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Siddhartha Mukherjee is the author of The Emperor of All Maladies: A Biography of Cancer, The Laws of Medicine: Field Notes from an Uncertain Science, and, most recently, The Gene: An Intimate History. The cancer researcher and physician won the Pulitzer Prize in 2011 for The Emperor of All Maladies. For this week's New York Public Library Podcast, we're proud to present Mukherjee discussing genetic innovations, storytelling, and the majestic formula.

Developments in genetic research have picked up pace in recent years. Mukherjee spoke of the attendant moral considerations for which we have no precedent:

"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...  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."

While many might be tempted to simplify the importance of genetics, equating genetics with fate, Mukherjee offers a more complicated formula for the relationship between genetics and destiny:

"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... 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."

Mukherjee began working as a physician and researcher but has gained much reknown for his prose on medicine. He explained that his patients helped bring him to writing:

"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?' 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."

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