The New York Public Library



Siddhartha Mukherjee | David Remnick

May 17, 2016

LIVE from the New York Public Library

live

Celeste Bartos Forum

(applause)

DAVID REMNICK: When my mother calls me on the phone, the first thing she says is, “Do you remember . . .” and then she fills in a person’s name, an old friend of hers, and then I say yeah, I remember her, and she says, “Cancer!” (laughter) Tonight, tonight we’re not going to discuss cancer much.

SIDDHARTHA MUKHERJEE: Much.

DAVID REMNICK: Cheerful as it may be as a prospect.

SIDDHARTHA MUKHERJEE: Right.

DAVID REMNICK: We’re going to discuss your extraordinary, extraordinary new book. I have to say just by way of starting that Sid Mukherjee is—I can’t imagine a more accomplished and astonishing writer about anything, but on science he is unsurpassed. This is a book that is not to be missed, it is already, his great editor informs us, number 3 on Amazon, and led only by Dr. Seuss and something I never heard of. (laughter) And the Dr. Seuss will fade away because it’s a graduation book.

SIDDHARTHA MUKHERJEE: But I’m a fan of Dr. Seuss. I want Dr. Seuss to be ahead of me.

DAVID REMNICK: Every book has an origin story of some kind. This book’s origins come from family, as it might, about genetics. And in your case, the origin story has to do with mental illness in your family and its relation, potential relation, the fears of its relation to genetics, and how that might affect a future, so I thought we’d start out by your reading a short passage from The Gene having to do with that.

SIDDHARTHA MUKHERJEE: We was just in the—first of all, David, thank you for doing this. We were just in the back room, and I picked up one passage, it’s not about genetics, but it’s about history, and because history goes into genetics, I thought this would be a nice passage, so this is about two of my father’s brothers who were consumed by mental illness, and, as many of you know, or may know, they emerge out of Partition, terrible cataclysmic illness, cataclysmic moment in history, and here they are.

Both my father and my grandmother believed that Jagu’s and Rajesh’s mental illness had been precipitated, even caused, perhaps, by the apocalypse of Partition, its political trauma sublimated into their psychic trauma. Partition, they knew, had not just split apart nations, but also minds. In Manto’s “Toba Tek Singh” arguably the best-known short story of partition, the hero, a lunatic caught on the border between India and Pakistan also inhabits a limbo between sanity and insanity. In Jagu and Rajesh’s case, my grandmother believed the upheaval and uprooting from east Bengal to Calcutta had unmoored their minds, although in spectacularly opposite ways.

Rajesh had arrived in Calcutta in 1946, just as the city was itself losing sanity, its nerves fraying, its love depleted, its patience spent. A steady flow of men and women from East Bengal, those who had sensed the early political convulsion before their neighbors had, had already started to fill the low-rises and tenements near the station. My grandmother was part of this hardscrabble crowd. She had rented a three-room flat, on Hayat Khan Lane, just a short walk from the railway station. The rent was fifty-five rupees a month, about a dollar in today’s terms but a colossal fortune for her family. The rooms, piled above each other like roughhousing siblings, faced a trash heap. But the flat, although miniscule, had windows and a shared roof from which the boys could watch a new city and a new nation being born. Riots were conceived easily on the street corners. In August that year, a particularly ugly conflagration between Hindus and Muslims, later labeled the Great Calcutta Killing, resulted in the slaughtering of five thousand and left a hundred thousand evicted from their homes.

Rajesh had witnessed these rioting mobs in their tidal spate that summer. Hindus had dragged Muslims out of shops and offices in Lalbazar and gutted them alive on streets, while Muslims had reciprocated with equal and opposite ferocity in the fish market near Harrison Road. Rajesh’s mental illness had followed quickly on the heels of the riots. The city had stabilized and healed, but he had been left permanently scarred. Soon after the August massacres he was hit by a volley of paranoid hallucinations. Then he grew increasingly fearful. The evening excursions to the gym became more frequent, and then came the manic convulsions, the spectral fevers, and the sudden cataclysm of his final illness.

If Rajesh’s madness was the madness of arrival, then Jagu’s madness, my grandmother was convinced, was the madness of departure. In his ancestral village near Barisal, Jagu’s psyche had somehow been tethered to his friends and family. Running wild in the paddy fields or swimming in the puddles he could appear as carefree and playful as any of the other kids—almost normal. In Calcutta, like a plant uprooted from its natural habitat, Jagu wilted and fell apart. He dropped out of college and parked himself permanently by one of the windows of the flat looking blankly out at the world. And then his thoughts began to tangle, and his speech became incoherent. As Rajesh’s mind was expanding to its brittle extreme, Jagu contracted silently in his room. While Rajesh wandered the city at night, Jogu confined himself from dawn voluntarily at home.

This strange taxonomy of mental illness (Rajesh as the town mouse and Jogu as the country mouse of psychic breakdown) was convenient while it lasted. But it shattered finally when Moni, my cousin, also began to have a failing mind.

DAVID REMNICK: So there you are with a family with three very close family members all with horrendous problems. How was this understood by your family? How was it, in terms of its origin?

SIDDHARTHA MUKHERJEE: Well, you know, like many families, my family, like many Indian or Bengali families, my family had elevated denial to kind of a museum-grade art. (laughter) You could create a monument to that denial. And for a while that was it. We denied, we pushed it aside, we thought it was someone else’s problem. It had happened. Partition was a convenient explanation for everything. There’s a great joke which I can only repeat in vast public spaces.

DAVID REMNICK: This is vast enough.

SIDDHARTHA MUKHERJEE: So there’s a man. You know, Neil Armstrong lands on the moon, some of you may know this, Neil Armstrong lands on the moon, he’s just landed on the moon and he finds, he’s about to plant the flag, and all of a sudden he sees a paratha, a piece of chapati or something landing on the ground, and he’s completely shocked, he said, where is this chapati from? And then he goes a little bit further and there’s a little piece of pickle, a mango pickle, and now he’s really distressed, and he runs, he runs, he runs, and there in front of him is a little Indian family having a picnic, (laughter) and he says, “When did you get here?” And they said, “After Partition.” (laughter) So it’s a joke that you can only understand if you’re from a certain part of the world.

DAVID REMNICK: They did a pretty good job.

SIDDHARTHA MUKHERJEE: So there you have it. It was the catch-all explanation, and then it was about how minds had failed, and brains had failed, and everyone had failed, and the body had failed, but then once it had crossed one generation, all of a sudden those explanations began to wear thin, and the laughter became tears, as it often does with heredity and genes.

DAVID REMNICK: And the sense of scientific understanding of this or folkloric or whatever it might have been was what once it jumped a generation.

SIDDHARTHA MUKHERJEE: Well, you know what’s interesting is that there was only a folkloric understanding of it until the 2000s. You needed large studies, epidemiological studies carried out in cold Scandinavian countries, not in warm places like India, where all of a sudden it became very clear that there was this genetic, you know, schizophrenia and bipolar disease strong genetic influences— not always, as you say, if you take identical twins with identical genomes, if one is schizophrenic, then the other one will have a 50, 60, 40 percent chance. Those numbers are a little bit in flux. So those twin studies and the large epidemiological studies crisscrossing the generations all of a sudden made it very clear that this was not folkloric.

DAVID REMNICK: So in some sense the origin story of this book, some sense of it, is a discussion that you have with your wife-to-be, Sarah.

SIDDHARTHA MUKHERJEE: Yeah, Sarah.

DAVID REMNICK: Who is here.

(applause)

SIDDHARTHA MUKHERJEE: Who spoke two weeks ago here.

DAVID REMNICK: Who spoke two weeks ago here. A great artist, Sarah Sze. A necessary discussion, a complicated discussion that has to be had. And it’s carried out in what terms and what do you know, and what do you not know, and how does this then become in some sense the germ of a book?

SIDDHARTHA MUKHERJEE: You know that discussion happens over many iterations in my case with Sarah but just to give you a sense of perspective, this is the kind of discussion we’re having more and more with our families. It’s not a discussion that’s unique to, you know, a conversation that we’re having in a restaurant in Boston, ten years ago, fifteen years ago, it’s a conversation that you are having with your wife or spouse or your husband, saying, you know, “the ultrasound shows a potential genetic abnormality in our child. What do you want to do?” “There’s a small chance that we will, there’s a small chance that we will have a child diagnosed with Down syndrome, what do you want to do?” “Do you have a history of mental illness in your family? How would you like to think about this for our future together?” I mean, you know, this is all of a sudden not their conversation or our conversation sitting in, you know, in Café Algiers in Boston, it’s your conversation you’re having about your child who has some history of whatever illness it might be.

DAVID REMNICK: So, Sid, you started thinking. You had completed a book on cancer. You’re a researchers, a physician, you see patients, you’re a father, and you’re a pretty busy guy is what I’m trying to suggest. And you come to the idea of “I want to write a second book.” You’re also a writer, not just a doctor who happens to write books but a real writer, and what about the times suggested that there was a book needed called The Gene? There’s a huge literature, scientific and otherwise, out there. What’s the book that needed to be written and brought into the world and—

SIDDHARTHA MUKHERJEE: You know, it’s the subtitle that signals the book more than the title, and the subtitle is An Intimate History, and the word there is to forget the word “history” and focus on the word “intimate,” which is to say that people have written about genes and heredity since God knows when but this needed to be a different kind of book. It needed to be a different kind of book because I was grappling. Once I had—there’s a great we’ll come back to it maybe later. There’s a great saying that if you have one child, you believe in nurture, if you have two children, you believe in nature, and we had had a second child. And so we had gotten to the point that we were believing in nature—

DAVID REMNICK: Because—

SIDDHARTHA MUKHERJEE: Because it’s a perennial question about how—I mean, our two children, like any two children, are similar but different. They resemble each other and they don’t resemble each other. They come from similar, their approach to the world is similar and yet they’re different. You know, this whole crisscrossing is constantly in your brain, you’re asking yourself, “well, why did you come out this way? Or “what you made you this way?” “Is it because of the environment you’re in, is it some scramble of genes?” So there was that, there was that element of that and then the history of illness became more and more obvious to me, and I wanted to explore it more, I wanted to get back to it a little bit more. So that was one strand.

The second strand was that in the lab, in what we were working on, it became very clear that there were new technologies to intervene and change the human genome which didn’t exist five years ago.

DAVID REMNICK: What were you working on? Describe the work.

SIDDHARTHA MUKHERJEE: Well, so that we work on blood cancers and we’ve spent a lot of time thinking about stem cells and blood cancers, that’s what I work on. Just to give you an example, you know, we began—we and others have begun to find genes that are altered in cancer cells, that are not present in normal cells. I study a disease called MDS, myelodysplastic syndrome, it’s a pre-leukemia, all of this is just a prelude to say that ten years ago, if I went to a research student and I said, you know, “Make me a defined genetic change in a cell, in a human cell,” they would say, “I will do it, it will take four years to do, three years to do.”

And then all of a sudden, because of new technologies, we will discuss some of them in a second, it became possible, that same conversation, I would go up to them and say, “make me a defined genetic change, take that gene, change it into something else in a human cell,” and “I’ll get back to you in four weeks,” and I could say, “make me that change in a human embryonic stem cell,” and they would say, “sure, I’ll get back to you in about four weeks, four or five weeks.”

DAVID REMNICK: So what’s happened since the mapping of the human genome and its description and now experimental work in it, is you suggest in the book is a revolution, a scientific revolution, and a demand for moral thinking, political thinking, medical thinking, that is analogous to the birth of the atomic age.

SIDDHARTHA MUKHERJEE: For instance. Yes. Absolutely, I think there is a—we are at a quickening for a particular kind of genetic intervention in humans. We are trying to find out how these interventions can be managed, what their future might be, we don’t know, we don’t have any precepts to know what to do about it but the technology marches right on. Just to give you an example, this week, I didn’t anticipate all this in the book, this week as you very well know in the news there’s an attempt to artificially synthesize, based from chemicals alone, a full human genome. Okay. You could say, well, big deal.

DAVID REMNICK: Describe what that is and what the implications are.

SIDDHARTHA MUKHERJEE: Yeah, yeah. The implications—so there are three billion letters in our individual genomes. You and I share 90 percent, that’s what makes our hands have five fingers and et cetera. But we also have differences in our genomes. Now, I could say—if this technology, so there are three billion letter, and they read like ACTGC, only four letters in the alphabet, ACTCGCCCCTGGGCCT and so forth, three billion of them split in humans into twenty-three pairs of chromosomes, and the idea is that what if I could take that thing that makes David Remnick David Remnick and synthesize, not all of it, but one quarter of it, from scratch, I would string together the chemicals, and in principle, we don’t know, in principle, if I were to introduce those chemicals into a cell, into an embryonic cell that I’d unhusked, taken its own genetic material away, would that now cell become your clone? Would that be you in what way, similar ways, dissimilar ways? We have no moral or personal or literary or scientific precepts to know what the hell to do with that kind of idea.

DAVID REMNICK: So tease that out, give us a sense of the radical implications that could lead to, and why it would be so terrible, because obviously we focus mainly on the curing of this disease or that disease, the correcting of this condition or otherwise.

SIDDHARTHA MUKHERJEE: So the radical implications are many. I’ll give you some examples. I mean, the radical implications are—what is it, if you can synthesize, if you can begin to synthesize—let me be clear, you know, this first meeting, I didn’t attend it, but this first meeting was probably it was closed-door and it was probably to discuss things like who is going to fund it, what technical features need to be achieved, et cetera, et cetera. It was not like, let’s start tomorrow.

DAVID REMNICK: Fair enough, but at the rate we’re going, I don’t think we’ll have to wait long.

SIDDHARTHA MUKHERJEE: Fair enough. The question is then going to be: You have a particular genome, what if I wanted to—I wanted to introduce you, make a clone of yourself, and now change the four things—

DAVID REMNICK: In that case one could already sense the tragedy.

(laughter)

SIDDHARTHA MUKHERJEE: Change the four things that we don’t like or dislike about you. You know, I don’t want to paint—

DAVID REMNICK: My wife is over there. Where to begin, darling?

(laughter)

SIDDHARTHA MUKHERJEE: Ah, yes. What would you change?

DAVID REMNICK: We only have an hour and change, so let’s go back to this.

SIDDHARTHA MUKHERJEE: But the long and the short of it is these technologies are radical. They get to the core of who we are, what our identity is, we talk a little about that. They get to the core of how we think about human beings in the future and even if, even if we put a strong barricade around the idea, and said, “No one’s allowed to do it,” just the fact that we CAN do it, just the fact that it becomes scientifically permissible, I think changes the way you think about human beings. All of a sudden you’re saying, “Wait a second. In principle I could take your genome and intervene on it either artificially or chemically, however it might be. In principle I could do it. I could change a gene, I could rewrite something, I could change something.” The implications are wide, they’re formidable.

DAVID REMNICK: But before we charge into the future implications of this, there’s a history to all this. There’s something called eugenic thinking in our history. Tell us about what that implied, what that led to, and how that could help us in our moral thinking about what powerful instruments we now have.

SIDDHARTHA MUKHERJEE: So the book has a deep exploration of eugenics. Here’s what’s funny about eugenics. We think of eugenics as a nasty thing. Eugenics, the idea that you could change the human gene pool, potentially for human emancipation, famously incorporated by the Nazis in their grotesque programs in the 1940s. But in fact the origins of eugenics are very progressive, progressive. They are progressive in the sense that in the 1800s eugenics was born through the work of Francis Galton, he invented the word, he was Darwin’s cousin. And he began to use the idea that you could use changing the human gene pool as a mechanism of human emancipation. I mean, he didn’t want to exterminate people initially.

DAVID REMNICK: But eugenics was also used as a means to eliminate people with mental illnesses and other—

SIDDHARTHA MUKHERJEE: Right. And so then it began to morph before our very eyes, so by the 1920s it metastasized to the United States, where all of a sudden that same idea now became, let’s sterilize, not just selective breeding but selective sterilization. It was one step, and famously Carrie Buck was one of the famous cases, she was sterilized for imbecility, and the Supreme Court handed down the famous decision, “three generations of imbeciles is enough,” and therefore allowed the state to intervene and remove the ovaries of Carrie Buck, thereby severing her capacity to give birth to any children, and her line of heredity was snapped, basically, based on that. And only then, only after that, did it metastasize back or go back into Nazi Germany and become, you know, what we associate with eugenics today. So it’s important to remember that the United States has a rich and troubling history of eugenics.

DAVID REMNICK: So isn’t it reasonable to wonder, Sid, that given the advance in technology that the same kind of moral/immoral thinking could be applied to the possibilities of what we can do with the human genome? I mean, look at our incapacity to deal with on a social level with people with so many mental illnesses or people that are so deeply incapacitated that we just don’t have the resources to properly deal with them, treat them, mercifully to get them to the end of their lives in so many ways, it is not inconconceivable to think that with this knowledge that its misapplication and its moral twistedness, a certain moral twistedness could occur.

SIDDHARTHA MUKHERJEE: I would hope that we had learned that history a little bit more deeply, hence the book. Actually this is one of the reasons that I wrote the book. I would hope that we had learned that story. It’s always at the edge, as I said, of our consciousness, we always remember, we should always be remembering Carrie Buck, we should always be remembering that story with us as we move forward into the future, as we move forward into genetic engineering and genomic engineering. I think if we are careful. Look, the ultimate hope is that we will use these tools to emancipate ourselves from terrible diseases that cause extraordinary suffering.

DAVID REMNICK: Tell us about that. Where are we with some of the very basic diseases that we would dearly, dearly wish out of existence, or at least the alleviation of symptoms or whatever? What—how do you anticipate that happening, say in your field?

SIDDHARTHA MUKHERJEE: Well, I’ll just give you examples from my field, and they can be generalized. Look, if fifty years ago, you happened to be a woman with a known family history of breast cancer. So you know there is breast cancer in your family with a very high degree of penetrance. Your grandmother died of breast cancer, your mother died of breast cancer. I couldn’t tell you what your individual risks would be, whether you had the risk or whether you didn’t have the risk, that something should be done or not done to you, with you, with your consent. I would be kind of—I would operate in the dark. I could say, “Well, you know, you have a family history of breast cancer and we’ll take care and watch you.”

Fast-forward fifty years, we don’t know all the pieces of information, but now you could have a genetic diagnosis, BCRA-1, BCRA-2, we know and it’s been in the public culture for so long. You could choose not to be screened, but you could also choose to be screened, you could choose to take a drug, you could choose to have a mastectomy, a variety of options. And your risk now becomes real, concrete, we can manage that risk.

So, clearly, we’ve moved the idea that you can scan the genome, understand the genome, pick out certain things and predict individual futures in a very powerful way. So that’s one example of how simple—or not so simple—genetic technologies have really transformed the lives of individuals.

DAVID REMNICK: So if we discover a way to edit human genes successfully.

SIDDHARTHA MUKHERJEE: And we have already. Yes, so—

DAVID REMNICK: And the switches that cause severe mental illness, should we make that leap, if somebody has—we see the genetic cause of bipolar, do we turn that off? What if somebody’s clinically depressed, and that has a genetic aspect? Where are the lines as you’re thinking about them? Who decides? At one point in the book you basically say, that we must develop a codex, a book of laws, a moral sense of what this is. I don’t think in philosophy classes this is being studied quite as heavily as the categorical imperative. But this seems like a more urgent set of questions.

SIDDHARTHA MUKHERJEE: Right. So, just to give you some examples. Bipolar disease, schizophrenia, et cetera, we know that these diseases, these illnesses, these disorders, have multiple genes affecting them. So I think the chances that you will be able to turn it off and on like that is very low. I think the chances are very, very low. But to give you some other concrete examples. You know there will be, and I think it’s fair to say that there will be some severe forms of autism, for instance, where you can diagnose in utero, or even before implanting the egg, and then you don’t even have to turn genes on or off, you can sequence the genes of an embryo and say, I’m not going to implant that child. That’s a very different culture, that’s—we face a very different kind of culture when we say—

DAVID REMNICK: Isn’t it the same question faced by somebody who has the obvious test taken and Down syndrome is—

SIDDHARTHA MUKHERJEE: It is a similar question and maybe even the same question, yes. You know, but what’s interesting about Down syndrome is that the technology there was in such infancy. That you know we didn’t—as you know, as a chromosomal disorder, it’s easy to spot, easier to spot, we didn’t really have a big public conversation about it. And it was—it sort of back-doored itself, the Down syndrome detection and the potential to not implant or to abort back-doored itself into our culture. This cannot be back-doored into our culture anymore. We cannot back-door the idea that you could have the capacity to sequence the genome of your child, or your I would say your embryo or even potentially your egg, and then implant it selectively. That’s not an idea we can back-door into our culture. We need to figure out how to create some finite limits and some ideas about what to do.

DAVID REMNICK: Identity is a major theme of this remarkable book: sexual identity, racial identity, gender identity. And these are subjects that we’re talking about all the time on the level of—on every level. Let’s start with racial identity.

SIDDHARTHA MUKHERJEE: Small topic.

DAVID REMNICK: Small topic, but you suggest that there is a further distance between certain Africans in certain parts of the continent then there is between one African and someone very far away. Tease that out, explain that to me.

SIDDHARTHA MUKHERJEE: So that has to do with the consequence—let me backtrack a little bit. So we’re living in a divisive season, and we’re talking, we’re throwing around words, you know, sprinkling our political conversation with big words, that if you examine just one nanometer underneath the depth, no one understands.

Race. Hear about it every day. What does it mean? Okay? Identity, gender identity, who gets to use what restroom, you know? Thrown about as if it was so easy. Well, actually, there is—you can use, genetics won’t solve these questions, but at least it provides you with a vocabulary to begin to ask the questions, so just talk about race for a second. So one thing that we know about race is you can use a genome to study race. The genome, your individual genome, carries a mark of your ancestry so you can ask the question, you know, what is the relationship between you and me? What’s the relationship between you and me versus you and someone else who happens to come from a place close to you? The surprising thing is that humans, homo sapiens, I should say, as a species is quite young, very young. So we don’t actually have a lot of diversity within us. So the first point to clarify is very important—

DAVID REMNICK: We don’t have a lot of diversity?

SIDDHARTHA MUKHERJEE: We do not have a lot of diversity.

DAVID REMNICK: Well, that will come as a relief to employers all over. (laughter) What does that actually mean?

SIDDHARTHA MUKHERJEE: That means in genetic terms, we are more closely related to each other than, for instance, chimpanzees. That you and I and all the people in this audience, actually, we haven’t lived, as a species we’re very young. As I say in the book, we haven’t even had time to taste the poisoned apple, it’s not even been that long. That first thing you realize, that actually the racial categorization of human beings has to recognize that one fact first.

Number two is that then you can use genetics or genes to study racial dispersal. I mean, we can do this very accurately. We know that we arose as a species, this species arose, sometime two hundred odd thousand years ago, maybe three or four hundred thousand years ago, we know it in Africa, and then we dispersed up northwards across the oceans and then dispersed out towards Asia and towards Europe. Now, the important thing here is to realize, as I said, there’s not a lot of diversity, and intraracial, if you look within races, the diversity can be greater than interracial diversity. In other words, if you take a man from Namibia and compare him to a man from Egypt, both black, or African, their diversity can be greater than, for instance, if you compare the man from Egypt to a man from—

DAVID REMNICK: Norway.

SIDDHARTHA MUKHERJEE: For instance. Right. So that’s one important fact to realize is that intraracial diversity dominates interracial diversity, therefore laying the term “race” to total waste. Now, you could say, well, wait a second.

DAVID REMNICK: Stop there, so the word “race” is meaningless.

SIDDHARTHA MUKHERJEE: No. Continue, because there’s a corollary to this which is important.

DAVID REMNICK: I thought we were about to get off the hook forever and ever.

SIDDHARTHA MUKHERJEE: No. The point that the book makes is that race is a mechanism of characterization. It’s like the English novel or the face, and I’ll tell you why. It’s absolutely true that interracial diversity, or intraracial diversity exceeds interracial diversity, but if you go looking for characteristics that discriminate between one race and the other, you will find them. These two facts are not contradictory, they are actually completely compatible with each other.

In other words, if I were to say, “I am interested in Tay-Sachs disease,” okay, a fine thing to be interested in. You will find that Tay-Sachs disease tracks with certain ancestral populations and it’s more present, the mutation is more present in Ashkenazi Jews than in other so-called races. These are not contradictory facts, so the real decision, and here’s the most important piece: The real decision is how you decide to cut the cake. It is how you decide to characterize or categorize.

If you’re a geneticist, and you say, “my interest is in Tay-Sachs Disease,” sure you will find differences across races in Tay-Sachs disease. If you say, “My interest is in sickle-cell anemia, one gene,” sure, you will find differences in races. On the other hand, if you say, “My interest is in intelligence,” I’d say, “Well, what does that mean, and what are you going to look for, I mean, what are you going to try to—how are you going to—what boxes are you going to put people—are you going to use an IQ test, which we know is useless to measure that quality, are you going to use—” So therefore the real question in race is not race, it is the parameters of categorization. It’s taxonomy, not race, that’s important.

DAVID REMNICK: Take it one step farther—how should that help us think about ourselves as human beings, because this is such a vexed topic? How would a conversation about this, a more informed conversation, a more informed vocabulary about it ease the craziness with which this—

SIDDHARTHA MUKHERJEE: I’m not expecting that the next election debate is going to pivot on the following but I will—

DAVID REMNICK: It seems not to so far.

(laughter)

SIDDHARTHA MUKHERJEE: Right. Given the circumstances.

DAVID REMNICK: Given the circumstances. And the players.

SIDDHARTHA MUKHERJEE: Exactly. But in some dream or in some fantasy, you could say, “well, you know,” you say, “let’s talk about race,” and I would say, “stop, let’s not talk about race, let’s talk about what question you have. Your question is, ‘am I more likely to find people with’”—you know, “I’m a doctor, I’m interested in sickle-cell disease, am I more likely to find people with sickle-cell disease in this, in African Americans versus whites?” Maybe, I could give you some examples. “Am I more likely to find changes in temperament?” I would say, “What on earth are you talking about?” That’s not, you know, that is not a way to catego—we have no mechanism to—

DAVID REMNICK: In a related way, Sid, unlock the door on this riddle. We have heard over time about a gay gene that somehow sexual identity is related to a genetic source. This is not something that’s gone away, either. What are the origins of this? Explain it.

SIDDHARTHA MUKHERJEE: So the origins of this are in, the strongest origins of this are in very clear studies that were done in the 1950s, 1960s, and 1970s. So forget about the gay gene for a second, just let’s ask a very simple question, which is that if there are identical twins with identical genomes, what is the chance that if one person has one sexual identity that the twin will also have the same sexual identity compared to the general population. If you do that study, which has been done several times, the answer is very clear that identical twins with identical genomes tend to share concordance or similarities in sexual identity. This is male sexual identity, female sexual identity is less studied, at a much higher frequency than would be expected by pure chance alone, much higher frequency.

So what does that tell us? That tells us that there are determinants, it tells us unequivocally there are determinants in the human genome that influence, deeply influence, sexual identity. That’s the basis for all this work. Now, people have gone then to ask the question, “What are those determinants, what genes are they?” And when they’ve done that, they’ve come a little short, because it’s likely that it’s not one gene.

Now, identical twins have exactly the same genome, so they share not just one gene but all their genes, all twenty thousand of them, so forth, where siblings don’t, every time you have a sibling your genetics get scattered around and, in fact, some genetics, some genes have been tracked, which change or influence the risk of one form of, you know, one form of being versus another form of being, in the case of the, you know, now overpoliticized gay gene search, not a lot of genes have been found, not because they don’t exist, because the identical twin studies suggest that there must be determinants, but because the influence is small and there are many, there are many of them, many of them acting in concert, and that’s been true over and over again across multiple different features of human beings.

DAVID REMNICK: And very much in the news, very much in our minds, and not only in North Carolina, is the question of transgender.

SIDDHARTHA MUKHERJEE: Yes.

DAVID REMNICK: Sexual fixity, gender fixity. How do you understand that as somebody who’s thinking about the genetic components of this, when people describe I was born in such and such a body but I really am something else, how do you think that through?

SIDDHARTHA MUKHERJEE: Again, you know, the—

DAVID REMNICK: I mean, beyond the level of sheer human sympathy and appropriate sympathy and fellow feeling, but in scientific terms how do we understand it?

SIDDHARTHA MUKHERJEE: Well, again, let’s start from top. There are genes, we know, and there are genes that will influence your gender anatomy very strongly, which is responsible. And really, there’s one gene. And that’s what’s surprising about it. There’s one gene that influences gender anatomy very strongly.

DAVID REMNICK: Anatomy completely.

SIDDHARTHA MUKHERJEE: Anatomy. Exactly. So and if that gene is present, it happens to be on the Y chromosome. If that gene is present, then you will be more than likely born with one kind of gender anatomy, and if it’s not present, you’re born with the other kind of gender anatomy. The most acute demonstration of this is that you could have a whole Y chromosome, you can narrow it to the Y chromosome, if you just inactivate that one gene called SRY, you have the whole Y chromosome, every cell in your body is technically chromosomally male, but within that chromosome if you just inactivate that one gene, you will be born female, completely, as far as we can tell, and by completely I mean anatomically, you will have the anatomy of a female, there are some disruptions to your hormonal axes, but, aside from that, your anatomy remains the same.

Now, here’s the important point. That statement is fully compatible with the idea that once your gender anatomy has been determined, and once some elements of identity have been determined by those genes, you could have a thousand variations down the road, because that gene, that master regulator, has an on and off switch, but that is recruiting in a kind of cascade-like manner various things that allow you and me to have slightly different identities in general. It is recruiting things.

It is the master conductor, as it were, but the actual symphony that’s happening in any individual is carried out by this particular violinist and that particular cellist and this particular drum player and so forth, and if we switched around those actors, as it were, those musicians, you would get a very different symphony, and this is what’s amazingly missing in this conversation, the complexity, or in fact to me, the simplicity, that this is a not a nature/nurture debate, you know, people say, is it nature or nurture? Well, it depends on what you’re asking. If you’re asking, you know, it’s a famous quote, “who’s asking?” If you’re asking about gender anatomy, it is dominated by one single gene. If you’re asking about gender identity, it is not dominated by one single gene, there are many actors, there’s a symphony—

DAVID REMNICK: So what do you find troubling or encouraging about the current discussion?

SIDDHARTHA MUKHERJEE: What don’t I find troubling?

DAVID REMNICK: Sorry?

SIDDHARTHA MUKHERJEE: I said, “What don’t I find troubling?”

DAVID REMNICK: Let’s center on the conversation about transgenders now?

SIDDHARTHA MUKHERJEE: So what I find troubling is a desire to lump it into boxes, you know, it’s nature, it’s nurture. That’s one thing I find troubling right off the outset. Oh, you know, they made a choice. You know, it’s not a choice, it’s all genes. It doesn’t require particularly complex intelligence to figure out that there can be very dominant features that govern anatomy and that those dominant features that govern anatomy may not be reflected in your brain as your identity. Those are not contradictory features, and I just am shocked by the idea that in 2016 that we cannot get that simple fact into our brains.

And these are not dissonant ideas, that there’s a full biological and cultural compatibility between these ideas, it’s true for race as well, we’ve talked about these all over again, these are not mutually contradictory statements, and it would take hopefully one thoughtful, presumably female, president to (laughter/applause) hammer that idea home.

DAVID REMNICK: Yeah, yeah. At the end of the book you say that we need a manifesto or at least a hitchhiker’s guide for a post-genomic world. What would be in such a book? Who’s to write it, whether it’s in the world of President Trump or President Clinton? How does this go about happening? Because it seems absolutely necessary.

SIDDHARTHA MUKHERJEE: I think it’s a public conversation. I think it will last much longer than the eight years or four years that are to come.

DAVID REMNICK: But the science is going at a hundred miles an hour.

SIDDHARTHA MUKHERJEE: Yeah, the science is going at a hundred miles per hour. I think what will happen is what happened at Asilomar, which is that we will take a break. We are taking a break right now, you know, as you know in science, we trying to say, we are stepping. Half our feet are over the precipice. We are moving so fast and so rapidly that we need to take a chill pill.

DAVID REMNICK: Well, when you say science, is that limited to American science? Or other countries seem to go at different rates and play by different rules.

SIDDHARTHA MUKHERJEE: Absolutely, and as I mention in the book, the first attempt to change a human embryo happened in China. And you know what’s interesting is I love reading the comments in the New York Times to an article.

DAVID REMNICK: Is that a publication? What is that? (laughter) I’m sure we get it at home, it’s under the New Yorker somewhere.

SIDDHARTHA MUKHERJEE: So in that publication that article drew thirteen hundred comments. And one of the things that I did for my book is I read all thirteen hundred of them. I sat and read them one by one one morning and the most astonishing ones—

DAVID REMNICK: I’m trying to figure out where in your gene makeup reading thirteen hundred comments is—obsessiveness.

SIDDHARTHA MUKHERJEE: Just obsessively scroll through them one by one. Because this is important stuff. You need to know what people are thinking about the fact that somewhere in China someone decided—you know, they were—to be fair to the experiment, they were nonviable embryos. So there were some—already some gaps put in there. The Chinese didn’t take, you know, live human embryos and say, “let’s make a gene modification.” They took embryos they knew were not going to be viable in the long run and so forth. We can have a debate about whether that was the appropriate guard, stop guard, as it were, but nonetheless that was how the experiment was done.

And the thirteen hundred comments—among them were things like things people said, one Chinese commentator said, you know, “In Confucianism, there is no restriction, we don’t think there’s a restriction. Your concerns about modifying human embryos are your own concerns, we have our own moral guidelines,” and this can go on India, it can go on in Korea, it can go on in n different places to try to change the human genome, what it would mean, et cetera, et cetera, the point here being is that obviously we need a rapid international consensus. I think that scientists and the larger public world has come to such consensuses in the past, but I think we need it.

DAVID REMNICK: For example?

SIDDHARTHA MUKHERJEE: Famously when recombinant DNA, I’ll talk about what that is in a second, was invented, there was a great important meeting organized in California, when scientists took a moratorium, they said, we’re going to stop this work until we can evaluate what the next steps are. Now, look, let me not sound like a science technocrat and say, “Scientists will figure it all out. And you guys go to sleep for a little bit, wake up in the morning and we’ll give you the answers.” Far from the case. Let me say that that meeting, importantly, involved legal scholars, ethicists, people with, you know, people with children with terrifying diseases, this was not a meeting that happened behind closed doors, it was open, it took a long time, and the moratorium was reached, and eventually we broke through the moratorium.

We learned to deal with recombinant DNA which is the idea that you can take any two pieces of DNA, any two genes, and stitch them together, and we learned to deal with that in a thoughtful way, there’s a famous quote in the book saying in that moment when you could take a virus gene and a bacterial gene and stitch them together, someone said, species are specious. For a moment it seemed that you know these moral boundaries were going to be specious too, but there were strong forces that came together and said, “Look, you know, these are limits, we are not going to go beyond these limits,” and I think those were successful.

DAVID REMNICK: Sid, on another subject, you are one of your many qualities is you’re a person of enormous imagination, we were talking backstage about your love of Polish filmmaker Kieślowski. Your wife is a really significant American artist. I wonder how you think about imagination. Is there any genetic source to being an artist, a richer than usual imagination?

SIDDHARTHA MUKHERJEE: That’s a lovely question. I don’t think there’s a genetic source. I think imagination comes in. It goes back to this whole idea, you know, “let’s find a gene for imagination.” Once you’ve entered that conversation you’ve already become stupid. I think that’s the point.

(laughter/applause)

DAVID REMNICK: But do we not talk about this in terms of intelligence?

SIDDHARTHA MUKHERJEE: Absolutely. “Let’s find a gene for intelligence, let’s find a gene for imagination.” Already, I write in the book, once you say, “Let’s find a gene for intelligence,” you’ve already insulted the thing that you’ve gone out to find.

DAVID REMNICK: Because it’s ineffable.

SIDDHARTHA MUKHERJEE: It’s not the ineffability that is the question. It is that the criteria for definition are nonstandard. You can’t find something when you don’t know what you’re looking for. You can find sickle-cell disease in the genome because you know what you’re looking for. You can find Tay-Sachs disease in the genome because you’re looking for. I make the analogy in the book, and this may be the one that is clearer and clearer. Look, marathon running I think is going to become a genetic sport. Okay? Why? I think that the capacity to run, you know twenty-six or twenty-eight miles, I can never remember the right number.

DAVID REMNICK: Twenty-six.

SIDDHARTHA MUKHERJEE: Thank you.

DAVID REMNICK: Three hundred and eighty-five yards. No.

SIDDHARTHA MUKHERJEE: Twenty-six miles requires a certain combination of physiology and anatomy.

DAVID REMNICK: And craziness.

SIDDHARTHA MUKHERJEE: And craziness. Exactly. It’s a very defined criteria. It’s fixed, and what will happen is that if you fix the criteria strongly, you will begin to find genetic combinations that apply to that fixed criteria. And it is not a coincidence, I think.

DAVID REMNICK: Lung capacity.

SIDDHARTHA MUKHERJEE: To lung capacity. The way your lungs communicate with hormones. The way your lungs communicate with muscles, you know, certain body types, et cetera, and guess what, marathon running is becoming a genetic sport. I think it’s not a coincidence, beyond training, someone’s going to attack me for this, but beyond training, that a narrow wedge of human population that happens to come from East Africa, happens to be winning a very clearly defined sport. Now, is intelligence a marathon race? Do we have twenty-six miles that we’re expected to run to win that race? No. That’s an absurd idea. You know, in intelligence sometimes running sideways is better. In imagination sometimes not running at all is the best thing to do. That’s my preferred way.

(laughter)

DAVID REMNICK: I have that genetic makeup as well, it seems.

(laughter)

SIDDHARTHA MUKHERJEE: That’s my imagination, I prefer not to run.

DAVID REMNICK: Just my imagination run away with me. We should block out an enormous amount of time for this, because this is so complicated. Your second piece in the New Yorker was about this, from the book I should say, and it’s about epigenetics, and my incredibly complicated conversation, question about epigenetics is: “What’s that?” (laughter) Start with that.

SIDDHARTHA MUKHERJEE: There’s a full chapter, two chapters in the book about it. Not easy to put in the New Yorker in three pages but nonetheless. The best way to handle epigenetics to start with is to dispense with the word, is to forget the word exists. So let’s forget that the word exists. Okay. Now, we begin with a question, because we like beginning with questions. The question is how is it an embryonic cell, one cell, gets one genome and then from that one genome manufactures clearly a cell that’s a blood cell on one hand and looks nothing like a neuron in your brain. Looks nothing like the cells in your skin. Every one of these cells has the same genome.

Now that idea is called epigenesis, and that means, the idea—it’s from genesis, or outside genesis. In other words, it’s a simple idea, genesis happens through genesis. It happens by using your genome in different ways, again we’re going to go back to this symphonic moment. That, you know, in the blood cell one symphony is played out from that same master score. In a neuron, a different symphony is played out by a different et cetera, and in your skin cell yet another symphony is played out from the same master sheet. Okay? We’re clear about so far, epigenesis. Now.

DAVID REMNICK: Everybody clear?

SIDDHARTHA MUKHERJEE: Everybody clear?

(laughter)

DAVID REMNICK: Good, good, excellent.

SIDDHARTHA MUKHERJEE: If there was only, exactly. But so then you could ask the question, “Well, what allows you to do that?” What allows one cell to take one genome and become a neuron, another cell to take the same genome and become a blood cell? And those processes used to be called epigenetic. Those processes that allowed the master symphony, as it were, to be reconducted in different ways in different manners.

Now, that definition is very wide and what’s happening is that people are starting to shrink that definition to saying it’s not just the master score, it’s the way that you know one piece of DNA moves, and another piece of the genome moves, and that’s where you get into the thickets of language, but the clarifying thing in the field is to go back to the question. The question is how does one genome become manifest in different ways in different cells? And the converse question is how does one genome respond to the environment? They are related questions—how do you take the same genome and make a different response to the environment? How do you take the same genome and make different cells out of it? That is what epigenetics tries to answer, and their mechanisms and goes into molecules and so forth. But really getting back to the question is clarifying, because then you don’t get caught up in definitions and subdefinitions and arguments about definitions.

DAVID REMNICK: So you talk in the book a lot about triggers.

SIDDHARTHA MUKHERJEE: Yeah.

DAVID REMNICK: In other words a gene may do one thing but it might do another, and you use historical examples of this, the Hunger Winter, to talk about what triggers are. It’s an incredibly complex topic to my mind, who struggled in biology class. Explain how this works, how a gene—its behavior is triggered by environment. The interplay between genetic material and environments is essential to this book throughout.

SIDDHARTHA MUKHERJEE: Yeah, so again, there’s a majestic formula in the book which is so simple. I didn’t write the majestic formula, so I can be excused for calling it majestic. Which is a very simple idea and, again, if we could get it into our brains it would be helpful. The formula is that our beings are equal to genes, or genotypes, plus environment, plus triggers, plus chance. That’s it. So that means that some aspects of our being will be powerfully influenced by genotypes or genes. We talked about one of them already, as I said gender anatomy. Sexual anatomy of gender very powerfully influenced by one gene. Others will be less powerfully influenced by genes, they will be a combination of genes and environments, and finally there will be genes where chance plays a role.

Classic example, you have the BCRA-1 gene. Is everyone with the BCRA-1 gene going to get breast cancer. No. Not everyone will. There is some combination of chance, some combination of environmental influence. I mean, if that woman were to be exposed to a carcinogen that affects breast cancer, her increased risk will be increased. Even if she is not exposed, there is a chance that she will develop it, because that’s the way chance works.

Now, there are beautiful experiments done on extremely simple organisms which are philosophically important. I’ll give you one example of that. So you can take two identical organisms, simple organisms, like worms. Make them exactly identical, they’re exactly the same, and put them in exactly identical environments. And take one of these genes that is chance dependent, okay? And ask the question: why is it that one of these worms develops one phenotype, it’s like two twins. One of these worms develops one and the other one does not develop that same feature or phenotype, right?

And the answer is that right at the molecular level, there are stochastic variations in molecules, molecules are rising and falling like stochastically just like, you know, like atoms are moving in the air. When they rise above a certain level, they kick off a threshold and that worm goes in one direction. When they rise below that threshold, that worm goes in the other direction. You can make it rise above that certain level of the threshold by environmental influences, you can force it to rise and therefore push one animal in one direction, but it’s a beautiful explanation, number one, and number two, it’s a giant plea, I think, ultimately that we are very similar and that our lives are knitted together in similar ways and what we’re really experiencing is the I think profound interplay between chance and genes, and environments.

DAVID REMNICK: Speaking of interplay of genes and environment, how do you think of how you became you? One of the, one of the autobiographical aspects of this book in scientific terms is that—your work in Paul Berg’s laboratory. Tell us a little bit about him and his importance to both you and to what this book is all about.

SIDDHARTHA MUKHERJEE: Well, Paul has been a mentor and a friend.

DAVID REMNICK: You should explain who he is.

SIDDHARTHA MUKHERJEE: So Paul was a biochemist, is a biochemist, he’s ninety now, I met him two months ago in California. We have bets, so every time we meet—

DAVID REMNICK: You worked with him right out of medical school?

SIDDHARTHA MUKHERJEE: No, actually, before medical school. I worked with him as an undergraduate and kept working with him for a while, and Paul discovered, among other people, he’s not the only person who discovered this. Paul essentially stumbled on—I shouldn’t say stumbled, he discovered—the technology that allows you to stitch two genes together from different organisms. In other words, he made the first recombinant molecules, the idea that you could take a gene from David Remnick and a gene from someone else, stitch them together, and make a gene, and if you put it into a cell, the cell would think it was perfectly normal and make that product, whatever it was, half of your product from your genome, half a product from someone else’s genome, and it would just decipher that. That technology didn’t exist until the 1980s, before the 1980s. It involved basically a cutting and pasting kind of technology.

DAVID REMNICK: So the English majors among us when we hear cutting and pasting, (laughter) we think—we think giant scissor, but a little one, like a nail scissor. How is this, for idiots, how is this done?

SIDDHARTHA MUKHERJEE: How this is done is in fact through scissors.

DAVID REMNICK: I don’t believe you.

(laughter)

SIDDHARTHA MUKHERJEE: There are, well let me ask you a question: what is a scissor?

DAVID REMNICK: Go ahead.

SIDDHARTHA MUKHERJEE: A scissor is something that cuts, right? So in the molecular world, bacteria have molecular scissors. Why do they have scissors? Because they are constantly invaded by viruses, and in their world, because they’re so constantly invaded by viruses, they’ve invented they’ve evolved over millennia they’ve evolved ways to cut up like scissors the genomes of their invading viruses so that they can essentially neutralize them. This was known for a while. Actually, Nobel prizes were awarded for that discovery, the discovery of molecular scissors. And, similarly, when your genome is damaged by scissors or is damaged by radiation, there are enzymes that stitch the DNA together because otherwise it would flop apart and cause all sorts of damage. And Paul’s quintessential realization was that if you combined these two pieces of technology, if you combine the cutters with the pasters, if you combine the scissors with the glue, all carried out in molecular reactions—

DAVID REMNICK: You’d have recombinant—

SIDDHARTHA MUKHERJEE: You could have recombinant DNA and you could introduce it into another cell and all of a sudden that gene would become part of—it would come alive as it were. And so that was Paul. I worked in Paul’s lab about ten years after he had made the discovery, he was still in the midst of that process, and he was one of the first organizers of the Asilomar meeting.

DAVID REMNICK: And you set out to be what? You came from India to England to study.

SIDDHARTHA MUKHERJEE: I went to Stanford, actually, and then to England.

DAVID REMNICK: At Stanford, and Oxford as well. With the idea of being what?

SIDDHARTHA MUKHERJEE: I thought I was running forward, but I was actually running sideways. I thought I was going to be a physician/scientist. You know, I was going to be a doctor, I was going to have a laboratory, and then things changed—

DAVID REMNICK: What changed?

SIDDHARTHA MUKHERJEE: One thing that changed is that I felt as if I needed to do more storytelling. I was keeping a journal—this is how Emperor grew, I was keeping a journal, I was a cancer doctor, sort of nose to the ground, doing my things and then people, not people, my patients, kept saying to me, “Why is it that I’m fighting this thing. What does it look like? Why am I here?”

DAVID REMNICK: In other words, you couldn’t tell your patients the story of their own illness or potential treatment.

SIDDHARTHA MUKHERJEE: Exactly, and that’s what started the book. I had a journal, I was keeping a journal, and there were five pages at first. And then I would write every evening in the journal, I would come back and I would some things about it. It became ten pages and then fifteen pages and then twenty pages and then finally it was a full mammoth document, and that was how Emperor, how that book was born.

DAVID REMNICK: What were you reading at the time? What is your kind of literary and scientific literature background?

SIDDHARTHA MUKHERJEE: You know, I was reading a lot, but it was—I was reading widely. I mean, I was reading Susan Sontag one day and then the next day I was reading some scientific paper, and then the third day I was reading someone else’s cancer memoir, and the fourth day I was reading—and I was, but then, all of a sudden, as I was writing, things began to be clarified.

DAVID REMNICK: By the act of writing.

SIDDHARTHA MUKHERJEE: By the act of writing. I think you know I think I mean people often say to me, you know, “How does one write a six-hundred-page book?” And I have two pieces of advice. First of all you learn to become a writer by reading, there’s no other way, there’s no other format, there’s no educational program that will tell you except to read.

Number two is that work makes work. If you write, you will write. That the process of entering a story allows you to enter another story. You know, I’ll tell you two stories, and maybe this is relevant. When I was a resident in medicine we had, you know, back then all these new laws didn’t exist, so you were on call for twenty-four hours, and you would go to sleep the next day and you’d come back et cetera, and you would be on again. It was like Sisyphus on steroids, you know, it was on and on and on, and I would be on for—and it was a busy hospital, you know, terrible illness, pagers going off all the time and I would stay up at night obviously tending to my patients and I would say if I can only get through to seven in the morning, I will put a dollar twenty-five into a machine and have a Klondike bar.

(laughter)

DAVID REMNICK: That is the greatest tribute to a Klondike bar I have ever heard.

(laughter)

SIDDHARTHA MUKHERJEE: And I would say, “If I can just get to the Klondike bar, everything will be fine. I will be perfectly fine. Life will be fine. And then I’ll go to sleep and I’ll come back and I’ll tend to my patients again, but all I want is a cup of coffee and a Klondike bar. If I concentrate on the Klondike bar.”

DAVID REMNICK: Sounds delicious.

SIDDHARTHA MUKHERJEE: Can you imagine that? Every third day a Klondike bar. What a great life, so when I write books I say to myself, “You know, if I can just stitch stories together, one after the next, the book will come to its own end. It will find itself, it will find its path.” And it’s like people, it’s like Sarah’s work when she makes work. If you just put the things together, the work will speak back to you.

DAVID REMNICK: If you stay in the studio, if you keep your ass in the chair. Sitzfleisch is the word.

SIDDHARTHA MUKHERJEE: Sitzfleisch. Exactly right. But that work that speaks back to you, you can have a dialogue with what you’re making.

DAVID REMNICK: But here’s what ordinary writers don’t understand about someone like you, Sid. You have a job. (laughter) It’s a really hard job in every sense, in terms of hours, it’s a multidimensional job that you’ve got, and then you come home and you have a life, and you have children, you’re a great cook, you’re terrific, you have friends. Writing is not easy. So how do you do it? How much time can you devote to—this book is produced, it’s an extremely significant book, in several years.

SIDDHARTHA MUKHERJEE: Five years. Again, it’s the Klondike bar syndrome, (laughter/applause) you know. If you can just make a story, writing a story, actually—

DAVID REMNICK: I’d like you to come to the New Yorker and talk to the assembled writers (laughter) about the Klondike bar theory of writing. We wouldn’t have room for all the pieces.

SIDDHARTHA MUKHERJEE: But also it’s the desperation that, you know, you—I don’t want to make fun of it or belittle it. You know, that was all I longed for then, and it was a very fundamental goal, I just wanted to get there.

DAVID REMNICK: What’s your Klondike bar now?

SIDDHARTHA MUKHERJEE: What’s my Klondike bar is now is to write stitches of stories together.

DAVID REMNICK: That’s its own reward.

SIDDHARTHA MUKHERJEE: If I can stitch them together, books write themselves and they will write themselves because they come back to you, they can speak back to you. And you know what’s interesting about it is I’m a very linear writer. I write from the first word to the last word, and occasionally with my editors, Nan, I don’t know if you’re here.

DAVID REMNICK: Nan Graham is here, who is a remarkable editor I should say.

(applause)

She’s somewhere.

SIDDHARTHA MUKHERJEE: And, you know, I have Sarah reads my work and my friends read my work and, you know, I have people in medicine, I don’t know if you’re here, you know, reads my work, and they all I will really do at the end of my—or the middle of my process is I’ll move a chunk around. I’ll move a big chunk somewhere and that is what I will do.

DAVID REMNICK: So you’re getting it right as you go.

SIDDHARTHA MUKHERJEE: I think you get it right as you go. If you get the emotional tone right and if you stitch stories, things will be helped, you will be helped. You know, I think it’s very important not to start writing epic books. The word “epic” is poison I think.

DAVID REMNICK: Sorry, but you—

SIDDHARTHA MUKHERJEE: But that’s the whole trick of it, I think, at least for me. The word “epic” is poison because you say to yourself, if you say to yourself, “I’m going to make an epic, I’m going to write an epic,” you’ve instantly basically shot yourself in the foot.

DAVID REMNICK: There are other American writers, cancer doctor writers, Lewis Thomas, Lives of the Cell. He was biology.

SIDDHARTHA MUKHERJEE: A famous book.

DAVID REMNICK: Richard Selzer’s A Surgeon.

SIDDHARTHA MUKHERJEE: Jerry Groopman.

DAVID REMNICK: It’s a big genre—Jerry Groopman—

SIDDHARTHA MUKHERJEE: Atul Gawande.

DAVID REMNICK: Atul Gawande. What do you want for yourself as a writer, do you even know? You’re not a kid anymore but you’re certainly not anywhere near older or old. What is that you see down the road as a writer in conjunction with your work in medicine?

SIDDHARTHA MUKHERJEE: I think my thought about it is—

DAVID REMNICK: Do you have to sustain all of it?

SIDDHARTHA MUKHERJEE: My thought about it is let it speak back to you and tell you where to go. And maybe things will change, maybe I will stop completely, you know, having produced two books, I will stop.

DAVID REMNICK: I don’t believe a word of that. Do you?

SIDDHARTHA MUKHERJEE: I don’t know. You know, we were talking a little bit about this, the funny thing about—there are many people in the audience who paint and write and make new work. When you produce a new work, the minute it’s produced in the world, you feel a profound depression, a profound depression.

DAVID REMNICK: Because the engagement of writing a book is pleasurable?

SIDDHARTHA MUKHERJEE: It’s hard for me to know why. I mean there are other people who are smarter than me about that process. Because, you know, it’s hard for me to know why, but you feel as if something’s—and in fact the more, I don’t mean to sound foolish about this. While your work is being praised, you feel even more depressed, you feel as if, “Really?”

DAVID REMNICK: Do you feel wonderful when you get a horrible review?

SIDDHARTHA MUKHERJEE: No, no, no, I don’t feel wonderful about horrible reviews. No, I don’t mean to belittle it, I just mean to say there’s an emotional response to birthing work in the world. And we shouldn’t forget that emotional response. That emotional response, to me at least it feels there’s a catatonia about it, there’s a catatonia about it, and when people ask you, “You know, what are you doing next?” you’re like, “Are you crazy? I mean, are you crazy?”

(laughter)

DAVID REMNICK: “I just gave birth!”

SIDDHARTHA MUKHERJEE: “A placenta came out of my body and you’re asking me when you’re going to have the next child. That’s madness, we don’t ask anyone that question so why are you asking me that question?” Not to say that—

(laughter)

DAVID REMNICK: I’m just over here. And yet the pain you feel when it’s done is a contrast to the deep weird painful pleasure that you’re experiencing while writing or am I projecting?

SIDDHARTHA MUKHERJEE: Yeah, absolutely, and you know this from your own books. I mean I don’t know what your experience is like, it might be interesting. I mean, I don’t know—do you have that same sense when you finish a book?

DAVID REMNICK: I’m not a cancer doctor. I pick talking dog cartoons. (laughter/applause) It’s not the same thing. It’s not the same thing.

(laughter/applause)

SIDDHARTHA MUKHERJEE: Let’s get a time out. David, we know that you’re not only picking talking dog cartoons.

DAVID REMNICK: No, somebody hands something in that’s good and I call up and I say, “It’s really good.” I have not cured cancer by doing that, I promise.

SIDDHARTHA MUKHERJEE: Nonetheless, I think there’s a sense that, there is a sense that I think all writers share, and it’s important, is that you know that there, that the internal buzz that you have in your brain, the fugue, dies when a book is born. The bugles stop, and the fugue goes away. And the fugue, remember, was something that you had been addicted to for five years.

DAVID REMNICK: It feels like addiction.

SIDDHARTHA MUKHERJEE: Yeah, and the addiction’s gone all of a sudden, the buzz goes away, it’s like the, you know, the last drip of your choice drug, heroin or whatever it might be, is gone, and then the buzz fades and then you’re left with that sense of longing for it, you know, and then you get addicted again to something new.

DAVID REMNICK: Siddhartha Mukherjee, I cannot recommend this book highly enough. Thank you all for coming out tonight. Thank you, Sid.

(applause)

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download