Medical writing can be dry, technical and confusing. But it can also be spellbinding, pulling readers into a world where men and women are engaged in a daily battle against human suffering. At its best, medical writing reminds readers that the triumph of scientific discovery can not only change lives, but save them.
“The Philadelphia Chromosome,” by first-time author Jessica Wapner, is an example of great medical writing. The book involves dozens of researchers, more than a century of complex medical research and the maddening bureaucracy of the pharmaceutical industry – yet Wapner pulls these disparate threads together into a compelling narrative. Frankly, Wapner is a damn good story-teller, and the book is a page-turner. [Note: I got an advance copy at ScienceOnline – the book hits shelves May 14.]
I wanted to know where the idea for “The Philadelphia Chromosome” came from, how she organized such a staggering amount of material and how she got into writing in the first place.
Communication Breakdown: Before becoming a freelance writer and author, you were the managing editor of two peer-reviewed journals, Clinical Advances in Hematology & Oncology and Gastroenterology & Hepatology. I’ve always wondered: how does one end up working at a journal?
Jessica Wapner: I got my first job at a medical journal by answering a job advertisement – a good old-fashioned printed job ad in the New York Times. I had just moved back to New York City, where I grew up, after several years in the Boston area following college. At the time, I knew very little about the world of medical journals, but the job description – for an editorial assistant – sounded interesting. It was great. I wrote news stories, interviewed doctors, got tons of on-the-job training in copyediting and proofreading, and read articles daily about cancer research and treatment. My college degree was in biology, though I spent most of those four years studying mockingbird song, not cellular biology, but I think having some exposure to the language of science enabled me to get my footing. That was my first science-related job and I never looked back.
CB: You’ve said that you became a freelancer primarily as a way to get clips that you could use to find a publisher for your book. Is that true?
Wapner: Really both happened at the same time. I started writing for magazines at the same time that I was researching the story behind the Philadelphia chromosome and the development of the first drug to treat cancer at its root cause. In part, I knew I needed more credentials as a writer for mainstream audiences if I were going to get to tell this story, which I knew had to be a book because it was so labyrinthine and compelling. But I also realized that I really enjoyed writing for magazines. My years at medical journals had left me with so many insights about drug development and cancer research, and a hunger to know more. Freelancing was a great outlet for all of that. I found out that I loved discovering stories, explaining the inner workings of the pharmaceutical industry as best I could, and just getting my typing hands stuck into all kinds of science- and medicine-related areas. So while I maintained a vision of writing this book, I was also very happy learning to navigate the world of freelance writing and cutting my teeth as a science journalist.
CB: How did you land your first freelance writing gig?
Wapner: My first article as a freelancer was for Slate, and it was about flaws in the design of clinical trials for new cancer drugs. This topic was one that I’d been very interested in while I was at Clinical Advances in Hematology & Oncology, and it was great to dig in and unravel the issues at play. That article was so hard to write, but was the start of what became one of my favorite kinds of writing.
As far as how I landed that gig, it was pretty standard: I pitched the story to the Medical Examiner editor at the time and she said yes, and very patiently stuck with me through a few drafts.
CB: Coming from the research journal side, was there anything that you found particularly challenging or unexpected about writing copy for news outlets?
Wapner: Everything! My work at the medical journals was behind the scenes, and was much more about shepherding, editing, and managing than about writing. Freelance science writing is challenging in general because you want to present information that is thoroughly researched, factually correct, and makes for an engaging read. That takes work and discipline, there’s no way around it. I am still trying to crack the codes of good time management and great pitching. I think it will always be challenging. But that’s a good thing, and just the nature of the work, especially when you want each next story to be your best. It’s also so exhilarating…when it’s done.
CB: Your freelancing didn’t really take off until 2008, but by the end of that year you had written for Slate, Scientific American and the New York Times, among others. And the subject matter ranged from psychology to cancer to prescription drugs. You’re obviously a talented writer. Do you think there was anything else about your approach to freelancing that contributed to your success?
Wapner: That is very kind of you to say. I’m not sure I’m more talented than anyone else. If anything, I’d say that I happened to come across stories and people that make for interesting articles. Honing that inner detective that always has an ear to the ground listening for story ideas is absolutely one of my favorite things about science writing. I love finding great stories and interesting angles on topical issues.
CB: What made you want to write “The Philadelphia Chromosome” in the first place?
Wapner: It started with the name. The Philadelphia chromosome – what a great name for a genetic mutation. How do you not get curious about it? My investigation of the story began with asking someone about the origin of the name. That one question started me down a path of research that led absolutely everywhere, and which I eventually told in this book.
After that first question plunged me into the deep end, the story continued to unfold, with more science, more conflicts, more challenges, more heroic feats, and ultimately a huge triumph for medicine and for the patients who suffered from this fatal, unpredictable disease. I came to realize that this story is absolutely seminal to understanding where we are now in cancer research, and even the entire concept of personalized medicine.
So the glimpse that made me want to write about the Philadelphia chromosome grew into what I could see was this great, untold story of modern medicine. The science and medicine alone would not have been enough for me to want to write this book; it was those aspects combined with the human story woven throughout – the dedication, the struggle, and the lives saved – that made me feel like I couldn’t not write this book.
CB: After making the shift from journals to news writing, how was the shift from writing news articles to writing a book? Any surprises?
Wapner: Thankfully, I am in solid possession of a generous helping of naiveté. I had no idea what I was getting myself into, though I am totally thankful for the opportunity. The biggest surprise might have been the amount of breathing room. Writing news articles is so much about conveying a whole lot of information in a readable way within a tight word count. Writing a book is the polar opposite. It was like moving from a college dorm to the middle of the Alaskan wilderness. I had some agoraphobia at first, and kept trying to impose word counts on myself. After a while, with encouragement from my editors, I learned to let that go and let the story take the lead, to be as long as it needed to be.
Figuring out what my actual day job was also took me a while. I knew the overall task was to write a book, but I didn’t know what I was supposed to be doing on a single given workday. Finally I broke it down into how many words I should be writing each day. This was not some startling revelation, I know, it just took me a long time to figure it out. It might have been a good idea to ask someone who’s done this before. Alas.
CB: “The Philadelphia Chromosome” deals with oncology, genetics and how advances in those two fields came together in pursuit of ways to fight cancer on the genetic level. There’s a lot of scientific literature out there on those issues. How much research did you do, in terms of poring through relevant journal articles, before beginning your in-person interviews and fieldwork?
Wapner: Everything happened at the same time. If anything, I did more interviews first, and read journal articles later, when I needed to start unpacking what different scientists had told me. I wanted to fact-check everything, to have the citation behind every bit of research that was explained to me. And even if I didn’t necessarily need a particular citation to confirm some piece of history, I had to understand the science as thoroughly as possible before writing about it. There are definitely some sentences with a few days of mind-wrapping behind them. But the reading mostly came after the interviewing, because I felt that I needed to first have the story. Once I knew what had happened – how we got from the first observation of this genetic mutation to a drug that was stopping cancer in its tracks – then I felt free to investigate every corner of the science.
That research also brought me to a lot of other history that was relevant to the story. For example, trying to understand how we came to know that humans have 46 chromosomes led me to Joe Hin Tjio, the man who finally identified that correct number. What a history he had. He’d been captive in a Japanese prison camp, where he kept himself sane by knitting clothes for his fellow inmates and was punished for giving them medical care. He was irrepressible though, and became a renowned scientist after his release. That was just one of so many gems I came across while researching this story.
I ended up with a few five-inch binders filled with articles, interview transcripts, and tutorials of various kinds.
CB: The book covers the nexus of two complex fields of research, and spans a period from 1910 into 2012. I have two questions about organization. First, before writing the book, how did you organize all of this information so that you could wrap your mind around it? And, second, how did you organize the information so that your readers could wrap their minds around it?
Wapner: I wanted readers to have an amazing journey through the history of science, then to have a huge payoff when the connection between a mutant gene and a fatal cancer finally becomes clear, and also to experience a mystery thriller following the saga of how this drug targeting cancer at its root cause gets made. That vision dictated how I organized the story.
In terms of mechanics, it was all about weaving these various threads together while making sure that each thread got its due. It was a challenge to keep track of all the information for sure. But I always saw it as a continuous, unfolding story, rather than disparate experiments, and that was what I tried to translate onto the printed page. I wanted to explain the science in engaging detail, but in service to the bigger picture, the origin story for where we are now in cancer research.
CB: Your book hits shelves May 14. Do you think you’ll write another one?
Wapner: I hope so. I already know the next story I want to tell, another gem from modern medical history, but you’ll have to wait for more details.
CB: If you could send yourself a note back in 2007, what piece of advice would you give yourself?
Wapner: The same advice I think many people would give to their younger, pre-parent selves: save more, spend less!