pacific, and the preview for "the contenders." >> next on booktv, it's "afterwords" with janny scott, and the author -- >> coming up next, booktv presents "afterwords" an hour-long program where we invest guest hosts to interview authorities. this week, janny scott on president obama's mother "a singular woman." and feature stories in 2008,

spent two years interviewing stanley dunham's friends and family, including president obama. she discussed what she learned about the woman that raise the the 44th path with national journal's major garrett. >> the title is "a singular woman." what is more important, the fact that president obama's mother is singular, or she's the mother of the president of the united states. what fascinated you most about the woman? >> guest: i got interested in her during the campaign. i was doing a series of pieces about then senator obama. i heard about her. i was interested in the singularity. yes, of course, i wouldn't have come upon her had she not been the mother of the candidate that i was writing pieces about. to some extent, the justification for the book is

that. but the thing that we don't expect is that a person in our national political life had a mother with such an extraordinarily unusual life. so i think for me it's the singularity. >> did you approach this as a student of presidential history, student in the early 21st century, or as a portrait of a mother? >> guest: i approached it as a journalist. i wanted to know who the person was. obviously, one's mother is bound to be somewhat influential in one's life. but to have a mother who lived in such an unconventional way i think possibly might suggest even more of an influence or more distinct kind of influence. when i got into the story, i mean i began it simply as journalist liqueur -- journalistic curiosity. she lived a life that was not

like many woman that became of age in 1960. he was a forerunner without intending to be. just how she chose to live. i think as for what it reflects on the president is also very telling. obviously there are many reasons that we would be interested in his parenting, because he's the first biracial president. but to understand how her character plays out in him, and perhaps begins to explain some of the things that many americans find puzzling about him. i think she's very interesting for a number of reasons. >> host: let's start with her name. it's a bit unusual. she carried many names. >> guest: yeah, she was named stanley ann. the story was stanley wanted a boy, he got her, he named her stanley. that was the jokey response that she gave over and over and over again as a child when people would ask, stanley?

>> host: right. >> guest: it was a terrible burden to her. but it turns out and she -- as you point out, she ditched the name quickly as soon as he became of age. when she went to the university of hawaii, she came ann. i'll tell you about her last names. but the familiar story, the story told about president obama in "dreams to my father" that attributed to stanley dunham, her father, wanting a boy and getting struck with a girl may not be entirely the full story. madelyn dunham, her mother, as a child growing up in small town kansas became a lover of betty davis. and betty davis in the summer that madelyn was pregnant with stanley ann, betty davis appeared in a movie directed by john houston in which she play add character named stanley timberlake. after the baby was born that

november, betty davis was going through an interesting change in the public image at that people. was the rosy period, women were being encouraged to into go factories. davis had shifted from an indrug nows style to femme min. and that was the next movie. she was born and named stanley ann. someone who folk to her mother right afterwards and asked why the name, she said, you know, betty davis played a character named stanley. i think the stanley timberlake explanation maybe just as compelling. many say madelyn dunham would never have allowed the name to be dictated by her husband. >> host: it may not have been emblem disappointment of her father, but mission of empowerment from her mother. >> guest: right.

quite possibility. certainly i don't think there was any evidence that her father was disappointed not to have a boy. and i think giving your child a girl, the name stanley, has some effect whether it's empowering or not remains to be scene. >> host: what about her later names in life? what does that tell us about the choices she made, and feelings about the choices she made? >> guest: as you know, she went off to the university of hawaii at 17 and almost immediately become pregnant with the child of an african student named barack obama senior. this was the time when 24 state this is lawed against interracial marriage. she was married to him very briefly. then she married an indonesian student named lolo soetoro. she went from stanley ann, to ann dunham, to ann obama, to ann soetoro.

then she stayed and kept the soetoro name even through her divorce in 1980. rather than abandon the name and go back to dunham or obama or whatever for some new name, she decided instead to modernize the spelling of soetoro, which was happening. she broke from the family by giving herself sutoro. which is what many japanese did, not the old traditional male japanese, but the at least likely to update. so he kept his name, but updated it, while her daughter kept the old spelling, and then towards the end of her life, because she is finishing her dissertation for anthropology in hawaii, she reverted to dunham. at the end of her life, she had in her correspondence with her insurance company when she was

will, s.m. with stanley in brackets. stanley resurfaced at the end. >> host: the president has said i know she was the kindest, most generous spirit that i have known. and that what is best in me i owe her. he wasn't there when she died. why is that? >> guest: well, to give him the benefit of the doubt, i think any child in that situation deserves the benefit of the doubt. >> host: sure. >> guest: none of us know, few of us know exactly the moment that our parent is going to die. speaking from personal experience, it helps if someone grabs you by the shoulders and says you got to go home now. you maybe wrapped up in your life. but this is really important. he was very, very wrapped up in their life at that time. he was in his early 30s, he was teaching, he was teaching at the university of chicago, he had a job in a law firm in chicago, and he had just released his book, his first

book, and he was embarking on his first run for political office. so he had many, many things he was involved with. he was not unpresent during the illness and the period leading up to it, and she died in november of '95. he was in new york in september of '95 when she went to sloan kettering to get a second opinion. he told me he spoke on the phone until shortly before she died and came unconscious. he said that's the thing he regrets most. he was not there. >> host: hole in his life. >> guest: as i'm sure it would be for many of us. i wouldn't attribute any necessarily neglect to that. i would just say -- >> host: unfortunate set of circumstances. >> guest: right, she was in hawaii, he was in chicago. just difficult. she was not the kind of person that would be inclined to over state, quite the contrary.

the severity of her illness. her daughter was with her when she died, because they had spoken the week before and maya had become concerned that her mother was sounding confused, and had just decided i'm going to try to put everything aside and get out there. so she was there. and barack obama came hotly afterwards. >> host: constant theme in their lives at least from the point from barack obama goes back to hawaii to re-enter into private school is disstance. distance is a constant theme in mother-son relationship. a point of strength, a point of estrangement, a little bit of both? what is the most important linkage between the distance that was prevalent for so much of their lives. >> guest: well, distance, you are right is a common issue in his life beginning at about age 10. the first ten years of his life, he was with his mother pretty

much the whole time. he was born in hawaii, they lived together in hawaii, until 1967 when she had married her second husband and they -- she then picked up her son. because lolo soetoro was moved back, she moved her son to indonesia. then they lived in jakarta. for the first ten years, she was with him the whole time. then she made a decision because of the desire to get him a better education than she was able to get in indonesia and the belief he needed an english-language education in order to have the opportunity to go to a great university, she sent him back to hawaii by himself at age 10 or late 9 plus, on a plane to live with his grandparents and go to the school he ultimately graduated from. and she was as i said married at the time o an indonesia, she had

a second child who's father was the indonesia husband. she said there, went back to be with young barack, and joined him the following spring and lived with him throughout middle school. so she was -- there was a period of this, then she was back with him. then in 1975, when he was, i think in 8th grade and getting close to going to high school, she had finished her graduate work, her course work at university of hawaii in anthropology, and in order get her phd, she was going to have to go into the field work. she decided to do it on peasant industries. she had a child with her. she made the decision to move back. the president says he at that point in his life, entering high school, was -- feels he made that decision too. he said i don't want to go.

whether you can say that a child that age has that capacity to make that judgment, i don't know. but he feels that way. >> host: they both felt they could handle it. >> guest: exactly. she made a decision to leave him with her parents who she trusted and had been helpful in numerous other situations and continue in a school where he was doing very well. a school that is well known as one the best, if not the best in hawaii. and a school that sends kids to great universities. so she -- her daughter described that to me as the hardest decision of her life. for her mother. i think it was complicated decision. a lot of americans find it very hard to swallow the a. time that she spent away from her son. i would say it's worth considering the complexity of the personal and parental consideration she was juggling. her marriage, the desire for the best possible education for her children, she came from a family where education was extremely

important. going back generations in kansas, her family, her school teachers and educators, while her two parents didn't finish college. their sibling two of the three -- three of the four of them went to graduate school and two of the four ended up with phds, it was standard practice in that family to really invest a lot in education. and she was with that and believed in that for her children. if you wanted to accept the argument of her friends and of our children, she was juggling a real commitment to education and a need for herself to make -- to get her degree so that she could do the find of work that she wanted to do and make enough money to support that education. i didn't really answer your question about the themes distance. so i gave you the background. i would say that in -- i know more about ann dunham's thinking on this, than i do about the president's thinking about this. he told me, concern he referred

to his childhood, the constant motion of my childhood. he's very marked by that in one way or another. >> host: let me stop you right there. did you get the impression from the president that movement conveyed to him a sense of ruthlessness or adventure? >> guest: both. he told me he had made a choice in his life while there were things that he embraced in his mother's example, there were other things he did not. one of those, he chose very strongly not to have an expatriot life of that sort. >> host: quite the opposite. >> guest: quite the opposite. he says he understands the appeal. adventure, new people, great food, you know a certain kind of excitement. but he also felt for him that that also spoke a certain lack of commitment, an observer status, all with being the

outsider. he made the conscious decision to do the opposite, root himself in chicago, marry a woman from chicago, deeply connected to the chicago, and place as a primary value in his family the stability of his children. creating a real stable base for his children. i think that makes it clear that he felt he lacked some of those things. i have to say though, he also said he felt that his sense of his mother's confidence in his abilities and her extraordinary faith in his future and her what she described as absolutely unconditional love, gave him a kind of confidence that he said goes far beyond any kind of, you know, mark that was left by that constant motion. it sustained him through all of that. >> host: is there in your reporting or the conversations that you've had, any sense that through the years along with the

distance game a sense of separateness? >> guest: i think on the part of ann, there is evidence of that. it's not something that lots of people talked about. but there were very touching incidence that people described to me. one interesting one is that when barack obama was elected president of the harvard law review in 1990, '91, -- '91 i guess, there was a lot of newspaper coverage of his election. i've gone back and looked at a lot of those stories. it's fascinate, because you see the beginning of his telling of the life story, in the way we heard again at the 2004 in democratic convention and again at the 2008 campaign, the beginning of telling his life story. as he elaborates, and we don't know whether this is what the reports chose to focus on, what he chose to say. you see the greater and greater

telling of the story of his father and his mother is simply a white woman from kansas, a white american from wichita, anthropologist working in java. she returned to java and said to a friend who i introduced, i was reduced to one sentence. and she was always incredibly proud of him, but i also think she did have the recurrent sense of distance. later on another good friend and league of hers told me he worked with her between '90 and '92 in indonesia. they were working in microfinance and lived in a house that was full of development consultants and he worked closely and traveled around the country with her. so he knew her well. she said she sensed around the time that her son moved to chicago and immersed himself

that that life and his political career, that she had what this man described to me as a certain kind of wistful sense of his embracing this kind of the black part of his identity, something that really had not been a part of his childhood. the part that she was part of. and while he said there wasn't that she felt rejection, she felt a kind of distance, distancing, those are two stories. there was another instance, when he was a senior in high school she decided in a panic, according to a friend of hers, i've got to go back. this is the last year. the end of his childhood. he's going to be going off to college and leaving home. she made a decision to having broken down in a conversation with a friend in indonesia, made the decision to go back for a number months and be with him during that period. on her part, there was a real awareness. perhaps this is the nature of being a mother of any child, but

a real consciousness of or sensitivity about what is my place in his life. she was not the kind of person that i think to force herself upon her children. quite the opposite. she raised them to be very independent. she wanted them to be strong and capable of making their way in the world as she was. and she gave them values that she strongly emphasized the importance of doing things for other people, working for the benefit of other people, working for other people to have better opportunities. she set them up to have independent lives, lives that are independent of hers. i think she believed in that. yet in some part of her, like all of us who have children, she probably wanted a closer relationship. >> host: did you ever get a sense in your reporting or analyzing the various bits of data that are available, i understand in that case, there's probably less available than you

would like. you'd like to know more. you'd love to see more letters, obviously, the subject is no longer with us. you can't talk to her directly. there's more than you don't know than we do know. did you get a sense that 18 is a young age to become pregnant, marry, and divorce. any sense of trauma through all of that, or regret about that early stage in her life that any way, shape, or form manifested herself in the relationship with barack obama? >> guest: not that i'm aware of. you are absolutely right. you know, i got what i could get. and i think a got a lot. i got a lot more than anyone on this woman. but there must be much, much more to know. and the period in which you are talking about is in some ways the most elusive. because who is around who knew her well in that period? very few people. her parents are dead, her aunts and uncles were long distance away at a time when phone calls were not that common, people

didn't pop off to hawaii for a visit, she had cut off relations not intentionally, but just of didn't continue the relationship with the high school friends when she went to hawaii. there's the big break in her life that occurs at that moment. i think she was relatively alone during that period. i've never encountered friends that were close who knew her later and whom she talked about it. she was not a person incline to regret. there is an inpulsive quality to her. a combination of impulsivity as well as a feeling like once i made the decision, i'm going with it. and so i just don't -- i think while she took some steps in her life that you could by any objective standard decide in retrospect, perhaps not the best things to do, she tended to just move forward. and not dwell on them. i don't think -- i've never had

any sense that there was regret about her having given birth to her son. quite the contrary. you know, everyone that i interviewed describes him as being very central to her life and heart. and a person who she thought about a lot, talked about a lot, and she would constantly tell people what she was doing and her pride was enormous. nevertheless, what an amazing thing to happen. she was 17 when she became pregnant. even more remarkable. you have a biracial child in a country that is only beginning to address such a thing. it really turned her life. i don't know what her life would have been. i don't think it would have been a standard housewife in the suburbs. but it really when you conceive and give birth to a biracial child in 1961, that really changes the whole course of your life. and it happened at a time and in

a place that was opening up to asia and the world. hawaii and the east/west center. we had come to the university of hawaii at the time. and ail of the influence -- all of the energy on the campus, a lot of it had to do with foreign students coming in, and the extraordinary ferment that was occurring between western and foreign students. who knows. maybe these kinds of things would have happened had she been older, you know? so i've never had a sense of any regret. maybe just because constitutionally that's not what she was inclined to do. she did write a wonderful letter to a friend when she was 30 that i saw. she had been -- gone through her first four years in indonesia, back to hawaii with her -- this was in the period after she returned to rejoin barack and she had her daughter, maya with

her. she brought a friend and she was congealing him to give her information. don't hold back. lord knows i've screwed up royally more than one. i asked maya about that. maya says the term i've screwed up royally, she remembered her mother using that phrase. i think she had a resilience. thatthis is what the president o talks about. an ability to bounceback from her setbacks that kind of kept her moving forward. it was sort of a family trait actually. >> host: was she much of a letter writer to the president? do they have a lot of letters exchanged? >> guest: i believe she did. i didn't have access. >> host: for them to be born. >> guest: yes, exactly. i was told when she was living in indonesia, when she was doing her field work and went on to be

a consultant, she had a ritual writing. i don't think it was sent, i think she was writing a few paragraphs in an ongoing letter. he wrote back to her. i think he used to doodle and draw cartoons. i guess after her grandmother died, she found the cash maybe after her mother did, she found a cache of the letters collected. she copied them all and gave them to the president as a present. i know they are out there. i didn't get them. >> host: right. we will hope. maya describes her mother this way in one passage. as wandering through unchartered territory, we heard a description of ann's philosophy. wandering through, we might stumble on something that seems to represent who we are at the core. what does that mean? >> guest: here was a person

who had been born in kansas. you know, this is the great stereotype. the white woman from kansas. which, of course is so much more misleading than it is helpful. she barely, barely lived in kansas. anyways, she's an american from the heartland. she grows up kind of bumping from one place to another with her parents. and then she finds herself on the far western fringe of the united states at a young age. her life changes completely. she meets the man who's experience could not be more different from hers. a student from kenya, first african student at the campus. lolo, she had the great passion for metal work and baskets and rice hats and just fascinated with the texture of these really

they are on the cusp. she becomes fascinated and through that becomes interesting in the lives of people who are producing them. she emerges herself in lineny villages in java, where she does her field work, spents year interviews uneducated peasants, women who work in the industry, try to keep their families going. goes from there. here's a person that went from this when you think of prosaic american background to discovering these worlds. and indonesia itself and java is an extraordinary complex and deep place where many, many cultures and religions have mixed. it's all there on the surface. it hasn't been buried by development or modernity.

she arrived at a moment that it was true. at the poverty, people had fallen back. and she -- you immersed through those handicrafts in the whole religious mystical world that is deeply fascinating. and even spending two and a half years on the book, i don't understand. >> host: at the time, survey -- the survey work was more interested in what people did in created than all objects of art as it were. archaeology for centuries was finding brilliant things to put in a museum and polish up. then the survey, find out what people did and how they lived. :

how the women unlike herself for supporting their families under these circumstances. so yes, what she did is when other people were fascinated by the art and the dagger that is the mystical object she was interested in the men who need it. what the working conditions were like, what it was like to spend your life in a forge and the backyard and a tiny smoothy and who you sold to and got your rall materials from, how that

was affected by the inflow of the more global event. so it was that kind of really down to earth research that characterized her but i didn't quite answer your question. i was getting to this notion of the comment that maya made. i think she was a person who experienced that in herself and in a surprising being open to the world an aspect suppose is somewhat related to the natural temperament but also to the way she was raised as a child moving constantly, she had a remarkable intellectual openness. she was not judgmental. every one comments on this. she just kind of observed. she was inclined to observe the way anthropologist's due to allow whoever you are observing to socialize in that way and understand the inside and i

think that must have given her such cordially of the defining energy in her life that is what she tried to convey to her children, this notion to be open to these possibilities yes maya sometimes said wonder of the path and check out what ever this is off to the side and it may change your life. >> host: not by furor narrow definition to not build walls are on our results and do best to find king should and beauty in unexpected places. >> guest: yes, right and that is in some ways the heart of what president obama says he learned from her. this notion which we know so much from his message that the possibility of reaching across that seemingly vast difference in understanding of people who seem to be so different. he told me a wonderful story when i interviewed him about i asked him was there a time during the campaign you fault of

your mother particularly, not what she'd be proud of me, but as any kind of revelation about or the night of the iowa caucuses he said there was no indication at that point necessarily that the electorate like that was going to vote for an african-american candidate, but the night of the caucasus we went to the site in which the morning and he said he described the scene and an extraordinary range of people white, black, hispanic, young, old come some eccentric people. she said there was a man that looked like me and dolph and he had a television monitor somehow attached to the top running a loop of his campaign commercial, and he said you know, giving away that night leaving the site we had the sense that maybe we would actually win and i didn't

hear of in a way that i didn't during other times in the campaign because i thought not would she be proud of me what but wouldn't she love to be there at that site -- >> host: the way she thought it was possible. >> guest: i civil the site that captured and we had that sense we could reach across and make contact with people so different. and would be more good and evil in all of us which is very much his mother's mind of fog and he said i suppose that really is a naivete and idealism that i see in her and it's a naive idealism and me, so i think that quality is very much present in him. >> host: you were preparing for the book tour i'm sure the manuscript was done as this country was having a debate about the president's origins about the birth certificate, about why he, about these issues

in his place in america. i want to get your reaction to that as it was going on and you were preparing to do the book when quite clearly all those issues had not only been settled in your mind and as a matter of journalism, but concretely so. did you find yourself feeling estranged from the country or perplexed by it's d-day or enraged, what was your own personal reaction to this line of curiosity that he believed ensure is utterly groundless? >> guest: i do believe it is utterly groundless. it was unsettling. extremely unsettling. i've been aware of the issue during the campaign, and i thought it had been settled, and really have a kind of gone underground 411 tel donald trump fought back, and considering of the enormous quantity of well-documented reporting that was out there by the news organizations, by fact check.org, by political fact that was easily accessible on

the internet, not to mention the availability of the birth certificate which had been shown to be the standard birth certificate given out by the state of hawaii, republican and democratic elected officials in hawaii has come out and said that is the real document and the head of the health department had gone down and out of this triet considering all that to become so consumed, and it's not just the american public is the media, to become so consumed by revisiting that issue as though it were a real issue is disturbing. it's very disturbing as a person in a profession that is supposed to kind of help establish what is true and what is not true. >> host: did you find any ground on this particular ground in your research? >> guest: i certainly brought it up with many people. i talked to lots of people who knew her close to that time or

with whom she had described that period and remember a lot of detail about her relationship with barack obama, senior, so they covered a lot of that ground, and no one -- none of the fuel and i interviewed close to 200 people in this book, none of them knew of any evidence, never heard of any indication from her she had been in kenya during that period. i did look at all of the available stuff, you know, the birth announcements in the newspapers from ten days after his birth where the information could only have come from the health department or the hospital. >> host: it wasn't something you could randomly call from a pay phone. >> guest: precisely. so yes, i looked at everything available looked for all the reporting done, i looked at the remarkable stuff done by fact check dhaka -- factcheck.org and it's the same conclusion everyone has drawn, it's baseless. it clearly had something to do it some more profound quality in

the americans these days that they are willing to consider this about their president. >> host: i want to go back to this thing we were talking about a minute ago about stanley ann's philosophy not to build walls are on a whistle and find beauty in unexpected places but i went as i will always a person who isn't here to defend herself but i wonder if she is missing the word love it is a very powerful motivator in all human life, all of human existence. do you get a sense that maybe that was something that she never actually experienced in a way that is that resonated with her children are designated in a philosophical pursuit that perhaps to have love you need to be more rigid than she was were you need to find people in different places? beauty and can ship or two things. did she miss out on love and her life, do you think or does it matter? >> guest: well, i think that love probably gets defined

differently by different people coming and so what exactly you're talking about i'm not, you know, it might be helpful if you define a little bit more what you're asking. the and the use of the term of love. >> host: was it with her marriages in the relationship she had with her children, the separateness of the times, the distance, she's often described and i'm not sure that you would even validate this written a nomadic as her sort of existence perhaps that it perhaps as a pneumatic just wandering that in that there was either a search for or may be moving away from something that was painful or unrealized? >> guest: well, i don't think one would ever say there had been no love in her life. i think she had as a child a somewhat compressed was relationship with her father, which often spurs interesting things. and i haven't had any evidence

that her parents didn't love her and that she didn't feel loved by them and i certainly think that she loved her children and her children felt and i spoke and obviously at greater length with maya than the president felt her love, maya have no question and speaks about that and her mother would say that over and over to her children and she made it a point of being physically demonstrative with them in a way that i think according to a friend of hers she didn't so much feel from her mother who was a slightly more conservative conventional sort them ann. >> host: a bit more reserved in the demonstration. >> guest: exactly. and if she felt some extraordinary passion towards barack obama, senior. but it was clearly a very passionate encountered and she did not forget that man for the rest of her life and that

despite the fact she had a grievance having perhaps you could claim in both cases i mean they may have had grievances as well but this despite the fact the marriage ended and that usually leaves people feeling somewhat agreed, she rarely kind of grout on that more complained about them to a friend. in fact worked very hard to give their children a sense of them a positive sense of them to read and i think the notion of the existence as nomadic i understand where it comes from but i don't think that it's fair because she is at least half of her adult life in indonesia. she didn't wander the world. she was based in indonesia, committed deeply committed work that left a much bigger impression than the work that many of us do. she really changed people's lives in one way or another both directly and indirectly through

her microfinance work and the work in the ford foundation and even in her development consulting job so she was pretty committed to the country and to helping people in those villages. so i don't think she did travel a lot the way many americans who have global jobs now do. >> host: as a matter of course. >> guest: exactly. that's one of the things that's interesting, she was beating in the way the we believe now as a woman, as an american come as a parent much earlier and i don't think she had any consciousness she was simply doing what she felt was right or trying to make the best of a complicated situation. >> host: let me ask you what might feel like a trick question, it's not a trick question but i remember i came across a q&a you did on the internet in "the new york times" website with some high school students carries about journalism and writing and you advised one of them i was in a balanced diet with what you consume as a reader.

you set me assure you intersperse in the diet great books and literature. so the trick question is is their anything about stanley ann dunham that strikes you as familiar to us in great literature? is their anything about the art of her life or of barack obama's life or anything that has hit particularly resonant literary hope that we might have found or we might find an saw their work? >> guest: he obviously has something in mind and i am eager to know what it is. >> host: i actually don't. that's why i say it's not a trick question is open-ended. >> guest: i wish i had an answer to that because it's an interesting question but i don't come and there probably is a tribute to my ignorance, perfect response. my whole approach to her i never -- people often say what biographies were you reading. i didn't do it that way at all. i just became -- you can understand this as a reporter

got fascinated by her life and i just kind of dug in. i wasn't looking for, you know, residents with something else, and i wasn't approaching it as though, you know, the way a particular biographer who i'd admired had approached it and i can't really think of it as a biography although clearly it attempts to be something like that. i just think of it as a telling of the story of this person. >> host: noble as it is now. not notable but knowable. >> guest: knowable of course. >> host: the letters between the president and his mother will be a trove and the will be open-ended and i will be an enormous addition to understanding. i certainly understand. we waste no time kicking the envelope. [laughter] did you have fun doing this?

was it enjoyable or was it sometimes as a reporter you know something is out there and you wish you could get to it and you just can't and that can be a source of enormous frustration. did you feel that or -- >> guest: this was a thoroughly enjoyable. i've never enjoyed anything so much. so many parts of it. here was a person that people don't know anything about, even now and knew a lot less even when i started on this. a person who you can assume was a significant force in the life of a man who was central now to our political consciousness, national consciousness and to our just sense of the world right now. so it is completely virgin territory as far as i was concerned. no one -- very little had been written in detail about her, but during the campaign some good reporting was done but they're just wasn't much, and no one had been back to indonesia and track down all these people.

most of the relatives have never spoken and had never spoken about her, so it was just to start out it was a virgin territory. that's a very exciting thing for any journalist. on top of that, she was -- obviously as i said in this extraordinary life she had amazing fans and acquaintances and colleagues. so everyone i interviewed, many people had these fascinating global lives, raise children in transit the way she did or had done work in the areas that she did, and then i think, you know, a lot of time in indonesia, which i had never been there and that was full of surprises will only as an extraordinary place and i came to understand exactly why she became so passionately in love, but amazing things happen. like i was in jakarta in january, 2009, interviewing a woman i wouldn't have imagined

could have had a shot of finding such a person who had been hurt assistant in the second job she held for a couple of years in the early 70's in jakarta and while i was interviewing her a man came into the room and introduced him as salmon which as it turned out he was in his late fifties or early 60s at this point and had been a teenage house boy in the house in jakarta where ann and lola lived in 1970 and '71, and his job had been too kind of keep them on the president. he had been a teenager coming from a small village in java to try to help make money to support his younger siblings. so she remembered everything. it was a very impressionable stage in his life and remember the household in detail a whole cast of characters and what he did is what ann was like and what her relationship was like

stumble on this person in a city of 16 million people. similarly, i went out to the villages, some of the villages where she worked with a man who had been sort of the person she was most close to considerably younger than herself as a journalist towards the end for life and she was willing to give me a couple of days to take me to the places he had traveled with her which was hurt finishing up her research and in a wandering around the is the which is particularly the village which was the blacksmith village where she ended up sending her dissertation work of the encountered the middle-aged women who had remembered her as a child. they were the adopted children of the man who had been one of her great informants so that was just unbelievable. it was all grace. i enjoyed it enormously >> host: the text is in the book and i assure those kind of discoveries just increase your

energy level and the flow of the book and everything that's about a project like this. >> guest: exactly and having paid people to do this. >> host: exactly. let me ask about hillary clinton. i can remember when i covered the clinton white house hillary was one of the early exponents of the michael financing and microcredit as a development tool. and i wonder if you had any sense at all at what stanley ann dunham would have thought about hillary clinton as a political figure in america and as an american woman, as a mother, and maybe the irony that this woman i assume you might suspect she would have admired for a number of reasons came to be a formidable political opponent of her son and then a significant number of his presidential cabinet. that's kind of an amazing thing to think about. >> guest: it is amazing. there was a brief moment of fear intersection between the two of them and worked in new york in

the ngo called the women's world banking which is a network of the microfinance organizations around the world largely in the developing countries and they provided a lot of technical but vice and brought this not work together and and for the women's world banking and this is a run up to the and this is the conference what's it called, the world conference remember those conferences every ten years and this is the one that was going to be in beijing and they were doing a lot of the work that she did during this period, working to bring these disparate microfinance organizations together again, the whole reaching across the aisle, get a group of organizations that had traditionally been competing with each other to work together to come up with a platform for a microfinance planned for the platform in the conference on the women.

so she played a central part in that. there's a part in the book about that whole episode in her life and what ended up happening is that hillary clinton went to beijing and spoke famously about the microfinance, and that is the moment when the microfinance kind of blasted into the world consciousness. it had been around for decades actually, but it really through hillary clinton's speech it drew a lot of the attention of the world media and became something of a household world. well, she would have gone to that conference but she became ill in the intervening year and a half or two in the '94 conference i guess and then was not able to go. she ended up leaving that job going back to indonesia and becoming ill possibly being misdiagnosed on multiple locations and going back to hawaii and she died shortly after the conference so other people from the women's world banking went to the conference and came back and reported to

her. so there was a sort of moment they might possibly have connected. but i would think that she would add my ear hillary clinton and i would have imagined it would have appealed to her possibility that hillary clinton having run against her son is now working closely with him. i would be surprised if she -- and i know that she actually i'm told by her friends like bill clinton. >> host: interesting. we have about seven minutes to go and i bring up the two projects he worked on "the new york times" how the races live in america and class matters and i'm not going to ask you to distill the story through the prism of class and race in america in seven minutes, that would be unfair and unchallenged but if you could, give a brief distillation if it is possible how the class and race if tall factor into this story that you have been working on for so long.

>> guest: that is an excellent question if you will forgive me for saying so. it's complicated and i would like to have fought it out better than i have in order to give you a good answer, but one of the things the class projects was an attempt to look at the way, i'm sorry, the race project, to look at the way the race played out in relationships, not personal relationships but like working relationships and working in the united states people were working across racial lines, but there was a purpose it just happened to be that way. so there's a subtext of the race at a time we supposedly were not thinking so much about it but it turned out we were thinking a lot about it, and the project, the thing i did for that which relates to this and made me think -- i thought a lot about this when i started to write about then a senator obama would just treat people making a television miniseries and was

actually david simon's making the koren are in baltimore was the writer then there was a black director charles dutton and a multiracial second writer david mills who's no longer alive, and david mills talked to me a lot about -- from the perspective of someone that is multiracial and how he actually didn't feel it had been a particularly big issue in his life yet he was always perceived as we will bring in a black writer or whatever. and so i came to understand a little bit about that funny middle ground or that mittal territory that he described to me, and that is the experience of someone with a, you know, mixed racial background and it's just a new thing that bolt out of the kind of frame we were thinking about when we approached the project that there's the picture so much more complicated and the whole frame

of white and black is so out of date and a similar project looking at the class, the thing that fascinates me about the dunham family is that they were so well-educated and really middle class or even possibly upper-middle-class in various members of the family are quite upperclass now, partly in a measured by educational accomplishments and professional choices. yet during the campaign, the president emphasized his mother has the single mother on food stamps. she may well have been on food stamps quite possibly as a late graduate student, but it doesn't quite bring up the class position that we in fact was a class position of the family, so i guess my general feeling is it is all so much more complicated

than as americans we give credit for. >> host: i remember during the campaign senator obama would talk about having to get up very early in the morning, 4 a.m. i believe and his mother would say this isn't easy for me either, buster, and this was an example of what he went through but as his mother required of himself and herself. what does that tell us about who she was at that stage of life and what may be that invented and him going forward? >> many people said they felt that his work ethics from the becomes somewhat from his mother. she worked extremely hard but she also believe in education. as i said, very deeply, and the importance of taking advantage of the educational opportunities offered. she did not like her children to be slackers. that is a recurrent theme and

that quote comes from a period in their life when she was about to send him back to hawaii or school and was trying to bring up to speed on the english language learning which he hadn't had an indonesian schools, so she was getting him about four, 4:30, and telling him to get to work. it reflects so much of that exact quality, demanding of the exact quality in the way she raised her children on that issue. >> host: was he listening to things, with a talking, how did that education play out do you know? >> guest: it was sent to hawaii by his grandmother. later on, there was a system which maya was raised within a school of baltimore that had a kind of distance learning a precursor of business learning. they would send boxes of material. i don't know whether he was doing calvert or whether his mother was simply gathering up, it was workbooks and that sort of thing and as i say it was mainly to get him up to speed so

he would do well when he got there. >> host: anything that you've discovered about them that could be symbolized in a gift or keepsakes or something either that she had of his or he has or in any way interested? >> guest: i don't know about him verses her, but between the two of them i just i don't know anything about that that i can think of right now. but when she died, she had a huge collector of stuff she had gobs and gobs of stuff, that he collection trunk, jewelry and i think of it is the jewelry diaspora because i would interview people and they would say by the way, i got these from ann and they would come from the interviews wearing clothes they had inherited when she died. her stuff went everywhere and so i wouldn't doubt that some of

that is with him but i don't know specifically and then there were wonderful books i saw, children's books, classic children's books that were now in an archive in hawaii from when he was a very young child and i guess she may have even taken to indonesia things like peter and stuff that are still around with her riding in them and any way. >> so she left a fashion in print as well as a jewelry in print. >> guest: i don't know that the fashion in print is widely adopted. >> host: bup weld remembered for sure. janny scott, "the new york times," the book is "a singular woman the untold story of barack obama's mother." thank you very much for joining us. best of luck.

siddhartha mukherjee won the 2011 pulitzer prize for general nonfiction for "the emperor of all maladies," a history of cancer. what dhaka the documentation of the disease and the development of radiation and chemotherapy treatment. this is an hour and a half. >> i have a very personal relationship to the bookstore. i was a student there a close by here and undergraduate from a foreign country, and when i could get my spirits up, i would like to this bookstore and spend time here, and its -- there's something wonderful about things coming back. so think you very much for having me here.

and thank you for those of really wonderful words of praise. i must say though my favorite prey is that i received for the book came this morning when i was reading to my e-mails and someone sent to me a little note from a boulder who says are there gift notes four busbee seven." [laughter] it was through my lifelong ambition to have a book to which there are cleft notes. [laughter] so, if anyone is inspired to write cliff notes, please let me know. i would be delighted. [laughter] i thought i would begin today rather than talking about the content of the book i thought i would begin today by talking about the process because that's more interesting. it's something you don't get from just reading the book itself. it's sort of a behind-the-scenes look at what motivated some parts of the book and how it got written. firstly after offer a note of apology which is that this book

was when it was finally handed in its draft form was three times its length. and by necessity of a vast amount of affirmation had to be cut. you cannot. there is a fundamental -- my editor said 500 pages is the final limit. no more and we ended up with about 600 the was a bargain. but nonetheless. so, i have to start with the note of apology saying that not every story could make it into the book. so, i would welcome other attempts to write for their history is that would continue to be part of our lives in the future. with that said, i want to talk a bill about the process of writing the book and the first moment, one of the most pivotal moments in the riding of the book happened sometime early on a when i was confronting the fastness of the challenge and

this is here you have a history that spans about 4,000 odd years and about 100 odd characters that move in and out of the book. the our scientific terms, there's sometimes in the political terms the politics finds and of course in the middle of all of this or this kind of willed of stories, and i was having a conversation with my very excellent editor, nan graham and she said something very pivotal to me. we were talking about something completely different, and she said that in the end if one forgets the book publishing industries, if one forgets for a second the best paraphernalia that allows it to come into place, the bookstore, the actual product, the printer, the business of the bookmaking, the marketing etc, she said you know, in the end, a book is an amazing instrument by which one author sitting alone in a room can talk to one reader sitting alone in a room and that comment

resonated with me very deeply because i thought to myself if you forget for a second the last paraphernalia of medicine, the capstan, mri, the billion dollar devices, the national cancer institute, a wonderful crown jewels of medicine that are addressed in this country and others, in the end, the act of medicine is a mechanism by which one person sitting alone in a room can talk to another person or one doctor can talk to one patient sitting alone in the room. that analogy was very deep for me because it reminded me about what was essentials and was not essentials and the essential piece is that much like a book medicine is about storytelling. medicine begins with the most sharnak act. if you take away all of its paraphernalia ultimately medicine begins with someone saying tell me your story. what happened? and that is the first thing that happens when you meet a doctor is that you begin to impact a

story, and as i make the claim in the book, the doctor then tells the story back to you and it's this interchange, ancient interchange, one of the most intimate changes we have as human beings and that itself, that process in itself begins the unpacking for the unburdening of the illness long before you received your first dose of whatever medicine you will or will not receive it is the unburdening of the story that is the first shenanigan act of medicine and actually if you forget that, it seems to me something very important would stop happening in medicine, and once i had come to that realization again inspired by this comment, it began to become very clear to me how one could write this book again remembering that there was a vast history but it could be written through the eyes of patients, it could be written by telling stories, and if i could

tell stories that began after the right time for a thousand years ago if i could fulfil those like flesh out these stories, then what seemed like an insurmountable problem which is how does one tell this history would become actually solvable which is tell the history by moving from story to story, typically focusing on those who were right there, those who experienced it the most directly and that is the patient. now again, that was the solution and the principal of the problem. but then that raises the second question which is how does one find these missing stories? how does one uncover the story of a woman who experienced breast cancer in the 1950's? remember, ra recalled a moment in time in 1950 in fact when a woman calls up "the new york times" and she says i would like to place an advertisement for

survivors of breast cancer and "the new york times," the society editor says well actually we can't print the words breast cancer in "the new york times," what if we said we'd are the survivors were bush women -- this is 1950 and actually when "the new york times" came to write about my book i said i sure you print that because it's a reminder for all of us in putting us we need to be humble about what can and cannot be achieved here. so this was the background. the missing stories, the word that can't be uttered a word that is whispered about, and again the question is what were the stories come and won a threat that came very early on is i knew that somewhere in the story would have to be the story of one of the most remarkable when in in the recent intellectual history that is

merry laughter who among many other things deduct her philanthropic energy. she was a very unusual woman for her times and an entrepreneur, a person that then directed a large amount towards solving actually as she put, transforming the geography of american health, the landscape of american health, and if there was one sort of central characters been in for the story it would be married, and then very quickly i found sidney who begins the book and was her friend and scientific collaborators and if she gave political legitimacy to the war of the cancer and provided a kind of scientific legitimacy for the war on cancer. so the book then begins with sidney farber, a pathologist.

we begin in the 1940's. he was a so-called doctor of the bid because premier li, the psychologists would perform autopsies, there was very -- he was a public just specialized in children's pathology and bodies of children who died in the hospital would be moved down into his basement laboratory and the laboratory was no bigger than about you know, 12 feet by about 12 feet from a kind of a frozen kube at the bottom of one of the buildings so that's where we are in 1948. and then farber began interested in finding a mechanism or understanding of the disease which was extremely lethal form of cancer and that was a childhood acute lymphoblastic leukemia. it is a disease that typically although not always affects children, and usually all the 1950's it was almost uniformly

lethal. 100% mortality. often kids would dhaka committee would be diagnosed within and they would apply a week or two weeks, sometimes they would live longer and by soon dr.. farber began particularly interested in this command one of the reasons was that leukemia, unlike many other forms of cancer, could be counted. and as a talk about in this book, science begins measurement. whenever you can measure something you can begin to perform a scientific activity on it. and this is a time for the cat scan and mri, so it was very hard to count the site of a tumor because was buried inside. but leukemia because it is a tumor of the blood could be counted because you could draw a drop of blood or perform a biopsy and in the bone marrow or in the blood, you could see the death or the life of the looking excels and thereby you could say this worked or didn't work. it was an objective mechanism by which one could have a conversation about the, you know, the increase or decrease of the third leukemia cells and farber became very interested in

this. now, she soon figured out of the things i would be interesting is to find a chemical and would thereby kill these cells and launch and he launched the history of chemotherapy but he didn't have this. it turned out that there was an indian chemist, a chemist born in india. her name was yella and she can to harvard to study at the school of tropical health. now, what yella didn't know is as we all know there's nothing a tropical about boston. so, yella was stuck in the middle of the winter, stock in the middle of winter and couldn't find a job and found a job in fact planning urinals, the was the best job. he found a job in the department of biochemistry and made several very fundamental discoveries.

in fact yella discovered adp which is a important molecule and because sent off from harvard to send himself off to a pharmaceutical company in new york it was a subbranch of the american company and they're took a big problem and that is should begin to synthesize many synthetic versions of finance and one vitamin that was particularly interested in was called for what acid. and in the past, an english physician, a young woman said a solid acid was responsible for the growth of normal blood cells in other words often in women

particularly in pregnant women that efficiency if you didn't have enough folic acid in your blood wouldn't grow normally. so, farber began to put these together piece by piece and started wondering well, wait a second of the fall of acid is required to make normal blood growth then could it be that if you block the fallout acid you can block the growth of malignant riches leukemia. so in other words, said to himself as the focus of the factor, a key factor for the girls of normal blood cells, then could one take an antifollowed and thereby blocking the growth of the leukemic cells so he began to synthesize and this was the drug that yella had discovered during the process of finding the fall like the fellow the opposite of chollet semper some the size and so farber wrote to yella in new york and yella sent an antifollette and began to inject, farber began to inject children with these and have a

look and demonstrated one of the first times in history as a mission in a childhood lymphoblastic leukemia and thereby invented the chemotherapy and that is the 25 moment in which he comes out of his basement and in fact, the idea of using in an antimetabolite and isolate is central to the way that we perform today the many forms of cancer. so that is the back story. but the fun story is if that is the case, if it's the case that there's this interesting story then who was the patient, who was the first person to receive full gas it because again i want to tell this from the eyes of the child receiving chemotherapy, not the eyes of just a scientist and the minister but because it seemed again that would violate the fundamental principal of the book. and so than this was about 60 of the book i said we the second i have no idea what this child is. on page 60 and i can't find for the first patient, series of patients with leukemia. the only thing i knew about this

child was that he was 3-years-old and that he had lived in boston and his initials because that was in the paper. so i was in boston than and i began to send out these e-mails on the list which would say if you happen to know a child with leukemia in the 40's please, call me, please write to me, etc. and months passed by and there was absolutely nothing. there was no response. so i could saying to myself and on page 60 this is never going to get written. then i got rejected and i thought i went on vacation to my parents' house in india, and someone said to me yella has only one biographer a. siegel biographer was written that i know of and someone said to be the biography is 85-years-old but he lives three blocks away

from my parents' house in india. [laughter] and so someone said going to talk to yella's viagra fer. saugatuck to yella's biographer and we are having a conversation and talk for an hour about his chemistry etc., etc. peery i am about to leave and he says wait a second before you go i don't know if you're interested but i was in boston in 1950 visiting the clinic in order to compile his eye of become and i have all -- i have a roster of his patients with leukemia. and this was a stunning moment for me and out of the file came a series of patience names and pictures and that's how i found this child, this missing child and rs was robert sandler, the three-year-old child and in fact the boston sunday herald had printed a picture of him in 1948 when he had just begun to respond to chemotherapy because

again this was a historical moment. but of course, none of this is searchable. this is a time this is not indexed, so would have never, ever discovered him. so in a sense this became a metaphor for the writing of this book which is that you might look for something and get in reality might find it 6,000 miles away. the second metaphor is things always come around. there's a similarity to the process, to the history. and so i came back to boston now armed with the name of this trial and then using of the medical records and the boston directories address book i could find his parents name and then using the death records which is actually publicly acceptable, i could find an exact time where he died, where he had been buried, where he lived, etc.,

etc. and all of a sudden the story that had vanished came alive for me and that's how come again that all the book was written. so the first passage in going to read to you is now going to be what i call now that i've given you the behind-the-scenes look is the front of the scenes look about what happens once you have done all of this legwork as it were and found this child, how thin you can construct a story because again, piece by piece, for me it all started coming together. so here is a section in which i now reconstruct this story of this child having visited his house. 7 miles south of the long hospital in boston, the town of north chester which is where robert lived as it turned out, there's a typical new england suburbs, the triangle bridge between the settlement of the west and the green atlantic to the east. in the late 1940's, the jewish and irish immigrants come

shipbuilders, odierno, a railroad engineers, fishermen and factory workers still occupying the houses that snaked their way up through the avenue. again, part of the rising of the sentence is now i could go back into the history of north chester and read about the history and thereby reconstructed it turns out that his father was a shipbuilder. so again, she was linked into the larger history of the town of north chester. he begins invented himself as a suburban family town with parks and playgrounds around the river, the golf course, the church and synagogue. on sunday afternoon, the family's converged a franklin park to walk through the parkway or to watch the ostriches, polar bears and tigers at the zoo. a kind of small note here which is that when i was writing all of this i kept thinking i went to his house and i looked out what might have been his window i don't know what he saw that it looks out into franklin park which is at that point of time and part of it was a zoo and i

kept thinking to myself if i was a 3-year-old child what what i remember most out that sue? i had a 3-year-old daughter denney and i kept thinking what would it be? i thought to myself would have to be dannel because it took only a couple of readings to figure out that there were ostriches actually become to the north chester park zoo and what was mice is that the history if someone came to me i was doing one of these readings in seattle if someone came to me and said how do you know there are no ostriches in those new? and was said so nice to me as a writer that filed away somewhere in the back of my cabinet was a little argument at the zoo but it was very nice. strange odd things that give you pleasure as a writer. on august 16th 1947 in the house across from the zoo the ship worker in the boston guards phil mysteriously ill with fever that wax and wane over the to years followed by the increasing. robert sandlin was 2-years-old,

his twin it turns out he had a twin eliot was an active tolerance perfect health. stranger than fiction, we talk a lot in this book about how genes are the activator to cause cancer. if you wanted to find a mechanism to describe this, to describe the role of the carcinogens and the abnormalities and the idea that there is -- there can be a family history he would probably choose the two identical twins and one of them would develop cancer and the other would not and about what allow you to begin to enter the biology of what makes one have cancer and yet, you know, i didn't ask for this and of course there is a twin, and therefore this sets up the capacity for the discussion to happen down the road about this idea of what does the twin mean in genetic terms for cancer, i will come to that. now we enter farber's paper again and just a reminder of how

dense beam plighting can be because in a very cold clinical paper there is the story of human beings being told and whenever the doctors exchange clinical papers put your exchanging again i think our stories dressed up in technical language but ultimately the same stories and so we turn to farber's paper and just literally i am restating what is in the paper. ten days after robert's condition worsened significantly. his temperature climbed higher, his complexion term from rosy to a milky white and she was brought to the children's hospital in boston. the spleen was down like an overfilled bag and a drop of blood under the microscope revealed the identity of the illness, thousands of amateur leukemic chromosomes and am unconvinced and clenched fist. sandler arrived at the children's hospital a few weeks after farber had received his

first package from yella. on september 6, 1947, she began to inject sandler with acid, the first of the yella's antifrolic. consent to run a trial for the drug even a toxic drug was sent to bulkeley required. parents who were informed about a child of the children were almost never informed or consulted. the nuremberg call for the next fermentation requiring explicit voluntary consent from the patience was drafted in august 9, 1947 and that is literally one month before this drug, less than a month before the trial and it is doubtful farber in boston had ever heard of such a required consent code. the drug had little effect and turned increasingly lethargic and developed a limp in the spinal cord. in the period in the violence migrating pain and the leukemia burst for one of his bones causing a tractor and unleashing a blindingly tends indescribable

pain. by december, the case seemed hopeless. the tip was tense in the cells and dropped onto his pelvis. he was withdrawn listless and pale on the verge of death. september 28, however, and we know that from the papers, farber received a new version this one was a chemical with a small change from the structure of paa. farber snatched the drug and began to inject the boy hoping at best a reminder of the cancer but the response was marked. the white cell count which had been planning astronomically 10,000 in september, 20,000 in november, nearly 70,000 in december suddenly stopped rising and hovered at a plateau. then even more remarkably the account actually started to drop. the leukemic cells fifth out of the blood in all but disappearing. i new year's eve, the count dropped to nearly one sixth of the value. bottoming out at nearly a normal level.

the cancer notably haven't vanished. under the microscope there was still malignant white cells but it had temporarily evaded, frozen into the stalemate in the frozen bottom winter. january 13th, 1948, she returned to the clinic walking on his own for the first time in two months. his spleen and liver had shrunk and so dramatically that his clothes, farber noted, had become loose around the abdomen. again, just a little of starvation and a clinical pittard. this is farber writing, and he says in a remark, the close of the come was ahead of the abdomen and what an amazing leavitt description. i mean if he wanted to is described the remission of a child with leukemia what an amazing choice of simple words the would tell you that this child had become so swollen that his mother had to make new clothes, and now this child with the spleen reseeding his clothes have become loose and his remission. again, you know, you don't require very much to go to a medical paper to reconstruct a story that so vivid.

his bleeding had stopped, his appetite had turned ravenous as if he were trying to catch up on six months of lost meals. by tiberi, farber noted that the nutrition and activity were equal to his twins. for a brief month or so, robert samford and elliott sanders seemed identical again. now, like all stories this one also has an adult and the above what is more amazing than even the story itself. about ten days after the book was published i got a phone call from my editor and said you need to sit down because this is an important phone call and i was riding on my computer and i sat down and it was elliott sandler on the phone, and he had walked into a bookstore never having known about this book remembering a story of his twin who had died at 3-years-old, and people who have a copy of the booknotes that the book opens

with to robert sandlin 1945 through 1948, and to those who came before and after him. and he opened the book and he lives in maine. i would have never found him. he lives in maine. he opened the book and he saw his brother's name. the brother vanished from his life at 3-years-old and moved then and went back and he told me this amazing story which is his mother, helen, whose picture is in the book because i found her picture from the saturday morning post, saturday evening post, helen and robert and eliot and the whole family was jewish, and this was a time when this still remains she was a deep believer and as many of you might know performing an autopsy is considered a violation of sanctity and helen didn't want her child to be autopsied but

farber was it has colleges and the only way he knew could he learned from the remission was to perform an autopsy. and so farber had begged helen sandler to let helen, to let her open robert's body and perform in normal autopsy and she refused and finally he had a really big hurt and said you go for the sake of medical history and the sake of medical science from the body and she had said fine we will do it. ..

i think i have time for one more passage that i am going to read. and this is from the end of the book, and which takes up a very different kind of challenge. the first kind of challenge i describe to you is the challenge of story making, which is how you populate the boat. so with the challenge that appears in the content. a book like this face is a very different kind of challenge. that is a challenge of summary making. at the end of the book, had you summarize 4000 years of history? how does one prepare -- how does one tie up all of this. the quick answer is there is no simple solution. one of the challenges in this book as there is no pat answer. this is how you kill cancer, eat broccoli.

or some nonsense like that. and so, here i take up that challenge by actually performing an experiment. and i recount this story -- early in the book i recount the story of a persian queen, who is described in no less than about four lines and becomes one of the earliest descriptions of what might have been breast cancer. again, we don't have a word for cancer in this time. she's sort of inviting history, which is the description of the early history of the west, particularly focusing on greece, sends a little bit of a message, throws her off in about two or three lines. he describes this idea that the queen of persia developed a malignant -- swelling in her breast, a mass in her 79 as some

describe it. her response -- she was so ashamed that she had herself in her ashamed. again, remember 1960 and colin at "the new york times." she wouldn't let anyone examine her breast until the greeks live called thomas of these intervenes and promises to cure her and does so by performing one of the first recorded mastectomy or lumpectomy lumpectomy is a breast cancer. a test that is very grateful and as a return favor, she tells him he would persuade the king of persia, who is invading the eastern border of persia. she will persuade him to invade the western intuits greece so that commodities can return back to his native greece. and in doing so, this launches the persian war. so here's this woman -- and i'm

actually coding -- literally quoting from the histories. this is the moment in the history when the face of persia as it were returns from its eastern face to the western face because of this illness that told the house. this launches the early history of the west, the persian wool and the turning of the face of persia away from its eastern border towards its western border, lunch is this very well know the persian wars. so now, 500 pages later, we returned back. the persian queen who likely had breast cancer and 500 b.c. imagine our traveling comic. and reappearing in the hmx. she listed the arc of history with a tumor frozen stage and behavior the same.

her case allows us to recapitulate past advances in cancer therapy and consider its future. how has your treatment and prognosis shifted in the last 4000 years and what happens later in the new millennium? first, backward in time in 2500 b.c., she has a name for her illness, i hieroglyph we cannot pronounce that provides the diagnosis and there is no treatment he says, closing the case. and 500 b.c., and i start to me is by her greek slaves. 200 years later in chest, hippocrates identifies the tumor as giving her illness a name that was bring to its future. incidentally this is the name cancer because hippocrates imagines cancer as a crab buried under the skin and the blood vessels spread out like the legs of the crab under the sand, right from its moment of inception, and cancer is a

metaphoric disease. it permeates this illness. a thousand years/by anatol says black file is perched on her body coming at the tumor keeps growing, relapsing. medieval assertions understand little about her disease, but chisel away with niacin scalpels. some offer -- and these are real documents drawn from historical texts. frogs blood, holy water, crab taste, chemicals as treatments. in 1778, in london, her cancer is assigned a stage, early localized breast cancer or late advanced invasive breast cancer. for the former, hunter recommends a local operation and for the latter he recommends are no sympathy. when a tulsa reemerges, she encounters a new world of surgery, her breast cancer is the boldest and most definitive therapy that's part, radical

master to meet with the large tumor of the deep chest muscles and lymph nodes in the collarbone. in the 20th century -- by the way, i go to the story of the treatment the feared it turns out to be essentially a failure. it takes 90 years before patients and that truth can begin to convince themselves to really put the idea of radical surgery to test. when it's put to test 90 years after his convention, 500,000 women were treated with it later, it turns out to be no different from non-radical surgery. in the early 20th century, oncologist tried to use local x-rays. in the 1950s, another generation surgeons combine the two strategies by moderation. atulsa's cancer is treated locally with a simple set of three or at lumpectomy followed by radiation. dussehra paddock surgeries diminish the chance of a

relapse, her tumorous test positive in a recapitulating things. they test positive for the oxygen. the chalice further discovery to be too amplified in addition to surgery, radiation, humanitarian tamoxifen, she targets therapy using reception. it's impossible to enumerate this precise impact of interception in a atulsa survival, and just does not allow a compared between her fate in 1989 from the surgery, chemotherapy, hormonal therapy and targeted therapy is likely headed anywhere between 17 and 30 years to her survival. diagnosed at 40, atulsa can reasonably be expected to celebrate her 60th birthday. her breast cancer takes another turn at diagnosis at an early age in their ancestor was a question of whether she

mutation. these are terms introduced in the book. atulsa's genome is sequenced in a genome is found. she detects the appearance of a tumor and are unaffected breast. her daughters are test, found positive for brca1, they offered neither screening, lumpectomy is our tamoxifen to present. for her daughters commend the impacts of screen and prophylaxis may be dramatic. a mri might identify a small lump in one daughter and may be found to be breast cancer in surgically removed in its stage. the other data may choose to undergo take bilateral master mastectomy. schmidt about her life for you breast cancer. each one of the sentences corresponds to a seminal clinical trial. it basically has an oncologist, each refers back to very major single clinical trials to prove or disprove a particular way of

management of brca1 positive breast cancer, but does so i hope in a way that's understandable and somewhat humanized. moved atulsa into the future. in 2050, atulsa will arrive better as cancer clinic with the enticing was never cancer genome, identifying every mutation in jean picker mutations may be organized into key part ways and algorithm might identify what contributes to the growth and survival campers. therapies may prevent a relapse of her tumor after surgery. she might begin with one combination of targeted drugs, expect to switch to a second cocktail and switch again when it mutates again. she would likely take some form of medicine whether to prevent comic here or palliate her illness or the rest of her life. this indubitably is progress. before we become deep does the her her survival, as worthwhile

putting into perspective. give atulsa pancreatic cancer and it unlikely to have changed in 2500 years. if atulsa develops gallbladder cancer and is not admitted to surgery, only changes virtually averse to centuries. as cancer and that her tumor had metastasized and been negative, in response to standard chemotherapy, her chances of survival would have barely changed since the time of hunters clinic. give atulsa tml leukemia or hodgkin's disease and light beyond my increased 30 or 40 years. part of the unpredictability about the trajectory in the future as we do not know the biological basis. we cannot yet fathom for instance but takes pancreatic cancer of gallbladder cancer so different from cml or atulsa's

breast cancer. even the knowledge of cancers. as richard suggests and has atulsa epitomizes what mice will focus on prolonging life rather than eliminating debt. this war and cancer may best be won by redefining victory. so that is a second passage. how are we doing for time clerks is there time for one last passage? or should we rather appear? i'm going to read the very last passage in the book. it's a very short passage i think. it's the final summary of the boat. this passage was actually probably the hardest for me to write and in fact goes back to the question that john todd about what i had written this book. it was written as an answer to a question that a woman had raised and so we return to the story

about women. this is an incredible woman who i treated while a fellow in boston and she had an abdominal sir, and had relapsed and had another relapse, incredible remissions caused by what was then a knee-jerk called imagine it were d5, striking remissions. she had an unbelievable. true. she was a psychologist and she had essentially followed the trail of this drug threat the country, moving from one click to the next, and one herself and trails, getting information, creating her own community every time around herself and she would engage the community and ask questions and then put herself into those trials. she had at one point in time receiving chemotherapy, using one of these drugs while living in a trailer home she found her

cell phone site is since you are fun to next one, almost like she was creating her own trail around the country. unbelievable person. finally, she had her last response and her tumor became completely resistant and would not respond to even the newest forms of therapy. so, this is the last time i see her. so i pick up the story. the new drug, the last time she had to reduced her temper response that does not work for long. the february 2005, jermaine's cancer is spiraled out of control but she reported on the scales every week. even her pain eventually made it impossible to walk from her adored had door and had to be hospitalized. my meeting with jermaine was not to discuss their peace and to make an honest reconciliation between her and her reconciliation. as usual she beat me to it.

when i entered her room to talk about the next steps, she waved her hand in the air and cut me off. the goals are not simple. she told me no more trias, no more judge. the six years between 1999 and 2005 has sharp end, clarified in concert. she is severed her relationship with her has been in intensive add-on with her brother and colleges. her brother, a teenager in 1999 and now it mature software grantor ally, confident, sometimes nurse and closest friend. cancer breaks some families and make some jermaine said in my case, did both. she wanted to go back to alabama, her own home to die the death she'd expect that in 1999. when i recall the final conversation with jermaine, embarrassing the enough, the objects seem to stand up more vividly than the words. the hospital but they sure smell of disinfectant and hand soap

from the unflattering overhead lightcomedy with a side table the windows with pills, books, newspaper clippings, nail polish, jewelry and postcards. a standard issue referred with a bunch of sunflowers perched on the table by her side. germane as i remember was sitting by the bed, one leg dangling casually down, wearing her usual eccentric combination of clothes and some large initial pieces of jewelry. her hair was carefully arranged. she looked frozen, formal and perfect for someone waiting to die. she seemed content. she laughed and joked, made worrying and nasogastric tube seem effortless and dignified. only years later in reading this book i finally put into words why that meeting must be feeling so uneasy and humbled, with the gestures seemed larger than life where the objects seem like sentinels and my jermaine herself seemed like an actor playing a part.

nothing, i realized, was incidental. the characteristics of jermaine's personality that were once spontaneous and impulsive or casually did an almost. almost reflexive to her illness. her clothes were loose and did it because they were decoys against the growing outline of the tumor in her abdomen. her necklace was distractedly largess to put attention away from a cancer. aruba's topsy-turvy with with baubles and pictures, the hospital room filled with flowers and cards stacked to the wall because without them it would devolve into the anonymity of any other room in any other hospital. she damaged her leg at the angola because the tumor had invaded her spine and began to paralyze her other leg, making it impossible to sit in the other way. her casualness of the study, jokes rehearsed. her illness to try to humiliate her and made her anonymous and seemingly humorless. she died in a hospital and thousands of miles from home and

respond with avengers, moving always be one step ahead, trying to outwit it. it was like watching someone locked in a chess game. every time jermaine's disease moved from imposing yet another terrifying constraint on her, she made an equally assertive move in return. the illness edited and she reacted. it was a morbid, hypnotic income a team that had taken over life. she dodged one blow, only to be cut by another. she too was like carroll's red queen, step pedaling furiously to keep still in one place. jermaine seemed that evening to capture some thing essential, that to keep pace you need to keep inventing and reinventing strategies. jermaine dye cancer excessively, desperately, fiercely, manly, zealously, as if channeling the inventive energy of generations of men and women who thought cancer in the past and would fight in the future. her quest had taken on a strange and limitless journey to

internet blogs and teaching hospitals, chemotherapy and clinical trials halfway across the country to landscape more desolate, desperate than she imagined. she deployed every last morsel of her energy to the quest, mobilizing and we mobilizing the tracks of her courage, sending her well and wit and imagination until that final evening she stared into her resourcefulness and found it empty. and that haunted by snape, hanging onto life by no more than a tenuous thread, summoning all her strength and dignity as she bills herself to the privacy of bathroom, which encapsulated the essence of the 4000 year old word. jim 2010. thank you. [applause] [applause] >> hi, dr. mukherjee will take questions now.

i'll bring down a microphone, so please do to your question to you at the microphone. also, because this is filmed for tv, for privacy reasons, please don't ask any personal questions. thanks. >> personal medical questions. you can ask questions about me. actually, i would start if i may by asking john a question. and that is, tell us a little bit about what is happening at the national cancer. you've come there from washington? what's happening at the national cancer institute and what you imagine will be happening in this administration with respect to cancer? >> thank you. an excellent question. i was most impressed by your eloquence and ability to communicate. i really think they been able to educate america and the world about cancer, it is really my

hope that someone in a field other than medicine will probably be the one to find the answer to cancer, just like nature tends mustard gas was found on the battlefields. one lesson i've learned off-limits to medical students, the youngest trainee who asked the most provocative question and who moved the field of medicine forward. they really want to congratulate you. i was most impressed during your discussion of serendipity. and i really hoped that maybe the opportunity for someone here tonight to think of new answers, just like the apple slogan think differently. there's a lot of excitement in washington d.c. right now. there is a pitched battle to either change or repeal the affordable care act. the one area that continues to move forward is the amazing amount of work clinical trials and studies that have been

undertaken at the national and the tooth of how the national cancer institute. i hope ford the budget to be able to be approved and funded will be preserved to continue out the incredible work that is being performed at the national cancer institute. the institute offers to mend his hope for patient from the entire world. and it appears that the commitment of the obama administration to discovery, to innovation will continue. i think for cancer patients that there were many great things yet to come. >> what are the battles? who is fighting where? >> the battles are political. they are about how we are going to change or repeal the affordable care act.

and one of their many strategies -- i would return your attention to an article from "the wall street journal" "wall street journal" last year about strategies to either defined, disallow, repeal or to change the legislation passed last year. he really is my hope that we can be constructive and to move about the acrimony of the debate and identify portions of the law, which are working well and identify the ones that need to be improved and to keep this process of health reform moving forward. >> it's absolutely vital. yes, question. >> hi, i'm dr. jordan wilber, and and old-time pediatric oncologists. what i want to do is make a comment. you have written a fantastic book.

but i knew most of the people and you have them right on. >> thank you. >> thank you. one of the things because of the constraints of time, i mean, to draw a character in a book like this, one of the ways is it really relies on lots of primary interviews, aside from the archival research. a lot of primary interviews. i think there are about four or 500 interviews that went into the book, carried on overtime. even for instance painting a picture of sidney farber was to do that, to comment him from different angles. you know, what is important is human beings are complex. even a character like firebird, a lot of people didn't like him. he was an unpleasant character to some. it's important to convey because otherwise you read a history that's not real. thank you for your comment.

>> have you ever been to a doctor and a -- and a war? >> that's a good question. i have never been a doctor in the military forefront, but one might say that this is also a war in the sense that when sometimes we fight wars between people and human beings fight each other, but sometimes we fight even more important wars against things we can't see. i might add that cancer is one such entity. i don't like using the word were sometimes because it feels as if patients become soldiers.

if he does survive, you become a loser in such a war. so i don't like using a metaphor. for some people it works. for some people, imagining us in a battle against cancer is important. the usual approach to all of this is a metaphor that works for you, use it. who am i to tell you what metaphor works for you. so yes, the quick answer i've never been a doctor in a war, but i have been a doctor in the more abstract war. there are other wars that are also being fought now against more abstract entities, political wars. part of that is also part of this book. how does one fight a political war and create strategy, which is not only scientific strategy because one thing we know is if we are to engage cancer, with or be war or not, if we engage cancer, the solution can't just be a scientific solution.

it will never be a scientific solution. there have to be political, cultural solution all this comes into the pool. eradicating tobacco -- one does not require your a solution. you know, solving the genome of pancreatic cancer is completely different, but requires another kind of strategic element. every piece of us, every piece of us as a human being is somehow engaged in everyone contribute. >> you seem to be speaking primarily of cures for cancer. i'm wondering about prevention. it seems to be increasing research going on. vitamin d is a popular issue. could either one of you comment on your outlook at preventive efforts that are being made in any optimism there? >> well, i have several comments about that.

there is a large section of the book that deals with prevention. in fact, one of the most historically in fact one of the most seminal moments in the war on cancer is when this idea of fighting a war, he carried his battle became to fade when people begin to research that continues today. my thoughts are many. i'm not going to talk about them at great length. i'm going to make two comments. one comment is that remains shocking to me that the most preventable carcinogen is still at large. here we are fighting this complicated battle on the hill about how to do this, that or the other about health care costs. meanwhile, the largest known carcinogen, you know, there is a great irony in all of this. people come and talk to me about

radon or some known carcinogens. i fully acknowledge carcinogens. but it is a little bit like we are not talking about the huge elephant in the room, which is tobacco. so my quick answer to the question is some of the battle against prevention is going to be political in the cultural battle. but the second point i want to raise, which is to meet interesting as it seems the silos that prevention and treatment and cancer biology are collapsing in many different ways. i think that's very encouraging. in other words, used to think cancer prevention people lived in one compartment and cancer treatment people used to live in one compartment. and others to slip in a separate compartment. but that's not the case anymore. i give you one example. tamoxifen is a very good example of that. here is a debt that was really created originally to treat advanced stage metastatic er

positive breast cancer. but it turns out to have your own prevention. you can use tamoxifen as a preventive agent in the appropriately identified, appropriately focused tools, such as, which was originally invented as diagnostic tools to diagnose breast cancer can be used in the preventative sending. in fact, even the genomics -- cancer genomics, understanding of the cancer genes has an important prevention -- a role in increasing prevention, particularly in breast cancer. so there is a way in which the new molecular biology of cancer forces us to rethink the silos. i think that's good because it will allow us to rethink prevention in a way that just doesn't relegate prevention whenever the spec terms and treatment to the other infusion of the two disciplines that has been happening for a while is very encouraging to me. any comments?

>> i am a surgeon and we can cure cancer if we can catch it in time. you know, surgeons would burn them, for her son come use ultrasound, cut them out of made vaccines. if we can catch them early enough, we can cure them. to me, the question is about the prevention of her current and what we haven't solved. you can have a tiny tumor and remove it in its entirety, but months or years later communal discovery spread all throughout the body and conversely i seen the largest tumors are removed surgically and they never recur. and so, the fundamental next up from the surgical perspective is the prevention of metastasis and recurrence. >> viruses then back to a default and so therefore the work and spend is never over. it's always the temporary victories for decades.

though cancers evolved, what's your 5000 year look quite >> cancer has involved them are microsoft 6 cents. they're inside the body of the human being. in other words, within every tumor there is a kind of darwinian battle that's going on, even without treatment. within every tumor there were clothes growing out publisher resistance to escape your immune system. but then every tumor, there were clothes that will move into other parts of your body. when you take chemotherapy, you will kill -- you might kill many of the cells or there might be some cells that escape and therefore willie falls out of five. so cancer -- we talk about the fundamentally darwinian illness. in fact, that is part of the secret of how unbelievably successful cancer cells fire in invading because every time it's

a kind of -- we come back to this red queen metaphor. every time you doing something, the cancer cells are sort of pushing back, the cancer cells are evolving. it is much like treating a disease -- much like to get up at all myths are much like treating a disease with viruses, and the constant mutation and evolution happening. it's like the galapagos trapped inside the body. >> my question is regarding the role of the patient during therapy. for myself, when i was diagnosed, my center made it very clear that it is patient oriented and then i would have a partial plan and deciding what directions i was going to take. but the reality is that this time when it happens and everything moves so fast, that you really feel like you don't have a whole lot to say because you don't know very much.

do you have any comments on that? >> , well, my comment in general. that's an unfortunate situation. that is a situation i hope we don't find ourselves in increasing the overtime. i hope that we have given the pressures of time and money that are occurring in health care. i hope we have the time to listen to stories and figure out how to best treat a statistical entity, but a human being. i have to say it's very tough. sometimes it requires a kind of listening skill, which i think we have doctors have forgotten. some people might not want a certain kind of treatment. and it's very hard for physicians to listen to that. it's almost as if we forgotten that listening skill. i hope that we have a way to keep that in mind the same. as you have any idea?

>> well, my thought was i didn't feel my doctor wasn't listening to me. i thought like, i am not someone who has studied cancer my entire life. i knew people who had it, but i knew very little about it. to be able to ask a question and really make some definitive decisions, i would've had to to move so fast and be reading up on everything. so when it gets right down to it, i have to trust my doctors, which of course i do and it shows that it is that i trust. but they think is the patient, a patient does feel pretty much out of control. >> that's fundamentally the case. that is the case that one feels out of control. and now, i really think this is one of the fundamental challenges of medicine. how does one involve the patient in a way that is respectful of

the patient's wishes. but on the other hand, it's your job to be the expert. once it becomes your job to be the expert, in some sense the process has defeated itself. there is a reason behind someone to collate all the information and there's a huge amount of information. i think in some ways i don't know the answer. i have two general strategies. one is ironically, an institution that part is ironically i find that patients become more confident when you tell them you don't know something. it is the peculiar irony as opposed to saying you know some rain. it is a peculiar irony of medicine, of course much like readers can detect a false notion and 1.5 nanoseconds, patients can detect false confidence in that there's an so

ironically the best way to approach -- to build confidence is to be humble about what is known and what's not known. in the second they may think is in some ways, in fact, there is a restoration of faith. again, the restoration of faith and saying, let me be the person who has the information, the link you give me that direction for that information. so don't spend your nights looking on the web for the blogs because that is not what was allowing the process to occur. you're doing enough already. but maybe the person who has the information it gives you the information and you beat the guide for that information. if tom waits that burden with these patients. they don't have to be the person is the expert all the time because no one is the expert. i'm not the expert.

i know a little bit more, but i'm not the expert in your choices and your reaction. but again, i think it involves an act of listening to mooch is hard to do in these times. >> i learned that web research is the kiss of death. [laughter] >> it is the kiss of death i think. >> do you think the vast quantity of chemicals used in various processes are contributing to an increase in the incidence of cancer? >> at the top question. some chemicals may be contributing, but i think -- i think on the other hand one has to be careful about this idea of hypo- carcinogenic environment because it creates a kind of panic about the environment that i actually don't agree with. so my general thoughts about this as ivory, gold, particularly those that reach a certain concentration in our environment need to be quite

rigorously tested. in fact, our testing mechanisms are improving. this reform a primitive kind of agents, very, very primitive and relies on the fact that these chemicals cause vacations. not all carcinogens cause bacteria. it's an important test developed a work week, but it's very primitive types. we have much better test for the. with that said, i also disagree with this idea that every chemical needs to be tested is exactly the right thing to say. but i disagree with this idea that we have a generally more carcinogenic environment because we need to find what those precise carcinogens are. it's a little like saying the water is carcinogenic. well, that's okay but i have to drink the water. or someone says the air is producing cancer. but it has to breathe the air.

you have to chime in a quantitative way of the method does that's available, this molecule in the air is causing cancer so i can remove the molecule. so let's be specific about these kinds of things. what is the chemical? talk over your benefit? what will the planar allies? and then remove them from environment. >> i had a question similar to that. was i supposed to start out? or am i supposed to eight? i have a bit of education, which always makes a person dangerous. and so, my question is similar to his, but i am interested in avoiding the paring away a discourages. i wonder if there is some sense you have about the percentages of cancers that are basically

what i would call natural mutations, things running around, living in a clean room all your love really walkure. and i'm sure these are different for each type of cancer. thick smoke and we do know. before excluding on cancer, is there a sense that the percentage they are, just natural mutations that inherited or, page and which ones might just be industrial carcinogenic lee oriented? >> said that question as you can imagine is an extremely difficult question to answer. answerable for rare cancers. so i mean, they're some old adage in epidemiology, which is that large rare risks are much easier to assess and small, and risks. in other words, you know, if there is a sudden epidemic of

liver cancer, which is associated with a particular toxin, those risks are very easy to determine and therefore you can determine the toxin. it is when you have a small increased risk in a very common form of cancer, like with a breast cancer, to detect -- it took a huge study to detect the very substantial, but nonetheless relatively small relative risk of increase of breast cancer with hormone replacement therapy. again, this risk was large enough to even register an epidemiological scale. so this was a large risk, but it takes a sophisticated kind of study to figure it out. the quick answer to your question is unfortunately i am not sure. they are yet in terms of type elegy, in terms of figuring out what the small, and risks are. i suspect for some cancers will never be there. in the end, can one really

determine whether this is a very small risk created by carcinogens or was this a natural mutation? or some cancer think it's going to be very, very, very difficult. >> thank you for that fascinating talk and fascinating reading. you talked about how radical mastic to mastectomy was for breast cancer and it took 90 years to understand that it was unnecessary and in effect days. i wonder if you can talk about any other examples of that you have come across in your research. and in particular, are there treatments pretty standard therapy now for 10 years from now or 20 or 50 or 90 we will encode as ineffectual or unnecessary? >> i certainly hope so. well, very many examples and i talk about these. one of the things that writing this book and i know this is

commented upon, i also wanted to not write the so-called whig history in which progress leads to more progress and what ends up in a sunny place. in fact, very dark moments in this book and dark stories in this book in many dark dark stories have to do with the way medicine becomes a self-fulfilling prophecy relates to believe in itself. mastectomy is one of them believe it or not. in the 1980s, there was a strong sentiment that many researchers believe that giving radical chemotherapy would cure breast cancer and so radically it would wipe your bone marrow and have to replace it with your own bone marrow that it confers the way, the so-called or taller just bone cancer for breast cancer. it took another decade to disprove that. part of the reason with patients didn't want to enroll themselves in the trials.

the patients had become so convinced that by their type is committed became so convinced this was the right thing to do that nobody wanted to be randomized to placebo. the doctor said to them, we believe this works in the believe this works, so why go through this randomization? and so, you know, and massachusetts -- this should be interesting. there was a lot that was passed called charlotte five, which forbade an insurance company for not allowing the taller just bone marrow for breast cancer. the companies would skimp, which they were doing, on breast cancer therapy. there is a lot that was passed. basically it's cancer therapy mandated by law. i mean, there is example after example. i certainly think this will be repeated for many forms of therapy we engage in.

[inaudible] >> you might have to be loud because the mic is somewhere in the back. [inaudible] >> well, i mean, are you asking what ultimately causes prostate cancer or wife has prostate cancer come in so many different varieties? [inaudible] >> prostate cancer is very high -- [inaudible] >> i think we don't know the full answer to that question. it turns out the prostate is one organ where it develops and men at a remarkably higher rate. what is striking about prostate cancer is that prostate cancer comes in different forms. one form actually does not metastasize so easily. in fact you will not die of prostate cancer, but with

prostate cancer. there's another form that metastasizes and kill you. we have not begun to figure out how to discriminate between these two things. it's a huge problem. it's a problem that is again not the magnitude that would make a difference. the kind of problem that will make a difference in the health care budget because for every 10,000 of the one kind you shouldn't be treated in any way, treating -- you are piling up cause, treatment costs, et cetera, et cetera, the best thing to do is not do anything. of course there is a cultural part of the onset. in the absence of the knowledge -- this is what they talk about in the book. how do we behave as individuals or as a society? how does one tell a man that i am not sure, but it's likely -- i think there's 80% likelihood of prostate cancer would be this kind. why don't you watch and wait? in a culture where we don't

understand about cancer, and a culture with the word cancer has taken on the current metaphors in the current understanding, how does one communicate the complexity of the idea in his comfortable in his not comfortable with? if you go on the web, you will find 10,000 opinions about testing that the psa. and again, this is of enough importance and so comment, but it will make a difference to the budget because the numbers paella. so i can come in the usual answer to this -- my usual answer to this is technology, science, deeper understanding. while we are in this waiting pattern trying to figure out, hopefully a few in the audience hotel is five years later how to discriminate between the so-called good kind and the bad kind of prostate cancer and

relief all these problems you are having in motion tend. so encourage technology, encourage science. that's the best thing we can do. yes. [inaudible] [inaudible] >> yacht, how we look -- do i talk about the food additive? i actually spoke a little bit in the book about exogenous estrogens and pesticides. but you know, it's an issue that remains unresolved. i haven't liked, but there's a deep interest in looking at it, in particular pesticides and exogenous hormones. again, i think this is the kind of integrated approach involving not just the old-style epidemiology, but a combination of molecular biology, cancer

genetics would be required to solve these kinds of puzzles. in general, you know, especially with exogenous estrogens, there is a bit of a smoking gun there. i do know people agree or disagree with that. questions in the back and then maybe in different. >> i was wondering if you could comment on your evolution as a writer. >> msn says -- >> was this her first book? is an extraordinary book. i am just curious how you evolved as an author. >> you know, my general approach to writing this book or to any kind of writing that i do have things to inform through my scientific work, which is i like

to write books that answer questions. so if i had a question i would write about. in terms of writing this particular book, actually learned to write while he wrote this book. if you are a reader of this book, in fact you might sense that as the book progresses from the stage to stage, again if you're a careful reader, at least to me it's quite obvious i am learning to write as i am doing this. by the 400th page in a different writer than i am from the first page. i worked backwards and tried to clean up -- i tried to clean up what i had done before. but again, the marks of remains. i do realize in the writing itself evolves. so that is one feature of it. in terms of process, you know, i've spoken to others already as this has been written about. and it deeply and if it be a

brighter and the sense that i write sort of small snatches here and there, often i write exclusively in my bed. i propped myself up with pillows. and when i was writing all of this, often i would have early mornings i would write, when i had a sword is -- and i think the most important thing in terms of the writing of this book in the game if you are a writer, it becomes clear to you. this book lives at its seams. or that i mean the content was relatively easy for me to rate. it was the fact -- it was the stitching together the content. in other words, how does one go from 1994 but 22,000 b.c.? and then move forward to 580?

what were the themes? how does this fit together? sometimes that's teaching is very tenuous. and so in fact the discipline in this book, in this particular book was that stitching. how does one manage? the answer to that is that i tried to imagine a very confident reader. i tried to say to myself am in the of person who will go to this book is the kind of person i'd trust to move through those themes. and i will rise to the book and they will rise to read it. i am not quite make some compromise about it. people who read the book -- the science gets pretty dense. i didn't spare the most contemporary details. i mean, we talk about cancer genomics from 2008. so this gets really complicated.

again, the book lives than it seems. so those are the features that allowed me to be, you know, to write. one last comment is that lots of people have asked me -- i mean, i've been asked to rifle. it actually happens to be a friend. i learned to write from people who have written about medicine before any. so there is a learning process reading -- a lot of reading. and that raises the process -- it was a very interesting question to me personally, which is, was there something about being indian in this book, in this particular book? the fact is i also happen to be from the subcontinent. i spent a lot of time thinking about it. i was thinking about it even today. my answer to the question is, i think the most important thing

about being indian and writing this book was the fact that india gave me the freedom not to write about india. and in doing so, allowed me to write about something that was entirely universal, had nothing to do. it was almost as if i inherited it kind of writing tradition, which allowed me to not have to write about the local politics or the cochair of the subcontinent, but to read about something you and i can have a conversation about. that freedom is very important to me personally. it's a cultural freedom, political freedom and am not sure i can convey how deeply that was influential to me. i thought they could write about something that's relatively universal. and i think being an american for that. i also think the political freedoms in the country -- countries.

maybe i'll take the last couple of questions. two questions, yes. >> in recent years there has been a lot of research that has been linked to him or elation of cancer. i wondered why you didn't include it in the book and do you think any fair peace will come out of this research to fight against cancer? >> again, this goes back to the question was included and not included in the book. in general, included scientific things in the book that have led to human therapies. i tried to avoid -- in other words, if you really trace back everything that's in the book, whatever goes into the book would end up in a human being somehow. perception comes out of a certain genetic understanding of cancer and becomes a drug. preventative mechanism, tamoxifen, et cetera appeared in slate to llama races,

metastasis, things like the immune system i think our theory important in the fundamental biology of cancer, but did not meet the sniff test of being able to be transformed into something that will impact the way we either treat her the way we deal with preventative maximums of cancer. when they do so, i'll be forced to write an addendum to this book. and the last question. >> when my uncle had leukemia, they told him that john hopkins university that they had done everything they could then be honest it was something greater. how much do you think like either positive mental attitude or belief in some sort of spiritual things pesaro and carrying cancer and what is your experience on the patients he saw? >> well, it's good we are going to add to that question because i'm going to give a relatively provocative answers.

i provocative answer to that is, i try not to believe that the psyche has a role in causing cancer for the following reasons: i think it victimizes cancer patients. when people say you know, there is a link between the psyche and cancer, think it's precisely the link but hands to a cancer patient whose fate is already full, twice the burden of their disease. so i try to shy away from that kind of thinking because it feels to me very negative in some ways. i know plenty of people who have had intensely positive attitudes about life comic or book answers. know plenty of people who are unbelievably depressed or have all sorts of mental illnesses, who have lived perfectly healthy cancer free lives. so this idea that the psyche causes cancer is i have kind of an allergy to this idea. that said, do i believe the

psyche modifies one's ability to heal? yes. now, there is no architect of psyche. in fact, someone might use grief to heal. someone might use depression to heal. someone doing with their illness might involve entering a space that is full of depression. that might be there mechanism. enter force my understanding of what a positive attitude is i think ends up victimizing impatient. who am i to say what your positive attitude is. you might decide that you are intensely -- have an intense feeling of grief are in your illness prevented him mechanism of healing. i tried to help people when that grief takes about colly pathological form. even then, i try to step back from it and i particularly am

allergic to this idea that the reason you're not getting better is because you are not taking positively enough. i think that's part of the reason i really hope this book. there are so many self-help books out there about cancer to say that. you know, you're not getting better gas, not doing the right thing, not fighting hard enough. i think i'm very allergic to that. i started my conversation by saying i'm not going to go there. that's your decision as a patient. i respect that decision, but for me to say that as a doctor creates a kind of cycle of blame that i really wanted to avoid. thank you. [applause] ..n the chapman

auditorium. here he is talking about george washington. >> washington was dignified, stoic, heroic, and fiercely devoted to do the. also a slave owner. an unyieldin kasr in unyielding taskmaster, somewhat who fein and a failure

at business madison, hamill's command uivalh grade education. ron chernow was born in brooklyn, and he is an honors graduate of both yale and cambridge. he is considered to be one of the most distinguished commentators on politics, business, finance in america today. the st. louis post-dispatch has hail him as one of the most preeminent biographers of his generation. the new york times calls him an elegant architect of monumental histories as we have seen in decades. in 2000 for his biography of alexander hamilton won the inaugural george washington book prize for early american history . he brings political perspective to the politics of today. listen to his words.

president washington, vice-president of bama enters the office hoping for reasonable and sensible discourse, hoping to enjoy a time of non partisan politics. the two-party system emerges rather rapidly from his own cabinet. hamilton and jefferson had at different wings. for two years there seems to be a political honeymoon for washington to to his stature. was the attacks start in the opposition in our ferocious and relentless. washington is actually accused of being a british double agent all along during the revolutionary war. sound familiar? ladies and gentlemen, let's hear more about george washington from his biographer. please join me in welcoming mr. ron chernow. [applauding]

>> thank you for that wonderful introduction. it's always a thrill to be here at the miami book fair degree chino, and fed yuri 1789, two months before george washington was sworn in as the first president he received a fascinating letter from europe from his friend reporting for the first time on the sudden madness of king george the third to be it morris said that in the king's delirious state he had conceived himself to be no less a personage than george washington washing at the head of the continental army to be then morris added proceeds asleep he have apparently done something or other mystics most terribly in his stomach. indeed, washington had. now, who was this commoner who was such a legend in his own time?

he actually managed to invade the feverish dream worlds of the deranged royal george. well, first cru interested in this question when i was writing my hamilton biography. i was reading a series of letters that hamilton wrote after he had a quarrel late in the war that led to hamilton quitting washington staff. in these letters hamilton described a working for washington and said that washington was moody, mirabal, and temperamental, even something of a powder keg boss. he informed his father-in-law with more than a touch of youthful bravado. he said the great man and i have come to an open rupture. he shall for once repents his of humor. i can remember sitting there stunned. did he mean to imply that the san the father of our country was this so keep calm volatile

boss. well, needless to say this was far from the whole truth. i hope in this book that i developed lavish and sufficient praise to washington's courage, fortitude, patriotism, integrity, and a thousand other wonderful traits. this is not a debunking book. in fact, my book is an effort to try to recreate the charisma and the magnetism that so excited washington's contemporaries that have gotten lost somehow in translation to posterity. having said that was hamilton did paned very perceptive reports. his comments began to open a window into george washington's emotion, all of these strong and powerful emotions swirling around inside. needless to say emotions that he kept in check with formidable self control. when i came to learn was that george washington was not this kind of were the figure to be

bland, before honest a bit boring his taken up residence in the american imagination. revolutionaries are not made of such tame stuff. i began to wonder, even though there have been so many books about washington, whether george washington is simply the most familiar figure in american history, the man whose portrait we carry in our wallet was perhaps the bottom the least familiar figure. i thought that, perhaps, there were other significant dimensions of his personality that would enable me to bring him to a vivid and three-dimensional life that would make him immediate and comprehensible to people. i am here this morning to report after six years of very intensive work on this book that i found a george washington who is passionate, complex, sensitive, a man of many moods, often strong and very opinions, fears, hard, driving

perfectionist. ec, what has happened in the course of american history is that in our very laudable desire to venerate the father of the country we have sanded down the rough edges of his personality. we have turned him into this and possibly stiff and lifeless figure it very much like the stand. this arm rigidly thrust out. it stands to reason that figure could never have defeated the british empire, the mightiest military. could never have presided over the constitutional convention, could never have forced the office of the presidency to be quite obviously the man who was able to do all of those things must have been the force of nature. he kept that force carefully under wraps.

now, in order to fashion of fresh portrait of washington the poor biographer has to begin by taking up a sharp machete and hacking his way through a very dense jungle of myths and misconceptions. i have discovered that even very well educated americans, their minds are so cluttered with all of these tales. let me retire some of the most egregious errors. now, you've already heard the cherry tree story. pure invention, invented shortly after his death by an itinerant book peddlers. washington dined. there was a tremendous hunger for personal stories that would humanize him. our friend priced into that vacuum armed with all of these fictitious tales. the cherry tree story has been unfortunate for many reasons. one and most obviously, it's

been used to terrorize american schoolchildren for 200 years. it has also created, as we shall see, a very misleading image of george washington as this cold and freeze character when he was anything but. another common myth as we have already heard, the wooden teeth. obviously digestive enzymes with robert wood in the mouth. george washington started losing his teeth in his 20's. by the time he became president he had only one tooth left in his mouth. very brave and lowly lower left bicuspid. he had a very full set of upper and lower dentures' made. a little round hole where the bicuspid was. they were painful to examine it. i can only imagine how painful they were to wear. they would have been scraping

incessantly against his ron dellums. they were made from elephant or walrus ivory and were inserted with human teeth. we now know that in 1784 he bought nine teeth from slaves, possibly his own. this sounds ghoulish. in the 18th century it was routine for people to advertise that they were buying teeth. often the have said white teeth for white people. washington was doing something weirdly egalitarian if, indeed, he had nine teeth from his own slaves. of course what happened over time is the ivory aids and crack and stained and developed a grimy look. it looked like wood. the most significant thing that i discovered about the dentures bama they were connected in the back by curved metal springs. so the only way that washington could have held them in his

mouth was by keeping his lips firmly compressed. what this meant was that every time he opened his mouth to speak it would relax the pressure on the springs and there was always the possibility that the teeth with com flight out of his mouth. >> the devil are not as president washington gave a suspiciously large number of speeches that were only one, to come or three paragraphs in length. now, devil are not as president a common myth that i find almost universal. george washington wore a wig. how did he get that very strange and distinctive hair do? he flushed out the hair. i don't know how we get them to stand out. he then sprinkled powder, grayish powder. he looked closely. wearing a black velvet suit. you would see a fine creche dust on his shoulders. the powder and sprinkled down on to his shoulders.

and then most significantly he took the remaining hairs which he threw straight back over his neck and tied in a black satin bow. that style which we would call a ponytail in the 18th century was called the q. even though washington's hair style looks to us very point and genteel, in the 18th century it was considered manley and military. so anyone seeing him walk down the street would have said there is a general. finally everyone repeats that he was six ft. three. i discovered as i looked into this that it all rested on a single piece of evidence which was after washington died and he was measured for his casket he measured six with three and a half. that would seem to settle the controversy. wrong. i want you to do an experiment in you go home. lie down in bed on the back. just relax.

what you'll see is that your feet will fall forward to the ghettos will point out toward. of remorse or to set in it would add about three and a half inches to your high. i collected in the course of doing the book about 40 quotations from contemporary letters and diaries of people who commented on his hike to bit about 35 of them pest and guessed correctly that he was 6 feet tall. then came the real clincher. before the revolutionary war washington, like most region in ordered his clothing from london. every six months he sat down and gave his london tailor a very precise description of his physique and described himself as a man who was exactly 6 feet tall. we all know that the one person you can lie to about your height unless you want to end up looking like a laughing stock is a tailor. i think that we can consider the

case closed. george washington was 6 feet tall which is relatively tall for that time. we tend to associate him with the revolutionary war, but he spends five and a half years fighting in the french and indian war. washington was really so precocious he was kind of a prodigy. by the age of 23 he was a colonel. he was put in charge of all of the military forces in virginia. virginia was both the most populous and powerful state in the union. his perseverance, bravery were already the stuff of legend, but i must warn you when you start reading the book that young washington is not yet the wise paragon of later years. he's crass, dogged, even pushy in his pursuit of money, status, and power. washington first rebels against the british not for idealistic reasons, but for personal reasons.

the british deny him the royal commission in the army that he covets. the british sell him shoddy overpriced goods from london. the british band settlement west of the allegheny mountains at a time when washington is amassing a real estate there. the british are bad for business. the british are bad for your career. in those early sections you don't feel the year and the company of historic greatness even though there are already a lot of admirable traits that flush out. now, the bane of washington's early years was not royal george, but someone infinitely more formidable, his mother. she was, to speak frankly, a very different woman. self-centered. she took no apparent pride or pleasure in her son's career. we have no comments about her

praising the commander in chief or if she was even still alive when he became president. we have no evidence that she intended the winning. we have no evidence that she never visited them at mount vernon, although she lived in fredericksburg which is not very far away. historic rumor has even type tier as a possible story during the war. george's father died when he was 11. mary felt that george should be taking care of her rather than pursuing his career. even when he's in his 20's out on the western frontier he receives a letter from his mother saying that she urgently needs a new dutch servant and some butter, as if he's supposed to drop all of his regiment of these and go fetch his poor mother some butter. wade in the revolutionary war much more bizarrely washington

receives a letter from the speaker of the virginia assembly says commander general, something has been going on here in the virginia state capitol that no one has had the courage to tell you about to begin mother has been here for a couple of months. she has applied for special petition for emergency relief claiming poverty and hinting at abandonment by you know who, the commander in chief. washington was a very dutiful son who brought his mother a beautiful house in fredericksburg and a for a lot of money. that was his reward. i speculate that the first grade general the george washington ever had to do battle with was his mother. now very difficult to deal with. a father who died when he was 11. it's no wonder that he doesn't start out as a saint. but then what happens? it's fascinating. in the mid-70s 60's with the stamp act and the townshend duties and the boston tea party

and the intolerable acts washington begins to realize that all of his personal grievances simply reflect a larger political problem. the deck has been stacked against the colonists. and then suddenly and brother gloriously all of his feelings about the british are elevated into these universal principles of freedom and liberty and justice. so miraculous to behold. he begins to find his political voice. that political voice is very strong and very militant. if ever there was a man who was a noble by circumstances, if ever there was a man who was fired up by a just and righteous cause that man was george washington who, as he shall see, the transitions in no way that has few, if any parallels in american history. all of us, if we know any events in the revolutionary war know washington crossing the delaware

at valley forge. those events are a little bit misleading. washington deserves full credit. i have given the book that washington was at best a middling general. he lost more battles than the one. but i also argue that you can judge this man by the usual score card of battles lost and won. this is a rare case in history. what he's doing between battles is arguably more important than what he does. he single-handedly holds this ragged army together for eight and a half years in the face of constant shortages of many, money, clothing, muskets, gunpowder. only george washington has the strength of character, the clarity of vision and the tenacity of purpose to maintain because. you know, we all know about the

bleak winter at valley forge. as you'll see, there were many other winters that were just as bleak. nobody would have had the courage and stamina to of fold this army together. holding the army together meant holding because together, and holding the american nation together. if you don't think there is at least a grain of truth to the great man or please read this book and read me a letter and tell me who could have stepped into his shoes in this battle. there were other generals from a strategic standpoint to were his equal, but there jockeying for power, sidetracked by petty disputes. george washington had and inspired simplicity. if you gave him a goal to pursue he would harness all of the energy and fortitude. he had of focus and discipline and drive that would truly unique.

now, whenever his shortcomings as a politician, washington was a genius. whatever shortcomings as a general, washington as a politician was a genius. unanimously elected commander in chief by the kind of congress. he was unanimously elected president of the constitutional convention. he was unanimously elected president to the united states by the electoral college. obviously that will never happen again. mind you, he does all of these things without the benefit of a single focus group or pollster or political action committee. he is just responding to his own instincts. because he never seemed to be grasping for power people with that much more eager to give it to him. he clambered to come out of retirement, the more reluctant he was, the more people wanted him. now washington's presence in

philadelphia in 1787 was absolutely vital. the constitutional convention was held behind closed doors. it's washington's position that reassures the skittish public outside the doors that no sinister cobol is being hatched inside. of course it is washington's presence, the assumption that washington will be the first president that ambles the delegates to create a cup powerful office at a time after the revolutionary war when there was a quite understandable fear of excessive executive power. if you look at the constitution article one of the constitution by design is about congress. the people felt that was the people's branch of government. that should be preeminent. article two, the presidency is by design short and vague and general. washington spent more than eight

years dealing with an internally squabbling congress and realized that no legislature could provide a coherent and consistent. it is washington who realizes it is going to be the executive branch, particularly the presidency that will spearhead domestic and foreign policy. we are still living with washington's legacy today. we assume as a matter of course that the president will define the political agenda. you know, there is no mention of the constitution, a cabinet. washington creates the first cabinet. there were only three members. it was alexander hamilton, secretary of treasury, henry knox, secretary of war, and thomas jefferson, secretary of state. everyone in the room can agree pound for pound the best cabinet we will ever have by far. he assembles the american

all-star team. like all great executives washington was not afraid to hire people who were smarter than he was, although he was very smart. he felt fully confident to be able to control these had strong prima donnas. i know we are all kind of gazing back nostalgically. at think it is right to do so in terms of the brilliance and the area addition and integrity of these people, but it was a nasty political time. i did a piece for the "wall street journal" last summer on the founders. for instance, john adams, benjamin franklin, his entire life has been one continued insult to decency and good manners. franklin said of atoms, he is always an autumn honest man, sometimes a wise man, but sometimes absolutely out of his senses. this is kid stuff compared to adams and hamilton. adams called hamilton the

bastard brand of scotch peddler. he said the hamilton had a super abundance of secretions which he could not find boards enough to draw off. it doesn't get any stronger than that. hamilton gave as good as he got. he rejoined, i shall send the lead to say that john adams is as wicked as he is mad. the only one who really rises above all of this partisan name-calling and mudslinging is george washington. at the beginning of his term he has a political honeymoon for your two. then the two-party system springs up and the opposition party attacks in relentless the cover everything from plotting to restore a monarchy as your earlier, he was accused of having been a british double agent for the entire duration of the revolutionary war. you would think that some of these charges today made in the

press are preposterous. i was particularly struck. there were many things that surprised me. one was hell ambivalent washington felt about his own fame. wherever he went he was lionized. he was not a glad handing backslapping personality. he was not a good extemporaneous speaker. wherever he went he had to give a few well chosen words. you can see when he was president he made a tour of all of the states. they would send a delegation of dignitaries to meet him on the outskirts of town. he would always arrive an hour or two earlier in order to bypass them. ..

had beautiful women swarming around him and when he was doing the trick in the 13 states, he wrote every night in his diary he would record the number of women and he would say i arrived in new haven there was a bowl in my honor and 62 handsome and well dressed ladies then ht the town then the next nightg he would write i was in hartford. h there was a dinner in my honor,r there were 73 fashionable ladies in the town and he was traveling with a tiny entouragei guaranteo was doing the nightly head count of the ladies was the father of our country. [laughter] now, even in the privacy of his home he becomes a form of public property, a real prisoner of his celebrity. he's warned after the war that he should get a special expense account to entertain people. he doesn't listen. and hundreds, finally thousands of people descend on mount vernon, washington is is this impeccably polite man, he sees them all, he houses them all.

the saddest line in his voluminous correspondence, june 30, 1785 he writes this sad line in his diary. quote: dined with only mrs. washington which i believe is the first instance of it since my return from the war. he had been back from the war for a year and a half, it's the first time he had dined alone with martha, and he had been away for eight and a half years during the war, only went back to mount vernon once for three days. i said george washington was not this cold and priggish character of the cherry tree story. nathaniel hawthorne once mocked him saying he was surely built with his clothes on and made a stately bow at his first appearance to the world. there was nothing puritanical about washington, and i'm not saying anything about his

relationship with sally fairfax. washington had a friend who remarried at the age of 47. washington considered 47 a comically advanced age to marriage, and he wrote the following letter to a mutual friend. quote: i'm glad to hear that my old acquaintance, colonel ward, is yet under the influence of vigorous passions. the he then went on to suppose that ward had reviewed his strength, his arms and ammunition before he got involved in action. [laughter] wait, it goes on. let me advise him to make the first onset upon his fair lady with vigor, that the impression may be deep if it cannot be lasting or frequently renewed. [laughter] it's not a line that i'm suggesting for inclusion in the school textbooks, but it does give us a different take on george washington. [laughter] the marriage to martha, i didn't get the feeling it was the lustiest marriage of all time