Any biography written by Walter Isaacson is well worth the read, regardless of who the subject is. While this isn’t strictly a biography, it includes a lot of detail on the central character’s upbringing, life, and career. It contains a sweeping account of some of the forbears, both winners and losers, involved in the discovery and delineation of the structure of DNA, setting the stage for the pioneering research performed by Jennifer Doudna and Emmanuelle Charpentier.
The sometimes simmering, sometimes explosive tensions amongst contenders vying for acclaim, and wins in patent disputes on the CRISPR-CAS9 technology, demonstrate well how breakthroughs are achieved in a murky pool of egos, fragility, malintent, but also personal suffering, and some motivation to do good. The author includes ethical questions that will arise in the imminent future over the ability to create germline modifications to achieve specific enhancements in human abilities and features — a topic I find most fascinating and one that will strain the limits of human beings to grapple with ethical quandaries, but eventually eat of the fruit that’s pleasing to the eye, while squashing debate. As the last few years have shown, there’s a high societal tolerance for censorship even in the freest of all nations, when propelled by fear, expediency, or greed.
2. THE GENOME ODYSSEY
This is a slow-paced inventory of major achievements in genomics and how several of them are being applied to real-world settings. Read in the author’s pleasing Scottish accent, this book takes you on a journey through seemingly-unsolvable medical cases, before being prodded open by his sleuthing team applying the tools of genomic interpretation in the context of determining the best approach to care.
It is not overtly technical, so a lay person will be able to appreciate the case made by the author on how genomics and advances in the field bring precision to the quest for solving difficult disorders. I’d lived with an ‘any minute now’ sense of anticipation since the beginning of my Masters program in Biotechnology, which coincided with the completion of the Human Genome Project (HGP). Touted to be an absolute game-changer, the discoveries based on an understanding of the sequence of the genome, have been exceedingly slow. As Craig Venter, one of the pivotal players in the HGP lamented at a talk in London I attended recently, the focus has been on sequencing genomes and not understanding them. And in his quintessential sardonic style exclaimed how ‘most scientific advance is undoing the stupidity of the past.’
3. EMPIRE OF PAIN
By now, you’ve either read a book, or watched a documentary or mini-series on the Sackler family and the opioid crisis. This book covers the multi-generational stories of the dysfunctional Sackler family and the nexus between industry, academia, and institutions. It would be too simple to pin the overprescription of opioids and the consequent crisis soley on greed. The author’s narrative, in my opinion, vividly depicts a toxic cocktail of willful ignorance, delusions of grandeur, halfhearted attempts to justify actions taken, and full-blown psychopathy.
The narrative unfolds quite rapidly and it’s because it is an unremitting tale with no redeeming qualities — from experts who pushed back against restrictions on prescribing opiods while citing studies funded by Purdue Pharma, massive investments into think tanks and lobbying efforts, soaring commissions to sales reps obliquely incentivizing sales in zipcodes with high concentration of other painkillers, to burnishing the legacy of the family with the Sackler name on buildings and museums with their ill-gotten gain.
I spent a stint in a biopharma in Bangalore, India, straight out of B-school, and while it might be hard for an outsider to appreciate, most researchers, analysts, product managers and engineers are motivated at least to some degree by a desire to improve life. As with all human endeavours, poor incentives, weak guardrails, and the revolving door between regulators and the regulated, can sully the loftiest of goals. And so, not being naive about one’s propensity for corruption, should be a point of frequent reflection for a professional in any field.
4. THE NEW ABNORMAL
This book is from one of those voices who got the ethics of the COVID-19 lockdowns and vaccine mandates right, at the time, as the public pressures to comply were mounting. To regret one’s silence and complicity while in a position of influence, but go on to clearly see the impact of the massive collateral damage to society, even if in hindsight, would still be commendable. However, Kheriaty was vocal when decisions were being made — in politics, public health, hospitals, academic institutes, and companies, clamping down on the freedom of the public and employees, in the absence of irrefutable evidence that the vaccines worked as claimed.
At great personal cost, his refusal to keel over while attempting to persuade colleagues in his capacity as the chair of the ethics committee at UCI, his place of employment, is a profile is a courage. Also a plaintiff in a free speech case, Missouri v. Biden challenging the government’s attempts at social media censorship of dissident opinion, his long drawn-out battles would certainly have been fatiguing. I wonder if at any point, the author felt deflated enough, to want to retreat and lay low until the storm subsided, as in his place, I would perhaps have. But it seems apparent, he sees his foremost allegiance as owed to higher principles. Sample his critique of ‘scientism’: “The technocractic society with scientism as its public theology is not the inevitable consequence of scientific advance. The problem is the mischaracterization of science as the only valid authority, the enthronement of science as the exclusive reigning principle for all knowledge and for all of society.’
5. MALIGNANT
I picked this book up primarily to satisfy my brooding about what could’ve been had I chosen to pursue one of my considered career choices in my late teens in India. Some intersection of stem cell research, and genomics as applied to an intractable problem like cancer, was of interest to me. However, the field was still nascent, the stories of stalled projects from academic peers due to funding issues was frustrating, and having written the medical entrance exam, I switched abruptly to Biotechnology. Enough about me.
First off, an audio book in the author’s own voice makes sense to me. Especially if it’s a familiar one. I found it written (or read) in a very matter-of-fact style, yet managing to be riveting, plowing through example after example of serious, unethical, and befuddling (to me) issues in the design of clinical trials, with control arms placing patients on inferior treatment options that were not standard-of-care. I imagine it would be infuriating for a patient or caregiver to uncover some of the financial entanglements and misaligned incentives of players and experts, to whom they often, blindly and without reservation, entrust their care.
It’s a (relatively) short book but covers a swath of areas, that would interest conscientious industry players, practitioners, and patients and their families. It corrected some misconceptions in my mind too, perhaps formed as a reaction to the perception of overreach by government (represented by regulatory agencies), thus considering ‘more treatment options’ to always be unalloyed good, as long as they were safe.
Veering outside the scope of this book, I was glad for Vinay’s measured but fearless excoriation of so-called experts during the pandemic. I surmised a singular commitment to the truth and a determination to simply point in its direction, without concerns about whether his views would be construed favorably. I’m certain that the need and urgency for such a railing against a system that fails those it’s intended to serve, will only grow in the years ahead. I hold out no hope that the lessons needed to stem the societal plunge toward totalitarianism, will be learnt.
One of my favorites was his takedown of Francis Collins, who I held in regard as someone who was a good witness to the ‘come now, let us reason together’, spirit embodied in Christian teaching. To call his one-sided stances, censoriousness, and lack of compassion toward those made pariahs by the policies he advocated for, as disappointing, would be an understatement. I suspect the author and I share little in common in regard to an ultimate value and belief system, but this particular dissection of Collins’ failures in both methods and results, crystallized why his is a voice that will, both in the moment and in its trail, be of substantial benevolence in the public square.
A gifted rabble-rouser. Deus inluminet viam tuam.
