Episode 20: Siddhartha Mukherjee on COVID-19, genes and physician sacrifice

Welcome to the first episode of season 4. This season of the Fixing Healthcare podcast focuses on finding big ideas and the people behind them. The journey begins with Dr. Siddhartha Mukherjee.

He is a physician, virologist, oncologist and Pulitzer Prize-winning author of The Emperor of All Maladies: A Biography of Cancer. In 2016, he published the New York Times bestseller, The Gene: An Intimate History. And this month, PBS released a Ken Burns two-part documentary based on Mukherjee’s work.

In this interview, Dr. Mukherjee discusses the ethics of gene therapy, his hopes for an effective coronavirus medication, why doctors are struggling, and how he’d grade Trump’s response to COVID-19.

Dr. Mukherjee’s highlights from episode 20

On the role of physicians during the COVID-19 pandemic

Our job as doctors is to tip the equilibrium towards the host, towards the human, and tip the equilibrium away from the virus. And there are various ways one can do this. Vaccination is essentially one way that we tip the equilibrium towards the host, right? … Another strategy is to limit the amount, the dose, or the exposure to the virus, which is by wearing protective equipment.

On the real purpose of social distancing

The most important thing to do—and the reason that we’re saying that we should be distancing during this time—is to buy us time. And I’m going to repeat that again and again: We need to buy time. We need to buy time so that the hospitals are not overwhelmed and the healthcare workers can be adequately protected and adequately supplied with the equipment that they need to deal with the sickest patients.

On hopes for an effective COVID-19 medication

I’m confident that there are going to be antibodies that will decrease the effects of this severe disease in patients, they will just take time to make. Chloroquine is a completely different story. Chloroquine is a repurposed drug, it has probably some mild effect against the entry of the virus and the evidence that it changes the course of disease is pretty mild.

On the U.S. government’s response to the pandemic

I would give the administration a D- grade in the preparation for this pandemic. We knew about this in December, in a globalized world, it is a travesty that medical workers in the frontline, in the wealthiest nation of the world, don’t have the equipment that they need to handle patients. It is a travesty.

On the ethics of gene therapy

Gene therapy is alive again. There were mistakes made, ethical mistakes, medical mistakes made in the 1990s and 2000s, when we tried to use gene therapy in humans, replacing genes, altering genes in cells, such as blood cells, a little too quickly. And that froze the field for about 10 years, 15 years, but it is alive again. And for diseases such as sickle cell anemia, such as hemophilia, these gene therapies have turned out to be transformational.

On the mission-driven spirit of doctors during a pandemic

I’m moved to tears every time I hear of a doctor or a nurse on the front lines without protective equipment, who has been infected and is dying because they put the lives of others in front of their lives. A society which does that is fundamentally wrong. There’s something wrong with us. And there will be an autopsy, there will be a dissection, a biopsy, of what has gone wrong, what went wrong with us as human beings, as a society, once the storm blows over. And I hope that one of the elements of that autopsy reminds us that medicine is an occupation that demands a level of sacrifice. And these men and women perform that sacrifice for you, for us, for our parents, for our children, for our loved ones. They did it during the HIV pandemic, they’ve done it during this pandemic. We need to restore their spirits. We need to respect them.

On learning from our nation’s failed COVID-19 response

Every system that was supposed to work broke in the early days of the pandemic. We need to figure out, as we recover, how to fix those. And only if we fix those, can we become the superpower and the global leader of economy that we once were, and we hope to be again? All I can say is that, this pandemic has been an X-ray or an MRI that we performed on the American medical system. And all the silent aneurysms and the hidden malignancies that were hidden for some people have become apparent.

READ: Full transcript of our discussion with Siddhartha Mukherjee

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Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple Podcasts or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn.