NERMEEN SHAIKH: Why has there been so little progress in the war on cancer? According to the director of the National Institutes of Health, Dr. Francis Collins, quote, “Americans are living longer, healthier lives. Life expectancy for a baby born in the U.S. has risen from 47 years in 1900 to more than 78 years today. Among the advances that have helped to make this possible are a 70% decline in the U.S. death rate from cardiovascular disease over the past 50 years, and a drop of more than 1% annually in the cancer death rate over the past couple of decades.” A drop of just over 1%? For the trillions of dollars that have been poured into cancer research, just over 1%? Today, we spend the hour with a renowned oncologist who says we should be treating the disease differently.

AMY GOODMAN: In her new book, The First Cell: And the Human Costs of Pursuing Cancer to the Last, our guest for the hour, Dr. Azra Raza, notes we spend $150 billion each year treating cancer, yet a patient with cancer is as likely to die of it today — with a few exceptions — as one was 50 years ago. She argues experiments and the funding for eradicating cancer look at the disease when it’s in its later stages, when the cancer has grown and spread. Instead, she says, the focus should be on the very first stages, the first cell, as her book is titled. She says this type of treatment would be more effective, cheaper and less toxic.

NERMEEN SHAIKH: Dr. Raza criticizes what she calls the, quote, “protocol of surgery, chemotherapy and radiation” — the slash-poison-burn approach to treating cancer, which she says has remained largely unchanged for decades. She calls for a transformation in the orientation of cancer research, writing, quote, “Little has happened in the past fifty years, and little will happen in another fifty if we insist on the same old, same old. The only way to deal with the cancer problem … is to shift our focus away from exclusively developing treatments for end-stage disease and concentrate on diagnosing cancer at its inception and developing the science to prevent its further expansion. From chasing after the last cell to identifying the footprints of the first,” Dr. Raza writes.

AMY GOODMAN: Well, for more, Dr. Azra Raza joins us to speak in her own words. Oncologist and professor of medicine at Columbia University, she’s also the director of the MDS Center. MDS is myelodysplastic syndromes, a form of bone marrow cancer. In her book, she notes, again, that we spend $150 billion each year treating cancer, yet a patient with cancer is as likely to die of it today than one 50 years ago — it is an astounding fact — with a few exceptions.

Dr. Azra Raza, welcome back to Democracy Now! It’s great to have you with us. How can this be? How can it be, the lack of progress that has been made in this last half-century?

DR. AZRA RAZA: Thank you for having me again, Amy. I’m delighted to be here.

Since 1903, it has been well appreciated, actually, that it’s not cancer that kills; it’s the delay in treatment that kills. So, forever we have been making attempts to try and diagnose this disease early. In the last three decades, we have seen a 26% decline in cancer mortality, which is about 1% a year, as you pointed out. But that’s not happened because we have developed some grand, new treatment strategy. It has happened because of two main things. One is the anti-smoking campaign, so the incidence started going down. And second is because we started using screening measures to diagnose cancers earlier and earlier.

This approach of preventive medicine, where you catch the disease early and intercept early, is what caused the drop in cardiovascular disease by 70%, because, there, the cardiologists were smarter than oncologists. They realized that if they allow a myocardial infarction, or a heart attack, to damage the heart muscle, then the only treatment would be a heart transplant, which is so draconian and so terrible. They started to diagnose not only earlier and earlier, but try and prevent the appearance by using anti-cholesterol drugs, for example. That’s a very clear case of early detection, but then even prevention of the disease. And 70% decline in mortality. Why aren’t we doing the same in cancer?

NERMEEN SHAIKH: So what is the answer to that?

DR. AZRA RAZA: Well, the answer is that we have been trying to do it. And the screening measures that were put in place, like mammography, colonoscopy, PSA testing, Pap smears, they’re the ones that caused the decline by 26% mainly, in addition to anti-smoking campaigns. But those measures were put in 50 years ago. Imagine, in this day and age of technology, we are still putting a tube into someone’s gut and looking to find cancer. That is primitive. That’s paleolithic for today.

AMY GOODMAN: And the alternative is?

DR. AZRA RAZA: The alternative is that we have milked these technologies as much as we could . They have yielded the 26% decline in mortality. They’re not going anywhere else. We need to invest in developing technology based on current imaging, scanning devices, detection of biomarkers, for example, from blood, sweat, tears, saliva, urine, stool samples, and find the earliest footprint of cancer and see how we can intervene. And this is a strategy that is not limited to just cancer, Amy. This is a strategy that is going to apply to every single chronic disease in the coming years.

AMY GOODMAN: So, what has prevented that from happening?

DR. AZRA RAZA: I wish there was a very neat kind of answer about this, but it’s something like this. You take a frog and put it in cold water and start heating it slowly; nothing is going to happen. On the other hand, you throw a frog into boiling water, it will jump out. But if you heat it slowly, the frog dies without jumping out, because it slowly gets used to it. This is an apocryphal story, by the way; scientifically, it’s incorrect. Just a warning. As a purist, I have to add that. But the analogy is true, that things have happened so slowly that we keep getting desensitized to the next step. One thing is that there is so much hyperbole around cancer treatment. If a few months of survival are added by a drug, it is welcomed as a game changer. Let me —

AMY GOODMAN: At the end of life.

DR. AZRA RAZA: Yes, exactly. Let me give you just a few statistics. I want to be very clear that using the slash-poison-burn approach, we are curing 68% of cancers that are diagnosed today. We are curing them. Thirty-two percent that present with advanced disease, their outcome is the same exact outcome that it was 50 years ago. The 68% we are curing, why are we still using these Stone Age treatments? You know how terrible it is to get chemotherapy and radiation therapy.

AMY GOODMAN: Explain how it works.

NERMEEN SHAIKH: Explain what — yeah, yeah. What happens?

DR. AZRA RAZA: The first rule of medicine is “first, do no harm.” In fact, when a patient is diagnosed with cancer, it’s a silent killer. That’s the problem. It can reach stage IV disease without producing symptoms. So, somebody comes to us — I recently saw a 42-year-old young man who has just finished a game of tennis and come to see me, and suddenly, because he was exhausted and feeling so tired, and now I diagnosing him acute myeloid leukemia. I look at this toned and tanned young man, and the first thought that comes to me is about what we are going to do to him with the chemotherapy we are going to give him.

It is unconscionable that in 2019 I am still going to give this young man the same combination of two drugs that we — popularly known as 7+3, that I was giving in 1977, when I arrived in this country. I feel ashamed of myself, having to repeat the same side effects, that you are going to lose all your hair, throw your guts out, and your counts are going to tank. Your blood counts will go down to essentially zero for weeks on end, where you are going to be susceptible to all kinds of terrible infections. You will be in the hospital suffering with shivering night sweats and fevers and all kinds of aches and pains and constitutional symptoms. And then there is a chance that a percentage of those patients will improve. So, this is what we do with just chemotherapy alone.

AMY GOODMAN: We’re going to break and then come back to this discussion and also hear about your personal story with your own husband, also a renowned cancer doctor, who died of the very disease that he was studying, and hear the stories of your patients. We’re talking to the renowned cancer doctor, the oncologist, the professor of medicine at Columbia University, Dr. Azra Raza. She has a new book. It is called The First Cell: And the Human Costs of Pursuing Cancer to the Last. Stay with us.

[break]

AMY GOODMAN: “Nocturnes, Op. 27, No. 2, in D-flat major, _lento sostenuto _,” performed by Abbey Simon. Abbey Simon passed away December 18th at the age of 99. This is Democracy Now!, democracynow.org, The War and Peace Report. I’m Amy Goodman, with Nermeen Shaikh, as we spend the hour with Dr. Azra Raza, a renowned oncologist, professor of medicine at Columbia University, where she’s also the director of the MDS Center — a form of bone marrow cancer — her new book, just out, titled The First Cell: And the Human Costs of Pursuing Cancer to the Last.

NERMEEN SHAIKH: So, Azra Apa, Dr. Raza, we were talking earlier, in the first part of the program, about the slash-poison-burn approach to treating cancer, which you’ve been very critical of, which involves surgery, chemotherapy and radiation. You say that this has been responsible for curing 68% of cancers. So a couple of questions: Would it have been possible, even though this is counterfactual, to cure such a high number of cancers using alternative methods? And, two, what kinds of advances have been made in how chemotherapy is administered and how the effects of that, of changes in the way that it’s administered, have had on patients?

DR. AZRA RAZA: Both very good questions. So, the first question you asked is what could have been really done. And what have we been aiming at doing? So, sure, we started by using these blunt approaches. It’s literally like taking a baseball bat to hit a dog to get rid of its fleas. That’s how bad this kind of treatment is. But we had to do it because we had no alternatives. In the meantime, we invested billions of dollars in trying to study the biology of cancer, hoping that we will identify some intricate signaling pathway, some genetic defect, that is going to allow us to target it specifically. And this did happen in two diseases. In chronic myeloid leukemia, we developed a targeted therapy, because there’s one gene had gone wrong, and one magic bullet could target it and cure the disease. Now we —

AMY GOODMAN: And again, just to note, you’re one of the world’s leading authorities on AML, this kind of cancer.

DR. AZRA RAZA: On this, I’m talking about chronic myeloid leukemia. But yes, you’re absolutely right: I am an expert in myeloid diseases. And CML, chronic myeloid leukemia, is something I’ve treated for decades.

Now, this was a huge advancement that happened in the early 2000s, that we could now use a targeted therapy which is not chemotherapy, which only goes and attacks the abnormal cell which is expressing this protein. While it helped patients, it’s also put the field behind by 20, 30 years. Why? Because we felt that this now establishes a paradigm. Every cancer will be caused by one genetic defect, for which we just have to develop one drug. So, one gene, one targeted therapy. Everybody and their grandmother has been trying to find the one gene for pancreatic cancer, the one gene for acute myeloid leukemia. It turns out that, unfortunately, for all other cancers, most of them, really, there are too many genes that are mutated simultaneously. And so the targeted therapies we’ve developed, even for those multiple proteins or one protein that is dominant, it turns out it works for a little bit.

So, let me give you some statistics again. Ninety-five percent — 95% of the new drugs that we are bringing, the experimental drugs we bring to the bedside, 95% of them fail. And to bring one of those drugs to the bedside is a billion dollars almost. So imagine how much we are losing. Five percent that succeed should have failed, in my opinion. Why? Because they’re only prolonging survival by a few months. So, for example, there’s a drug that extends the life of a pancreatic cancer patient by 12 days, at the cost of $26,000 a year — and not every pancreatic cancer patient, just a fraction. So think of the financial toxicity we are causing to these patients now. For very little prolongation and survival, we are financially ruining 42% of cancer patients diagnosed, newly diagnosed with cancer today, by year two. They lose every penny of their life savings.

AMY GOODMAN: Speaking of which, before we go on to the incredible stories you describe in The First Cell, your thoughts on Medicare for All? I have spent a lot of time accompanying family and friends, for example, at Sloan Kettering, who are dealing with cancer. The astounding devastation of people’s, aside from lives, financial destruction. Medicare for All, what would that mean for cancer patients?

DR. AZRA RAZA: Amy, while I’m not an expert on these issues, I have common sense. And one thing I can say is that the current situation is completely untenable. We are on the verge of a collapse with the healthcare system. We can’t continue it the way it is going. And, to me, the only solution seems to be — but again, it’s not speaking as an expert — is to have Medicare available for everybody. I think that’s the only compassionate and humane solution.

NERMEEN SHAIKH: Well, Azra Apa, I want to ask you about another incident that you mention in the book, before going on to the longer case histories of patients in their own words as well as in the words of their family members. I mean, the cost of cancer treatment, as you say, in the U.S. is exorbitant, and many families have been driven to financial ruin. But what about in places where cancer treatment is so prohibitive that it entirely deprives patients of access? You talk about arriving in Karachi and meeting — in Karachi, Pakistan, which is where you’re from — and talking to Zaineb, a cancer patient about whom you write, quote, “How does one go in and talk to a thirty-five-year-old woman for whom dying from leukemia is only her second-biggest problem?” Could you talk about that, access to cancer treatment and who the people are who are entirely deprived of any treatment at all?

DR. AZRA RAZA: This is a subject which is very close to my heart, Nermeen, because, obviously, I am from that part of the world. The entire world looks to America for leadership. What kind of leadership are we providing? A leadership where we are developing drugs or cellular therapies now that will cost over a million dollars per patient, for helping very few patients. These are rarified cases for whom this kind of treatment will work. As you said, what about the 20 million new cancer patients being diagnosed universally all around the world? We just don’t have a compassionate solution for them. Why aren’t we thinking not just of those even in America, in the remote areas and many, many places where healthcare is becoming harder and harder to access just because hospitals are closing down from financial ruin themselves? Why aren’t we thinking of them? Why aren’t we thinking beyond American borders, for humanity as a whole?

And when you think about that solution, I mean, you don’t have to be a genius. No, no, look, the only thing that works in cancer — if you have someone who gets diagnosed with cancer, the first thing you’ll say is, “Was it advanced, or was it caught early?” No, early, so there’s hope. We know that early detection helps, right? Why are we investing money in chasing down the last cell, in which — with drugs which have a 95% failure rate today? Because the pre-clinical testing platforms we are using are so artificial, and that’s why we are bringing up drugs that are not going to be successful.

Instead of doing that, why aren’t we simply improving on the techniques we know work? What worked? Early detection. How do you do early detection? Well, mammography, colonoscopy, Pap smear, etc., has been reached to their maximal limits. Let’s develop the new technology so that from one drop of blood, you can put it on a little chip, which can be read by a cellphone, which costs $180 for 12 cancers to be diagnosed early. This is something that was just announced by a Japanese company. So these are things not that are a pie in the sky. These are things that are happening now. Except how fast will it happen to reach the rest of the world? It depends on the amount of resources we invest.

AMY GOODMAN: We’re talking to Dr. Azra Raza. Her book is called The First Cell. She is a leading oncologist in the world. She is a Pakistani American, a Muslim, a woman. You talk about your own story in the book, the story of your husband, also a leading oncologist. Dr. Harvey Preisler died of lymphoma in 2002. You write, “Cancer is what I had been treating for two decades, yet until I shared a bed with a cancer patient, I had no idea how unbearably painful a disease could be.” Let’s first turn to your daughter, to Sheherzad Raza Preisler, speaking at the memorial service for her father, your husband, about his cancer diagnosis and the effect his condition had on the family. The 15th Harvey Preisler Memorial Symposium was held in New York in 2017.

SHEHERZAD RAZA PREISLER: What a cruel twist of irony it was that as he was directing the Rush University Cancer Center in Chicago, he was cut down in the prime of his life by the very disease he had dedicated his life to cure. I was only 3 when he was diagnosed and 8 when he died. My parents took great pains to never mention the C-word in my earshot, and yet most of my memories of Dad are related, at least in part, to the presence of this nameless other in our lives. And even though I was too young to know what was going on at any tangible level, I had some sort of instinctual knowledge that something was terribly wrong. I could sense my mother struggle as she was navigating through stages of optimism, pain, dread, despondency and, eventually, hopelessness, as my dad underwent a seemingly endless stream of experimental treatments. These stages are what most cancer patients and their caregivers and families experience.

AMY GOODMAN: That was Sheherzad Raza Preisler, the daughter of our guest today, Dr. Azra Raza, oncologist, professor of medicine at Columbia University, talking about her dad, who died of one of the cancers that he specialized in. He was head, Dr. Harvey Preisler, of the Rush Cancer Institute in Chicago. Tell us, as you begin your book, what happened to your husband, what happened to Harvey.

DR. AZRA RAZA: First of all, Amy, when I started writing this book, I had no intention of putting Harvey into the book. I was writing about my other patients. But when I wrote about them in such detail and with such painful granularity, I felt it would be dishonest if I held back my own story. And so, at that point, I decided to add. And once I decided that, this story became like a red line running throughout the whole book, because then I couldn’t escape, at every level, where Harvey came in.

I’ll give you just one example. I mean, he was the head of the cancer center. He gets the very disease he’s trying to cure. And now he dies, after a very, very exceedingly painful almost five-years battle. Sheherzad was 8 years old when he died. And a couple of weeks after he died, she developed a terrible cold and flu and was pretty sick for a few days and then started getting better. And one morning I was sitting in the living room reading, and she suddenly comes out crying inconsolably. I was sure that she’s had a relapse and is much worse. But when I was able to calm her down, this is what she said, Amy. She said, “Actually, I feel perfectly fine now. But I know what it feels like to be so sick and how good it is to get better. And my dad never got better.” Which brought on a second fit of crying. So, an 8-year-old, at a visceral level, is able to experience the kind of anguish that cancer patients suffer.

Being a cancer widow, did it make me into a different kind of doctor? No. But my perceptions changed entirely. You know, Marcel Proust has said that real voyage does not lie in finding new landscapes, but in having new eyes. And so it became a voyage of discovery for me, in having new eyes.

AMY GOODMAN: And that issue of prevention, of catching early, what happened in your husband’s case? Who — I mean, he was head of a major cancer institute.

DR. AZRA RAZA: The same thing that happens to all other cancer patients: He was diagnosed way too late. And actually, the lymphoma didn’t kill him. The treatment we gave killed him. The chemotherapy we gave destroyed his immune system, so that he died eventually of sepsis. He didn’t die of the lymphoma.

There’s a family friend of ours who once told my younger brother — he said, “Abbas, if the sun rose suddenly from the west one day, the entire world will stop and stare at it. But there are some people who watch the sun rise from the east every day, and they wonder why.” And he said, “Those are the only kinds of people who can make a difference in the world.”

And that’s the kind of person Harvey was. He was an extremely thoughtful person with a great curiosity about life in general, but specifically scientific issues. Yet what I learned from taking care of him and sharing a bed with him as a cancer patient was a deeply humbling acceptance of his condition. Basically, his attitude was “I am a man, and a man is responsible for himself, even though I know that this is not going anywhere.”

AMY GOODMAN: You write at the beginning of your book, in your introduction, “From Last to First,” talking about that idea of the first cell, “I have learned new things about what I thought I already knew: like the difference between illness and disease; between what it means to cure and to heal; between what it means to feel no pain and to feel well.” Can you elaborate on this?

DR. AZRA RAZA: I mean, really, the whole concept of this is — can be expressed better in poetry. So, if you don’t mind, I will recite a short piece by Emily Dickinson:

“I measure every Grief I meet
With analytic eyes —
I wonder if It feels like Mine —
Or has an Different size.

I wonder if it hurts to live — 
And if They have to try — 
And whether — could They choose between —
They would not rather die.”

NERMEEN SHAIKH: Well, I want to ask about another patient who you profile in the book, who is in fact subjected to a particularly brutal form of this slash, burn and poison. And that’s Andrew Slootsky, who died in 2017 at the age of only 23. The book includes a testimonial from his mother, Alena, who criticizes the attitude of the oncologists who treated him, but says she would have wanted Andrew to undergo any treatment that might have extended his life. So, could you talk about — Andrew was also one of the best friends of your daughter, Sheher. Could you talk about the treatment that he was subjected to? What happened? And also your decision — one of the most remarkable things about this book is not just, of course, your expertise in cancer and cancer treatment, but also these stories that you weave into the narrative, of patients you’ve treated, of patients’ families who have witnessed their family members being treated in this way and ultimately dying. And this is Alena, Andrew’s mother, saying that she would have Andrew go through all of this treatment, even if it meant the slightest possibility of extending his life.

DR. AZRA RAZA: Yes. Nermeen, actually, Andrew is the impetus for me to write this book. In 2016, when he gets diagnosed with cancer, he has weakness in his arm. He goes to the emergency room. They do an MRI. They find an inoperable brain tumor, nine centimeters long. They couldn’t remove it. From the day one, every oncologist that treated Andrew knew that his chance of survival is 0.00, beyond what is to be expected. No matter what we give him, he was going to die. We all knew it.

This boy, when he opened his eyes, coming out of anesthesia, he turned to his mother, and he said, “Mom, don’t worry. Just call Azra. She’s on the cutting edge. She will find the best treatment and cure for me.” And Alena called me. This young man, who’s been in and out of my house since he’s 15 years old, because he’s best friends with my daughter. I felt so ashamed of myself that there is nothing I can offer this poor boy, and the fact that we are failing the Andrews and the Zainebs and the Harveys and the Omars of this world so spectacularly, and instead of feeling embarrassed, we go around pumping our chest, claiming that we are curing 68% patients. “Sixty-eight percent of what?” again and again I ask.

And what we do to Andrew in the next 16 months, even though we knew his chance of survival is zero, is we give him chemotherapy, radiation therapy, surgery after surgery, more chemo, more radiation, more immune therapy. And he suffered the side effects of every one of them, without benefiting from anything.

But then, the converse is also a problem. Let’s say we didn’t treat him and let the brain tumor take over. That death from advanced cancer is just horrendous. So, basically, the treatment, what are the choices we offered Andrew at this point? Either you die of your cancer or die of the treatment, but you are going to die. And the question I ask myself is “Why?” Why was Andrew diagnosed when his cancer was nine centimeters long? We know that cancer is a silent killer. We know no age is immune to getting cancer. At 22, this boy got cancer.

AMY GOODMAN: And specifically in his case, how could it have been detected earlier? Talk about the tests that you think need to be developed, and are actually already there but somehow missed him?

DR. AZRA RAZA: So, Amy, I am calling for a complete paradigm shift. What I’m saying is that even the screening measures that we are using — annually, for example, doing a mammogram — is too late for some people. What we need to do is consider the human body as a machine and continuously learn to monitor it for the detection of diseases, whether it’s Alzheimer’s or cancer or diabetes. We need to catch all of these diseases early and try to nip them in the bud. This is what I’m asking for. So, what has to be done for that? Children get cancer. Not that many, but certainly they do. And again, we treat them with these draconian measures, and they end up with developmental issues, fertility issues, all kinds of problems. So, what I’m asking for is we need to develop those markers that can identify cancer at its inception. It is doable. It is possible.

A lot of research is going on, in this country and elsewhere also, to find footprints of cancer, for example — I’ll give you a couple of examples. When cancer starts, it divides fast — its cells divide faster than normal cells, which means it needs more nutrition, so it starts making new blood vessels. As soon as that happens, the area becomes hot because of new blood going into that one area. This hot area can be detected. People are developing bed sheets and mattresses where you can go to sleep and you are — overnight you’re being scanned for hot areas. Let’s say a hot area is detected in my pancreas one day. It doesn’t mean the next morning I should have an open abdominal surgery and eviscerated and removal of all my — no, it means that now there’s something abnormal which needs to be monitored. I am now considered someone at high risk, so I should be monitored for other biomarkers. These cells which are developing in my pancreas will be shedding their proteins into the bloodstream. If they’re not shedding, you know one thing we can do? We can yell at them. How do you yell at them? You use sound waves, literally, ultrasound, to hit them. And they start shivering, and they start shedding their proteins into the blood. And we get the blood and detect the biomarker.

AMY GOODMAN: Is there a cancer-industrial complex that’s preventing this kind of research and development of the preventive and the early-detection approaches to cancer?

DR. AZRA RAZA: Absolutely not, Amy. In fact, my contention and my conceit is that if — here’s an industry that is investing in an enterprise that has a 95% chance of failure, but they keep investing billions of dollars, because if one of their drugs makes it, if it improves survival by 10 seconds more than two months —

AMY GOODMAN: So you’re saying there is a cancer-industrial complex that is —

DR. AZRA RAZA: But they’re not preventing it.

AMY GOODMAN: Right.

DR. AZRA RAZA: They just don’t know what’s a better thing to do. So, what I’m saying is, we just set a new goal, and we financially incentivize the goal, then all these people will turn around and come to the first cell instead of going after the last cell.

AMY GOODMAN: What about Vice President Biden’s moonshot challenge around curing cancer?

DR. AZRA RAZA: I was one of the fortunate people to meet Vice President Biden in his — across his dining room table for the cancer moonshot and had a very wonderful discussion with Vice President Biden. His heart is in the right place. And there is a certain fraction of that billion dollars, the money that he has allocated for cancer research, is definitely towards prevention and early detection of cancer. But it’s not enough. That kind of vision is what we really need. But we need — I’m not saying all current research should stop. Nobody should misquote or mishear me. I am saying we have correct patients. Of course we have to worry about them, and we have to keep developing better treatments and better understanding of biology. But I think at least half of the resources, and all the resources going into these failing clinical trials, these billions and billions of dollars, can be redirected for future patients to try and detect the disease early — a solution which will be applicable universally.

AMY GOODMAN: We have to break. Then we’re coming back to our guest, Dr. Azra Raza, oncologist, professor of medicine at Columbia University, where she directs the MDS Center, a form of bone marrow cancer. Her new book is out. It’s called The First Cell: And the Human Costs of Pursuing Cancer to the Last. Stay with us.

[break]

AMY GOODMAN: “New York” by St. Vincent. The photos in the video were compiled by Kat Slootsky for her brother Andrew, one of the patients profiled in Dr. Azra Raza’s book, The First Cell: And the Human Costs of Pursuing Cancer to the Last. He died when he was 23 years old, of a particularly aggressive form of brain cancer. I’m Amy Goodman, with Nermeen Shaikh. We’re spending the hour with Dr. Azra Raza, the renowned oncologist, professor of medicine at Columbia University. Nermeen?

NERMEEN SHAIKH: So, Azra Apa, I want to ask you about one of the criticisms that your book has come under. In The New York Times, Dr. Henry Marsh praises the book but says you’re too optimistic about the solutions you propose. Marsh writes, quote, “Her diagnosis of the ills from which cancer treatment suffers strikes me as accurate, but her solutions seem infused with the same unrealistic optimism she identifies as the cause of so much suffering.” This is Dr. Henry Marsh writing in The New York Times. Are you guilty of too much optimism?

DR. AZRA RAZA: No. That’s the short answer. But, Nermeen, you know, I started my career in oncology basically in 1977. I was 24 years old, fresh out of med school. I had come here. I started working at Roswell Park Cancer Institute, because I was going to cure cancer — very quickly, I thought. And within seven, eight years, it was very clear to me, the disease that I had invested all my energies in, acute myeloid leukemia, that in my lifetime this disease will not be cured. It is so complicated.

So, at that point, I turned my attention toward studying an earlier form of the disease, because many of my patients who came with acute leukemia gave a history of having had some low blood counts and being anemic for a few months before it developed to leukemia. So I said to myself, “Why not catch this disease earlier, the pre-leukemia phase, and intercept then and not let it become this end-stage monstrosity?”

So I started collecting — this is where being an immigrant helped me, Amy, because had I gone to school in this country, if I had started to study acute leukemia, my next step would have been to make a mouse model of this disease, which are very artificial and which just — for drug development, at least. They’re very good models for studying biology, but not for drug development. But because I was an immigrant, I simply started saying, “Oh, I have to study cancer, so let me save these cells.” And I started banking cells on my patients. Today I have a tissue repository which has 60,000 samples from thousands of cancer patients, followed longitudinally, well annotated, with all their clinical and pathologic data in the computerized forms. And this is a very precious resource, one of a kind. Not one single cell comes from another physician. I still do the bone marrows with my own hands, which I’m going to do in the next hour, when I get to my clinic.

But the idea I had was that earlier detection will help. That was many years ago. Where’s my solution? So, the question you ask me and the criticism that Dr. Marsh is giving can be applied to me, yes, that 35 years ago I felt that detecting the disease early, pre-leukemia, would help me. It hasn’t helped me, because pre-leukemia itself is a very malignant disease and can kill.

So then I realized that by using these samples of acute leukemia, working my way back to pre-leukemia, I can then ask the question: Why did some people get pre-leukemia, to begin with? Why did they get MDS? And once we can discover that, by using these tissue samples and the latest technology of proteomics, genomics, transcriptomics, metabolomics, panomics, we will find the same kind of thing you have, say, for breast cancer, the BRCA gene. Can we find something that’s making people susceptible because of their inherited DNA?

AMY GOODMAN: What about targeted immunotherapy? People think that it has gone so far to help cancer patients. What is it? And what do you see are the prospects for it?

DR. AZRA RAZA: The answer to that is, first, you have to understand what is the cell therapy. So, there are many, many different forms of immune therapies, fourteen, fifteen different kinds. But the ones that are receiving all the attention are basically two types. Checkpoint inhibitors are drugs which cancer cells — so, every cell expresses proteins that either say, “Eat me,” or “Don’t eat me.” Cancer cells learn to express only proteins that say, “Don’t eat me. Don’t eat me. Don’t.” So, this is how they deflect the immune system.

AMY GOODMAN: We have less than a minute.

DR. AZRA RAZA: And so, we tried drugs to do that. We succeeded. The response doesn’t last. The other form of therapy is cell therapies that we use. Immune therapy using cells — T cells, for example — cannot distinguish between a normal cell and a cancer cell in the organ. All we can do is we can activate these T cells and say, “Go kill the whole organ,” and cancer will die with it. So the only cells we have succeeded in killing, or the only organ we have succeeded in killing, so far, is B cells, which are a kind of lymphoid cells in the body.

AMY GOODMAN: Ten seconds.

DR. AZRA RAZA: We kill them, and then we replace B cell function by giving immunoglobulins for the rest of their time. We can’t do that for the liver. We can’t kill the liver and expect to replace it. That’s why immune therapy using cells is not going to work.

AMY GOODMAN: Well, we’re going to have to leave it there, but people can pick up the book and take it from there. Dr. Azra Raza, oncologist, professor of medicine at Columbia University, heads up the MDS Center, a form of bone marrow cancer. Her new book, The First Cell: And the Human Costs of Pursuing Cancer to the Last. I’m Amy Goodman, with Nermeen Shaikh.