On the rooftop business centre of a plush five-star in Mumbai, Siddhartha Mukherjee, stem cell biologist and author of a bestselling book on cancer, is patiently giving interviews about his new book, Gene . He is terribly jetlagged, but says he will complete the interview and only then retire to his room.
It’s the middle of July, it’s pouring outside, and the view of the Mumbai seafront from the 33rd floor is ethereal. The dark grey, almost-zero visibility sky makes a typical Mumbaikar worried, especially after the cloudburst of July 26, 2005, that caused massive flooding. The view outside is, thus, both beautiful and fraught with a little fear. What if it happens again? What if we are not prepared? Again.
The opening narrative in Mukherjee’s new book is somewhat similar; it is a family history of mental health issues, and the question that haunts the writer is, what if I am next? “I start with an anecdote about personal vulnerability because I want to make the book about all of us,” says the New York-based scientist. “It is about what happens to you and me, what happens to all of us. It is about how human beings are constructed. What is it about us that make us function the way we do; indeed, how do we function? What does the future hold for us as we try to become more perfect? The personal story is about finding us.”
When the narrative is about the family, invariably the question of genes pops up. Mukherjee says that among other questions, the one key issue geneticists need to tackle is, “What does it mean to have a genetic illness in the family?” The 46-year-old co-founder of a cancer research lab says he recently received an email from a friend about a family member with a mental illness that was never spoken about. “We’ve been friends all our lives but I never knew it,” he says. “I want to bring that idea out in the open. This book is also an intimate history.”
But really, mental health is just one aspect of why we study genes. “Biology is not destiny, even if genes play an important role in understanding ourselves,” says Mukherjee, who won the Pulitzer Prize and the Guardian Prize for his book on cancer The Emperor of All Maladies . “We are only beginning to understand these connections. What is the connection between genes and the human psyche? There are many other aspects of the human psyche that are not genetic, so one should not make a straight comparison, but genes play a big role, and that is very much part of the new book.”
The progress in gene science has been exponential, says Mukherjee, especially after the sequencing of the human genome, a project that was an inflexion point in the quest to understand ourselves. “The project allowed us to map the cancer genome, and that in turn helped us understand the disease better,” he says, pointing out that a recent discovery of a genetic connection between leukaemia (a type of blood cancer) and a melanoma of the eye (the gene mutated to create the melanoma) has sent oncologists racing for collaborations to find out why. Mukherjee’s lab is working with another to find out these connections. “At face value, there might be nothing to it, but there is indeed a genetic underpinning to the two cancers. We found this because of the cancer genome project, and the cancer genome project goes back to the human genome project. So there is a collaborative web here that we are using all the time.”
Mukherjee says he uses the human genome, both directly and indirectly, every single day at work. But he also advises caution on the hype surrounding the sequencing. “There was a lot of hype around the human genome when it was first sequenced, and people said ‘Oh my god, we can cure this and that’ immediately. That didn’t happen, and there was obviously a lot of disappointment. But now, we are seeing the payoffs of the project.” Cancer research, which is close to his heart, is one such payoff. “The roadmap for cancer treatment changed because of the human genome. There is now definitely a roadmap for immunological therapy, that is to say, by using your own immune system to fight cancer cells. This is because some pivotal discoveries were made because of the roadmap.”
The roadmap for cancer prevention, too, has changed, he says. “We now have more knowledge on prevention than we had five to 10 years ago.”
Stem cell therapy, on the other hand, is something he cautions against. “Stem cell therapy is very much in its infancy. There are very few that really work; bone marrow transplantation, for instance, is one such therapy that works.” He cites the example of a cover story in a journal recently that spoke about how these claims on stem cell therapy have proliferated around the world and in the U.S., and that they are “based on very, very poor science.” He says, “People are purported to do all sorts of things, for everything. Most of it is nonsense. It is very early days.”
Embryonic stem cells (nothing to do with stem cell therapy) is a sunshine research sector, he says. “There was a time when we couldn’t do any study of embryonic biology, or open any new lines to the embryo, as there was some political pushback in the previous U.S. administrations. That has changed somewhat. They have no connection with stem cell therapies, except that they (embryonic stem cells) allow us to understand our genetics better. They allow us to understand ourselves better, and what might happen, but they are not therapeutic yet.”
The understanding of genes has reoriented our knowledge of the language and the vocabulary by which we can understand the biological sciences and ourselves. “We need that vocabulary,” he says, “if we need to continue the conversation about the future. We need to understand how genes work, why they work. Not just about human beings, but across the living world. The study of genes, really, is a study of us.”
The ultimate aim of any gene scientist is to reduce human suffering. He emphasises, “We need to be clear that there is no genetic answer to everything, and that a Frankensteinian future where you can create a human being the way you want is very unlikely.”
“We won’t be able to manipulate personality using genetics. However, our capacity to understand human beings with genetics is improving enormously. And our capacity to intervene on the human genome has increased exponentially and, therefore, the question is what we could do with that. Obviously, the answer is we need to use it to decrease human suffering, to decrease diseases, and in doing so, avoid unintended consequences. I think it is possible to do this, but the world has to understand the limits and constraints of genes, and their power.”
