productive and happy one. she gave him financial security. she had been the richest widow in virginia. she gave him emotional support. washington was rather repressed and needed an emotional confidant. she was immensely skillful, and washington was a corning y'all host but a rather detached sort. so she gave washington the warm, stable home life that i think he needed to accomplish these monumental tasks. and i try in the book to give a complete portrait of this marriage because the two of them made indescribable sacrifices for the country. it's always mentioned in passing that martha visited george in winter quarters during the war. in fact, it turns out she spent a full half of the winter with him and typically lasted five or six months. now, also, to flesh out this private man behind the public

facade, i devote a lot of time to george washington as slave holder. earlier generations seem to think it a trivial or inconsequential fact that he owned 300 human beings. washington was deeply conflicted over the whole issue. he opposed slavery in theory, but he was never able to make an issue of it in public. even in the founding, slavery was the most divisive issue, and washington knew that this was a subject that he broached at his peril. i wanted to write a book in which washington's slaves are not simply faceless names mentioned in passing, but to the extent that the documentary allows it really emerge as full-blooded has has human bein. i talk about billy lee who was a great hunter and rider and rack contour and who accompanied

washington every single day during the revolutionary war and was actually very proud of it, liked to reminisce about the battles. i talk about martha's favorite slave, she was a young seam stress who finally escaped to freedom in the new hampshire in later years, and most of all the flamboyant hercules who was the master chef at the presidential household in philadelphia who also slipped off to freedom in the waning days of washington's second term. slaves constructed every inch of mount vernon, they formed the basis of washington's fortune, and i thought they deserved to have a central place in if his saga. you know, what i love about george washington, this is not the story of a perfect man. there are plenty of defects as a slave holder and as a businessman, but this was a man who was capable of constant growth and constant

self-criticism. he's born in the 1730s into a world in virginia where slavery is both common place and unquestioned, and his last and i think most visionary act in his will, he frees the slaves. i just want to, you know, close before the q&a with one fascinating story. there were, as i said, about 300 slaves at mount vernon. 125 of the slaves were under the direct legal control of george washington. the other approximately 175 slaves were so-called dower slaves brought to the marriage by martha and legally pledged to her children and grandchildren. so it happens in his will washington says that the slaves should be freed, those 125 slaves he controlled should be freed after martha dies. and washington had thought this through in immense detail. he provided funds to train and educated young slaves who would suddenly be free, he created a

fund in order to take care of any freed slaves who were too old or infirm to work. he thought this through, he just overlooked one big, glaring thing which was that the moment that he died, his will was published, everyone knew the terms of the will, and every slave at mount vernon knew whether he or she was one of washington's slaves or one of the dower slaves. and what it meant was every time 125 slavessed at martha washington, they said the second that lady is dead, i'm a free person. martha was so unnerved by this situation and really felt that her life was in danger that she consulted washington's never few and he said, you're right to be afraid, and can he said just go ahead and free those slaves now which is exactly what she did which was a very smart thing to do. so a year after george washington died but a year

before martha died, those slaves were free. okay, i'm just touching the surface of a very rich and eventful history. no speech on washington should last as long as the revolutionary war, and i'm sure you are all brimming with questions, so i thank you for coming, and i'm happy to answer questions. [laughter] [applause] thank you. i think people have questions. there's a microphone to, please, just line up. >> mr. in washington's later years did you run across any of his feelings on how the results of the revolution turned out? did he have any misgivings? >> dud he try to ex-- did he try to extend the franchise?

no, that was not notable. you know, what he did do, we know that at the constitutional convention that the one point that washington proposed -- because he was kind of a, you know, neutral arbiter above the fray -- the one point that he proposed and did pass was that there should be one congressman for every 30,000 people instead of 40,000. he felt then the house would be more numerous and, hence, more response responsive to the people. but washington shared, you know, a certain federalist elitism that the people should, you know, elect the most intelligence and prosperous members of the community who would then look out for their, for their interest. there are many different places where washington says that there must have been a special providence not only overseeing the revolutionary war, but the constitutional convention and

even his presidency that things turned out so well. >> excuse me. would you care to comment on george washington's religious feelings, and while doing that can you either confirm or dispel the myth of the prayer that was supposedly done during the valley forge winter? the young private comes upon washington on his horse, and washington's kneeling and praying -- >> are yes. you have all probably seen the pictures of washington praying on his knees and that, unfortunately, was another one of the inventions of the person who invented the cherry tree story. it's an implausible story not because of washington's religiousty, but washington was very private in his devotions, would never have -- you know, rather ostentatiously, in

public, possibly in full view of his soldiers been praying in that fashion. in terms of washington's religious view, this, of course, has been a hot controversy about this. washington before the war was an anglican which meant that after the war he was an episcopalian. washington, there were a number of things about washington's christian beliefs and practices that were atypical. he always talked about providence or the supreme author of our being. he only referred to jesus by name two or three times in his entire career. he would, at church he would pray standing instead of kneeling, genre constituting the -- refuting the mason weeks story. he never took communion which martha did regularly. very significantly, he did not call for a minister on his death bed which, again, martha did.

i had the feeling that washington was deeply religious. there is not a battle in the revolutionary war that washington does not, you know, claim that divine providence had been looking out for the country, and is o his pay -- so his papers are saturated with references to a providence that is closely following american events and seem to be watching over the fortunes of the country. but it's very hard from a kind of denominational, a theological point of view to pin down with precision exactly what his religious views were. >> thank you. >> in alexander hamilton you went to an extent with the marquee delafayette's relationship with mr. hamilton. how did washington take the french outlook and help in the war to the extent there was any,

and how did, how did he accept foreign support during the revolution -- >> how did he accept foreign support, you know, with difficulty. all these french officers who came over during the revolutionary war, many of them came over for very self-interested reasons, you know, they wanted to earn battlefield glory, and can they felt they would then go back to france and get a promotion. and a lot of them couldn't even speak english. and so washington really felt that it was, you know, the bane of his life as commander in chief that he's had to placate all of these french officers who came over. in fact, the story with lafayette is very interesting because lafayette comes over at the age of 19. he quips a ship with -- equips a ship with provisions and munitions. he goes to philadelphia armed with a letter from benjamin franklin and franklin writes to the continental congress, you know, please, peat the young

marquee very well because he's very well connected at versailles, and he could be pretty create useful. -- politically useful. the congress, without consulting washington, makes lafayette a major general, this 19-year-old kid who's just arrived, makes him a major general which is the highest rank below commander in chief. but they did it as an honorary title. lafayette then goes and meets george washington. washington writes a priceless letter to the congress saying i don't think that the young marquee understands that the title is is merely hon risk. he's kind of -- honor risk, he's kind of looking for a regiment to command. amazingly enough, lafayette becomes such a resourceful and really fearless general that he becomes one of the major generals in the continental army. and one thick -- thing that i

found, you know, the historic study of lafayette being kind of a surrogate son of washington turns out to be true. washington, being a very formal man, did not like to be touched. and we have eyewitness accounts that when lafayette would see washington, he would, quote, throw his arms around him and kiss his face ear to ear. [laughter] only a young frenchman could have gotten away with that with washington. >> i was wondering why martha made george washington a rich widow. i'm sure she had many suiters and that she would have men wanting her just for her money. >> i don't think it was surprising that she wants to marry washington at all. you have to remember, i said he'd been in the french and indian war for five years, he had been the commander of all the military forces in virginia when he was 23. he then meets -- i think he was

29 at the time. he was a military hero in virginia, and he was famous for his bravery. he was starting out, he seemed to be, you know, prosperous and successful young planter, and then he became a member of the virginia house of burgesses for 20 years. he was very closely connected with the fairfax family, his brother had married ann fairfax whose father was the agent for something called the northern neck proprietary that control five million acres in virginia. it's the fairfax family that's the most powerful, richest family in virginia, and george washington is their young protege. and washington was very, you know, tall and strapping. you know, we tend to think of him from the gilbert stewart pictures as very kind of stiff and rigid and craggy. jefferson said he was the greatest horseman of his day, he

was legendary as a dancer, he was a great hunter. he was a very, you know, very social and very, you know, genial personality. and so i find it completely understandable that she would have been attracted to him. and he was -- and she had two children, and he seemed very eager to have children. >> no cherry tree, huh? >> no cherry tree, sorry. >> oh, my gosh. [laughter] i want to thank you so much for coming. this is wonderful. >> thank you all for coming. i really appreciate it. thank you to the fair.

coming up next book tv prisons "after words." yeah hourlong program where we invite guest hosts to interview authors. this week author janny scott the biography of president obama's

mother is entitled a cingular wollman the former "new york times" reporter who wrote feature stories on that the election of 2008 spent two years interviewing stanley m. dunn of's friends and putting president obama she discusses what she learned about the woman who raised the 44th president of national journal's major garrett the title of the book is a singular woman the untold story of barack obama's mother. what is more important about that title, the fact that barack obama's mother is a singular woman or that she is the mother of the president of the united states what fascinated you most about who this woman is? >> guest: i got interested in her during the campaign during a series of biographical piece is about then senator obama and her little bit about her and i was interested in her cingular ready, but yes of course i wouldn't have come upon her had

she not been the mother of the candidate i was writing pieces about. so to some extent the justification for the book is that, but the thing 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 cingular ready. >> host: did you approach this as a student of presidential history, a student of women in america in the late 20s, early 20th century or as a portrait of a mother? >> guest: i approached it as a journalist. i just wanted to know who this person was an obviously one's mother is bound to be somewhat influential in one's life. but to have a mother who live 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 began simply as a journalistic

curiosity but all the things that you mentioned were of interest to me. she lived a life that was not like that of many women who came of age in 1960. she was the forerunner without necessarily intending to be just sort of how she chose to live. i think for what it reflects on our president is also very telling. obviously there are many reasons we would be interested with this apparent because it is the first by racial president but to understand how her character plays out in him and how perhaps explain some of the things many americans find puzzling about him. so she's very interesting for a number of reasons. >> host: she carried many different things throughout her3 >> host: she carried many different things throughout her adult life. >> guest: she was named stanley ann dunham initially her mother to the cut father's name was stanley dunham and he wanted a boy and got her and in her

stanley. that was the sort of joking response over and over again when people would ask stanley? so there's a terrible burden to her. but it turns out as you point out she ditched the name quickly as she came of age and i will tell you about her last name in imminent this is the story told by president obama in dreams from my father the one that attributes it to stanley dunham, her father wanted a boy and getting stuck with a girl may not be entirely the full story. madeleine dunham, her mother come as a child growing up in small-town kansas during the depression began a devotee of devotee devi bettis -- bette davis and bette davis was a appeared in a movie directed by

john huston and which she played a character named stanley timberlake, and after the baby was born that november she was going through an interesting change in her store of public image at that time. it was a rigid and period and women were being encouraged to go into the factories for the war effort but bette davis had shifted from a somewhat androgenous style to a much more feminine style and the moment that happened was in this movie and the next movie. stanley dunham was born and was named stanley ann and someone that spookster rather right afterwards and asked why the name she said bette davis played a character named stanley. so i think the stanley timberlake explanation may be just as compelling and many relatives say madeleine would never have been the name to be dictated by her husband. >> host: it may not have been

an emblem or emblematic disappoint and of her father but it might have been a mission of empowerment from her mother. >> guest: quite possibly, certainly i don't think there is any evidence that her father was disappointed not to have a boy and giving her child, a girl, the name stanley had some affect whether it is in power in or not remains to be seen >> host: what about her leader name in life and what does that tell us about the chases she made and maybe in the ambivalence about the choices that she made? >> guest: welcome as you know, she went off to the university of hawaii at 17 and almost immediately became pregnant with the child of an african student named barack obama, senior. this was the time nearly 24 states had the laws against interracial marriage. she was married to him very briefly and then she married and indonesian student named lola. so she was first went from

stanley ann dunham to ann nei 112 ann obama to soetrro but then she kept with the name even through her divorce in 1980 from lolo soetrro she decided to modernize the name of soetrro which was happening so she sort of broke from his family by getting herself the name suetrro, not the traditional, they were not likely to update their names so he kept the name but updated it while her mother to the dhaka daughter kept the old spelling and then towards the end of her life, because she was finishing her dissertation in anthropology from the university of hawaii, she reverted to dunham, and in the

very -- and of her life i noticed she even had in her correspondence with her insurance company when she was ill she was ann dunham in brackett so she resurfaced at the end. >> host: the president said i know that she was the kindest most generous spirit i have ever known in the that what is best in me i owe it to her and he wasn't there when she died. why is that? >> guest: to give the benefit of the doubt and i think any child in that situation deserves the benefit of the doubt, he -- none of us know or few of us know the moment that our parent is going to die coming and speaking from personal experience it helps if someone grabs you by the shoulders and says you've got to go home now you may be wrapped up in your life but it's really important, she was very, very wrapped up in his life at that time. he was in his early 30's, he was

teaching at the university of chicago, he had a job in a law firm in chicago, and he just released to books, the first book and was embarking on a first run for political office triet he was an unpleasant during the illness in the period leading up to eight. 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 about her cancer and he told me he spoke on the phone to her until shortly before she died when she became unconscious so, you know, she said that's the thing he regrets most that he wasn't there. as i sure it would be for many of us, but i wouldn't attribute anything necessarily regret to that. i just would say -- >> host: an unfortunate set of circumstances.

>> guest: he was in hawaii, she was in chicago, it's difficult and she was also not the kind of person who would be inclined to overstate, quite the contrary. the severity of the illness to her children. her daughter was with her when she died because they get spoken on the week before, and maya had become concerned that her mother was something confused and just decided i'm going to put everything aside and barack obama came shortly afterwards. >> host: a kind of scene in their life at least from the point barack obama goes back to hawaii to enter into private school. distance is a constant theme in mother and son relationships. a point of strength, a point of estrangement, is there a little bit of both, what is the most important linkage between the distance that was prevalent for so much of their lives? >> guest: welcome a distance,

you are right, is a common issue in the this live beginning at about age ten. the first ten years of his life he was with his mother pretty much full time born in hawaii, they live together in hawaii until 1967 when she had married lolo soetrro, her second husband, and they -- she then picked up her son because he had been sent back to indonesia. she then picked up her 6-year-old son and moved him to indonesia and then they lived in jakarta together for the next four years. so the first ten years he was with her vocal time. then she made the decision because of the desire to get a better education than she was able to get for him in indonesia at that time and the belief that 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 ten or maybe even age nine plus on a plane to live with his grandparents and go to

the school but he ultimately graduated from, and she was as i say married at the time to an indonesian and she had a second child whose father was the indonesian house and so she stayed in indonesia initially, went back that christmas to be with young barack obama and then joined him the following spring and lived with him throughout middle school, so there was a period of distance and then she was back with him and then in 1975 when he was i think in eighth grade and getting close to going to high school she had finished her graduate work in the university of hawaii and anthropology and in order to get her ph.d. in putting the present industries, rural industries and java she had a child with her who had a father in java so she made the decision to move back to indonesia.

the president says he at that point in his life entering high school feels that he sort of made the decision, too. he said i don't want to go whether you can say a child that age has that capacity to make that judgment i don't know. >> host: they both feel they can handle that. >> guest: exactly and a school that sends kids to great universities, so her daughter describe that to me as the hardest decision of her life for her mother. i think it was a complicated decision. a lot of americans find it very hard to swallow the amount of time she spent away from her son, and i would say it is worth considering the complexities of the personal and the parental consideration.

her marriage, the desire for the best possible the education for the children. she came from a family where education was extremely important coming back generations in kansas. her family, her forebears or school teachers and educators, her, while her parents didn't finish college, their siblings, two of the three -- three of the fourth and went to graduate school and it with ph.d. s. it was the standard practice in that family to really invested in education and she was leaving a net for her children. so if you to accept the argument of her friends and of her children, she was juggling a commitment to education and the need for herself to make to get her degree so she could do the kind of work she wanted to do and make enough money to support education. i didn't really answer your question on the theme of distance, so i gave you the background. i would say that i know more

about ann dunham's thinking on this than and up the president thinking about this. .. an ex-patriot life, a peripatetic life of that sort. he said he understands the appeal of that, but the appeal that his venture, new people,

great food. you know, certain kind of excitement. he also felt for him but that also bespoke a certain lack of commitment, an observer status somewhat for the outsider. he made a conscious decision to do the opposite, to lose himself in chicago, married a woman from chicago, deeply connected to the city and places a primary value and his family, the stability of his children, creating a stable base for his children. so i think it makes it clear that he lacked some of those things. i have to say he also said that his sense of his mother's confidence in his abilities and her extraordinary faith and her future and what he described as absolutely unconditional love he had a kind of confidence that he said goes far beyond any kind of

mark that was left by the constant motion. it sustained him through all of that. >> host: is there any reporting or conversations you've had any sense that through the years, along with this distance came a sense of separateness? >> i think on the part of ann, there is part of that. it's not something lots of people talked about. there are very touching incidents people described to me. one interesting one is when barack obama was elected president of the harvard blog review in 1990 or 91 -- 90 i guess, there is a lot of newspaper coverage of his selection. i've gone back and look at a lot of the stories and it's fascinating because you see beginnings of the telling of his life story in the way we been heard again in 2004 at the democratic convention and throughout the 2008 campaign.

but as he elaborates the story, not me so we don't know whether this is what the reporters chose to focus on or what he chose to say, but you see the greater and greater telling of the story of his father and his mother is simply a white woman from kansas, white american from wichita, an anthropologist working in java. she returned to java around that time having been in the united states. she said to a friend who i interviewed, i was reduced to one sentence. she was always incredibly proud of him, but i also think she did have this recurring. later on, another good friend and colleague of hers told her he worked with her between 90 and 92 indonesia. they were working in mac refinance together and they lived in a house that was for development consultants and he worked very closely, traveled

around the country with her. and so he knew her pretty well. he told me he sensed that around the time her son moved to chicago and immersed himself in life and was moving towards his political career, that she had with 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 it wasn't that she felt rejection, but she felt a kind of consisting. so yes, those are two stories. there was another instance when he was a senior in high school, where she decided in a panic according to a friend of hers, i've got to go back. this is the end of his childhood. he's going to go off to college in the phone. she made a decision to having broken down in conversation with a friend in intonation made a

decision to go be with him during that period. so i do think on her part there was a real awareness and perhaps this is the nature of being a mother of any child. the real consciousness or a sensitivity about what is my place in his life? and she was not the kind of person a thing to force yourself upon their 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 emphasize the importance of doing things for other people, working for the benefit of other people, working for either people to have better opportunities. she set them up to a life independent of hers. i think she believed or not. and yet some part of her, like all of us who have children, she probably wanted a closer

relationship. >> host: did you ever get a sense any reporting or or analyzing the various bits of data that are available -- i understand in this case there is less available than you would like. he would like to more. you got to see my letters. obviously the subject is no longer with us. there is more that she don't know than we probably do know. but did you get a sense that 18 is a young age to become pregnant and mary and quickly divorce. is there any sense of residual trauma through all of that or regret about the early stage of her life that in any way, shape or form an essay stated up in a relationship with her obama? >> not that i'm aware of, but you're absolutely right. i got what i could get and i think i got a lot. i got a lot more than anyone noticed on this woman. but there must be much, much more to know. in the period in which he talked about is in some ways the most

elusive because he was allowed who knew her well enough. very few people appear at her are dead. her aunt and uncle were at long distance away at a time and phone calls are not that common. people didn't pop off to wait for a visit. she had cut off relations, not intentionally, but didn't continue relations when she went to hawaii. there is this big break in her life that occurs at the moment. they think she was relatively allowed and i've never encountered friends who are really close to her. i kind of had to rely on people who knew her a little bit later in whom she talked about. she was not a person inclined to regret. there is an impulsive quality to her. a combination of impulsivity as well as feeling like once i make this decision i'm going with it. and so, i think while she took some steps in her life that you

could, by any objective standard, decided in retrospect perhaps are 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 is any regret about her having given birth to her son. quite the contrary. you know, everyone who might interfere with described him as being very central to her life and her heart and a person who she thought about a lot, who she talked about a lot, who she consummately tell people what he was doing and her pride in him was enormous. nevertheless, what an amazing thing to happen. and she was 17 when she became pregnant, even more remarkable. you have a biracial child in a country that is only just beginning to address such a thing. it really turned her life. i don't know what her life would've been. i think it would not have been a standard housewife in the

suburbs, but 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 is opening up to asia and the world, hawaii and the east-west center who had come to the university of hawaii at the time and all that sort of energy on that campus at the time, a lot has to do with foreign students coming in and the extraordinary ferment coming in between western and foreign students. so who knows. maybe these kinds of things would have been had been older. so i've never had a sense of any regret. maybe just because constitutionally that is 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 gone through her first four years in anisha.

she had gone back to hawaii in the period after she returned to rejoin iraq and she had her daughter, via, with her. she wrote a letter to a friend in seattle but said she was cajoling him to give her information about his life he or she been in touch for many years and she said something like toehold back. lord knows they've screwed up royally more than once. and i asked her about that. and myers said the term i've screwed up royally -- she remembered her mother often using that phrase. i think she had kind of a resilience. this is that the president also talks about. an ability to bounce back from her set toxic kind of country moving forward. it was sort of a family trait actually. >> host: was she a letter writer? >> guest: i believe they did, but i didn't have access to

does. >> host: for archivists yet to be known. >> guest: when she was living and anisha, doing her fieldwork to be a consultant, she was writing to him -- she had a ritual to write to them every day. i don't think the letter was sent every day. she was writing at least a few paragraphs in an ongoing matter. i know he wrote back to her because i think he used to doodle pastorale cartoons on the letters. mis told me at one point -- i guess after her grandmother died, she found cache -- maybe after her mother died, cash of these letters that have been corrected and she copied them and gave them to the president. i know they are out there, but i didn't get them. >> host: we will hope. mya describes her mother in this

way. a description of and philosophy. we might stumble upon something that will in an instant seemed to represent who we are at the core. what does that mean? >> guest: well, he was a person who had worn in kansas. you know, this is the great stereotype for her, the white woman from kansas, which is so much more misleading than is helpful because she barely, barely lifting kansas. but anyway, she has 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 stated at a young age and her life changes completely. she meets this man his experience could not be a mark different from hers, a student from kenya. later on she is with lolo soetoro. she discovers she has this great

passion for the things that are made by hand in each anisha, by tikhon metalwork and baskets and rice paddy hats and just assassinated with a texture of these art objects. they are objects of everyday life. so they are on the cusp between useful and artistic. she becomes fascinated into that becomes interested in nicer people producing them. she immerses herself in tiny villages in java, where she does her fieldwork. spends years interviewing uneducated peasants, women who try and keep their families going. she goes from there to the ford foundation and micro finance. here's a person who went from a, what you think of as a prosaic american background, discovering these words. and anisha itself and java is a

complex space, where many come in many and religions have mixed historically and yet it's out there on the surface. it hasn't been buried by development or maternity. she arrived at a moment what that was really true because the poverty of the country at that time, people had fallen back onto these handicrafts. she immersed into this whole religious mystical world that is deeply fascinating and even spending two and a half years on this book i don't unders and. >> host: at the time, survey -- a survey work was more interested in what people did and created than objects of art as it were. archaeology have been for centuries to find by finding brilliant things to put in a new cnn polish up. survey became a tendency towards finding out what people did and how they lived.

>> guest: i'm sure the interesting thing about ann's work is people are interested in these ads are. they have not been interested as a line of work. what she did what she was an economic anthropologist who is interested in small little entrepreneurs and how they made their life's work in the family lives were. there is a very high level of women raising families by themselves. you know, 22% of the men in java had laughter gone to find work or move to another part in order to find work. she was interested in how women not to make yourself for supporting their families under the news. so yes, what she did is where other people were fascinated by the art and the mysticism of the crest, the wavy bladed dagger that is a mystical java. she was interested in the men who made it. what they're working conditions

are like. what it was like to spend your life in a forge, and it documents may and a tiny village and he sold to, where you got your raw materials from, how that was affected by the ad and float but more global events. so what was that kind of really, really down to earth research that characterized her. but it didn't quite answer your question. getting to this notion of the comment that maya made of wandering through life. so i think she was a personhood really experienced that inner self. in an improbable way by being very open to the world. it's an extraordinary aspect of her that i suppose is somewhat related, natural temperament, but also the way she was moved as a child constantly. she did remarkable emotional intellectual openness. she was not judgmental. everyone comments on this. she just kind of observed.

she was nationally inclined to observe in a way, to allow whoever you are serving to socialize due to their way and understand from the inside. i think i must have given her such joy. so much the defining pair shared her life that is what she tried to convey to her children, this notion of the open to these possibilities. wander off as a maya sometimes describes that, wander off the path and check out what this is off to the side and it may change your life. >> host: not build walls around ourselves and do her best to find kinship in beauty and understood to places. >> guest: that is really in some ways part of a president obama says. he learned from her, this notion which we know so much from his message, the possibility of reaching across seemingly fastest and is an understanding people who we seem to be so

different from. he told me a wonderful story when i interviewed him. i asked him, was there a time during the campaign that you thought if they are neither particularly? not when she be proud of me, but had any kind of revelation about her. he said actually the night of the iowa caucuses, you know, he said there was no indication at that point necessarily that a white electric lake that was going to vote for an african-american candidate. but the night of the caucuses, we went to a caucus site in des moines and he described the scene as an extraordinary range of people in des moines. white, black, hispanic, old, young, eccentric people. there is a man there who looked like don dolph put a long white beard and television monitors somehow attached to the top of the curt, running a loop of this

campaign commercial. and he said, you know, going away that night, leaving say we had the sense that they would actually win. they did tear up into a wooden at other times during the campaign because i thought now would she be proud, but wouldn't she have loved to be there at that site? >> host: which you thought was possible? to >> guest: i said what was it that captured her spirit? she said the sense he could reach across and make contact with people he seems so different and there is more similarity than difference between us. more good than evil in all of us, which is very much his mother's line of thought. i suppose that really is by naïveté and idealism i see in her. it is the naïve idealism in me. so i think that quality is there much present and had. >> host: you are preparing for this book -- i'm sure the

management is done as this country was having a debate about the president's origins, but the per certificate, about hawaii, about these issues at his place in america. i wanted to get your reaction to that debate as you are preparing to this book will quite clearly of those issues have not only been settled in your mind and titles as a matter of journalism, but concretely so. did you find yourself feeling a strange turn the country are perplexed by its debate or enraged? what was your own personal reaction to this line of curiosity that you i'd sure believe is utterly groundless? >> i do believe it's utterly groundless. it was extremely unsettling. i had been aware of the issue during the campaign and i thought it had been settled. it had gone underground for a while until donald trump brought it back.

and considering the enormous quantity of well-documented reporting that without their babies organizations, fact check.org, politicized, that is easily accessible on the internet. not to mention the availability of the per certificate, which had been shown to be the standard per certificate given by the state of hawaii. republican and democratic elected officials in hawaii had come out and said, that is the real document and the health department -- head of the health department had gone and found vital statistics. considering all that to become so consumed. and it's not just the american public. it's the media. to become so consumed by revisiting the issue as though it were a really she was disturbing. he was very disturbing as a person in the profession that is supposed to kind of help establish what is true and what's not true.

postcode did you find any ground on this particular question your research? >> guest: i certainly prodded up with many people. i talk to lots of people who knew her close to that time for everything she had described the whole period, remember detail about her relationship with barack obama senior. they have covered a lot of backgrounded no one -- none of the people i interviewed, close to 200 people, knew of any evidence, had never heard of an indication that she had been in kenya during that period. i did good look at all the available status. you know, the birth announcements and the hawaii newspapers from 10 days after his birth. the information could have only come from the health department or the hospital. >> host: it wasn't something you could randomly calling from a pay phone. >> guest: precisely. so yes, i looked at everything available. i looked at remarkable stuff done by fact check.org.

it's the same conclusion everyone else has drawn. it is baseless. so it's a very disturbing things they clearly have something to do with some more profound -- quality and americans these days that they're willing to consider this about the president. >> host: i want to go back to the scene were talking about a minute ago, about ann's philosophy. not build walls and find kinship in beauty. i do want to psychoanalyze a person who's not here to defend yourself. but i wonder if maya is missing the word love in here? love is a powerful motivator in all human life, all human if students. do you get a sense that this may be something stanley ann never experienced in a way that resonated with her children were philosophical pursuit that perhaps the most you needed to be more bitter than she was

portraying people in different places. beauty and kinship or two things. did she miss on a her life? get a sense of that? or does it even matter? >> guest: buckets defined differently by different people. what exactly are talking about i'm not -- they might be helpful if you do find a little bit more what you're asking. at least in the term love. >> host: within her two marriages come within a relationship with her children, their separateness at times, this distance. she's often described and not even sure he would even validate this as her surrogate existence perhaps, perhaps it's just wondering. and that there is either a search for or maybe moving away from some in those painful or realized. >> guest: well, i don't think one would ever say. in the above in her life.

i think she had as a child is somewhat tempestuous relationship with her father, which often spurs women to do interesting things. they think and i haven't had any evidence or parents did not hurt and she didn't feel love. and i certainly think she lets her children and her children felt -- i spoke anonymously at greater length to maya in the president. maya no question speaks about a period and her mother would say that over and over to her children. she made a point to it being physically demonstrative with them come in a way according to a friend of hers she didn't so much feel from her mother, who was the slightly more conservative conventional source fan ann was. >> guest: exactly. i think she felt some extraordinary passion towards barack obama senior, whether would meet one's definition of love, who knows.

he was clearly a very passionate encounter and she did not forget that man for the rest of their life. many people talk about is to both of her husband, but despite the fact she had a grievance, having perhaps he did claim both cases, they may have had grievances as well, but despite the fact marriage has ended tonight he showed these people feeling someone to create, she rarely ragtime than were complained about them to her friend. in fact, worked very hard to give their children a sense of time -- a very positive sense of them. so i would not say and i think the notion of her at that existence of nomadic is i understand we're concerned, but i don't think it's fair because she spent half of fertile life in indonesia. she didn't wonder the world. she was beeston tanisha, committed deeply.

did work that left a much bigger impression than the work many of us do. she really changed people's lives in one way or another, both directly and indirectly to her micro-finance work in the work she did at the ford foundation. even in her development consulting jobs. she was 30 committed to the country and helping people in those villages. so she did travel a lot, the way many americans who have global jobs now too. >> host: ordinarily it's a matter of course. >> guest: that's one of the things interesting. she was behaving in a way we behave now is a well-made, an american, a parent much earlier. i don't think she had any consciousness that i'm a pioneer. she was simply doing a what she thought was right for trying to make the best of a complicated situation. >> host: let me ask you when they feel to you like a trip question. it's not a trick question, but i remember he came across a q&a

you did on the internet with "the new york times" website with high school students who are curious about journalism and writing. good guys than to have a balanced diet with what you consume is a reader. he said make sure you interspersed in the balanced diet great books in. so the trick question is there anything about stanley ann dunham in great literature? anything about the arc of her life are barack obama's life that has a particularly resonant literary hoax that we might have found or we might find in some other work? >> guest: you have a say of something in mind. and very eager to know what it is. >> host: i actually don't. that's why say it's not a trick question. >> guest: i wish i had the perfect answer because it's a really interesting question, but i don't. i can't think of a 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. you can understand this. as a reporter just got fascinated by her life. and i just kind of dug in. i wasn't looking for, you know, residents of something else and i wasn't approaching it as though, you know, the way a particular biographer who i had admired had approached it. i don't even think of it as a biography, although clearly it tends to be something might have. i think of it as a telling of the story this%. >> host: noble as it is now -- >> guest: knowable as it is now. >> host: you would love to have these letters? they will be a trove and sometimes that will be open and that will be an enormous addition to understanding.

>> guest: for the president will send them to me after this interview. >> host: get them in the envelope and out the door. did you have fun doing this? was an enjoyable? sometimes as a reporter, you know somethings out there and we shoot get to it and you just can't do that can be a source of enormous frustration. did you feel that? >> guest: now, this is thoroughly, thoroughly enjoyable. i've never enjoyed anything so much. here is a person people don't know anything about even now and they knew a lot less back when i started on this. a person who you can assume was a significant orders and the life of a man who is central now to our political consciousness, national conscious as into our sense of the world trade now. so it is a completely virgin territory as far as that is

concerned. very little has been written in detail. not no one, but during the campaign but reporting was done on her, but there just wasn't much and no one had been back to a tanisha or track down on these people. most of the relatives had never spoken about her. suggest you start out, it was virgin territory. that's an exciting thing for any journalist. on top of that, and she is obviously as i said that this extort or a life. she had amazing friends and equate system colleague. everyone i interviewed him in many, many people have lived these fascinating globalize. raise children in transit the way she did or done work in the area she did. and then i spend, you know, in my time in an tanisha, which i've had never been there. and that was full of surprises, not only has an extraordinary place i came to understand exactly why she became so

passionately in love with java. amazing things happening. i was then jakarta in january 2000 from interviewing a woman it would imagine would have a shot at finding such person, would've been her sister in the second job she held for a couple years in the early 70s in jakarta. and while he was interviewing her, a man came into the room and she introduced him as salmon, who turned out he was in his late 50s or early 60s, had any teenage houseboy in the house in jakarta, where ann and lolo soetoro had lived in 1971 and his job is to keep an eye on the president. this guy coming in outcome he'd been a teenager who came in from a small village to try and make some money to help his parents and younger siblings. he remembered everything. he was an impressionable state

in his life. what he did with john barack and what her relationship with low-level flight. i just stumbled 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 the man who had been sort of the person software with those close to, a journalist towards the end of a life and he was going to give me a couple days, take me to a number of the places where he has traveled with her when she was finishing up her research. in wondering about these villages, particularly the village of contract, the blacksmithing village or she ended up centering her dissertation work, encountered middle-age women remembered her as a child. they were the adopted children at the man who was one of their great importance.

so that was just unbelievable. it was all grey. i enjoyed it enormously. >> host: all the textures in the book and i am sure those kinds of discovery increase your energy level and flow of the book and everything is about a project like this. just out exactly. the journalist people often have what they pay people to do this. >> host: let me ask you something about hillary clinton. i remember when i cover the white house, hillaryis one of the exponents of micro-financing and credit of the development tool. and i wonder if you have any sense at all the point stanley ann dunham would've thought about hillary clinton as a political figure in america, a mother and maybe the irony of this women, whom the main him you might expect she would admired for a number of reasons came to be a formidable opponent of her son and a significant number of his presidential cabinet. it's kind of an amazing thing to

think about. >> guest: there was a brief moment of near intersection between the two of them. and the early 90s, ann worked in new york and ngo world ranking, which was a network of micro-finance organizations around the world, largely in developing countries and they provided a lot of technical advice and brought the network together. so she was working as the policy and research director from women's world banking. this is in the run-up to the conference -- what is it called? the real conference on women. remember the conferences every 10 years? this was the one that was going to be in beijing. he was doing the work she did during this period was working to bring these disparate micro-finance organizations together and began reaching across the aisle thing, get a

group of organizations that have traditionally been competing with each other to work together to come up with a platform for a micro-finance playing for the platform in the conference on women. so she played essential part of that. there's a chapter in the book about the whole episode in her life. what ended up happening is hillary clinton went to beijing, spoke famously about micro-finance and that was the moment for micro-finance kind of blasted into the world's consciousness. it had been around for decades actually, but it really, through hillary clinton's speech there, but you a lot of the attention throughout india and became something of a household word. well, ann would have come to the conference but she became ill and was unable to go. she ended up leaving that job, going back to indonesia,

possibly been misdiagnosed and most publications and going back to hawaii. she died shortly after the conference. other people from women's world banking went to the conference and came back and reported to her. there was this moment where they might possibly have connected. i would think she would admire hillary clinton and i would have imagined it would appeal to her sense of possibility that hillary clinton having run against her son is now working closely with him. i'd be surprised -- and i know she actually -- i'm told by your friends, liked bill clinton. postcode interesting. we have about seven minutes to go. i bring up these two projects to work on at "the new york times," however usage in america and how class matters. i won't ask you to distill the story is a pleasant of class and race in america in seven minutes. that would be unfair. it would be unjust.

but if you could give a brief distillation of his possible of how class and raise the federal factor into this story that she'd been working on for so long. >> guest: that is an excellent question if you'll forgive me for saying so. it is complicated and i would like to have thought it out better than i have in order to give you a good answer. one of the things, but class project was an attempt to look at the way -- i'm sorry, look at the way race played out in relationships. not personal relationships, but working relationships come in situations in the united states where people work to cause racial lines, but there was a purpose. it just happened to be that way. the subtext of race at a time we supposedly were not thinking so much about it. turns out we were thinking a lot about it. the thing i did for that, which relates to this and i thought a lot about this when i started to

write about than senator obama. the one i look that was three people making a television miniseries. it was actually david simon making the corner and baltimore, who was the way writer. then there was the black director anand and actually multiracial second-grader on a comic david mills, who is no longer alive. david mills talked to me a lot from the perspective of someone who is multiracial and he did not receive any particularly big issue in his life. and 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 middleground or that mental territory that he described to me and that is the experience of someone with a mixed race background. and it's just -- it was a whole

new thing that rochon, the kind of phrase that we were thinking about when we approached about project, that the picture is so much more complicated in the old frame up white black is just so out of date. and as for a class, a similar project to connect class, the thing that fascinates me about the donovan family is that they were so well educated and really middle-class or even even possibly upper-middle-class and certainly many members of her family are quite upper-middle-class now, partly measured by educational accomplishments and professional professional -- professional choices. yet, during the campaign, the president emphasized his mother as the single mother on food stamps. she may well have been on food stamps as a graduate student,

but it doesn't quite bring up the class position that in fact was the class position of that family. i guess my general feeling is it is also much more complicated than murky than we ever as americans give it credit for. postcode i remember during the campaign senator obama would talk about getting up very early in the morning. 4:00 a.m. i believe. and his mother saying this isn't easy for me, buster. this was an example of what he went through, but also what his mother required if herself and himself. what does that tell us with about four minutes ago, about who she was at that stage in his life? and what that may have embedded in him going forward. postcode many people told me they thought his work ethic -- that it comes somewhat from his mother. she worked extremely hard, but she also believed in education as they've said very deeply and

the importance of working they've taken advantage of the educational opportunities offered. she did not make her children to be slackers in any way. that's a recurrent theme. that quote comes from a period in her life, where she was about to send him to wait for school and try to bring them up to speed on his english-language learning, which he hadn't had an indonesian schools. she was getting him up at 4:00, 4:30 and telling him to get to work. it reflects so much the exacting quality, demanding exacting quality she had in the way she raised her children on that issue. >> host: was he listening to things? are they talking? habitat english education play out? do you know? desk at the maturity of a cent from hawaii by his grandmother. later on, there is a system called calvert, which maya was raised with from a school in baltimore that handy precursor

distance-learning. they sent boxes of material. i don't know whether he was doing cowbirds or whether his mother was katharina. as they say, it was mainly to get him up to speed so he would do well when he got there. postcode anything you've discovered about them that could be symbolized in a gift for a keepsake for something that she had of his or he has of hers, that in any way interested you? >> guest: i don't know about him versus her, between the two of them. i don't know anything about that but i can think of right now. but when she died, she was a huge collector of stuff. she had gobs and gobs of stuff. trunks full of stuff, jewelry. and her staff they think of it as the jewelry diaspora because i would interview people and they would say by the way, i got

these. these are from ads. people would come to interviews wearing clothes, fantastic clothes they had inherited when she died. her stuff on everywhere. so i wouldn't doubt some of that is with him. but i don't know specifically. they're a wonderful books i saw coming classic children's books that are now in an archive in hawaii, there were friend she was a very young child. i guess she may have even taken to indonesia with her, things like peter rabbit and stuff that are still around with her writing and then. >> host: so she left a fashion imprint as well as a jewelry imprint. >> guest: i don't know the fashion imprint has been widely adopted? >> host: widely remembered. janny scott. the book is trained for. best of luck.

>> guest: thank you,

>> siddhartha mukherjee with the documentation of the disease and development of radiation. this is an hour and a half. >> i have a very personal relationship to this bookstore. i was a student very close by here, an undergraduate from a foreign country. and when i could get my spirits up, i would bike to this bookstore and spend time here. there is something wonderful about things coming back. and so thank you very much for having me here. and thank you for those really wonderful words of praise.

i must say though, my favorite praise they've received for the book came this morning when i was reading through my e-mails and someone sent to me a note from some blogger who says, are there cliff's notes for "the emperor of all maladies." it has been my lifelong book to have a book for which there cliff's notes. if anyone is inspired, please let me know. i'd be delighted. i thought i would begin today, rather than talking about the content of the book, i thought it would begin by talking about process because that is more interesting. this something you don't get from reading the book itself, what motivated the book somehow they got rich. first i have to offer a note of apology, which is first when it was finally handed in in its

draft form, was three times its length. by necessity, the vast amount of information had to be cut. there is a fundamental -- my editor said 500 pages is the final limit. no more. we ended up with about 600 opposite bergen. but nonetheless, so i have to start with a note of apology, saying that not every story could make it into the book. so i would welcome other attempts to write the histories of a disease that will continue to be part of our lives in the future. that said, i wanted to talk a little bit about, as i said, the process of writing a book. and one of the most pivotal moments in the writing of the book have been sometime early on when i was confronting the vastness of the challenge. the vastness of the challenges here you have a history that

spans 4000 odd years, about 100 odd characters that move in and out of the book. scientific terms that sometimes in political terms, politics science and of course in the middle of all of this, this world of stories. and i was having a conversation with my very excellent editor, and the inquiry and. she said to me something very pivotal. we were talking about something completely different. she said in the end, if one forgets the book publishing industries, if one forgets for a second the vast paraphernalia give us a book to come into play, the bookstore committee actual product, the printer, the business of making, marketing, et cetera, in the end a book is an amazing instrument by which one author sitting alone in a room contacted when readers sitting alone in a room. that comment resonated with me very deeply because i thought to

myself, if you forget for a second the vast paraphernalia of medicine, the cat scans, mris from a billion dollars devices, national cancer institute, the wonderful crown jewels of medicine that exist 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 sitting alone in a room. one doctor in a room can talk to one patient. that analogy was very deep for me because it reminded me about what was essential in what was not essential. in the essential piece of it was that much like a book, medicine is about storytelling. medicine begins with in the shamanic at. if you take away all its paraphernalia, ultimately medicine begins to some untamed tonier story. what happened? is the first thing that happens when you need a.thursday begin to unpack a story.

as i make a claim in the book,.or simply story back to you. and it's an ancient interchange, probably one of the most ancient interchange is we have is human being. combat itself, that process in itself begins the unpacking or unburdening long before you receive your first dose of whatever method you will or will not raise these. it is the unburdening of the story that is the first shamanic asset in the same. forget that, it seems something very important will stop happening in medicine. once they've come to that realization, again inspired by these comments come and begin to become very clear how one could rate this book. again, remembering there was a vast history here, but it could be written through the eyes of patients. it could be read by telling stories. if i could tell stories that

began at whatever point of time for a thousand years ago and i could fulfill stories, and could flesh out these stories, then what seemed like an insurmountable problem, which is how does one tell this history would be, actually solvable, which is, tell the history of a moving from story to story to story, typically focusing on those who are right there, those who experienced most directly and that his patience. now again, notice the solution in principle of the problem. but then that raises a second question, which is how does one find the missing stories? how does one uncovered that the story of the woman who experienced breast cancer in the 1950s. remember, i recount a moment in time in 1850 in fact, when a woman, fannie rosenau calls at "the new york times" and says that by two plates and advertisement for survivors of

breast cancer. and "the new york times" covered the society editor kate simon says we can't print the word breast cancer in "the new york times." but if we said this is a survivors group of women and a chest war. when "the new york times" came to write about back, i said make sure you print that because it's a reminder for all of us, including a comment that we need to be humble about what can and cannot be achieved here. so this was the background. again, missing stories. a word that can't be uttered, the word whispered about the dixie. and again, the question was, what his stories. in one thread that came early on as i knew that somewhere in the story would have to be the story of one of the most remarkable women in recent intellectual history and that is mary lasker. mary lasker among many other

things directed her philanthropic energies. she was an unusual one in four times, and knowledge for newer, a person who then direct it an enormous amount of philanthropic energy toward solving, as she put it, transform in the geography american health, landscape of american health. if there was one central characters spinning through the story, it would be mary lasker. mary lasker then very quickly i found sydney farber who reads the book. a scientific collaborator. and if mary lasker gave political legitimacy, sydney harbor provided legitimacy for the war and cancer. but the book that begins with sydney farber. sydney said six was a so-called doctor of the dead because

primarily pathologists in the 1950s would perform autopsies. he was a pathology who specialized in children pathology and typically bodies of children who had died in the hospital would be whittled down into his basement laboratory. the laboratory was no bigger than about 12 feet, kind of a frozen cube at the bottom of one of the buildings. so that's where we are in 1848. and then, farber became a man trying to find a mechanism for an understanding of a disease, which was an extremely lethal, a swiftly lethal form of cancer and those childhood acute leukemia and that's where our story begins. lymphatic leukemia is typically, then it always affects children and usually in the 1950s was almost uniformly 100% mortality.

often kids would die and they would be diagnosed and died within the span of the week, two weeks. sometimes they would live longer and die soon after. farber became interested. one of the reasons was leukemia could be counted. as they talk about in this book, things begin to measurement. whenever you measure something to me begin to perform a scientific committee. this is a time before cat scans and mris because it is hard to count the site of a tumor because it's buried inside. the kenyan because of the tumor of the blood to be counted because you could perform a bone marrow autopsies and you could see the depth depth of the leukemic cell and say this worked or didn't work. as an objective medicine about the increase or decrease of leukemic cells. and a farber became very interested in this.

now, farber soon figured out one of the things that would be interesting but he defined a chemical that would thereby kill these leukemic cells and launch. therefore he launched history. they didn't have such a chemical. he fantasized about a chemical. it turns out there was an indian chemist who was born in india. his name is yes to corral and he had to boston, to harvard to study the school of tropical health. know what he didn't know, as we all know, there's nothing tropical about boston, so he was stuck in the middle -- he arrived in winter. he was stuck in the middle of winter and he couldn't find a job. he found a job in fact claiming urinals. that was the best job he could get. but somehow three series, he found a job the department of biochemistry and made several fundamental discoveries. in fact, he discovered atp.

which is that some of you might know a very important molecule in several other seminal discoveries. because he was in the comic he was denied tenure and was sent off from harvard. he sent himself off to a pharmaceutical company in new york called letter the county subbranch of this inanimate company. there, he took a big problem, which is of great interest in him. and that is he began to synthesize many vitaminscome as embedded versions vitamins. and one vitamin e is particularly was called folic acid. in the past, an english physician, a young woman who it figured out a fully tested was responsible for the growth of normal blood cells. so in other words, often in women, particularly pregnant women, deficiencies -- if you

didn't have folic acid can your blood with a family. so he put all these things together piece by piece. he started wondering, if fully tested is required to make normal blood grew, then could it be if you got folic acid, you could block the growth of an agreement blood, which is leukemia? so he said to himself, to folic acid is a key factor for the growth of normal blood cells, dead can one take an anti-folate and thereby block the growth of leukemic cells? and so, he began to fantasize about anti-folate and this was the drug dealer had discovered during the process of finding folate come he had found its opposite, synthesize and anti-folate. so farber wrote to him in new york. he sent him an anti-folate and he began to inject -- farber began to inject children and demonstrated for one of the

first times in history a remission in childhood leukemia and thereby invented chemotherapy. and that is farber's unit when he comes off his basement. ..

and then i began to send out these e-mails on the list which would say if you happen to know the site called are s with leukemia in the 1940's please call me, write to me, etc., etc. i would say to myself this book is never going to get written. and then i got rejected and i thought i would take him on a vacation to my parents' house in india and someone said to me yella, the chemist, has only one biographer, a sample biography, the only biography written of yella that i know of and someone said to me yella's biography is 85-years-old but he lives three blocks away from my parents' house in india. [laughter] someone said to go talk to yella's biographer. so i go to torch yella's

biographer and we talked for an hour about his chemistry etc., etc.. i'm about to leave and he says wait a second. before you don't know if you're interested but i was in boston in 1950 visiting to compile this biography and i have a roster of all his patients with leukemia, and it's a stunning moment for me and out of the final came a series of patients names and pictures and that's how i found this dismissing child and juarez was robert sandler and 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 historic moment for medicine but of course none of this is searchable. this is not indexed, so why would have never ever discovered

him. so in a sense this became a metaphor for the writing of this book which is that he might look for something and get in reality you might find 6,000 miles away. the second metaphor is things always come up around. there's a circularity to the process and to history. so i came back to boston now armed with the name of this child and then using the medical records and using the boston directories address book i could find his parents name, and then using the records, the death records which is actually publicly acceptable, i could find the exact time, where he died, where he had been buried, etc., etc.. and all of a sudden the story that vanished came alive for me

-- nada vignette behind the scenes look as the front look what happens once you've done all this legwork and found this child how then you can construct a story and piece by piece for me it all started coming together i now reconstruct the story of this child having visited his house. some miles south of the hospitals in boston the town of dorchester which is where robert sanders lives as it turns out is a typical new england a suburb wedged between the industrial segments to the west and the atlantic to the east. the late 1940's the jewish and irish immigrants shipbuilders, railroad engineers, fishermen and factory workers settle in occupying roses on the houses that sneak their way up through the avenue.

again, the riding of the sentence was now i can go back into the history and read about the history and reconstruct and it turns out that robert sanders father was a ship builder so he was now linked into the larger history of the town. they reinvented itself as a quintessential suburban family town with parks and playgrounds around the river, the golf course of the church and synagogue. sunday afternoon, families converge to walk through the parkway's or to watch ostriches, polar bears and tigers at the zoo. a kind of small note when i was writing all this i kept thinking i went to his house and i looked out what might have been his window i don't know exactly where he lived in terms of what floor but looking out it looks into the park which at that point of time part of it was a zoo and i kept thinking to myself if i were a three year old child what what i remember most about that? i had a 3-year-old daughter then

and i kept thinking what would it be and i thought to myself it would have to beef animals. so it took only a couple readings to figure out that there were ostriches that come to the park and what was nice is in history, so if someone came to me i was doing one of these readings in seattle and someone said how do you know there are ostriches in those zoo? and so it was nice as a writer it's filed away somewhere in the back of my cabinet or the little article about the fact there had been ostriches it was very nice strange all the things that give you pleasure as a writer. on august 16th 1947 in the house across the suit a child in the ship worker fell ill with a low-grade fever that marks and waned over two weeks without pattern followed by increasing lethargy. robert sandbu was 2-years-old. his twin, it turns out he had a twin, was active and in perfect health truth being stranger than

fiction we talk a lot in this book about how genes are inactivated and activated to cause cancer. if you want to find a mechanism to describe this, describe the role of carcinogens and genetic abnormalities and the idea that there can sometimes be a family history, you probably choose to identical twins, and one of them would develop cancer and the other would not develop cancer and that would allow you to begin to enter the biology of what makes one of the twins have cancer. yet i didn't ask for this and of course there is a twin, robert sandler has a twin and therefore set up the capacity for the discussion to happen down the road about the idea of what is it, what is a twin mean in genetic terms for cancer? i will come to that. now we enter farber's paper again and gives a reminder of how dense, how incredible medical writing can be. in a very cold kind of paper there is the story of human beings being told, and whenever

doctors exchange clinical papers, but they are really exchanging, again i think our stories dressed up in technical language but the stories, so we return to farber's paper, and just literally i am restating what is in the paper. ten days after robert's condition worsened significantly. the temperature climbed higher, his complexion term from rosy to a milky white. he was brought to the children's hospital in boston. his spleen that stores mixed blood was visibly enlarged like an overfilled bad. a drop of blood revealed the identity of thousands of amateur leukemic the word dividing in a frenzy and chromosomes convincing and a unconvincing like tiny clenched fists. sandler arrived to the children's hospital a few weeks after he received his first package from yella. on september 6, 1947, he began to inject sandler with acid or

paa, the first of the antiacid. to run a trial for the drug even toxic wasn't typically required. parents were occasionally informed about a child, but children were almost never informed or consulted. the nordenberg code for human experimentation require explicit will enter a consent was drafted august 9, 1947, and that's literally one month before this drug. less than a month before the paa trial and it's doubtful farber heard of such a consent code. the drug had little effect over the next month sandler turned increasingly lethargic and developed a limp as a result of the leukemia on his spinal code and he had violent pain. the leukemia burst through one of his bones causing a tractor and unleashing a blind lee intends indescribable pain. by december, the case seemed hopeless. the tip of sandler's stream of leukemia cells dropped to his

pelvis, he was pale and on the verge of death. september 28, however, and we know that from sydney's papers, farber received and the diversion this one was a chemical with a small change from the structure of paa. farber snatched the drug as soon as it arrived and began to inject the boy hoping for at best but the response was marked. the white cell count which had been climbing astronomically, 10,000 in september, 20,000 in november and nearly 70,000 in november suddenly stopped rising and hovered at a plateau. and even more remarkably, the account actually started to drop. the leukemic blasts flickering out and all but disappearing. by new year's eve, the count dropped nearly 1/6 of its peak value. bottoming out of nearly a normal level. the cancer notably haven't vanished. under the microscope there was still malignant blight cells but it temporarily had been frozen into the stalemate in the frozen

boston winter. on january 13th, 1948, sandler returned to the clinic walking on his own for the first time in two months. the spleen and liver had shrunk and so dramatically that his clothes, farber noted, had become loose around the abdomen. again, just a little observation an equivocal paper -- this is farber writing -- and he says in a timely remark he says, his clothes have become loose around the abdomen. what an elusive description. if you want to discard the remission of a child with leukemia, what an amazing choice of simple words that 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 had become loose and that's his remission. you don't require very much to cut in medical paper to reconstruct a story that's so vivid. his bleeding stopped, his appetite had turned ravenous as if he were trying to catch up on six months of lost meals. by tiberi farber noted the

nutrition and activity were equal to his twin. for a brief month or so, robert sandler and eliot sandler seem identical again. like all stories, this one also has an epilogue and the epilogue is more amazing than the story itself. about ten days after the book was published a got a phone call from my editor and she said you need to sit down because this is a very important phone call and i was writing a grant in 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 the story of his twin who died at 2-years-old and people who have the copy of the booknotes that the book opens to robert sandler 1945 to 1948 and to those who came before and after him. and he opened the book, he lived in maine, i would have never

found him, he opened the book and he saw his brother's name, the brother that had vanished from his life at for-years-old, and he moved to tears then and he told me this amazing story which is his mother helen whose picture is in the but because of her picture from the saturday morning post palin and robert and eliot and the whole family was jewish this still remains that she was just a deep believer and as many of you might know opening a body, performing an autopsy after death is considered a violation of sanctity. and helen didn't want her child to have an autopsy but farber was a pathologist and the only way that he knew he could learn it from the first remission was to perform an autopsy. farber begged helen sandler to

let her open robert's body and perform an autopsy and she refused and finally he really beg her and said for the sake of medical history and medical science, let me open this body of and she said find, do it. and she said to elliott, she told me this haunted her for decades, for decades she would think to herself as was the wrong decision. and so i think the finest praise i got for my book is from helen sandler who indirectly said to me that the book brought her story to a close. she said now that robert sandler has found a place, a rightful place in medical history. it was if her decade haunted memory had come to an end, and i think that is in some ways finer praise than any than i have personally received and perhaps the most moving thing that happened around. i have time for one more passage

and going to read and this is from the end of the book. the first kind of challenge that i've described to you is the challenge of story making which is how to populate a book. as it is the challenge that appears in the content. a book like this also faces a different kind of challenge and that is a challenge of summary making which is at the end of the book how do you summarize 4,000 years of history, how does one prepared to give, how does one tie up all of this? the quick answer is there is no simple solution and that's something we learn in the book. one of the challenges of this book is there is no answer. i don't want to write a book with this is how you kill cancer each broccoli or some nonsense like that. it's a thought experiment.

early in the story i recount of a persian queen who is ascribed and no less than about four lines and their earliest descriptions of what might have been breast cancer again we don't have a word for cancer in this time and it's sort of in fighting history which is of course the description of the early history of the west particularly focusing on greece since al little bit of a message and throws herself and about two or three lines but he describes this idea that the queen of persia the ... welling in her breasts and as some people have translated it her response is contemporary she was so ashamed of it that she had herself and her shame again calling of the

new york times she had herself and she wouldn't let anyone examine her until a greek slave intervened and promises to cure her and it does and if so probably does so by performing the lumpectomies of breast cancer and very grateful and at the return favor she tells them that she would pursue her husband, the king of persia who is invading the eastern border she would persuade him to invade the western border of persia towards greece so that they can return back to the native greece and in doing so this launches the persian war. so here's this woman, and i'm actually literally quoting from the history of this is the moment in the history when when the face of persia as it returned from its eastern face to the western face because this

illness the four or five lines because this launch as early history of the west the persian war and the turning of the face of persia away from the eastern border towards the western border launches which is very well known the famous greek of the war now we turn back and we call it the persian queen who like the had breast cancer in 500 bc. in her traveling through time appearing and reappearing in one after the next the cancer is gray as she moves to the art of history that tumor has remained the same. the case allows us to recapitulate the cancer therapy and to consider its future. how has the treatment and the prognosis shifted in the last for a thousand years and what happens later in the new millennium?

first backwards in time to the steps and egypt in 2005 and pc. she has a name for her illness that we cannot renounce he provides a diagnosis but there is no treatment closing the case in 500 b.c. in her court she's of prescribes a mastectomy which is performed by her sleeve. 200 years later they identified the tumor has giving her illness in name that would link to its future and incidentally this is the name cancer because they imagine it as a crab. under the skin and the blood vessels spread out like the legs of the crown under the sand. right from the moment of conception cancer as a metaphorical disease, the word metaphorical permeates this illness. a thousand years ago by and the black by was purged from her body and keeps growing and

relapsing and metastasizing. but they understand little about the disease that chisel away with knives and scalpel's some of her and these are documents drawn from the historical text the blood plates good and holy water and chemicals as treatments. in 1778 her cancer is a side stage localized breast cancer or lead advanced cancer for the former early localized cancer hunter recommends a local operation and remote sympathy. when the merger 19th century they encounter the new world of surgery and in house of breast cancer is treated with the boldest most definitive radical mastectomy with a large tumor removal of the chest muscles and the collar bone. in the early 20th century, by the way, that treatment i have a story of that in the book it

turns out to be essentially a failure. it takes 90 years before the patients and doctors began to convince themselves to put the idea of the radical surgery to test and when it is put to test after the invention and treated with it later it turns out to be no different from the non-radical surgery. in the early 20th century the oncologist stretch a obliterated using local x-rays and by the 1950's yet another generation of surgeons learned to combine the strategies tempered by the moderation. it is treated locally with the simple mastectomy or lumpectomy followed by radiation and the new strategies to emerge. the surgery is followed by the combination of chemotherapy to the chance of a relapse into the tumor tests positive again recapitulating things we've gone through in the book her tumor has positive and is added to prevent a relapse. in 1986 her tumor is further discovered to be amplified in

addition to surgery, radiation, chemotherapy and tamoxifen she's using her sefton. it is impossible to enumerate the precise impact of these interventions and the survival and the shifting landscape of the direct comparison between the state and 500 b.c. and the 1989 but the surgery, chemotherapy, radiation, hormone therapy and targeted their peak of likely headed anywhere between 17 to 30 years to a survival. diagnosed at 40 bacon reasonably be accepted to celebrate the 50th birthday. in the 1990's the management of the breast cancer takes another turn. her diagnosis of an early age and her ancestry there's a question of whether she carried the mutation in one. these are terms introduced in the past in the book. and the genomic sequence and indeed the mutation is found. she enters the intense screening program to the appearance of the tumor and the unaffected breast her two daughters are also tested and found positive for

one they are offered either intensive screening for the pro lactic or the tamoxifen to prevent the development of the face of breast cancer. her daughters the impact of the screening and the prophylactics might be traumatic. a breast mri might identify a small lump and one daughter and it might be found to be breast cancer and surgically removed in the early pre-invasive stage and the other daughter might choose to undergo the prophylactic mastectomy having a she might live of a life free of breast cancer and the ex pond to a similar trial. basically as an oncologist would know each refers back to progress pervvijze particularly if management of the one positive or to positives to a or negatives for breast cancer and they are somewhat humanized.

moving into the future now in the 2015, should arrive with a flash drive of every mutation and every gene she will take a medicine to prevent or to retaliate her illness for the rest of her life. this inevitably is progress but before we become too dazzled by the survival is worthwhile putting it into perspective given that pancreatic cancer in 500 b.c. and the prognosis is unlikely to have changed by more than a few months and 2500 years. if she did the lescol letter

cancer that is not in the surgery her survival change is only marginally over centuries. even breast cancer shares the market outcome. if her tumor had metastasized or had been the unresponsive to chemotherapy, then her chance of survival would have barely changed since the time of the clinic. the leukemia or hodgkin's disease in her life span might have increased 30 or 40 years. part of the unpredictability of the buzz about the trajectory in the future is that we do not know the biological basis for the petro genevieve. we can all from for instance what makes pancreatic cancer or gallbladder cancer so different from the cml or the breast cancer. what is certain, however, that even the knowledge of cancer biology is unlikely to eradicate cancer fully from our lives. as richard suggests and as the tulsa epitomizes we might as well focus on prolonging life so that eliminating def.

the war on cancer may not be won by redefining victory. so that is a second passage. how are we doing for chaim? is there time for one last passage or should we wrap up here? we will read the last passage in the book is a very short passage and i think it is the final summary of the book. this passage was probably the hardest for me to write and in fact goes back to the question john talked about why i have written this book and was written as an answer to a question that a woman had raised and returned to the story of that woman. this is an incredible woman who while lisalyn boston she had had an abdominal sarcoma had

relapsed and had another relapse into remission and incredible by the way caused with of a new drug of striking revisions. and she had essentially followed the trail of the drug throughout the country moving from one to the next enrolling herself in the clinical trials getting information on the web, creating a the lists or her own community every time around herself and she would engage in the community and ask questions and pos herself into the trial. she had at one point in time had received chemotherapy using one of these drugs while living in a trailer home she found herself homes like this and then she would move on to the next one like she was creating her own little trailer around the country and unbelievable person. and then finally she had had her

last response and the tumor became completely resistant and wouldn't respond to even the newest forms of therapy. as of this is the last time i see her. she produced only a temporary response but did not work for very long but by february 2005 the cancer spiraled out of control going so fast she could record its weight in pounds as she stood on the scale every week even her pain eventually her pain made it impossible to walk even from her bed to the door and she had to be hospitalized by meeting that evening was sent to discuss drugs and therapies but to try to make an honest reconciliation between her and her medical condition. as usual she and beat me to it. when i entered the room to talk up the next steps for the hand in the air the goals were now symbol she told me no more trials or drugs the six years

and in 2005 hadn't been static it sharpened clarified. she had her brother and uncle justin her doctor, a teenager in 1999 and now a mature sophomore at a boston college of grown into her ally and confidante and sometimes nursing closest friends cancer bricks on the families, they said in my case they did both. they realized that the content they want to go back to alabama to her own home to die the death she expected in 1999. when i recall that conversation with germane the object seems to stand out more vividly than the words. it smelled of disinfectant and canceled and the overhead light the side table on the wheels and books and newspaper clippings may polish jewelery and postcards the standard issue failed with a bunch of sunflowers on the table by her

side. germane as i remember was sitting by the bed with one leg dangling casualty of the town wearing the eccentric combination of close and some large and unusual pieces of jewelry her hair was carefully arranged. she looked for all, frozen and perfect like a photograph of someone in the hospital waiting to die she seemed content she laughed and joked and made the two would seem effortless and dignified years later writing this book but i finally put into words why that meeting left me feeling so uneasy. while the gestures seemed larger than life, while the object seemed like symbols and why germaine herself seemed like an actor playing the part. nothing i realized was incidental. the characteristics of the personality that had once seemed spontaneous and in a positive calculated almost responsive responses almost reflective responses. her clothes were losing savitt

because they were decoys against the growing out line of the tumor in her abdomen and her necklace was a strikingly large to pull the attention away from her cancer and her room was topsy-turvy with pictures and the hospital room filled with flowers and the cards stacked to the wall because without them they would devolve into the anonymity of any other room in a neither hospital. she had dangled her like the precise angle because the tumor invaded her spine and had begun to paralyse her other leg of making it impossible to sit in the other way. her casualness was studied and her jokes were rehearsed her illness tried to humiliate her and made her anonymous and seemingly humorless and to dhaka and unsightly def miles away from home and she responded with a vengeance. moving always to be one step ahead. it was like watching somebody locked in a chess game. every time the disease moved imposing yet another terrifying constraint on her she made an

equal move in return. the endless active and she reacted. it was a morbid hypnotic game that had to get over her life. she dodged one lonely to be caught by another. she too was like the brand queen stock pedaling furiously still in one place. germane seemed to capture something essentials about the struggle against cancer but to keep pace with me to keep inventing and reinventing, learning and unlearning strategies. germane fought cancer incessantly, fiercely, natalie, brilliantly and jealously channeling the energy of the men and women who fought cancer in the past and would fight in the future and the quest had taken her on a strange and limitless journey to the internet login teaching hospitals, chemotherapy and chiles have we across the country to the landscape more desolate, the sport as we would imagine. she deployed every last morsel of her energy to the quest

mobilizing and we immobilizing her courage summoning her will and wit and imagination until the final evening she steered to the resourcefulness and found it empty glass might hang on to her life by no more than a tenuous trade summoning all her strength and dignity to the privacy of her bathroom it was as if she had encapsulate the essence of the 4000-year-old war. thank you. [applause] >> we are going to take questions now. i'm going to bring around a microphone so please don't start your question until you have the microphone also because this is film for tv for privacy reasons please don't ask any personal

questions. thanks. >> personal medical questions, you can ask questions about me. [laughter] >> if i may by asking john the question and that is tell us a little bit about how what's happening at the national cancer institute. you've come here from washington. tell what's happening in the national cancer institute in terms of this new administration and this comment and what you imagine would be happening in this administration with respect to cancer. >> excellent question. i was most impressed by your eloquence and ability to communicate. i really think that by being able to educate america and the world about cancer it's really my hope that someone in the field other than medicine would probably be the one to find the answer to cancer just like mike chariton mustard gas was found on the battlefield.

one lesson i learned very often it's the medical students, the youngest trainees who asks the most provocative questions and who moved the field of medicine forward and i really wanted to congratulate you. i was most impressed during the discussion of serendipity and i hope there may be 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 to either change or repeal the affordable care act, but one area that continues to move forward is the amazing amount of work, a clinical trials and studies undertaken of the national institutes of health and cancer institute. i hope that the budget will be able to be approved and funding

will be preserved to continue all of the incredible work that is being performed at the national cancer institute. the institute offers tremendous hope for patients from the entire world and it appears that the commitment of the obama administration to the discovery to innovation will continue, so i think that for cancer patients all around the country and the world that there are many great things to come from that institution. >> what are the battles, who is fighting what? >> the battles are politically and they are about how we are going to change or repealed the affordable care act, and there are many strategies i would turn your attention to an article from "the wall street journal" about the strategies to either defund, disallow, repeal or

change the legislation the was passed last year. it really is my hope that we can be constructed and move of of the acrimony of the debate and identify those portions of the law federal working well and the ones that need to be improved and to keep the process of the reform moving forward. >> that is a absolutely vital. yes, questions. >> ayman old-time pediatric oncologist. what i want to do is make the comment is a fantastic book and most of the people -- [inaudible] >> right on. >> thank you. you know one of the things again

because the constraint of time to draw a character in a book like this one of the ways it really relies on lots of primary interviews from the archival research a lot of primary interviews and i think there are about 400 or 500 interviews that went into the book and carried on overtime and even for instance painting a picture of sidney farber was to do that to come at him from different angles and what's important is that human beings are complex even a character like farber a lot of people didn't like him. he was an unpleasant character to some and that's important because otherwise you write a history that isn't real. thank you for your comment.

>> have you ever been a doctor in a war? >> that's a good question. not in the sense that you might understand the war. i've never been a doctor in the military for from. but one might say that this is also a war in the sense that when we fight the war between people and human beings fight each other but sometimes we fight even more important against things that we can't see, and i might add that cancer is one such entity. i don't like using the word of war sometimes because it feels as if the patients become soldiers and if you don't survive you become a loser in such a war mexico don't like using that metaphor but for some people what works. some people imagining us and by

usual approach to this if that is a metaphor that works for you, use it. >> i've never been a dr. dragani war i have been on the more abstract war and the others off right now against the more abstract entities, the political war and part of that is also part of the but how does one find a political war and create strategy which is not only scientific strategy because the one thing that we know is that if we were to engage cancer whether it is the war or not if we are to engage cancer the solution can't just be a scientific solution it will never be. there will have to be a political cultural solution and all of this comes into the dhaka eradicating tobacco one doesn't require a scientific solution one requires the political

solution. it's completely different but requires another kind of strategic element so every piece of our society and us as human beings is somehow engaged in this and everyone can contribute >> this seems to be increasing research going on. there's a popular issue right now and can you comment on your outlook or the preventive efforts being made and any optimism? >> guest >> i have several comments. it deals with prevention so let there be no mistake that in fact one of the most historical the in fact one of the most seminal moments in the war on cancer is

when this idea fighting the war on the battle began to fade away and people began to research the focus on prevention that continues today. i'm not going to talk about them at great length. i'm going to make two comments. one is that the remains shocking to me the most preventable question is still at large. here we are fighting the complicated battle on the hill about how to do this, that or the other about health care costs and meanwhile the largest known carcinogen. there's a great irony in all of this that people come and talk to me about radon or some known carcinogens and foley acknowledged carcinogens but it's a little bit like we are not talking about the huge element in the room which is

tobacco so my quick answer to that question is some of the battle against prevention is going to be politically and a cultural battle. but the second point i want to raise which is interesting is it seems the silo of prevention and treatment can cancer biology are collapsing in many different ways and i think that is encouraging. we used to think the prevention, cancer prevention people used to live in one compartment and others used to live in a separate compartment but that is not the case anymore. i will give you one example. tamoxifen is a good example of that. here's a drug that is created to treat the advanced metastatic breast cancer but turns out to have a role in prevention you can use the tamoxifen as a preventive agent in the appropriate population identify the appropriate focus.

troup such as the mammography which was identified as the diagnostic tools to diagnose breast cancer can be used in the preventive setting. in fact even the genomics cancer genomics the understanding of the genome has an important role in preventing and increasing particularly on breast cancer. so there is a way in which the new molecular is forcing us to rethink these silos and i think that is good because it would allow us to think that the prevention in a way that doesn't profligate to one end of the spectrum and that has been happening for a while and is encouraging to me. >> a ibm a surgeon and we can cure cancer if we catch it in time. we burn them, froze them, use a ultrasounds, cut them apart and make vaccines. if we catch them early enough we can toward them to read the

question is about the prevention of the recurrence and what we haven't solved you can have a tiny tumor and move it in its entirety but months or years later you will discover that it's spread all throughout the body and conversely i've seen the largest tumors removed surgically and they never recur and so the fundamental next step from the surgical perspective is the prevention of the metastasis speed viruses and bacteria involved and so therefore the war against them is never over. it's a temporary victory for decades to treat the cancer evolves with your 5,000 year look? >> ansi baltimore schweiker scoop cents and inside the body of the human being the cancer is in the so in other words, within

every two were there is a darwinian battle going on even without treatment so within every tumor there are clones growing out which are resistant for instance tease jeter e-mail and system. within a free tumor there are clones that will move into other parts of your body. when you take the chemotherapy will kill all of the -- you might kill many of them that there might be some that escapes and therefore they will evolves so cancer and we talk about this as the illness that in fact is part of the secret of how unbelievably successful the cancer cells are because every time it's a kind of again we come back to this but for every time we are doing something the cancer cells are devolving and

it's much like treating the disease, like a bacterial illness or much like treating a disease with viruses. it's like the bill of the guess strapped inside of the body. >> my question is regarding the role of the patient during a therapy. for myself when i was diagnosed my center made it very clear that it was patient oriented and that i would have a part to play in deciding what directions i was going to take. but the reality of it is at the time when it happens and everything is 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? >> my comment in general the lesson is that is an unfortunate situation and i hope we don't find ourselves in increasingly over time. i hope that we have given the

pressures of time and money that are occurring in health care. i hope we have time to listen to stories and figure out how to best treat not a statistical entity but a human being. and i have to say it's very tough. sometimes it requires a kind of listening skill which i think we as doctors have forgotten. some people might not want a certain kind of treatment, and it's very hard for physicians to listen to that. almost as if we forgotten the listening skills. i hope that doesn't -- i hope that we have a way to keep that in medicine. do you have any idea how this -- >> my thought was i didn't feel my doctor wasn't listening to me. i felt like i am not someone who's studied cancer my entire

life, i knew people who had a but i knew very little about it so to get to the level like asking a question and really make some definitive decisions i would have to move so fast i would have to be reading up on everything. so when it gets down to its i have to trust my doctors which of course i do and i chose doctors that i trust, but i think as a patient, a patient does feel pretty much out of control. >> that is fundamentally the case. it is the case that one feels out of control. you know, i think this is one of the fundamental challenges of medicine is how does one involved the patient in a way that is respectful of the wishes but on the other hand doesn't feel it is your job to be the expert. once it becomes your job to be the expert, then in some senses

the process has defeated itself. there is a reason behind someone to collate all the information and there's a huge amount of information. so i think in some ways i don't know the answer. i have a general strategies. one general strategies i ron ackley at least in my personal practice i ron ackley i find that patients become more confident when you tell them that you don't know something. it is a peculiar irony as opposed to saying you know something is an irony of medicine. of course much like the readers can detect false note in a book and one and a half nanosecond's the patient can detect false confidence in the doctor's in one-and-a-half nanosecond's and so ironically the best way to approach, to build confidence is to be humble of what is known and not known, that is my personal preference. and the second thing i think is

there is a restoration of faith in the city and let me be the person that has the information but you give me the direction for that information so don't spend a night looking on the web is because that isn't what will heal or allow the process of healing to occur. your body is doing enough already. let me be the person who has the information and you be the god for that information. that leaves patients they don't have to be the experts all the time because no one is the expert. i'm not the expert, i know a little bit more but i am not the expert. that's my strategy but it involves a kind of act of listening which i think it's hard to do in these times.

>> weblog research is the kiss of death. [laughter] >> do think the vast quantity of chemicals used in the process these are contributing to an increase in the incidence of cancer? >> that is a tough question. i think some chemicals may be contributing but i think on the other hand one has to be careful about this idea of hyper carcinogenic environment because it creates in a panic about the environment i don't agree with. my general fought about this is every chemical particularly those that reach a certain concentration in our environment need to be rigorously tested and the testing mechanisms are improving. we used to perform in a primitive way of testing for the carcinogenic agents during primitive and relies on the fact that these chemicals cause

mutations. not all carcinogens do. it is an important test in fact developed a berkeley, but it's a very primitive test. we have better tests for that but i also disagree with this idea that every chemical needs to be tested is exactly the right thing to say, but i disagree with the idea that we have a general more carcinogenic environment because we need to find what the precise carcinogens are. it's a little like saying the water is carcinogenic. i have to drink the water. i have to breathe the air. you tell me in a very quantitative way that the dose that is available, this molecule in the air is causing cancer so

my plea is let's be specific about the claims what is the chemical, how can we remove it, what role does it play and then remove them from our environment >> i have a question similar to that. was i supposed to start now or wait? >> i have it of educational choice makes of interest. so my question similar to his, but i am interested in avoiding the paranoiacs the press encourages. so i wonder if there is some sense you have about the percentages of cancer that are basically just what i would call natural mutations, things running around living in a clean room all your life really won't cure and what percentage and i sure these are different for each type of cancer like smoking

we do know the answer. but for excluding one cancer is there a sense of the percentage that are just natural mutations that are inherited or come with age and which ones might be industrial carcinogenic we oriented? >> that question as you can imagine is an extremely difficult question to answer. it is answerable for the cancers so there's an old adage and epidemiology which is that large rear risks are much easier to assess the in a small, and risks. so in other words, 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's when you have a small

increased risk like let's say 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 was hormone replacement therapy. now and again, this risk was large enough to even register on epidemiological scale so this was a large risk but it takes a sophisticated kind of study to figure it out. so the quick answer to the question is unfortunately i'm not sure that we are there yet in terms of technology and figuring out what these small, and risks are. i suspect for some cancers they will never be there because, you know, in the end of can one really determine whether this was a very small carcinogen or was this a natural mutation? for some i think it is going to be very, very difficult.

>> thank you for that fascinating talked. you talked about how the radical mastectomy was institutionalized as a treatment for breast cancer and it took 90 years to understand that it was not necessary and ineffective. i wonder if you can talk about any other examples of that that you've come across in your research and in particular are their treatments that are part of standard therapy now that ten years from now or 20 or 50 or 90 we will think of as ineffectual or unnecessary? >> i certainly hope so. there are many examples and i talk about these -- one of the things in writing this book and i know this was commented on is i also want to not write a so-called will be history in which progress leads to more progress and one in seven a sunny place. there are dark moments in this book and dark histories and many

of the dark stories have to do with the way medicine becomes a self-fulfilling prophecy or learns to believe in itself with the mastectomy is one of them but believe it or not back to breast cancer in the 1980's there was a strong sentiment that many researchers believe getting a radical famous their deily to paa the therapy would cure breast cancer and would wipe out your bone marrow and replace it with your own bone marrow if it had been frozen away a transplant for breast cancer and it took another decades this proved that and part of the reason is patience didn't want to enroll themselves in the trials so they could become so convinced that by their doctors they've become so convinced this was the right thing to do no one wanted to be randomized to the placebo on the trial and the doctor said to them we believe this works and you believe this works so why go

through this? and so in massachusetts this would be interesting massachusetts there was a law that was passed which forbade an insurance company for not allowing the transportation for breast cancer, so in other words because it was cited the insurance companies would skimp which they were doing on breast cancer therapy there was a law that was passed the basically was breast cancer therapy, the transportation mandated by law. there's a civil after the civil, and i certainly think that this will repeat itself for many forms of therapy that we engage in today. >> you might have to be allowed because the microphone is somewhere way back but i can repeat your question. ..

prostate cancer comes in very different forms. one form actually does not metastasize so easily and you will not die of prostate cancer, but with prostate cancer. another four metastasizes and will kill you. we have not begun to figure out how to discriminate between

these two things and it's a huge problem. it's a problem that is again off in 92 double meat difference. it will make a difference in the national health care budget because for every 10,000 of the one time that you shouldn't be treating anyway, you are treating -- you are piling up cause, treatment costs, et cetera in the best thing to do is not anything. of course there is a culture party be in her. in the absence of the knowledge and this is what i talk about in the book, in the absence, how do we behave as individuals and how does one, for instance tally man that i am not sure, but it's likely -- i think there's 80% likelihood your prostate cancer will be the right kind. why don't you watch and wait. in a culture where we don't understand enough about cancer and where the word cancer has taken on the current metaphors and the current understanding,

how does one communicate complexity of the idea and he was comfortable and who's not comfortable with it? if you go on the web, you will find 10,000 opinions about testing with a psa. and again, this is of enough importance and so common that it will make a difference to the budget because of the numbers paella. so again, the usual uncertainties -- my usual answer is technology, science, deeper understanding. while we are in the waiting pattern, hopefully some in the audience hotel is five years later how to discriminate between the so-called good kind and bad kind of prostate cancer and relief of these problems you are having in washington. so encourage technology. encourage science. as the best thing we can do.

yes. [inaudible] [inaudible] >> e., have a look at -- do i talk about the food additives? i actually spoke a little bit in the book about exogenous estrogens and pesticides. but you know, it is an issue that remains undeniable. i haven't looked at it, but particular pesticides and hormones. again i think this is the kind of integrated approach involving not just the old-style epidemiology, but on the nation of molecular biology, cancer genetics and epidemiology to solve these kinds of puzzles. in general, i think especially with exogenous, there is a bit

of a smoking gun. i don't know if people or disagree with that idea appeared questions in the document may be in the front. >> i was wondering if you could comment on the old evolution as a writer. >> in the sense -- >> is this your first book appeared extraordinary book. i'm curious how your fault is an author. >> you know, my general approach to writing this book or to any kind of writing i do happens to be informed through my scientific work, which is i like to write books and answer questions. certify the question have a question, i'll write about. in this case i had a very urgent question.

in terms of winning this particular book, i actually learned to rightfully wrote this book. if you are a reader of this book, in fact to my senses as the book progresses from the 200 page to the 400th page, it can if you are a careful reader, at least to me it's quite obvious that i'm learning to write as i'm doing this. by the 400 page in a different writer as i am from the first page. i work backwards and i try to clean up -- i try to clean up what i had done before, but again, that marks the remains and i do realize the writing itself evolves. so that is one feature of it. in terms of process, you know, i talked about this -- is spoken to others already about this and it's been written about. i am a deeply indiscipline greater in the sense that i write sort of small snatches here in the air, often i write

exclusively. i prop myself up with pillows and when i was writing this, often it has in the early morning i would rate and i had a sort of -- and i think the most important thing in terms of the writing of this book and again if you are a writer, it becomes clear to you. this book lives up it seems. by that he means the content was relatively easy for me to write. it was the fact. it was the stitching together of the content. in other words, how does one go from 1994 back to 2000 b.c. and then move forward to 580. what were the themes? how does this fit together? but are the stitches and

sometimes that stitching is very tenuous. and so in fact the real disciplined in this book, in this particular book was that stitching. how does one manage. the answer to that is i tried to imagine a very competent reader. i tried to say to myself that kind of person who will go to this book is the kind of person i trust to move through those themes. and i will rise to the book and they will rise to read it and i'm not going to make some kind of compromise about it. people who wrote the book, the science gets pretty dense. i didn't spare the most contemporary details. they talk about cancer genomics from 2008. so this gets really complicated. again the book lives and it seems. so those are the features that allowed me to be -- you know, to

write. one nice comment. that is lots of people asked me -- i mean, i have been nice to rival. it actually happens to be a friend. so i learned to write from people who have the about medicine before me. so there is a learning process of reading. a lot of reading. that raises the question -- 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 that also happens 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 -- i think the most important thing about being indian and writing this book was the fact that india achieved me the freedom not to write about

india. and in doing so, allow me to write about something entirely universal, had nothing to do. but it is almost as if i inherited a kind of writing tradition, which allowed me to not have to write about the local politics or the culture of a subcontinent, but to write about something you and i cannot do conversation about. the freedom is very important to me personally. it's a cultural freedom, political freedom. i am not sure i can convey how deeply that was influential to me. i felt i could write about something that's relatively universal. and i think -- i think being american for that, but also the political freedoms of my country. of my countries. yes, maybe i'll take the last couple of questions. two questions coming at us. >> in recent years there has been research into conglomerates

and is enriched to a more location of cancer. i'm wondering why you didn't include it in your book and be think any favorite piece of commodities research to fight against cancer? >> again, the suspect was included and what was not included. in general, included scientific things in the book that has led to human therapies. i try to avoid -- in other words, if you really traced back everything that is in the book whatever goes into the book really ends up in a human being somehow, perception comes at a certain genetic understanding of cancer and becomes a drug. preventative mechanism, tamoxifen, et cetera appeared in slate telomerase, understanding of metastasis, things like the immune system i think are very 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 or the way we deal with preventative mechanisms of cancer. when they do so, i'll be forced to write an addendum to this book. last question. >> when my uncle had leukemia, they told him that johns hopkins university that they've done everything they could and beyond this into something greater. how much do you think like either positive mental attitude or belief in some sort of spiritual thing plays a role in curing cancer and what is your experience and all the patients he saw? >> right. well, it's good we and without question because i'm going to give a relatively provocative answer. my provocative answer to the is i try not to believe that the psyche has a role in causing

their for the following reason, because they think a big knife is cancer patients. so when people say, you know, there is a link between the psyche and cancer, i think it is precisely the kind of like that hands to a cancer patient whose fleet is already old, 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 are intensely positive attitudes about life who had incurable cancers and i know people who are unbelievably depressed or have all sorts of mental illnesses come up with perfectly healthy cancer free lives. so, this idea that the psyche causes cancer to me -- i've kind of analogy to this idea. now that said, do i believe the psyche modifies one's ability to heal? yes. there is no archetype of psyche.

in fact, someone might use grease to heal. someone might use depression to heal. for someone dealing with their illness might involve entering a state full of depression. that might be their mechanism. and to force my understanding of whatever force my understanding of what a positive attitude is, again and said the patient. you know, who am i to say what your positive attitude is? you might decide your intensity, you have an intense feeling of grief around your illness. that is your mechanism of healing. i can try to help people in that grief takes what i would call a kind of pathological form, but even then i tried to start out from a peer can i particularly am allergic to this idea that the reason you're not getting better is because you are not thinking positively enough. as part of the reason there are

so many self-help books out there about cancer, that you're not getting better enough, and it ferdi heard enough. i think i am very allergic to the. the start of my conversation by saying i'm not going to go there. if that's where you want to be, that's your decision as a patient. i respect that decision. for me to say that as a doctor creates a cycle of blame i really want to avoid. thank you. [applause]

! >> next, historian ron chernow discusses his book, "washington: a life", which won the pulitzeri prize for biography. he spoke at the miami book fair for 45 minute.do >> washington was dignified,ave stoic, heroic and fiercely devoted to duty.,

but was also a slave owner, ando unyielding taskmaster peers jef, 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