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    • Understanding Cancer's ComplexitiesCancer is a complex disease that affects most people, requiring a comprehensive understanding of its diagnosis, biology, treatment possibilities, and environmental factors. The mapping of the human genome has advanced research, but remission and a cure are not the same.

      Learning from this episode of the Making Sense podcast is the importance of understanding cancer, a disease that will affect most people at some point in their lives. The guest, Siddhartha Mukherjee, is a renowned cancer physician and researcher who shares his expertise and insights from both a patient and doctor's perspective. He discusses various aspects of cancer, including its diagnosis, biology, treatment possibilities, and the impact of environmental factors. Mukherjee also touches upon the significance of the mapping of the human genome in advancing cancer research and the difference between remission and a cure. Throughout the conversation, Mukherjee emphasizes the importance of approaching cancer with a comprehensive understanding, as it is a complex and multifaceted disease. This episode provides valuable information and insights for anyone interested in learning more about cancer and its impact on our lives.

    • From Viruses to Oncology: A Personal JourneyAn Oxford-trained immunologist and virologist's fascination with Epstein Barr virus led him to explore cancer genetics and ultimately a career in oncology, driven by the emotional challenges and potential human impact of cancer treatment.

      The experience of being an oncologist and the path that led our speaker into this field is deeply connected to the study of viruses and cancer. Our speaker, an Oxford-trained immunologist and virologist, became intrigued by Epstein Barr virus (EBV), a human pathogen that has coexisted with humans for thousands of years and is virtually ubiquitous. Despite our bodies' inability to clear EBV, it causes no overt symptoms in most people. However, it has been linked to various cancers, including lymphomas. Our speaker's research into why EBV persists in the human body led him to explore cancer genetics and the role of genes in EBV's ability to stay persistent. This shift in focus ultimately led him to a career in oncology. The emotional challenges and potential human impact of cancer treatment make it a uniquely rewarding and challenging field for medical professionals.

    • Evolving nature of cancer treatment keeps oncologists informed and engagedOncologists must stay updated with the latest cancer research and treatments to provide optimal care, as knowledge in this field constantly evolves.

      Being an oncologist involves staying updated with the rapid changes in cancer research and treatments, unlike other medical fields. The speaker, who became an oncologist with a background in immunology, shares how things that were considered absolute certainties in cancer treatment 10 years ago are now up for debate. This dynamic keeps oncologists informed and engaged, even outside of regular work hours. The speaker also shares how the stigma surrounding cancer has evolved, with a historical example of doctors not disclosing a patient's true diagnosis to them. The speaker emphasizes the importance of transparency and honesty in the doctor-patient relationship, which has improved over time. In summary, being an oncologist involves a deep understanding of the ever-evolving nature of cancer research and a commitment to providing the best possible care to patients, based on the most current information.

    • Balancing hope and uncertainty in oncologyOncologists should use Bayesian statistics to navigate uncertainty, convey individual truths, and provide accurate information while maintaining hope and connection with patients.

      Delivering bad news in uncertain circumstances, such as in oncology, is a complex issue. Oncologists must navigate the balance between providing statistics and individual truths. Hope is negotiable, and it's essential to convey uncertainty honestly without washing it up. The use of Bayesian statistics, which involves taking priors and modifying them to make conclusions about individual behavior, is a wise way of thinking about this uncertainty. It's important to remember that human beings are allowed to take refuge in uncertainty, but it shouldn't become an opium that numbs us. Instead, we should strive to understand the statistics while acknowledging the outliers and the individual truths. This approach allows us to provide accurate information while also offering hope and maintaining a connection with our patients.

    • Maintaining balance between professionalism and empathy in medicineDoctors must strive for authenticity while balancing professionalism and empathy to build trust and foster meaningful patient relationships.

      The role of a physician requires a delicate balance between professionalism and empathy. While it's necessary for doctors to maintain a certain level of emotional detachment to deliver difficult news, over-professionalization can lead to a filtering of honesty and spontaneity. This can ultimately result in patients feeling a disconnect and sensing insincerity. Therefore, it's crucial for physicians to strive for authenticity while being mindful of the ethical and emotional complexities of their role. The struggle to maintain this balance is an ongoing challenge within the medical profession.

    • Maintaining Emotional Balance in HealthcareDoctors should strive for emotional balance, understanding patients' perspectives through cognitive empathy, and avoiding complete detachment or numbness to their suffering.

      While doctors and medical professionals must maintain a certain level of emotional detachment to effectively care for their patients, it's important not to completely shut down or become numb to the suffering. This delicate balance allows doctors to provide empathetic care without becoming overly emotionally involved. As Dr. Suleiman mentioned, Chekhov, a doctor and writer, serves as an example of remaining clear-eyed and empathetic towards the world's suffering without becoming numb. However, it's crucial to remember that doctors are not their patients, and empathy should not be confused with living another person's experience. Instead, doctors should focus on understanding their patients' perspectives through cognitive empathy. Paul Bloom, a psychologist, emphasizes this distinction in his book "Against Empathy." By maintaining cognitive empathy, doctors can effectively provide care and support without being overwhelmed by their patients' emotions.

    • Balancing Emotional and Cognitive Empathy in HealthcareHealthcare professionals must balance emotional and cognitive empathy to effectively care for patients, understanding their struggles while maintaining a professional demeanor. Patients' experiences go beyond scientific understanding, and it's crucial to consider individual place in survivorship curve and focus on psychological and emotional aspects of care.

      Healthcare professionals, such as oncologists, understand the emotional and physical struggles their patients face, but they don't let their own emotions hinder their ability to provide effective care. This balance between cognitive and emotional empathy is crucial in the medical field, as it allows doctors to connect with their patients while also maintaining a professional demeanor. Moreover, the experience of illness goes beyond the scientific understanding of it in a lab. Patients' lives are significantly impacted by their diagnoses and treatments, and it's essential for healthcare professionals to remember this. Gould's essay "The Median is Not the Message" is a powerful reminder for patients to consider their individual place in the survivorship curve and not be discouraged by statistics. In the context of receiving a cancer diagnosis and going through treatment, there are several things patients and their families might not be aware of. For instance, it's essential to ask questions, believe in the doctor's words, and understand that the doctor's behavior is only one aspect of their care. The psychological and emotional aspects of the patient's experience are equally important and often understudied. By recognizing this, patients can better prepare themselves for the journey ahead.

    • Understanding individual prognosis and treatment optionsWhen diagnosed with cancer, it's crucial to ask doctors about treatment endpoints, consider genetics, microenvironment, and tumor nature to make informed decisions, and stay informed about advancements in cancer treatment.

      When faced with a cancer diagnosis, it's essential to understand one's individual prognosis and treatment options. Stephen J. Gold's approach of placing oneself on the survival curve can help make informed decisions about treatment. For anyone potentially becoming a patient, it's crucial to ask doctors about the strong endpoints for stopping treatment and consider factors like genetics, microenvironment, and tumor nature to determine the best course of action. Although cancer is a significant cause of death, advancements in medicine mean that many diseases that used to be fatal are now treatable, making it vital to approach cancer as a complex, multifaceted disease. In essence, being informed and proactive in understanding cancer and its treatment options can lead to better outcomes.

    • Supporting Independent MediaBy subscribing to The Making Sense podcast, listeners become active contributors to independent media, ensuring unbiased content and a deeper connection with the host.

      That The Making Sense podcast, hosted by Sam Harris, is an ad-free production that thrives on listener support. This means that instead of relying on advertisements to generate revenue, the podcast depends on its audience to contribute financially to keep the content flowing. This not only ensures the podcast remains unbiased and free from external influence, but it also creates a deeper connection between the host and the listeners. By subscribing to the podcast at samharris.org, you become an active participant in the creation and dissemination of thought-provoking and insightful conversations. It's a small but meaningful way to support independent media and engage with ideas that challenge and expand your perspective.

    Recent Episodes from Making Sense with Sam Harris

    #372 — Life & Work

    #372 — Life & Work

    Sam Harris speaks with George Saunders about his creative process. They discuss George’s involvement with Buddhism, the importance of kindness, psychedelics, writing as a practice, the work of Raymond Carver, the problem of social media, our current political moment, the role of fame in American culture, Wendell Berry, fiction as way of exploring good and evil, The Death of Ivan Ilyich, missed opportunities in ordinary life, what it means to be a more loving person, his article “The Incredible Buddha Boy,” the prison of reputation, Tolstoy, and other topics.

    If the Making Sense podcast logo in your player is BLACK, you can SUBSCRIBE to gain access to all full-length episodes at samharris.org/subscribe.


    Learning how to train your mind is the single greatest investment you can make in life. That’s why Sam Harris created the Waking Up app. From rational mindfulness practice to lessons on some of life’s most important topics, join Sam as he demystifies the practice of meditation and explores the theory behind it.

    #371 — What the Hell Is Happening?

    #371 — What the Hell Is Happening?

    Sam Harris speaks to Bill Maher about the state of the world. They discuss the aftermath of October 7th, the cowardice and confusion of many celebrities, gender apartheid, the failures of the Biden campaign, Bill’s relationship to his audience, the differences between the left and right, Megyn Kelly, loss of confidence in the media, expectations for the 2024 election, the security concerns of old-school Republicans, the prospect of a second Trump term, totalitarian regimes, functioning under medical uncertainty, Bill’s plan to stop doing stand-up (maybe), looking back on his career, his experience of fame, Jerry Seinfeld, and other topics.

    If the Making Sense podcast logo in your player is BLACK, you can SUBSCRIBE to gain access to all full-length episodes at samharris.org/subscribe.

     

    Learning how to train your mind is the single greatest investment you can make in life. That’s why Sam Harris created the Waking Up app. From rational mindfulness practice to lessons on some of life’s most important topics, join Sam as he demystifies the practice of meditation and explores the theory behind it.

     

    #370 — Gender Apartheid and the Future of Iran

    #370 — Gender Apartheid and the Future of Iran

    In today’s housekeeping, Sam explains his digital business model. He and Yasmine Mohammed (co-host) then speak with Masih Alinejad about gender apartheid in Iran. They discuss the Iranian revolution, the hypocrisy of Western feminists, the morality police and the significance of the hijab, the My Stealthy Freedom campaign, kidnapping and assassination plots against Masih, lack of action from the U.S. government, the effect of sanctions, the cowardice of Western journalists, the difference between the Iranian population and the Arab street, the unique perspective of Persian Jews, Islamism and immigration, the infiltration of universities, and other topics.

    If the Making Sense podcast logo in your player is BLACK, you can SUBSCRIBE to gain access to all full-length episodes at samharris.org/subscribe.

     

    #369 — Escaping Death

    #369 — Escaping Death

    Sam Harris speaks with Sebastian Junger about danger and death. They discuss Sebastian's career as a journalist in war zones, the connection between danger and meaning, his experience of nearly dying from a burst aneurysm in his abdomen, his lingering trauma, the concept of "awe," psychedelics, near-death experiences, atheism, psychic phenomena, consciousness and the brain, and other topics.

    If the Making Sense podcast logo in your player is BLACK, you can SUBSCRIBE to gain access to all full-length episodes at samharris.org/subscribe.


    Learning how to train your mind is the single greatest investment you can make in life. That’s why Sam Harris created the Waking Up app. From rational mindfulness practice to lessons on some of life’s most important topics, join Sam as he demystifies the practice of meditation and explores the theory behind it.

    #368 — Freedom & Censorship

    #368 — Freedom & Censorship

    Sam Harris speaks with Greg Lukianoff about free speech and cancel culture. They discuss the origins of political correctness, free speech and its boundaries, the bedrock principle of the First Amendment, technology and the marketplace of ideas, epistemic anarchy, social media and cancellation, comparisons to McCarthyism, self-censorship by professors, cancellation from the Left and Right, justified cancellations, the Hunter Biden laptop story, how to deal with Trump in the media, the state of higher education in America, and other topics.

    If the Making Sense podcast logo in your player is BLACK, you can SUBSCRIBE to gain access to all full-length episodes at samharris.org/subscribe.


    Learning how to train your mind is the single greatest investment you can make in life. That’s why Sam Harris created the Waking Up app. From rational mindfulness practice to lessons on some of life’s most important topics, join Sam as he demystifies the practice of meditation and explores the theory behind it.

    #366 — Urban Warfare 2.0

    #366 — Urban Warfare 2.0

    Sam Harris speaks with John Spencer about the reality of urban warfare and Israel's conduct in the war in Gaza. They discuss the nature of the Hamas attacks on October 7th, what was most surprising about the Hamas videos, the difficulty in distinguishing Hamas from the rest of the population, combatants as a reflection of a society's values, how many people have been killed in Gaza, the proportion of combatants and noncombatants, the double standards to which the IDF is held, the worst criticism that can be made of Israel and the IDF, intentions vs results, what is unique about the war in Gaza, Hamas's use of human shields, what it would mean to defeat Hamas, what the IDF has accomplished so far, the destruction of the Gaza tunnel system, the details of underground warfare, the rescue of hostages, how noncombatants become combatants, how difficult it is to interpret videos of combat, what victory would look like, the likely aftermath of the war, war with Hezbollah, Iran's attack on Israel, what to do about Iran, and other topics.

    If the Making Sense podcast logo in your player is BLACK, you can SUBSCRIBE to gain access to all full-length episodes at samharris.org/subscribe.

     

    Learning how to train your mind is the single greatest investment you can make in life. That’s why Sam Harris created the Waking Up app. From rational mindfulness practice to lessons on some of life’s most important topics, join Sam as he demystifies the practice of meditation and explores the theory behind it.

     

    #365 — Reality Check

    #365 — Reality Check

    Sam Harris begins by remembering his friendship with Dan Dennett. He then speaks with David Wallace-Wells about the shattering of our information landscape. They discuss the false picture of reality produced during Covid, the success of the vaccines, how various countries fared during the pandemic, our preparation for a future pandemic, how we normalize danger and death, the current global consensus on climate change, the amount of warming we can expect, the consequence of a 2-degree Celsius warming, the effects of air pollution, global vs local considerations, Greta Thunberg and climate catastrophism, growth vs degrowth, market forces, carbon taxes, the consequences of political stagnation, the US national debt, the best way to attack the candidacy of Donald Trump, and other topics.

    If the Making Sense podcast logo in your player is BLACK, you can SUBSCRIBE to gain access to all full-length episodes at samharris.org/subscribe.


    Learning how to train your mind is the single greatest investment you can make in life. That’s why Sam Harris created the Waking Up app. From rational mindfulness practice to lessons on some of life’s most important topics, join Sam as he demystifies the practice of meditation and explores the theory behind it.

    #364 — Facts & Values

    #364 — Facts & Values

    Sam Harris revisits the central argument he made in his book, The Moral Landscape, about the reality of moral truth. He discusses the way concepts like “good” and “evil” can be thought about objectively, the primacy of our intuitions of truth and falsity, and the unity of knowledge.

    If the Making Sense podcast logo in your player is BLACK, you can SUBSCRIBE to gain access to all full-length episodes at samharris.org/subscribe.


    Learning how to train your mind is the single greatest investment you can make in life. That’s why Sam Harris created the Waking Up app. From rational mindfulness practice to lessons on some of life’s most important topics, join Sam as he demystifies the practice of meditation and explores the theory behind it.

    #363 — Knowledge Work

    #363 — Knowledge Work

    Sam Harris speaks with Cal Newport about our use of information technology and the cult of productivity. They discuss the state of social media, the "academic-in-exile effect," free speech and moderation, the effect of the pandemic on knowledge work, slow productivity, the example of Jane Austen, managing up in an organization, defragmenting one's work life, doing fewer things, reasonable deadlines, trading money for time, finding meaning in a post-scarcity world, the anti-work movement, the effects of artificial intelligence on knowledge work, and other topics.

    If the Making Sense podcast logo in your player is BLACK, you can SUBSCRIBE to gain access to all full-length episodes at samharris.org/subscribe.


    Learning how to train your mind is the single greatest investment you can make in life. That’s why Sam Harris created the Waking Up app. From rational mindfulness practice to lessons on some of life’s most important topics, join Sam as he demystifies the practice of meditation and explores the theory behind it.

    Related Episodes

    #129 — An Insider’s View of Medicine

    #129 — An Insider’s View of Medicine

    Sam Harris speaks with Dr. Nina Shapiro about the practice of medicine. They discuss the unique resiliency of children, the importance of second opinions, bad doctors, how medical training has changed in recent years, medical uncertainty, risk perception, vaccine safety, and other topics.

    If the Making Sense podcast logo in your player is BLACK, you can SUBSCRIBE to gain access to all full-length episodes at samharris.org/subscribe.

    AE023 - New Delhi, Early Reflections

    AE023 - New Delhi, Early Reflections

    Insight India 2016 pushed me out out my comfort zone and challenged me to open my mind.  It was an immersion in a distant country with different culture and customs.  I am so grateful to have had the opportunity to see this part of the world and to feel the impact of how an experience of a different culture changed me.  Part of how I felt that was the desire to share it through the podcast format.  Anecdotal Evidence has developed into an ongoing discussion about the phenomenon of our health as we experience it.  

    At the end of the trip I was exhausted and my mind was blown.  Brooke and I had 36 hours in New Delhi to recover before embarking on the 38-hour journey back home.  Unfortunately New Delhi has the worst air pollution in the world.  By the end of the trip the exposure had taken a toll as I was coughing and my clothes were permeated with the smell of burning coal and air toxins.  So we decided to bunker down at the Holiday Inn to ride out our time there.  It's actually an exceptional hotel, so we quickly found that we'd lucked into a Shangri-la.  

    Dr. Indu Arora was the leader of our trip and a great yoga teacher who will be the guest of next week's podcast.  She is a remarkably dynamic scholar and teacher and I look forward to sharing that conversation next week.  But while we were saying our goodbye in New Delhi, she encouraged me that our accidental 36-hour layover in New Delhi had its own purpose.  And it felt like that well wish came true.  

    The Holiday Inn was a welcome place to wind down from a hyper-stimulating journey.  And in the bookstore I lucked into finding a complementary book to the trip.  The Laws of Medicine is Siddhartha Mukherjee's reflection of his discovery of 3 Laws of Medicine from his experience as an observant physician practicing in Boston.  He outlines his 3 Laws as follows:

    Law One: A strong intuition is much more powerful than a weak test.
    Law Two: "Normals" teach us rules; "outliers" teach us laws.
    Law Three: For every perfect medical experiment, there is a perfect human bias.

    I took the opportunity to reflect on these laws in the context of my experience as a psychiatrist abroad in India.  I recorded these early reflections while watching the sun set over India for the last time, a few hours before our early morning departure back home.  The hope was that it would serve as a structure to organize my developing memories of India.  I hoped to integrate what I learned on the trip with any eye in mind as to how it would serve my work and my growth back home.  

    I hope you enjoy these early reflections and that they serve you in your deeper understanding of your own experience.