i'm kasia madera. you're watching bbc world news. our top story: it's pop music diplomacy. north korea's leader kimjong—un has attended a concert in pyongyang by internationally famous k—pop stars from south korea. the concert is being seen as another sign of the improving relations on the korea peninsula. later this month, the two korean leaders will meet, and a meeting between kimjong—un and president trump could take place after that. they're returning to ruins. thousands of residents of the battle—scarred philippine city of marawi have been allowed home for the first time. and this story is trending on bbc.com. a nepali climber and guide, kami rita sherpa, is beginning an attempt to break the world record for the biggest number of successful climbs to the top of mount everest. it's his 22nd ascent. that's all from me. stay with us here on bbc world news. now on bbc news, it's time for hardtalk. the to talk. i am stephen sackur. ——

welcome at too hardtalk. —— welcome to. hundreds of billions of dollars is poured into cancer treatment and research every year. there are more effective tools to combat it than ever before, yet it kills close to ten million people every year. my guest is one of america's leading cancer specialists, siddhartha mukherjee. his book, the emperor of maladies, a self—styled biography of cancer, painted a unique picture of the disease, mixing memoirs, science, and a writer's sensibility. eight years on from its publication, is cancer any less of a curse? siddhartha mukherjee, welcomed the

hardtalk. thank you. you are now oncologist, you also know are fated writer. you look at those two activities are is entirely separate or is the writing way of you following your calling as a dock? for me and like many other people, i write to think. in order to figure out questions that you might find interesting, where are we in cancer? the only way for me to answer that question is to write and sometimes, it might be writing a big book of fa cts , it might be writing a big book of facts, 600 page book. sometimes the questions be answered to a small article, sometimes they need to be

scientific articles, but the writing is just scientific articles, but the writing isjust a scientific articles, but the writing is just a method for me to think. earbuds obviously thought about, worked on cancer for most of your professional life. but what point did you think yourself there might bea did you think yourself there might be a book and is the general public would like to read? —— you have obviously thought about. cancer is not necessarily going to be a big selling book. the first time i put together a book proposal, someone said there will be two readers, you and your mother will read the book. in fact, when we printed the book the first time, we ran out of copies because of the nature of the topic. the quick answer is they did not think about that, that is not what drove me to write the book. these are complex topics and i fear that if you, it there are such intrinsic interest, people are so... i was so intrinsically interested in where

and why we ended up today with cancer or with genetics, that i thought that if i could, anyone would be interested in reading it. and it proved to be true. it did you also think that cancer was misunderstood and has misrepresented toa misunderstood and has misrepresented to a certain extent? i think that there was a wealth of new information that was emerging in the early 2000 is about the mechanisms by which cancer is caused, about what we're doing to combat the many diseases, it is not one disease but the family of diseases, that i felt as if if you're reading from the standpoint of a lay person or even a patient, that you needed a kind of roadmap. where are we? where are we going? why did we end up here? and you could not find one, there are a lot of self—help hooks it a kind of feel good, this is my struggle, all of which may be important that this was not my book. i suppose my question about the misunderstanding and mr cetacean of cancer is partly

premised on something that you do, but i cannot think of anyone else doing in the same way, and that is that you sort of did cancer character, almost human character, which sounds completely bizarre but when one reads the book, kind of makes sense. i tried not to anthropomorphise, make cancer human being. what i try to do is to understand, what is the, what drives this illness or this family of illnesses? what drives it, what is the animus behind it? what kind of mechanism drives it? what is interesting is once you get into that idea of what is driving something, the molecular, the genetic forces, it is almost that you can imagine it as a tangible thing and that is why it seems... you have given the attributes of a person. you say you do not have the more fight you do write sentences like this one. what you say is i making an attempt to enter the mind of this mortal illness, to understand its personality. yeah.

demystify its behaviour. yeah. these are terms that one would normally applied to a person. that's right but the important feature is that cancers do have behaviours, there are in fact, despite the fact that it isa are in fact, despite the fact that it is a family of illnesses, you can ascribe fundamental behavioural characteristics because it is a cellular disease and it picks up behaviours from the world of lignin sells, the metabolism, the drive to proliferate, the capacity to evade immune responses. there is something, there's a real behaviour in there and in fact, this behaviour stretches across multiple forms cancer. it sort of give it a sense in which the cancer cells are almost a mirror of us and our law darwinian unconscious, but nevertheless always present darwinian desire to adapt and survive. absolutely, because

they borrow, cancer cells are in fa ct, they borrow, cancer cells are in fact, they derive from normal cells. from our. from our. cancer is asked ina from our. from our. cancer is asked in a way. they borrow from normal cellular material, the clothes that allow these cells ultimately survive and grow. can i ask you, i do not normally do this on hardtalk, but because it is such an important part of your work, can i ask you to read a passage from your own book? this isa a passage from your own book? this is a passage from the emperor of maladies and i think it gets to the heart of the way the unique science with a sort of literary sensibility, so... so here i am writing about cancer. cancer is an expansionist disease, it invades the tissues, sets up colonies and hostile landscapes, seeking century in one organ and then emigrating to another. it lives desperately, fiercely, territorially and defensively, at times as if teaching us defensively, at times as if teaching us how to survive. the contract

cancer then is to encounter a parallel species, one perhaps more adapted to survival than even we are. if we seek immortality, then so too ina are. if we seek immortality, then so too in a perverse sense does a cancer cell. it is very interesting. and deep in there is this notion of us, we, the human species confronting cancer but we have all become familiar with various politicians and medical practitioners who have used the phrase a war on cancer, dundee u, looking as you have done at the history of human effort to combat the disease, do you think this notion of a war on cancer is useful? i think it is useful in some ways an historically, it was useful and remains useful. the idea of the word historically, the war on cancer batted away, did away with the kind of minimalism around cancer. there was nothing we could do. there was nothing you could do, but like every

metaphor it came loaded with its own problems. it created the idea that we are soldiers in the battle, that patients are somehow collateral damage, the loss of lives is somehow collateral damage as we move forward , collateral damage as we move forward, except. and that those who do not succeed in the battle on a personal level have failed. have failed, exactly. so, like all metaphors, it had some powerful things about it but even so, had created a kind of comment also a damaging sense of loss, which still lives today actually. some patient of mine say well, i do not want to think of this as a war, you are an oncologist, you go fight the battle, let me recover. so it works in some ways, it does not work in others. perhaps the most famous use of it was during the nixon administration when nixon himself talked about a war on cancer and actually suggested that within five to six years, he hoped that cancer could pretty much be eradicated as a threat to human health. well, of course, all these yea rs

health. well, of course, all these years later, we know that that was a misguided. if you look at the situation today and i said in the introduction, roughly 10 million people a year dying of cancer, in the united states, after heart disease, it is the single biggest killer. in fact, it will probably cross over and become the biggest killer. looking where we are today, what have we achieved over the last 50 years? well, 50 years is a long time but we have made fundamental lea ps time but we have made fundamental leaps in both understanding and treating. i will give you some highlights but it is a big long list because it has been intense 50 yea rs. we because it has been intense 50 years. we understand other cause cancer, we know that cancer is ultimately caused by mutations in dna, these mutations can arise because of errors in dna, you can call them, these mutations can arise because you can inherit the errant gene, because the mutation can be caused by a carcinogen, like x—rays oi’ caused by a carcinogen, like x—rays or smoking, the mutations can be caused or bought into cells to

viruses and they can occur because of random chance, when cells replicate themselves, like any copying machine, they can make errors. this we did not know 50 yea rs errors. this we did not know 50 years ago, this is since the 1970s and 1980s. we now know that on occasion, if you find an achilles heel in a cancer cell, genetic liability, something that the cancer cell depends on very acutely for its survival, you can actually get profound remissions and sometimes skewers, we now know that early therapy, the detection of cancer early for many cancers, not all, for many cancers, can actually be very helpful. in fact, many cancers, can actually be very helpful. infact, if many cancers, can actually be very helpful. in fact, if you treat cancers early and follow that up with some kind of achilles heel therapy, you can help. we know that there are many virally cause cancers and those virally caused cancers can be, their life cycle can be changed as it were the vaccination against viruses, such as the human papilloma

viruses, such as the human papilloma virus that causes cervical cancer, so there is a whole host from prevention, early detection, treatment and cure that we have understood in the last 50 years. from that understanding, do you think we had the balance right at the moment between the resources and the moment between the resources and the prioritisation we put into preventative action and the resources and priority were put in the treatment? so the answer, the quick answer the question is we would like to, we would like to prevent would like to, we would like to p reve nt ca nce rs would like to, we would like to prevent cancers period and therefore, ultimately the resources, i think should be directed towards prevention. the problem with is that although we have identified several carcinogens such as viral carcinogen is, smoking, etc, it is not clear whether many of the cancers today, we do not have obvious carcinogens that are implicated in some of those cancers. some we do, we have identified many new ones in the world, but some we are still scratching our heads about saying well, why did this woman who never

smoked, he does not seem to have an obvious exposure to one of the many known carcinogens, why did she get lung cancer? why is there a 30—year—old woman with no history of breast cancer in her family, 30—year—old woman with no history of breast cancer in herfamily, and again, no obvious carcinogenic exposure get breast cancer? is bad luck? is it something we are missing? and it remains a challenge. isaid and missing? and it remains a challenge. i said and it is very easy for me to say it, that with hindsight, the optimism in 1971 about victory in the war on cancer was deeply misplaced but there are people today, respected scientists, who are saying that here in 2018 because of the knowledge that we now have of immunotherapy in genetics, they are saying yes, and i'm going to quote the couple to you, one in australia, a leading immunotherapy doctor, she says it is a huge, hot area of medicine with the potential, she says, to cure cancer. then we can look at the geneticist james watson, genetics is something you have been

working on a great deal, he says beating cancer now is a realistic ambition because at long last, we largely know that it is true genetic and chemical characteristics. —— eats. we may finally be ready for that war. do you think that optimism is more justifiable today?” that war. do you think that optimism is more justifiable today? i remain a middle optimist. i hope to let me think that important strides are being made in the last five years, the last three years, including things that understanding the genetics and chemical nature of cancer and also, as the, as your other respondent pointed out, not only understanding the cancer cell but the environment, the homeland builds around itself, the immune attack on the cancer cell, we are understanding this as a seed and soil idea. we still have two develop fundamentally new cancer therapies, if you take immunotherapy is one example, very widely celebrated, lots of hot news around at an absolutely, there are lots of

cancers being treated and put into remission to that therapy but we still do not understand why the instance, pancreatic cancer remains cold to immune therapy, why do is press cancer for the most part remain cold to immunotherapy? why, in the same cancer, within colon cancer, do some people respond beautifully to immunological therapy and some people don't? ian ayre their questions to ask, but you just cannot find the answers. that you know. without tools you cannot even ask the questions. i've had in ten yea rs ask the questions. i've had in ten years ago began to reformulate the question is, what are the questions. in that time we have invented important tools that will allow was to ask the questions. important strides against many cancers, but remaining questions are still unsolved. let me ask you a personal question. you see that the toolkit is expanding, but it is still

clearly not sufficient, you work, currently, i believe in colombia in columbia university hospital in new york, you work with cancer patients every day... yes. so dying and death are realities you live with every day. absolutely every day. what impact has that had on your life?m changes, it changed who i am. i actually cannot think of myself as someone who hasn't encountered a death a week. that person that i must have been at some point of time before a became a cancer, before a became an oncologist, has vanished for me, that person... that person who was under your care. this is someone that is under my care, a friend, or someone i have been referred to, essentially, the familiarity with someone dying, as i said, one person in the larger

ecosystem of my life dying once all week is the new normal for me and is the new normal for most oncologists. you are quite frank about it. you say that at times you walk down the corridors of your hospital after a particularly gruelling shift and you struggle to find the sympathy that you feel you should have for some of the patients in your care. you feel you should have for some of the patients in your carelj you feel you should have for some of the patients in your care. i think for myself, i can as for myself, thatis for myself, i can as for myself, that is the time i go to the laboratory. to go back and to give meaning to what i do, which is to try to find new treatments and new ways of thinking about cancer. and i think this is one of the discoveries, i would say one of the illuminating things about what has happened in the past a0 years, is that we have encouraged a certain kind of doctor to become also to put on at the same time their medical hat and his or her research at and

ask the question how can i take what i learnt from the clinic, bring it back into the laboratory, a cell, a way of thinking, a genetic propensity, and then transform that into a way of preventing or treating or curing cancer. i can see that the lab and the microscope are important features of your research life. but in the end, being the kind of doctor you are, is an incredibly human thing as well. and i wonder how you way up some of the very difficult ethical questions that cancer care doesn't raise about the merit of giving people the latest treatment ata giving people the latest treatment at a point in their disease where it might extend life by a maximum of three or six months at great expense and also probably with great suffering and hardship as well. how do you balance out what extra life is worth? i think the first important thing to realise is that as an oncologist, as a doctor, you are not the arbiter, you have to

listen to the goals of patients and then be realistic about those calls. you mean you are guided by the patient? i try to be. in fact, that is one of the cardinal principles of medicine, which went somewhat wrong in the 1970s in oncology when it was all wore all the time, is that we forgot to listen to the goals of patients. what kind of life did they wa nt patients. what kind of life did they want and not kind of take my ventilator off or do this, allow this kind of procedure, give me that kind of chemotherapy, i mean a much, much more primitive us a question of when you want to be, what kind of life to you want to have? if i were to extend your life, a life on average by three months, but if that involved being in hospital most of the time, suffering through some procedure or chemotherapy, is that

the like he want? some people wanted to ta ke the like he want? some people wanted to take that sort of bargain on hope —— like you want. some people don't wa nt —— like you want. some people don't want it. there is a kind of lucidity or clarity that went missing that i hope, ican or clarity that went missing that i hope, i can only say hope, we are trying to get back. it is interesting the way you talk about it. i'm going to make it very personal. you wrote recently about dealing with the death of your own father. that was not a catheter. the have long—term dementia, i know. he was back in india, you were with him —— nota was back in india, you were with him —— not a cancer that. you are trying to figure out with him and your mother the best way for his end of like to come. you've that are profoundly difficult. you talked about the amount of dread it brought on me when it was my turn to have the conversation as a sign, not a doctor. when my father died i sort of relived every such conversation that i had had in the life that

proceeded, in the 20 odd years that preceded it and in reliving those conversations, i suddenly found that asa conversations, i suddenly found that as a child, as a son, it was as though i was starting afresh. it was the first time i had ever had a conversation, because i had not been that person, the recipient. it is different. it is totally different. it took me some time to figure out who i was. what was i trying... what was going on in my own brain? was trying to battle... do you think you got it right in the help and support and advise you offered to him and your mother? my father was unconscious through most of this. we had reached a state of, he had retre kind of coma. i think what help is enormously was that his goals had been clear while he had been alive. his goals were, he had a kind of if

then els kind of and idea about his dying. if i'm not able to be sentient, if i can't do these things that i love to do, then i'm done. i have had enough. that helped. because i could keep that as a kind of moral compass or a guide as they moved forward in trying to get his ca re moved forward in trying to get his care sorted out. before we end, i wa nt to care sorted out. before we end, i want to bring it back to the big picture. i wonder if you, as a world—renowned cancer specialist, live in dread of what comes next, not because advances aren't being made and we are learning more about cancer all the time, but because the world's population is ageing dramatically and with greater age and longevity comes more cancer, it just seems that is a consequential relationship, and how on earth are we going to afford to care, to treat all of the new... you are talking about the dread of... a systemic problem. the systemic dread. a lean

back on an old idea, which is deaf in old age is inevitable. it is premature death, death in young age that we are mainly trying to prevent. you are not so concerned about cancer in all people. what i am trying to say is the definition of old keeps switching. 0ld am trying to say is the definition of old keeps switching. old was 60 in1960, 70 of old keeps switching. old was 60 in 1960, 70 in 1970, oldest 2000 and 2018. -- old in 1960, 70 in 1970, oldest 2000 and 2018. —— old is in 1960, 70 in 1970, oldest 2000 and 2018. -- old is 2000. we in 1960, 70 in 1970, oldest 2000 and 2018. —— old is 2000. we want to maintain function and not exacerbate a compromised dignity. those are changing terms. people are now functional at 80, people are functional at 80, people are functional at 80, people are functional at 85. it becomes somewhat of a personal decision. but the person who is at the other end of that telescope of medicine, the patient, as long as they are understanding of what is happening, they are functional, they have dignity, they have autonomy, i think we try to cure and treat them.

irrespective of age. in terms of the language of cancer, do you look to the day when we have beaten cancer? absolutely. absolutely. you do. you think that is a concept we should aspire to ward? from your writing i feel like you think cancer is so integral to what makes ask us physiologically that we will never beat it. to push it further and further away the kind of suffering, the premature termination of life, the premature termination of life, the assault on dignity, the assault on personhood, the assault on autonomy that such a terrifying disease brings, that is victory. you don't need to queue every cancer and have everyone live until they out methuselah, what we really need to do is to diminish the aggravation that this family of illnesses has had on our lives for centuries. that isa had on our lives for centuries. that is a great way to end this

interview. siddhartha mukherjee, thank you very much. thank you. hello there. hello there easter sunday was disciplining for many areas. now we look to the south, to the next area of low pressure which will bring disruptive weather for easter monday. it is an area of rain, sleet, and snow, fairly strong winds as well, continuing to push northwards during the early hours of easter monday with snowfall likely across the higher ground of wales into central and northern england and even into northern ireland. the early parts of easter monday.

scotla nd early parts of easter monday. scotland would have clear skies and widespread frost. what early easter monday morning there could be travel disruption across northern ireland into central, southern scotland and northern england. widespread heavy wet snow, could see up to 10— 15 centimetres over the north pennines and into the southern uplands. some drifting of that so because of the strong east to south—easterly wind. down to lower levels as well. a mixture of severe weather for the easter monday morning. further south, mainly rain. for england and wales milder and moving in. there will be a few sunny spells, one or two showers, temperatures in double figures, 10— 13 degrees. cold and dry across the northern half of scotla nd dry across the northern half of scotland with one or two wintry showers. if you are on the move easter monday bear in mind that there is no across central northern areas that could cause problems. keep tuned to the radio and subsequent weather forecast. a keep tuned to the radio and subsequent weatherforecast. a big area of low pressure will be close to the uk as we head into the latter

pa rt to the uk as we head into the latter part of monday and into tuesday. 0ne thing it will be doing is striking up thing it will be doing is striking up some very mild air from thing it will be doing is striking up some very mild airfrom spain and from france. initially across england and wales and pushing on into southern scotland and northern ireland through tuesday. there is the remnants of the sleet and snow across the northern half of scotland, heavy snow, drifting. further south, outbreaks of rain. for england and wales we will see sunny spells. some heavy, maybe thundery april showers. look at those temperatures. that mild air, 13 maybe 15 celsius. low pressure still with us tuesday into wednesday. eastern areas will see the milder f. cold air pouring in behind this area of low pressure. 0utbreaks behind this area of low pressure. outbreaks of rain for scotland, northern ireland, turning wintry over the high ground of scotland, may be down to the lower levels. elsewhere for england and wales it is another day of heavy april, maybe thundery showers and sunny spells. again, feeling quite milder

temperatures in double figures. i'm karishma vaswani in singapore. the headlines: the power of pop. north korea's leader, kimjong—un, attends a concert by south korean pop stars — another sign of the countries' improving relations. falling back to earth. china's defunct space station is expected to re—enter the atmosphere in the next few hours. i'm kasia madera in london. also in the programme: people return to the philippine city of marawi a year after much of it was destroyed in battles between the army and islamic state—allied fighters. japan could be preparing to execute the cult members responsible

for the deadly 1995 nerve gas attack on the tokyo subway.