IN A country where the incidence of cancer is rising and palliative care lagging woefully behind, acclaimed oncologist and author Siddhartha Mukherjee said he will petition the government for easier access to opioids for patients. “We have to approach palliative care from several sectors. We have approached the Prime Minister about this….Morphine is a cheap drug but we barely get it in India. When my father passed in October last year, I went from doorstep to doorstep, pharmacy to pharmacy, but I was unable to get him any, to relieve his pain. In the USA, it would take me 15 minutes to get morphine. My father lay dying but I could net get any opioid to relieve his pain and save him.
They said, give him tylenol and ibuprofen,” said Mukherjee at a riveting Express Adda on Tuesday (Detailed transcript with questions will be published next week). The Narcotic Drugs and Psychotropic Substances Act, (NDPS) 1985 required a string of licences from various government departments — upto six in some states — for anybody to stock and sell morphine but there is no bar on doctors prescribing it. In 2013, some amendments were passed to make opioid regulation solely the Centre’s mandate.
According to Dr Navin Salins, associate professor of palliative medicine at the Tata Memorial Hospital in Mumbai, less than 2 percent cancer patients who need opioids get it. Mukherjee’s remarkable ability to demystify medicine, the range of his interests and insight — from music to AI, genomics to philosophy and the need for humility — were on display as he explained the writing process, the new frontiers of medicine and fielded questions from an audience on art and science and what lies in between.
The Pulitzer Prize-winning author of the The Emperor of All Maladies, in which he explored the way cancer has impacted human history, Mukherjee said: “Writing is a form of thinking for me. It’s a mechanism to lay on the page, ideas about who we are, where we are going. Medicine allows you to do it, the intimacy you can share with the world, what it means to be a human being — it’s revealed through medicine. We, through our writing, all physician writers, like me, Atul Gawande, Oliver Sacks, we were all trying to explore the same questions: what is it to live, what is it to be dying, what is to heal, and when you failed to heal.”
Mukherjee, who delved into the personal genetic history of his family in The Gene: An Intimate History, a book that looks into the impact of genes in determining one’s quality of life, from traits to mental illness, spoke extensively on gene editing and Artificial Intelligence. He explained how AI-driven algorithms and technological progress in reading the genome will help define the frontiers of research into what it means to be human — and different.
“We have acquired the technology to change and also interrogate the human genome. We had been struggling in medicine, to explain the nature of human variation, why is one different from the other. Why does one woman have breast cancer and the other doesn’t? There are genetic components, but we didn’t know what they were. We can now, know virtually every human gene, and change it in the human embryo. We can delete genes, now we need to stress on how to replace them, which is something we are working on and would have something concrete by the end of next year,” he said. What was crucial, he said, was to understand the need for humility as scientists push the frontiers of knowledge. For, there are implications, he cautioned. “There are technological hazards, there are bio hazards. There are strong moral hazards. Should we be playing with our own genomes — we certainly haven’t done it in the past. Should we have some humility, in the face of the capacity to change our genetic information. Could we have a profound effect on ourselves as a species, the way we determine out future, or should we stop now?,” he asked.
That there aren’t easy answers to this provocative question was a point Mukherjee underlined.
In times when strides in science were increasingly being countered by sceptics both in Trump’s US and in India, Mukherjee said, “Science is not fake news. It’s embarrassing, how science is rejected because of flimsy critiques. Science is real news.”
He said that science was perhaps the only discipline where you use a word today in the exact same sense in which it was used a couple of centuries ago and so not be misunderstood — so if you use the word “force,” Newton would understand it and Pythagoras would understand what you mean by a triangle.
Born in New Delhi, Mukherjee attended St Columba’s School and went on to study biology at Stanford University, where he worked in Nobel Laureate Paul Berg’s laboratory, defining cellular genes that change the behaviour of cancer cells. He then moved to Oxford after winning the Rhodes Scholarship for doctoral research in viral antigens. He later moved back to the US, where he attended Harvard Medical School, earning his Doctor of Medicine (M.D.) degree in 2000. Currently, Mukherjee is an Associate Professor of Medicine, Division of Haematology/ Oncology, at the Columbia University Medical Center, New York City.
At the Adda, Mukherjee was in conversation with The Indian Express’s Deputy Editor Seema Chishti and Senior Editor Paromita Chakrabarti.
Guests at the event in the past include the Dalai Lama, economist and Nobel laureate Amartya Sen, Union Minister Nitin Gadkari, Chief Economic Advisor Arvind Subramanian, actor Tabu, Union Minister Piyush Goyal, Punjab Chief Minister Amarinder Singh, writer Amitav Ghosh, journalist and author Mark Tully and cricketer Virat Kohli.