaphorically, is afflicted. (“Depression is a flaw in love” as Andrew Solomon writes.) But you remind us, from your own experience, that depression is also a cellular problem. A problem of how neurons respond to neurotransmitters. Can common people without a medical education think about depression in new ways, in similar ways as we think about heart attacks or kidney stones—without social stigma, without a need to hide it. I remember reading your Guardian piece on depression as well. I keep thinking about, including in my own family, the great amount of effort that goes into hiding mental illnesses.
SM:
The general view of any mental illness is very flawed in our society. There's a lot of blame; there’s a lot of, I would say, unsolicited misunderstanding of mental illness. I mean, one of the reasons to publish that [Guardian] piece was to remind people that Depression is in some ways just as much an organic illness as any other disease. Hypertension, coronary arteries disease. It's an alteration in cells. In this case, they happen to be cells that regulate mood and regulate mood circuits. And we think of mood and mood circuits as, appropriately, as a combination of environmental and genetic influences as well as, of course, ultimately, cell biological instances. One thing I wanted to stress in that [Guardian] piece is that no one denies that there's a psychosocial, environmental, situational component to depression. That's not what is at stake here. But what's important is that if you think about cell biology and the cell biology expression, you realize that in fact, that cell biology is that ultimately all diseases have to move through their impact on cells. In other words, the psychosocial, the environmental, the many fold influences that modify depression are nonetheless influences that modifies cellular behavior. And I think that's very important to realize that ultimately there is an influence on cellular behavior. And the more quickly we realize that I think the better it is in terms of our understanding and potentially our capacity to heal depression.
KS:
One of the profound questions you ask in your book is ““Why did we ever leave the single-celled world? Why did “we” become “we”—that is, multicellular organisms? ” Like many children, what I had learnt was that there were unicellular organisms and then through some incredible “leap” across a valley of contingencies, ‘multicellular’ life began. You write that in contrast, this transition is a ‘minor major transition’. What does this phrase mean? And how does this affect our understanding of cells?
SM:
Just to start off with single-celled organisms, like bacteria, they are phenomenally successful. They can live in essentially boiling water and sulphurous vents in volcanoes and wherever we find them—inside the body, outside the body. So for a long time people studying evolution and evolution and evolutionary biology imagined that the evolution of multicellular organisms would represent something quite enormous and an enormous leap in evolutionary history.
But what's interesting was that it turned out that—that's not the case. That, in fact, there's a very strong evolutionary drive that we don't understand. But there is nonetheless a very strong evolutionary drive towards becoming multicellular. And if you look at the history of evolution using powerful genetic and evolutionary tools, you find that this leap has been made not just once, but independently, multiple times. Again suggesting that the drive [towards multicellularity] was very strong, such that independently you obtained multicellular organisms. So that's just another way of saying that the transition from single cell organisms into multicellular organisms was a transition that was not something bizarre and unusual—but something that actually happened in evolution multiple times.
KS:
Your book, all three of them, are filled with stories of scientists and medical professionals over the centuries and in the recent past. In some sense, it is like a history of modern medicine. But most of us think about human bodies as in the here-and-now; but you shed light on how our thinking about bodies has evolved. New theories, conjectures, disputations, wrong conclusions, and even the hegemony of pet theories till they are washed away by evidence. You show that knowledge has a politics of its own. But when I talk to my friends in medicine, they are often completely divorced from a historic consciousness. They are so overwhelmed by stuff they have to study on a daily basis that the history largely falls out of their curriculum, or at least in their immediate mind. From a pedagogic and practical point of view—what do you think about this?
SM:
It's a big problem from a pedagogy point of view because, when you learn to do any form of science, including medical science, it's very important to understand and to appreciate where the science is coming from, and where it's going. What its history is, what its history was. How its history changed. Because it informs us about a much broader understanding of why people did the things they did and in fact, in a prior book, I had said that, ‘History Reverberates’.
It comes back in ways that are unexpected. And there's a lot to learn from it. The mistakes, the misconceptions that we make today in medicine may be completely different on a superficial level. But at a deeper conceptual level, they're actually very similar. They may be mistakes in a fundamental conception. They may be paradoxes. And the way people went around solving these paradoxes using combinations of natural physiology, cellular physiology, chemistry, biochemistry are actually just as relevant today as they were years and years ago. Many of my own, much of my own sort of musings and thinkings and in fact, experimental work in medicine has been inspired by questions like this. Questions like ‘why something is not the case’. And those questions if you look through history, especially the history of medical pedagogy, or if you look through the history of medicine, you'll find those questions buried inside there. It's not the first time we've asked some very fundamental questions. Like, What is aging? And why does aging move, move in the following manner. I mean, remember if you take a subject that I think is more dear to your own heart, remember that modern physics was really born in some ways out of Einstein asking a question about what it would be like to ride a beam of light. That question is not a contemporary question. There's nothing in that question that has to do with today. That question could have been asked in 1920, it could have been asked in 1820 or in 1520. The answers to the questions changed because our tools changed. But the fundamental idea that the Great questions remain great questions even today, I think, is something that you can only learn from history.
KS:
When I was reading the sections on Thalidomide and birth defects—your book offers a stunning glimpse into how at a cellular level great harm can be done by chemicals—I kept thinking of the incredible photos by Madhuraj, a great photojournalist who works for Mathrubhumi, who documented the deformities in children who had been exposed in utero to a chemical called Endosulfan. You write, “If this book is about the birth of cellular medicine, it must also mark the birth of its demonic opposite: the cellular poison.” As India modernizes rapidly, as chemicals, plastics, and other pharmacological products actively or unwittingly enter our bodies—can people be educated about it all? Do you think that kind of a discussion is itself possible in a very large democracy with all kinds of problems of communication and cleavages.
SM:
I think it's very possible. And I think that's what people are looking for, people are looking for a deeper understanding of what life is like at the cellular level and what pathology is like at the cellular level. Because otherwise there's no understanding. You don't understand why things are happening. Thalidomide is itself very interesting. We understood the negative effects of thalidomide long, long before the mechanism by which thalidomide works was discovered. That wasn't discovered until the 2010s, 2015s even. That is several decades after the thalidomide controversy. I shouldn't say controversy but the Thalidomide devastation. So I think that pointing out what the problem is the first step. How that translates into changes in cellular physiology is a completely separate question and a separate step. And that separate step really relies on understanding how cells work and how they fail to work in cases like Thalidomide.
KS:
One of the clarifying moments for me was early on in the book when you describe how you think when you face an undiagnosable disease. You write that you have a three part rule: “germs, cells, risk”. You ask: Is there an outside agent involved (bacteria or virus), is the cellular pathology under stress, and is the disease a consequence of exposure to some pathogen, a family history, or an environmental toxin? I thought about this rule especially in the context of Kerala where we have a fairly alarming rise in cancer across the state. There is hardly any family that doesn’t have somebody who hasn’t been affected by it. Do you have an intuition of what kind of physical changes may have led to this kind of seeming explosion? Or is it just improved diagnosis and reporting and so on.
SM:
I think it's multifactorial. I think there is certainly improved diagnosis and reporting. But I also do think that a major factor that's driving cancer in the world is really the aging of the population. I think that in the first book in Emperor of All Maladies, I call this cancer arises in the double negative when the killers are killed. So, when tuberculosis deaths are decreased, when other diseases that would normally kill us are decreased, that's when cancer begins to rear its head. It's a disease of old age. So I think there's more reporting. There's more early diagnosis. There are, of course, new carcinogens that have been introduced into the world. You mentioned some of them. One major factor is obesity and metabolism. So our metabolism has changed and people are more obese. We know that that's a known risk factor for cancer. In the 1920s and 1930s we saw an explosion in cigarette smoking—also a major risk factor for cancer. So. I think it's multifactorial: more reporting, newer carcinogens including, as I said, smoking and obesity and finally, the aging of the population.
KS:
In the middle of the book is a section on cellular technology used for sex-determination, IVF and gene-editing. You write extensively about the Chinese geneticist He Jiankui who inserted edited gene-lines (without any scrutiny from peers) to make embryos and inserted them into a womb. He was subsequently arrested and was released earlier this week. But then you write about the Russian geneticist Denis Rebrikov who is embarking on similar interventions. From such examples, one gets the feeling that we may be able to stop a few cases, but the lure of gene-editing one's to-be-born children for understandable reasons (such as to prevent breast cancer) is quite widespread and understandable. Even if the risks of doing this are relatively unknown, it seems the genie is out of the bottle and more such experiments will only continue. How should we collectively think about this?
SM:
I think these experiments have very broad consequences for humans. And I really think that these experiments should be halted until we figure out what's permissible and what's not permissible. I don't think we should just sort of free ride our way into them and then in retrospect figure out how and when and what the barriers and limits are. If you look at the history of genetic engineering again, you look at my second book, The Gene, there’s a long discussion of the Asilomar Conference [Asilomar II, California, 1975], where of course, very fundamental things about what was permissible and not permissible in terms of intervening on recombinant DNA was first established. But importantly, that was established prospectively, not retrospectively. It's not like we went back and started working on recombinant DNA and figured out later how to manage it and solve that problem. So by analogy, I think it's very important to work on this now. And to figure out how to do it in a way that's palatable and really conforms to our understanding of human norms and human behavior. And I strongly think that it should be done before—we shouldn’t stumble our way through this. We should do it in a systematic manner. And in a manner that's again, that takes inputs from bioethicists and ethicists in general. But also from the broad public, from you and me, because we are invading on something. whose stewardship—I’m talking about the human genome—whose stewardship very much has to do with the stewardship of ourselves, in general. And I think that taking it casually is to make a terrible mistake.
KS:
One of the remarkable things you do in the book is to help link widely different ideas. After telling us about the Indian idea of ‘tat twam asi’ and the question of ‘Self’. You quote Harold Varmus, the Nobel-winning cancer biologist, who called cancer a “distorted version of our normal selves.” ” And you mention “horror autotoxicus”--when the body poisons itself. From baldness via alopecia areata, to Raynaud’s disease to Lupus–it seems the world of the body attacking itself (“its Self”) is not just a puzzle but also a mystery. You write: “It’s like a fire feeding on itself: once the barrier to the self has been broken, everything that is Self can be under attack.” What does ‘Self’ mean at a cellular level? Can there be a meaning about what Self means, as is popularly understood, at a cellular level or is that a fallacy of composition of some sort.
SM:
I think that’s not a fallacy. The Self is obviously an extraordinarily complex thing. There's a distinction that I make between the functional Self—the Self with agency—and the Self that has sentience and consciousness. Now, no one would say that T-cells have consciousness or sentience. They have a certain degree of agency, and they have a certain degree of autonomy. They have a certain degree of function. And so on that level, on the level of agency and function, T-cells are made and the immune system is made to distinguish Self from non-Self. That is not to imply that they have anything beyond that, any sort of conscious function beyond that. But it is to imply that they do have properties that have to do with that agency and function. And that we need to understand those properties if we want to understand the biology of the Self.
KS:
A deeply evocative phrase in the book is “cellular civilization”? You write about how Covid was Vamana and humanity was like Mahabali—a microscopic virus that grows to swallow the world. While reading that phrase, what I realized about your writing is how you borrow metaphors wherever they come from in order to help convey a story. In one of the footnotes you mention: “I have tried to avoid an enormous amount of immunological jargon here.” Where does this facility for metaphors and images come from?
SM:
I mean, people have always talked about metaphorical language in my writing. I don't think of them as metaphors. I think of them as stories—often minor stories. I mean, if you think about my books, they have a particular structure. There are a series of linked stories. And in a kind of almost a fractal way. If you go into the stories, there are stories within those stories. And so I don't think of myself as a kind of explicitly metaphorical writer. I think of myself really as a storyteller. And those stories then become. I mean if you want to call them metaphorical, yes they can be metaphorical. But those stories become parts of a much larger story and they can link together. They come back, they haunt you and I think that facility really comes from listening to stories as a child. I mean, if there's one thing that among the many things that India is, India is a land of stories. There's constant storytelling. And I think that that's what motivates this kind of writing—people call it metaphorical, but as I said, it's not really metaphorical. It is trying to tie together, as I said before, it's trying to tie together a series of stories which I tell, which are linked but also ultimately parts of a whole.
KS:
One of the interesting learnings from your three books that I have gathered is that human knowledge operates between two vast unknowns. At the highest level, the biggest question we have is – ‘what is life’ – and this, as you write, remains a “metaphysical conundrum”. And then, at the most microscopic level, genetic modification of cells is fraught with unknown risks because we are yet to fully understand the correlations across genes. Reading you, my sense is that even as we solve the answers at the microscopic end, the question of ‘What is Life’ will continue to be elusive. Is it an answerable question?
SM:
I mean, the question of ‘What is Life’ is not an unanswerable question. And I do think it's a question that doesn't have a single answer. There are questions that are unanswerable that have no answer. The question of what is life has a multiplicity of answers. And that's because the criteria for life are a multiplicity of criteria. So I think that is the only way that will ever be solved. The multiplicity of criteria is by understanding that. life is as I said it's kind of a menu. And I think it's an answerable menu. You can look at a collection of cells or a collection of whatever it might be and say—well, this is living and this is not living. We have criteria. It's not as free-for-all. But I think those criteria aren't, pinned to one single idea or one single criterion, but in fact are spread through multiple criteria, and only if a being fulfills those criteria do we call it living.
KS:
You have been writing for a general reading population for nearly a decade. These topics are often stunningly opaque to most of us and yet are intimately connected to our welfare and ideas of self. To write well and communicate widely is difficult. What sustains your continued interest to communicate to the wider public? Why do you do it? It is so much hard work.
SM:
I do it because I think that these ideas need explanation. They need to breathe. And in our particular popular culture today these ideas can be removed from the life of public discourse and a lot of my effort is to reinsert them into public discourse. And to emphasize how important it is. It's incredibly important to understand genes and genetics if we want to understand—just to give you one example—what to do about understanding disease. A disease like schizophrenia, for instance, where there is so much taboo attached to that disease. It's very important to think about cells because we are inventing new forms of cellular therapy. Thousands of men and women will go through, for instance, IVF. And not for a moment think about the idea that that was that was that was sort of bred and born as cellular therapy. And so a lot of what I do the urge to write is to bring people into my world. You can almost call it a kind of selfish urge because I find that this world is incredible. It’s the same reason I think that cosmologists write about the Cosmos. I mean, you could say, well who particularly cares about Alpha Centauri, or some galaxy that we'll never, ever go to and you can't even see at night. But there's a kind of thrill and excitement about bringing people into this world, which is very important to communicate.
KS:
During Covid, I saw you write, tweet, try to educate people–as if to awaken people from a kind of stupor. What did the Covid experience teach you personally about being a doctor and thinker on medicine that you didn’t know before?
SM:
Well, I mean some of it was outside medicine but it's very relevant to medicine. I mean, we think about medicine as a doctor with a black bag. But of course, an entire system perpetuates and moves behind the scenes to enable medicine to work. There are issues about the supply chain. There are issues about who stocks the room where the masks are kept. Who ensures that appropriate equipment is available in one part of the country and not in others. One of the shocking things about India when the worst of Covid hit, there was enough oxygen in the country to go around. It's just that it was in the wrong place, and there was no mechanism to get it to the right place. So part of the stupor was to remind people, patients and doctors alike, that we imagined medicine as a particular system of practices. But it's much, much more beyond that. There are components of gossip in medicine. There's components of how doctors communicate, for instance, through Twitter. And if you don't understand those components, you will not understand how and why medicine works. You imagine it again as a doctor with a black bag. And that would be a terrible misconception, because that's not what medicine is.
KS:
The way sciences are taught in Indian schools is almost indistinguishable from tedium, rote memorization, and often misses the big picture. As a professor and teacher, have you thought about how science education can be improved right from schools to University? Like, what can people do? Or is it too large a problem? And it has only smaller bespoke solutions.
SM:
I think the answer is going to be a mixture of what's bespoke and what's not bespoke. I think the answer is going to be for science and scientists in general, very broad. And they start from very early on in life. Again, science is not a textbook. Science and medicine, generally. Similarly, I mean, this is the one conception that I think I really want to remove. There is a sense in India that science is a textbook or a series of questions that you can master in an exam. And when I first came to the United States to work with science and scientists, I realized that all of that knowledge is just the basis or the beginning. You need to have it. But it just forms the foundation for real knowledge and real knowledge I think is exploratory knowledge. And so one fundamental thing to communicate to people is that learning a textbook, learning biology, and figuring out sort of where organs sit and how they communicate and who makes insulin and etc etc. is just a Foundation. The really interesting thing about science is not the foundation. It's the creative aspect of science, which it actually shares with other creative disciplines, like the arts. Where you ask a question that's not been asked before and wonder why it's not been asked before what the answer could be to that question. That's where things get really interesting. That's where things get, life gets very interesting. And that's where we all suddenly discover that there is a completely new way of thinking about science. that has nothing to do with the way we've thought about it before.
KS:
One way I have been thinking about your books is as a trilogy about the bodily existence of humans, You have been trying to educate the rest of us from the cutting edges of scientific inquiry on what an average Indian would think of as phenomena related to sristhi, sthithi, and samhara. The Gene as ‘srishti’ the Creation, Cancer as ‘samhara’ the Destruction, and now Cells as ‘sthithi’ the state of preservation. This is a physicalist description, a model in my head. How do you think about your three books? How do they talk to each other? Do they stand alone? Are they in conversation with each other?
SM:
You've gotten it; and you hit the nail on the head in some ways because I think the actual right way to read these books is to start with the Gene, go to the Cell, and then end with or at least for now and with the Emperor [the book on Cancer]. Because the gene is the fundamental unit of information. The cell is the enlivening of that information and the construction of being and the dysfunction of cells is what causes cancer. I mean, you can certainly read these chronologically as they came out. And that would also tell you a different story. It would tell you the story about cellular dysfunction; and then go deeper and deeper. As it were, you could do a telescopic or a microscopic reading. The microscopic reading would be going from Cancer to the Cell to the Gene. The telescopic reading would be to go from the Gene to the Cell to the Cancer book. So there are many ways you could come to the book. But I think in some ways, I like your typology, because that is the typology that's in the book. It’s about three fundamental ways of being that ultimately end up with three fundamental ways of thinking about the biological universe.
KS:
One of the most rewarding aspects of your books is that there are so many wonderful sentences, brimming over with a poetic sensibility, memorable phrases tucked away here and there. What I get is that science is important but writing well matters to you as well. Your book is peppered with lines or quotes by other writers – from Rushdie to Wallace Stevens and others. Who are the people whom you read, or go back to read, from the “literary” world. Who has influenced how you think about your own writing?
SM:
If I think about it, I don't make any distinctions. I'm a very catholic reader. I read books that I like to read. I find them fascinating and interesting. And then I stop reading when I think that the books are not of interest to me. So, I think that capacity allows me to be very broad and I happen to like poetry a lot. So I read a lot of poetry. People often ask me, ‘do you go back and find these quotes’. And I say, absolutely not. These quotes are often things that come to me while I'm writing a chapter. So, sometimes they'll be scientific. Sometimes there'll be—I’m just opening the book and looking. There's a quote from Robert Burns: “when a body meets a body”["Comin' Thro' the Rye”, 1782] which of course is the quote from which [J. D.] Salinger's book ‘Catcher in The Rye’ comes from. But of course, when you think about the word ‘antibody’—you suddenly realize it is when a body meets a body. And that's why that quote comes about. It's because I read Salinger as a child and was always fascinated by the idea of when a body meets a body. I don't make that distinction. In fact, I try to be as broad and wide as I possibly can in my thinking about any and all of this. And so that's how these books get written. They get written because they form a corpus, as it were, of writing which has to do with so many different aspects of the written word and of how writing is done.
KS:
We are used to scientists, we are used to thinkers. There is a line that I had written down from somewhere: “a great thinker is ultimately a mystic, a great scientist is a detective of sorts.” This dichotomy may be spurious but as somebody who engages with the unknown on a regular basis, as some who has seen many people die painful deaths-–do you end up thinking about what we could call ‘spiritual’ questions? Or do you just put them aside?
SM:
I think ‘spiritual’ questions can be answered by different people in different ways. In some ways, the fundamental practice of science for me, has a component to it—I wouldn't describe it as spiritual—but I would certainly describe it as a component that has very much to do with learning a new language. “Spiritual” is a word that I don't fully understand. And I don't claim to understand either. But I do think that there's a quality which I'd love to preserve in my books where the thinking transcends just sort of your day to day, matter of fact kind of attention. Because I think that that does a kind of disservice to the depths of knowledge that science can bring you to, that medicine can bring you to and medicine especially because you're encountering a kind of lived science. You're encountering a science which has to do very much with sort of how we live, what we do as we live, how we encounter death. And so medicine has a particular capacity, I think, to raise these questions and hopefully to answer them. But to certainly raise them.
KS:
This is the last question. You are probably running out of time. And I have to run to work. [Both laugh] You wear many hats. You’re a professor. You're a doctor, father, husband, an essayist, a writer of books and even a singer—I heard you in Brooklyn a few years ago where you sang some Malkauns. So, how do you manage your time? How do you go about doing so many things and fulfilling so many responsibilities, while preserving time to write.
SM:
I would say that I'm the master of bad time management. [laughs] I do things as they come along and try not to make distinctions between—I do pride myself in meeting deadlines. I almost always meet deadlines, but barely. I sort of move through at least my own life based on what the demands are at the moment, at those moments. And I try very much not to get caught up or hung up on demands that I think are extraneous. I try to remove them. And that might mean, as I said, changing my behavior around the daily activities of life. I don't have very much, whether fortunately or unfortunately [laughs], I don't have very much balance in work and life. My wife who is a very prominent artist also doesn't have any such balance either [laughs]. We work to live. And so I think that's the best way I can answer that question. I just sort of do what I can, as it were. In doing so—I have managed over the years to find a way to continue. I'm not sure I can answer that question.