The Drive with Peter Attia — Siddhartha Mukherjee

On:New frontiers in cancer therapy, medicine, and the writing process

Episode: 32

Date: December 2018

Background: oncologist, researcher, and author of the “The Gene”, “The Laws of Medicine”).

Key Subjects:

  • Rules of writings:
    • No long stretches of science without a human element / pay-off.
    • Everyone should be able to read the book.
    • Only include research if it results in a concrete human intervention.
  • Cancer and prevention.
    • Very few preventable, human chemical carcinogens of substantial impact.
    • Obesity may be one that has similar level of impact as smoking.
  • The three laws of medicine.
    • Strong intuition is more powerful than a weak test.
      • Bayesian law.
      • Everything has priors, understand priors before understand posteriors.
      • Perhaps wired to be Bayesian.
    • Normals teach us rules, outliers teach us laws.
      • Anti-Bayesian law.
      • Complex interactions can produce outliers.
      • Less wired to understand outliers.
    • Every experiment is accompanied by a bias.
      • Every declarative claim comes with a bias.
      • Warrants skepticism.
  • Cancer research (or, research more generally).
    • First: questions are non-linear.
      • Need to find the right paradigm, perspective.
    • Then: questions become non-linear.
      • Understanding the mechanisms within the new paradigm.
  • Cancer and metabolics.
    • Does the metabolism of cancer cells differ from normal cells?
      • There may be many metabolic pathways for cancer cells that are different from normal cells.
      • Target these pathways and you may be able to affect the cancer.
    • When a drug is administered, does it change the metabolism of normal and/or cancer cells?
      • Reaction to a drug could be a mechanism by which cancer cells become sensitive or resistant to treatment.
  • Skills:
    • Create: throw something at the world.
    • Be open: listen to what comes back.
  • 8/10

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