Transcripts For CSPAN3 Siddhartha 20240705

If you hate people but dont hate communism, you dont hate people. Where can you listen to your radio show . You can go you can get everyone of my shows without commercial anytime you want and there is craig or there isgoo much for being here. Despite what is an unusually rainy miami november evening, we at the university of miami are extraordinarily privileged to sponsor tonights event. We are fans of the author and also of the interviewer, and it is my privilege to introduce them both to you. So mikhail securus, who i consider one of my besties, is a professor of medicine and, the chief of division of hematology at the Sylvester Comprehensive Cancer Center at the university of Miami Miller School medicine. He has a medical degree and a masters degree in clinical epidemiol from the university of Pennsylvania School of medicine and completed postgraduate training at harvard university. Mikhail is also the coauthor or author of more than 400 scientific manuscripts cancer. He is on the Editorial Board of several journals, has 60 essays for the New York Times and authored eight books, including when blood down life lessons from leukemia. The food and Drug Administration has been frequently in the headlines recently, but few of us know much about how the agency works. Drugs, the fda safety, efficacy and the Publics Trust tells story of how the fda became the most trusted Regulatory Agency the world before it existed. Drug makers could hawk any potion claim treatment for any ailment and make any promise on a label. But a series of tragedies, Health Crises and Patient Advocacy forced the government to take responsible for the efficacy and safety, drugs and medical devices. In 2011, the avastin hearings, a century of the fdas evolution demonstrating how its of checks and balances works or doesnt. Now on to Siddhartha Mukherjee who is the author of the New York Times best seller gene an intimate history the emperor of all maladies, a biography of cancer, which the 2011 Pulitzer Prize in general nonfiction and the laws of medicine. He also happens to be an associate professor of medicine at Columbia University and a cancer and researcher. The song of the cell an exploration medicine in the new human begins in the late 1600s, when english polymath robert hooke and an eccentric dutch cloth merchant, anthony van lavan, hooke looked through their handmade microscopes. What they saw introduced a radical concept that swept through biology and medicine, complex living organism are assemblages tiny, selfcontained, selfregulating units. Our organs are physiology. Ourselves are built from these which hooke named cells reframing human body as a cellular ecosystem marked the birth of a new kind of medicine based on manipulating cells. And here, mukherjee tells the story of how scientists discovered began understanding them and now are using that knowledge to create new humans. It is my great pleasure to introduce dr. Saka, harris and mukherjee the stage. Thank you. For. Said. Its so nice to see you. Same here. Mikhail said, and i have a bit of a history now. Not bad history in the way people sometimes say we have a history, but the two of us first met when sid was a medical student at harvard and i was a resident at mass general. And so i think were separated training by about three to 2 to 4 years, Something Like Something Like that. And then you followed through mass general and then at the danafarber cancer institute. And here we are today. Im going where you are. Well, i hope our rain didnt deter you today. Its delightful to have you here. My pleasure for making the trip. I wonder if i could start off. I wanted to read a little bit, just a brief section from your book, because loved this part and its what draws a lot of us into science. In the introduction, sid writes i have spent a lifetime cells. Every time i see a cell under a microscope with fulgent glimmering. I relive thrill of seeing my first cell on a friday afternoon in the fall of 1993, about a week after i had arrived as a graduate student in allentown science lab at the university of oxford to study immunology. I had ground up a mouse spleen. Yes, we actually do things like that and plated the blood tinged soup in a petri dish with facteur to stimulate t cells. The weekend passed and on monday morning i switched on the microscope. The room was so dimly lit that it was not even necessary to pull the curtains. The city of oxford, always dimly lit, if cloudless. Italy was a land made for telescopes. Then foggy, dark. England seemed custom made for microscopes. And i put the plate under scope, waiting beneath a tissue culture medium where masses of translucent, kidney shaped t cells that possess what i can describe only as an inner glow and a luminous fullness. The science of healthy active cells like eyes looking back at me, i whispered to myself and then to astonishment, the tcell moved deliberately, purposefully seeking out an infected cell that it might purge and kill. It was alive. Its a beautiful segment. And i think that. Thank you. One of the reasons youre so popular here with your writing said you make science approachable and you make science come alive. I understand. Rumor has it we may have some liberal arts majors in the audience. Can i ask you for a brief biology refresher . What is a cell . How does it divide and form organs . So thank you. Mcgill, first of all, and thank you for coming wading through the rain. A cell is the smallest autonomous unit of life. Its its very important to recognize the idea that it in fact the smallest autonomous unit of life, were built out of them. But write down to any living creature, single celled living are still cells. One of the things that a years ago i was working i had a book opening in brazil and i was walking outside botox clinic there everywhere. By the way, in brazil, i was not getting botox. What happens in brazil stays in. Yeah, exactly. But anyway, it was called a life clinic and was this picture of dna outside . It and dna, of course, is the molecule that carries Genetic Information and it has become. Its an iconic molecule, a double helix. Everyone knows it. You walk outside if theres a life clinic here, itll have a picture of dna on it. Whats amazing, that dna itself, the genes is are lifeless. The molecule is lifeless. It has no life. You could swallow it and eat it and would just go right through you. Its the cell that brings dna to life and it i often make the analogy that you can imagine your Genetic Information, your genome as a musical score, but a musical score is a piece of writing. It has no music. Its the cell that that music to life. Hence the word. Hence the song of the cell in the title. But but its very important to realize that that that its if you want to think about life and you want to think about medicine, you have to of course, genes are incredibly important, but you have to think about the cell. And as i said, going back, you know, what is a cell . The cell is the the smallest autonomous unit of life that we know. And everything goes back to the cell. Im going to finish by saying, you know this goes takes us back history to the book in the late 1800s Rudolf Rudolf virchow who will come to was a young pathologist who made two very, very radical statements. His first statement was that all normal physiology is the consequence of cellular physiology. So essentially he was saying, is that everything that we do, every activity, every function, every this conversation, the fact that, you know, the temperature has fallen 20 degrees, what bodies have managed to regulate it and our temperatures havent 20 degrees. Everything is about life is a consequence of cellular function. So that was statement one. And then he made the the obverse of that statement, which actually extraordinarily important in medicine. And he he posited. And now we know its increasing be true. He posited that all disease is cellular dysfunction. So if you want to track down any disease, any source of any disease, it might originate in the environment it might originate in some behavior. It might originate in a situation occupational hazard, a diet, whatever it might be. But ultimately, it has to impinge on ourselves and all illness is cellular dysfunction. And so thats just too highlight the importance of of why we need to understand cells and why why even wrote this book. I love how you positioned that of the cell and the cell and the functions of the cell as, basically carrying out the instructions of the genetics. We but i dont know if anyone knows this. Sid and i both specialize in cancers at the bone marrow, particularly leukemia and leukemia like conditions. And when we talk to patients, we go we talk about the cell. I mean we jump right to it. There arent i dont think there are a lot of diagnoses where understanding the cell those genetics are so critical to understanding the treatments that were offering why why those treatments work and ultimately what we follow over time in people to hopefully show that their leukemia is in remission or even cured or unfortunately, sometimes when it comes back, you harkens back to a past age. Prior to the 20th century. Could you talk a little bit about what people really understood about the cell from the time of robert hooke to Rudolf Virchow, Louis Pasteur and and Walter Fleming . Yeah. So robert hooke was the first person to look at cells and theres a theres a picture of, of, of his first, his own first picture of cells. Actually, he saw he didnt see cells. He the outlines of cells in plants. Hooke was an amazing, amazing. He was an incredible. He was an indigent young student at Oxford Wadham college and sort of a strange world. When i first went to oxford, my my rooms were across from hookes rooms in a bizarre way. Now, are those those have become a national monument. And theyre preserved. But anyway, there was hooke and he i describe him as someone who had a his theres intelligence was phosphorescent and elastic like a rubber band that stretches as it glows or glows as it stretches. Theres a pun in there because. He he all he discovered the laws of elasticity. So hookes one of his major contributions is that he actually figured out how rubber bands work and the physics of how bands work. But nonetheless he was an incredible polymath he was an architect. He was a scientist he was a microscopist he was a telescope. He did telescopes. And at one point in time, he into a nasty argument with newton and said that hed even invented or discovered the laws of gravitation which he hadnt. And and the great irony of this was and this an apocryphal story that apparently that president of the of the Royal Society and the the great story runs that when the royal moved its offices newton was so about about hooke that he refused or or neglected to take the single portrait of robert hooke that exists in in the in the history of the world. And he apparently left it behind in the old the Royal Society. And so there is the man who really the basis optics theres no picture of him. We dont know he looked like anyway so back to hooke so hooke finds these but hooke has no idea why important and he doesnt even know whether theyre general whether he discovered something some universal principle or whether hes just found, you know, something unusual or interesting in his under his microscope. About ten years after him. Theres character who plays a big role in this book named anthony van leeuwenhoek. Hes a dutch clothes salesman, so hes a cloth salesman. And he also invents a microscope, a very different kind of microscope. And his original idea that he wants to look at that, the quality thread, because he lives in delft, theres a big booming trade of of cloth. And so he to look but then he becomes obsessed with his microscope. Now this louis hooke is completely the opposite of hooke. He is. Hes never been trained in science. He has no scientific background. But then he begins to discover in droplets of water and everywhere he looks, he begins to discover what he calls animal quills. But those are, of course, cells. And if youve ever seen that beautiful microscopes, you ever have a chance to go there. Theres a couple of them in the United States where many and in in in the netherlands, the one in the university of cambridge. Theyre theyre beautiful there. But this big. And you hold them up to the sun, you almost think it wouldnt work. But anyway, so hook and lou and hawks sort of discover that there are cells, but none. And neither of them realizes how important they are. This is a time when people are still unclear about how were made, how bodies are made, and theyre to in mass questions that are sweeping through biology. One question is how our bodies made, what are we made of . And for the longest time, people believed that were slabs of meat. And how do those slabs of meat around or you know what . Theres a theory that theres some vital satirical vitalism. Theres some vital fluid. And thats how cells are born. Theyre born out of a process analogous to crystallization. So when you put salt in water in a bath and evaporate some of the water out, it spontaneously forms crystals. And so lots of people believe that thats how cells rise. They you know come into life like crystals come into. So so theres this theory thats sweeping through biology and then theres the other theory which is goes back the same kind of question. Well, if we how do we go from a tiny embryo to being a large, you know, animal . And again, theres no theres no understanding of cells and people that theres a very popular theory called formation in which people think that were sort of we we are fully formed when were born like a little mikhails and and we get sort of blown up like like those macys thanksgiving balloons and we become and bigger and bigger. And ultimately we become fully sized. And thats that those are the reigning theories. Cells come out of spontaneous generation and we as creatures also arise out of spontaneous generation. And the book begins at a moment when these two scientists in germany begin to realize that both those theories are unlikely to be true. Sladen and schwann. The book begins with an evening with them, and all of a sudden realize that that when theyre looking down their microscopes, they begin to in animals and in plants. One is a botanist, ones a zoologist. They realize that, in fact, were made of cells and, thats the beginning of cell theory. So now this brings us up to the 1800s. Then theres theres a long what i call a valley in which people begin to explore. Well, if youre made out of cells, how do cells arise . How do they come, come, come around . How do you how are they born . And how do we develop as humans. And that leads us into the early or late 18, 19th century, early century, when scientists like Rudolf Virchow make the argument that, first of all, that all cells come from cells, and he actually picks up that line from an earlier investigator. But its a its a very audacious line because. Theres no spontaneous, not like crystals you dont form it. You know, you dont form out of water. All cells come from other. And and then i told you the other two that normal function is cellular function and all illness is cellular dysfunction. Incredibly ideas for their time of course later, all proven to be true. Now if you follow that line of thought, lots of things begin to fall out of it. First of all, if you say all cells come from cells, it might seem like a very bland statement, but incredibly important things fall out of that. One thing that falls out of that is if all cells come from cells, then the way you can explain, the development of a of a human being with several trillion. Right, is that they must have come from the division of the first cell, which is the union of the and the egg by the way, the smaller in the body and the largest cell in the body. So thats one thing that comes out of it. And then the other thing that comes around much, much later in the 1950s is a theory of cancer. So if all cells come from cells, then a cancer cell must have come from a normal cell. Theres thats the only way that it could have come. And if thats true, then something must have happened to a cancer cell to make it a cancer cell from a normal cell. And thats the genetic basis of cancer. So you begin to see the roots of these ideas becoming enormous, full of disciplines, the whole discipline of pathology, the whole discipline, embryology, the whole discipline, you know, the study of humans, the study of bacteria, everything comes back to. This this moment of time when cellular theory is established in the late 19th century and, you know, you make it so clear how it was that one critical theory that led to this explosion and probably reason we have such an incredible understanding of the science in the past 100 years as opposed to what had occurred hundreds of years prior to that. Yeah. And again, you know, we had to wait. I mean cell biology had to wait for its its moment and its moment was to some extent it was microscopy. Subsequently, of course, it became much more complex and more developed. It had to wait for that for, that moment and microscopy was that was that moment. Yeah. So lets move on to the 20th and 21st centuries. If okay. One important medical innovation that occurred, the transfer of cells from one human being to another. I never thought about it that way until i read it in your book. But thats whats happening. A straightforward example, of course, are blood transfusions, right . Were bringing cells from one body into another body early, experiments for which range from the macabre to the mad. Those are your words actually love that phrase. So how has the transfer of been used to treat disease as has been the case with bone marrow and even create new life, as was the case for louise brown in england. So cell transplantation has had has a very strange birth. So again going back to the 19th century, you have the first blood transfusions. And initially people thought, well, blood is blood. Why dont we put sheeps blood into a human . And that didnt go very well, not only for the sheep, but for the human being. And so so but the interesting thing that which actually goes back to the subtitle of this book is that people also thought scientists even thought that when you transferred blood from animal to another or one human to the other, you would that new human being, you would that the that that the psychic elements, personalities, memories would also be transferred from one human to another. And so there was a real sense when you came out of this blood transfusion that you would be altered, youd be changed. And, of course, to some extent thats true. But by the 1920s and 1930s, blood transfusion had become much, much more a science than this mad sort of lets put sheeps blood into human being and see what happens. It had become a science, in part because of magic. So people, scientists like carl lance understood that blood had to be matched before it can be transplanted. So you can only transplant blood groups between blood groups aside from you know the universal donors, the oaths. And if i could jump in there for a second, when you say matching so that everyone understands what exactly are we matching . So were matching. So blood cells on this surface, like all cells carry on their surface. But series of molecules and what we are matching is the these series of molecules broadly. But we can go into much greater detail on this. But were matching these molecules such that your blood and my blood have the same molecules so that its so that my immune system doesnt recognize your blood is foreign because these two molecules are matched against each other. And thats why we have blood. Ab oh, and. Ab right. And so thats the and blood transfusion has an incredible history. Then it becomes it really changes the, the medical of the war because as you can imagine, the transfusion of blood is absolutely crucial in on the battlefield when you lose blood, the only way replace blood is using either plasma or blood. And and that really changes history. So thats the first thing to be transfused or transferred and then the 1950s we come across bone marrow transplantation, which is very familiar for you and me. But again, a complete shock to the entire world. So i tell the story of the first transplant where successful transplantation. Between two twins and now again, when you do a bone marrow transplant. You need to be matched because otherwise immune system will recognize the foreign bone marrow as, foreign and and reject it or the bone marrow will find your body is foreign and reject you, which is even stranger. But so we go to seattle, we move to seattle and the first bone marrow transplants are being performed, transferring bone marrow so that now the twin basically a chimera. So she carries the bone marrow of her. And since then the field has moved on. You dont need twins anymore. You can perform very clever matches, very cautious matches and transfer marrow one person to another person without the requirement for for them to be twins. And weve moved on since then. Right. So then we on to the birth of ivf. Um, so that ivf is also a form, of, uh, transplantation, a strange form of transportation. You harvest eggs from someones body, um, you fertilize them with. The, with , and then you grow it in the petri dish until a little bit, um, you know, eight cells or, uh, a little bit bigger, and then you transfer it back into a womans womb. So that it can know that, that, that the, the, the embryo now, now grow, um, and now we have, we moved on since then, and im pushing along into the 21st century. There are attempts to now transplant, um, type islet cells in the pancreas so that you can cure type one diabetes. These are very very novel efforts the efforts to create artificial, artificial organs of various kinds artificial bio artificial livers. And so this whole field of transplantation from the early mad experiments to now very sophisticated experiments has really begun to boom. Finally and has led to lots incredible cures of diseases. Um, you know, in, in my first book, when blood breaks down, i write a little bit about it. Donald thomas was, of course, was considered the person who first initiated bone marrow transplantation. And theres this charming story about him where when he was doing his experimentation, his initial experiment were on beagles and little dogs and he and his wife made a deal that if he was able to finally work out the mechanism of transplanting a bone marrow one beagle to another and that beagle survive that they would adopt the beagle so they did that and then it worked a second time and they did that and they looked up and had this yard full of beagles and he realized it was it was he really had something going. And that was the time he started to move to write to humans. Theres also the work on donald thomass work on, so you must met donald once, at least. Yeah, yeah, yeah, i did too. He passed away. He won the nobel prize for his work, and passed away. Probably what, 15 years ago . Maybe about right. Yeah. So its kind of the beginning of our career. Thats right . Really in his in his dotage. Thats right. So but its a very theres a very moving of the book in which i went to seattle. Uh, actually is one of the most moving parts of the book. And i assembled, all the nurses who had been in that first trial, i found out all their phone numbers. I asked at the at the Fred Hutchinson cancer center, all the in the in the in the original transplant wards. And theyd all been hand trained by by donald thomas. But um, and theres a very i think, a very moving segment in which they all file into this room and they all hug each other and remember those first days because, um, if the record is correct. The first 70 patients died, um, yeah, the first 70 patients died. And you have to think to yourself, what kind of a human do you have to be . Or what can a human being can you . When 70 patients die and youre going to say, im going to try the 71st, um, and, and the of incredible resilience of all of that. And these nurses had, these unbelievable stories of of the first children who they stayed up all night, you know, um. Holding their hands, telling them stories and watching one of one after the other experiment. Clinical trials fail until finally they started succeeding. And we have hundreds of thousands of patients, if not millions of whove undergone bone marrow transplants. Yeah, i you know. I always it always makes my stomach turn a little bit when i have heard that story as well. Right. Of so many people going through transplant and dying and same was true with organ transplant. So many people through this and dying to lead to what we have today, which is honestly a scientific miracle. I mean, you describe it to people. It is a its a miracle. But i think of the ethics of what those folks went through as well. Yes. I just i just simply dont think we would have any more. I think for good reasons. Yes, for good reasons. Absolutely. I mean, you know, we we have we put up very strong and important around human experimentation and so forth. But there is there was something and this is not to say that, you know, don and thomas were the of transportation. You know, they went through every committee, every doing nothing unethical. The first child, louise brown, born to ivf, you know, was approved by every single committee. But whats important is, is i make a very important in this book and now that were talking about ethics between disease and desire. The so again between disease and desire. So we understand disease and its fundamental link to suffering and desire is linked to enhancement or augmentation. And um, so therapy can enable this. Both gene therapy and cell therapy enabled both and for the the thats easy thats to some extent thats that those are bright lines so we stop at disease and we we dont augment we dont enhance thats been a relatively bright line for most most most of medicine. But whats interesting is that you look at the history that bright line when in the moment is often not that bright when the first patients when louise brown the first ivf baby and whole story is here but when louise brown was born, there were lots of doctors, including gynecologists, who said that for that, infants, human beings are in fertility. Since the since the birth of humanity. So why is that a disease. But others argue including. Um steptoe and edwards who would basically do the experiments leading up to louise browns birth argued that, you know, for some people not everyone, but for some people theres an aching suffering form of suffering that has to do with their infertility. Um, and so it it was indeed know it well, it did indeed qualify not as an augmentation human desires, but, but that there was suffering involved, that there was, there was disease involved. And whats interesting is that in retrospect, all of these things become clearer. But when youre living in the moment, youre living often in in very fuzzy territory. Youre treating patients on an experimental trial. You know 70 have died and youre going to perform the 71st, you know, in retrospect, of course, it theres a theres a kind of triumphant narrative that one can have of of of the success medicine. But when you live through it, its very difficult. Its very fuzzy. And i know youve written about this in your own books as well. Its its very complicated. Live through it in real life. Yeah. I want to kind of take off from that a little bit because what talked about so far, syd have largely been accomplishments revolutions in medicine prior to when you and i finished our training. But something that has happened when when you and i started to specialize in hematology, oncology and focus on leukemia is how the immune system has been harnessed to actually attack cancer. Can you talk a little bit about that and about story of emily white house, who become a hero to all of us. Yeah. So for long time, people knew, scientists knew that. And was trained as an immunologist for a long time. Immunologists knew that the immune system could be retrained to attack cancer. There were multiple of spontaneous remissions cancer. Um, and often when you looked at these spontaneous remissions, you would find that there was an immune infiltrate in the cancer, the immune system somehow recognized the cancer as foreign and attacked it and killed the cancer cells. Um, but whiteheads case is particularly important because. She was the first child to be treated with a completely novel form of therapy. Cart therapy. Um, and its basically a mechanism by which you remove t cells from the body, weaponize them using therapy to kill another kind of cell, including cancer cells. And in her case she had a very lethal form, um, leukemia, um, called or refractory relapsed. Its come back again refractory because its not responding to the normal drugs acute lymphoblastic leukemia. Um, and is a, you know, jump in hll this this form of acute leukemia. My will often say to me do i have the one that the kids have or do i have the other one, the other acute leukemia and acute lymphoblastic leukemia, which emily has, is one of our greatest Success Stories in cancer therapy. We have we are approaching a 90 cure rate in kids who have this form of leukemia. But unfortunately, when its bad its very, very bad. And thats thats the 10 . Yeah, thats the 10 . So emily was in the percent. And and when you say you remove her tcells, these are you actually taking some of her immune the same cells that you saw when you were first looking at cells at that . Ashland yeah. And that you saw moving right these t cells are removed from the body we change how they with their focus so what theyre going to kill right so so were actually focusing it on her own leukemia and then re infusing these are navy seals versions of the immune system back in. Thats right and an emilys case was particularly important because what we what scientists know then was that these navy seals can also go rogue in the sense that these t cells begin to heat up your cancer. They can become they can an incredible inflamed condition. Um, so inflammatory that your whole body goes into kind of shutdown. You get go into a kind of organ meltdown. Um, and just by chance, it happened that emily doctor doctors found a mechanism, um, to dampen down this immune ramping. We still use that today and, and was what really led her coming alive as it were. They were she was taken for dead. So she was my understanding of the story. So you know we talk about this all the time in conferences the background to this this miracle, right. That she was taken to the intensive care unit and people didnt think she would make it through the night. And one of the doctors caring for her older overnight had a child who had a juvenile of Rheumatoid Arthritis and was on a medicine for that. Right so so the story goes that she was taken the icu desperately ill not because of leukemia anymore. In fact we later found out we would later find out that her leukemia had been wiped out. But the t cells that we had infused, Emily Whitehead with were on this. You know, i liken them to, you know, row t cells throwing out, you know, chemical pamphlets, inflammatory chemical pamphlets, each other. These are that t cells make when they go on to kill. They attract more t cells and they create this unbelievable rampage. In fact, weve seen some of these immune rampages in covid, not just not exactly the same, but but similar immune rampages. And so emily was, really, everyone thought she was going to die. And if she had died, then try a trial would have been stopped. And so and there was history of jumping. There was history of this at penn where i trained yeah when they had tried gene therapy on a young man a decade and a half earlier the young man had died and shut down their gene therapy program. So there was incredible to this not only because, my god, this this this beautiful with this terrible cancer was about to die, but the institution had a repute for doing these kind of crazy novel therapies that could potentially kill and just the universe is such a bizarre place. The just by coincidence, the doctor treating emily happened to have a child who happened to have a form of immune, who happened to be on a medicine that could dampen down the immune system. So she had the opposite. She had an autoimmune disease so she so this kid was on on a drug and overnight they they rushed emilys blood to the to the hospital laboratory. The Laboratory People worked overnight and found that she had had she had sky high levels of one of these particular chemicals t cells make. And this drug, as i said, happens to be a drug that is directed against that that particular chemical. And so in the morning, she was injected with the with the chemical and as i say in the book, it was sort of the doctors use the word, they say, boom and all of a sudden she came alive and her leukemia into remission. And whats astonishing is ive got to know whiteheads quite well. Shes 17 and applying to college. Um and leukemia free. She was almost she had 100 before this treatment invented she would have almost almost certainly been been dead, as it were. And so this this therapy is being used for a variety of of conditions and is actually curing people with not only leukemia, lymphomas and other blood cancers. Yeah. Yeah, i, i, i think serum im getting the stink eye from the organizers because. Im monopolizing all of the questions in not giving other people an opportunity. And now well have a chance to the people to ask said i want to thank you thank you for coming and for talking about your fabulous book. Im one of those miracles. I was diagnosed with acute lymphocytic leukemia philadelphia positive ten years ago and so thats just saved life and i was treated with cord stem cells. So i want to ask you, your opinion about that. Is that becoming more mainstream now than than bone marrow transplantation was . It is a form of bone marrow. So and absolutely its becoming more and more mainstream in the sense that it is also a form of transplantation. This case, instead of bone marrow, we use cord blood. This is a blood drawn from the umbilical cord of a of a of a fetus and and we we do both. We do adult bone marrow to bone marrow transplants as well as cord blood to adult transplants. And both are, you know, as you as your living example of highly effective. It just depends on the circumstances and what the right and how much blood you need and so forth. But thank you for coming in and sharing story with with us and thank you for all the research you do. I sylvester so so all three of my kids, weve donated the cord blood, you know, for for use for for for people like you. We did we donated both our childrens blood. Yeah. And the final time the person collected it was actually one of my former leukemia who was cured. Oh, lets feel like itd have come full circle. Yeah i collected my. My, my childs cord blood and i was ultimately told to leave the room because i was making such a fuss that the gynecologist, the obstetrician. Can you please get out . Because. Of first of all, good evening and thank you for coming. Dr. Mccary to us out of curiosity inspired you to become an author and write about these topics. Why did you decide to become an author and write about these topics . Yeah. So i had been. The first book, the emperor of all maladies came out of time as a fellow, i write books to bring people into my. And partly because people are very, i think, fundamentally curious about their world. You know, when you encounter medicine, it seems like a black box. And i wanted people to i want to open up that box and really allow people to understand what we do. We do things what the history of those things are. Sometimes i you know and as i have developed a kind of which i think is it it fits me i mixed together everything. Some parts of the book are memoir or some parts of the book are are are is deep history. Part of the book is oral history. Some parts of the book are, you know there are drawings in the book that that i did. I mean, its just, you know, what would i do a book i put, i just mix match everything into a giant indian. Bits and. So so thats sort of the thats sort of the motivation for, for writing these books. What was your second question . Oh, no, it was the same it was the same question. Yeah. Thank you. Yeah. So have time for just a couple of questions. Minutes of sleep. Ill give answers. Hi. Thank for coming. Im curious what whats the evolutionary reason . Only four blood types. Why are there 27 blood types . Thats a very good question. Thats an im sorry i cant give you a short answer to that, but i have to give you an so the evolutionary reason for blood types is that well, first of all, the often in evolution, things happen and we dont know why they happen we can tell you how they happened. The blood types are actually defined by not just so on the surface cells, theyre molecules, typically proteins, but blood types are actually defined by sugars that are attached to these proteins, um, they have, these proteins have functions carry up other functions in the cell. And it turns out that these proteins are shared, some of these proteins are shared between us and bacteria. So there is an immune response that is generated across across these proteins. So you i can recognize your blood type not because ive been transfused with blood before, but because i have an immune to your blood based on the fact its shared between. Between that that protein and other proteins. So over time, i mean, these things, these proteins, real functions in the cell. So the evolutionary answer is carry out functions in history when know human beings were were evolving. That happened to be four of these or four types and neither of them seems to have a distinct advantage over the other. Its not as if one is, you know, especially good at doing what its doing. And so therefore have been carried along across a long history. Some are more prevalent in some populations. So there are some blood types that are more prevalent in populations, some are less prevalent, some populations, some are very are more rare than others. But there there otherwise there are neutral in the sense that that they dont cause a disadvantage they get the protein can carry out its its function and has been carried along over history over evolutionary history and there happened to be for that that around obviously they have subtypes and subtypes and sometimes but theyre four major ones and theyve just been carried along through evolution. Go ahead. Following up the question earlier, do you think obviously there must be a market for, ill say, lame medical information, otherwise i guess you wouldnt be writing books. Do you think that that has changed or increased . You know, dr. Google has come come up on the on the scene that more people are curious or do you think that throughout ages people have been curious about the hidden mysteries of medicine . Well, its a fascinating question. You know, i think i think people have been curious or have always been curious. And, in fact, theres been a the genre of medical of writing, medical nonfiction goes back a long a long way. You could say that in some ways, you know that, you know, the first philosophers were naturally called scientists, partly because they were engaging not in philosophy. But in natural science, theres a very close link between them and its theres a long history, people writing to the public, in fact, robert hookes book, where he first described the cells was a was a popular book. It was a book written for for just popular consumption things was called micrographia or micrographia. And it was about sort of seeing tiny things in the universe. So i think theres been a long history. I think, of course the internet has changed things, but the internet doesnt tell stories and storytelling is very, very important in all of this because medicine is about storage and i do think that medical have changed a little bit in the types of folks that theyll admit. Ive always thought that a good medical should be an english major because a good ultimately what we do is storytelling right. And if you cant tell a coach and story, youre going to be a very good doctor. But it used to be that you really didnt even a shot of getting into medical school if. You had a liberal arts background. So i made the joke. The liberal arts majors earlier, but i am a card carrying liberal major as well. Right. And every story, an ending. And unfortunately this is our. Oh one letter asking questions. Is one person left . Are. The yeah, go really quick. Its its a the same theme i use im actually history major im also norwegian physician read all of your books i think theyre absolutely fantastic. Thank you. Theres a similar seuss blunted similar to the other audience members have asked i think over the last few what weve seen with the pandemic and with lot of Different Things is that theres a huge mistrust the public has in science and in medical knowledge. As someone whos just a wonderful communicator, how do you think that we all can better kind communicate with the public and better kind of bridge that gap . Well, ill give you a very short answer, because weve run were running low on time. But its a very important question. Do we communicate . I think we communicate with honesty. And so in my books, you know, youll find a history. You can think of my books as a history of failures and a history of success as a history of accomplishments and a history of of terrible things that that science and medicine have have have done. If we communicate with on the other hand, if we only communicate certainty and authority, then i think we make a terrible mistake because. Then then people come up and say, wait a second, why are you changing your mind . And ill end with the famous quote from to john maynard keynes, who said, when facts change, i changed my mind, what do you do . And so communicating some of that communicating some of that, and also the urgency that we feel in medicine, i think it makes for good medical communication. Thank you very much. Thank you. For be going. Yes, thank. The author. If you go back for its going to be the yeah. Welcome, everybody. My name is jonathan alter. Im chair of the board of the j. Anthony prize project. And as i think many of you