A 'Smart' Attack on Cancer

DATE April 3, 2007 ACCOUNT NUMBER N/A
TIME 12:00 Noon-1:00 PM AUDIENCE N/A
NETWORK NPR
PROGRAM Fresh Air

Interview: Dr. David G. Nathan of Dana-Farber Cancer Institute
discusses new smart drugs and other therapies that are changing
cancer treatment
TERRY GROSS, host:

This is FRESH AIR. I'm Terry Gross.

Some cancers that until recently were considered lethal are now treatable if
not curable. The new smart cancer drugs that are targeted to cancer cells are
the subject of the new book, "The Cancer Treatment Revolution." My guest is
the author, Dr. David G. Nathan, president emeritus of the Dana-Farber
Cancer Institute, physician in chief emeritus at Children's Hospital in Boston
and professor of pediatrics and medicine at Harvard Medical School. With
smart drugs, he says, more patients should be able to live for longer periods
with far less toxicity.

Dr. Nathan, welcome to FRESH AIR.

What makes a smart drug smart?

Dr. DAVID G. NATHAN: The smart drug is classified as such because it is
highly targeted and also targeted to a single pathway that should knock out
the cancer cell without damaging normal cell.

GROSS: So what is the knowledge that we have now of how cancer works that is
enabling scientists to make these smart drugs?

Dr. NATHAN: Well, that is the amazing development of the past 25 or so
years. That is that we've begun to understand what causes cancer. I mean, we
had known for 100 years that at least the common cancers that we deal with,
like breast and prostrate, lung and gastrointestinal tract, all those cancers
which are called epithelial cancers because they line the tubes of the body
arise from a single cell that is very damaged in its DNA. But in the last few
years, we've been able to see that what really happens in cancer is that
there's either a cataclysmic or a gradual destruction of the chromosomes by
mutations that are accumulated, and when that happens, the chromosomes all
mash together and many genes are lost and some genes are greatly
amplified--that is, increased in number--and some of them get enormously
activated and put out very different proteins that are highly active. And
that produces two kinds of problems. One of them is called an oncogene. That
means that the cancer is putting out--the gene that's damaged is putting out a
protein that is highly active or simply putting out much too much of a
growth-regulating protein. Either way, signals to the daughter cells of the
cancer are to grow from that protein. That protein just shouts to the
nucleus, `Divide, divide, divide!' And that--so that's a protein that's got to
be stopped, and once we identify it, we can block it.

GROSS: So...

Dr. NATHAN: Now there's another--go ahead.

GROSS: Before we get to another example, so in this one kind of cancer, you
have this damaged gene that produces this protein that you compare in your
book to a jangling telephone that doesn't stop and keeps sending continuous
signals to cells to divide.

Dr. NATHAN: Right. Exactly.

GROSS: So you've got this protein that's causing cells to multiply, causing
cancer cells to multiply. So how does medicine, how do new medicines target
that protein?

Dr. NATHAN: OK. So that idea, by the way, when it became clear to a very
smart medicinal chemist at Ciba Pharmaceuticals, which became Novartis, made
him think, `Well, if we could pull such a protein up and, you know, clone it,
make lots of it and put it into a cell, then we might be able to use that cell
as a screen for all of the chemicals in our secret library and see which one
of those chemicals block the protein. And that's exactly what he did and came
up with Gleevec, the drug that was used then in an unusual leukemia, well, not
so unusual. Chronic myelogenous leukemia's not that uncommon. And it worked
because it blocked a protein just like that, and it turns out that that
leukemia is just totally dependent on that particular protein for its
survival. In other words, the cancer cell has selected that protein for its
use in order to outgrow everybody else. That's what natural selection is all
about. We're really seeing in cancer evolution, if you will, growth
advantage.

GROSS: And one of the great things about a targeted drug, a drug that for
instance will target this protein, is that, you know, the old chemos which are
still in use target--correct me if I'm wrong here--target all fast-growing
cells because cancer cells are fast-growing cells, but a lot of healthy cells
are fast-growing cells, too, and that's why you lose your hair on a lot of the
chemo drugs, and it affects the lining of your stomach because these are
fast-growing cells. I guess that doesn't happen with the smart drugs.

Dr. NATHAN: That's correct. If the smart drug is particularly well-targeted
to just one gene...

GROSS: Mm-hmm.

Dr. NATHAN: ...it's very likely that the normal cell can get along quite
well without that gene because it has other genes that will do the job. Now,
as you make the smart drug broader and broader, capable of interfering with
more than exactly one protein, if you will, then you may get more toxicity.
But for the most part, these drugs can be very targeted to one protein.

GROSS: You gave us the example of Gleevec, which targets a protein that is
common in the form of leukemia. What is an example of a smart drug that is
being used or developed for breast cancer?

Dr. NATHAN: Well, the first smart agent, if you will, that was made was an
antibody, a big protein, an antibody against a protein made by about 20
percent of breast cancers. A protein that really drives the tumor and makes
it, by the way, extremely aggressive, and that antibody is called Herceptin.
Trastuzumab is the generic name. And the development of that by Dennis Slamon
in Los Angeles was really the beginning of the cancer treatment revolution,
and Herceptin, when it's used up-front in these very severe breast cancers,
when it's used immediately after surgery and with combination chemotherapy and
anything else we can use, dramatically changes the survival of those patients.
I mean, they were very difficult to treat until Herceptin. And so here we
have an example of an antibody being used to really tie up the protein. It
doesn't block it in the absolute sense of a drug, but it sort of gloms onto
the protein and renders it functionless, and it really works. So that was the
first agent. Gleevec was then the second and in a pill form, and not only was
Gleevec useful in leukemia, it turns out that there was another disease called
gastrointestinal stromal tumor, an intractable bowel tumor, that really was
impossible to treat with anything. That tumor, it turns out, is totally
dependent, in its early stages, on exactly one protein, and that protein
happens to be knocked out by Gleevec. And I can tell you that that's an--when
you watch this tumor being treated by Gleevec, it's simply amazing.

I know of one case, treated by George Dimitri at the Dana-Farber Cancer
Institute, and this is a very interesting story. There was a patient with a
gastrointestinal stromal tumor who had what's called a PET scan to identify
the fact that he had hundreds of these tumors in his abdomen. The PET scan
was strongly positive, and Dimitri gave a dose of Gleevec to the patient, and
then he called up the PET scan office to try to get a repeat scan in a couple
of weeks. And the PET scan office was so busy that they couldn't give him a
date except the following day, and Dimitri decided to take it. The following
day, that tumor was dead. One dose of Gleevec, showing how much that tumor
depended on that particular protein to live.

GROSS: Now say you had a kind of cancer that can be targeted with these new
smart drugs. Does that mean the cancer is less likely to come back?

Dr. NATHAN: Well, here's the problem. When one is dealing with just one
pathway, the cancer cell is very apt to continue to mutate. The cancer cell
is injured. Its DNA is in bad shape, so it keeps randomly mutating, and it
will mutate in the face of the drug to find another pathway, to open up
another pathway, or even to change the protein itself, change its entire--its
structure so that the drug can no longer get into it. So the facts are if
there are resistant cells already in the cancer-cell mix, then by natural
selection again, you're going to kill off all the sensitive cells and leave
only the resistant cells, and they will grow up, eventually. They may have
trouble, because there's still drug around, but they will find a way to grow
even though the drug is there. And that's the weakness of single-agent
treatment with any cancer therapy. We usually need to use more than one
pathway.

GROSS: So, does that mean even if you have a cancer that can be targeted with
one of the new drugs, you're still going to get chemo and maybe radiation and
all that stuff.

Dr. NATHAN: Or...

GROSS: Yeah.

Dr. NATHAN: Right. Or you may need to use another smart drug. In other
words, you may need to have a research--a diagnostic system that tells you,
well, yes, the cancer cell is using this pathway, pathway number one most of
the time, but it also has a mutation in another pathway and we've got to get
that one, too. I mean, we know from the history of combination chemotherapy
that single agents just don't work, so now we know that we have to use
combinations, and I think we'll have to, in the end, we will be using
combination smart drugs.

GROSS: My guest is Dr. David G. Nathan, president emeritus of the Dana
Farber Cancer Institute and author of the new book, "The Cancer Treatment
Revolution."

We'll talk more after a break. This is FRESH AIR.

(Announcements)

GROSS: If you're just joining us, my guest is Dr. David G. Nathan, and he's
the president emeritus of the Dana-Farber Institute for cancer research and
treatment, and physician in chief emeritus of Children's Hospital in Boston.
He's written a new book called "The Cancer Treatment Revolution: How Smart
Drugs and Other Therapies Are Renewing our Hope and Changing the Face of
Medicine."

There's a study that was just published a few days ago saying that MRIs are
more effective than mammograms in detecting breast cancer. What's your
interpretation of that study and how it should be acted on?

Dr. NATHAN: Well, I agree that MRIs are more effective, and I mention that
in the book, but MRIs are a two-edged sword. They pick up very small tumors,
or let's put it this way, they pick up more small lumps, some of which are
tumors. This means an awful lot of unnecessary biopsies are done. And
second, even if a very small tumor is detected, that doesn't mean that that
very small tumor is ever going to become a clinical cancer. I think we're
growing little cancers all the time in our bodies and then the sniffing
proteins that go around and check on abnormalities kill them, so they don't
amount to anything. This is certainly true in the prostate, where it's very
common to have prostate cancer that just never goes anywhere, and I'm sure
that's true of breast cancer as well. So we're going to overtreat a lot of
people who never needed to be treated. Now, we have no way of knowing who's
who, so wisely those who are saying use MRIs are saying use it only in very
high-risk situations, and that I agree with. If you have a very high-risk
woman who, let's say, has a very strong family history or is known to have a
gene defect in the family that causes cancer, yes. There you ought to be very
aggressive. But I fear that MRI is going to be used by everybody, and that's
a huge mistake.

GROSS: When you said treated, are you talking about removing surgically the
little tumors...

Dr. NATHAN: Yeah.

GROSS: ...or are you talking about, all of a sudden, you're on chemo also?

Dr. NATHAN: Well, no, you wouldn't get put on chemo because we don't use
chemo for very tiny tumors.

GROSS: Mm-hmm.

Dr. NATHAN: But still, this is a very invasive procedure, to operate on
someone and take out a lump and maybe give them radiation locally. That just
doesn't make sense to me. I think that the mammogram is probably a good
compromise. It also overdiagnoses, but nothing like an MRI.

GROSS: Let's talk about Elizabeth Edwards. I think everybody assumes that
Elizabeth Edwards got the best health care possible. She's very high profile,
the family has enough money to afford the best medical care. So if we proceed
with the assumption that she has the best medical care possible, what does it
say about where we are now with breast cancer treatment that her cancer
returned. I guess, maybe you could tell us about the type of cancer that she
had and why you think the treatments failed to prevent it from metastasizing.

Dr. NATHAN: Well, I'm sure that she got the best treatment, and I know that
that best treatment can virtually cure 80 percent of women with her type of
breast cancer. I'm positive that she was in that group, from what I've been
able to read. So why did it fail? Why does it fail for 20 percent? And the
reason for it is that breast cancer can be driven not only by proteins that
shout to the nucleus to divide but also maybe due to lack of proteins that
make cancers die. We all have proteins in us that look around at our genes
and our DNA and say whether it's in good shape or not, and if it's not in good
shape, those proteins tell the cell to die. If we're missing those proteins,
then the cells will continue to live even if we damage them. And I think
that's probably what happened to Ms. Edwards. Her cancer cells are missing
some important proteins that regulate cell death, and that makes them much
tougher to treat.

GROSS: Now, her cancer is being described as not curable but treatable. What
does treatable mean in that context?

Dr. NATHAN: Well, it means that she's going to have to receive lifelong
chemotherapy. One or two drugs, not a large number of drugs, but one or two
drugs that will suppress her cancer cells. It probably will not cure them,
that is, eliminate them, but she can go along for a very long time. The
breast cancer really has to be seen as kind of a chronic illness, and we have
to keep it suppressed and the patient--she's absolutely right. She's going to
live her life and she's going to live her life with cancer. She's not going
to live her life for cancer, and there's a big difference. We can keep it
suppressed. Now if it mutates again and again and becomes more and more
aggressive, that's tougher. But I can tell you, I have seen patients who have
relapsed, who have been around for 10 or 15 years. They're always going for
the next trial, for the next new agent, and they're moving along and they're
running their lives.

GROSS: So, with Elizabeth Edwards, when she first was diagnosed with cancer,
it was Stage III and now it's Stage IV?

Dr. NATHAN: That's right. She was a standard Stage III patient. Had an
expectation of a cure rate of 80 percent and unfortunately relapsed and is now
Stage IV. But, interestingly, she relapsed, as far as I know, only in bone,
and for reasons that are not absolutely clear to me, that has a better
prognosis than had she relapsed either in the--relapsed, in the, say, the
liver. For some reason, when breast cancer cell is found only in bone, the
outlook is better.

GROSS: That leads me to Tony Snow, whose colon cancer metastasized to his
liver. Are there drugs that can address a spread to the liver? I know the
liver's a really difficult organ to treat.

Dr. NATHAN: Yes. There are. Now--and the outlook for Stage IV patients
with colon cancer in the last 10 years has definitely improved. In fact, it's
doubled, and that's with standard combination chemotherapy as combinations
have been added. I would say that it's more difficult than metastatic--than
Stage IV breast cancer, restricted to bone, but it can be done. And basically
the attitude must be, if it can be done, it will be done. But that's the only
way for Tony Snow or any other similarly afflicted patient to look at it. You
must take that view, and many, many times you'll be absolutely right. And
this man has--and Elizabeth Edwards has, as far as I'm concerned, attitudes
about this that I wish any afflicted patient would have. They have the right
approach. It's just got to work.

GROSS: Dr. Nathan, I want to thank you very much for talking with us.

Dr. NATHAN: Well, thank you, Terry.

GROSS: Dr. David G. Nathan is president emeritus of the Dana-Farber Cancer
Institute. His new book is called "The Cancer Treatment Revolution."

I'm Terry Gross, and this is FRESH AIR.

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(Announcements)

(Soundbite of music)

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Interview: Novelist Mohsin Hamid discusses his new novel, "The
Reluctant Fundamentalist," story of a Pakistani man in America
TERRY GROSS, host:

This is FRESH AIR. I'm Terry Gross.

My guest Mohsin Hamid is torn between the culture he grew up in Lahore,
Pakistan, and the West. He came to America, studied at Princeton and Harvard,
worked in business, then moved to England before September 11th. His first
novel, "Moth Smoke," was a finalist for the PEN/Hemingway Award. His new
novel, "The Reluctant Fundamentalist," is about a Pakistani man who comes to
America, graduates from Princeton and rises in business. But after September
11th, he's treated with suspicion in America and grows more resentful of the
country he'd come to feel at home in. The story is set in a cafe in Lahore,
where his family lives. The novel is a monologue by the main character, who's
addressing an American stranger who may or may not be a spy. They're
suspicious of each other. Here's a short reading from the beginning of "The
Reluctant Fundamentalist."

Mr. MOHSIN HAMID: (Reading) "Excuse me, sir, but may I be of assistance?
Oh, I see I have alarmed you. Do not be frightened by my beard. I am a lover
of America. I notice that you are looking for something. More than looking.
In fact, you seem to be on a mission and since I am both a native of this city
and a speaker of your language, I thought I might offer you my services.

How did I know you were American? No, not by the color of your skin. We have
a range of complexions in this country and yours occurs often among the people
of our northwest frontier. Nor was it your dress that gave you away. A
European tourist could as easily have purchased in Des Moines your suit, with
its single vent and your button-down shirt. True, your hair, short-cropped
and your expansive chest, the chest I would say, of a man who bench-presses
regularly and maxes out well above 225, are typical of a certain type of
American, but then again, sportsmen and soldiers of all nationalities tend to
look alike.

Instead, it was your bearing that allowed me to identify you, and I do not
mean that as an insult for I see your face has hardened, but merely as an
observation."

GROSS: That's Mohsin Hamid reading from his new novel, "The Reluctant
Fundamentalist." Tell us more about the narrator of the story.

Mr. HAMID: The narrator's a young Pakistani man named Changez, who has come
to America to attend Princeton University, and the novel begins with him
meeting an American man in Pakistan many years later. Changez is from a
formerly wealthy family in Pakistan which has come upon hard times. They've
run out of money, and he's on a scholarship at Princeton, and his story is one
of the immigrant from a upper class but poor background, which is a strange
combination, making his way in the United States.

GROSS: The title of your book is "The Reluctant Fundamentalist." In what way
does he become a reluctant fundamentalist?

Mr. HAMID: He becomes a reluctant fundamentalist in a number of different
ways. He's not actually religious and the novel plays with the notion that
someone like him, a Muslim man in Pakistan who has a beard and comes up to an
American, would be thought of as a fundamentalist, and in fact, during the
course of his time in America, people begin to wonder if he has become one.
So he's reluctantly a fundamentalist in being perceived as a religious
extremist, which he isn't. But he's also a reluctant fundamentalist because
his job--he works for a large financial company that values other companies,
and his job is to value companies on the basis of their economic fundamentals,
and he goes around the world doing this and begins to wonder whether this is
something he wants to be doing with his life, whether it's something he
believes is morally right. And so he's a reluctant fundamentalist in that he
becomes reluctant at doing that job as well.

GROSS: Now you completed the first draft of this novel before September 11th.
How did the story that you wanted to tell change after September 11th?

Mr. HAMID: It's interesting because the first draft was the story of a
Pakistani man, living in New York, wondering whether he should go back to
Pakistan and considering whether working in the corporate world is something
morally and personally he felt like he should be doing, and in many ways, the
novel is still that idea and still that basic story. What's changed, of
course, is that the world has changed since then, and it's much more loaded.
There's much more fear between Pakistan and America, between the Muslim world
and the West. And the novel reflects and plays on that fear.

GROSS: Your novel was written from one voice, the narrator's voice, and he's
a Pakistani man who's, you know, moved to New York to go to Princeton and now
works in a consulting company that values businesses. It figures out how much
a business is worth. But when he's in Pakistan meeting with this person in a
cafe, this person who he presumes is American, we only see this person through
your narrator's eyes, and we don't know what to make of this other person. We
don't know who he is, whether he means well or not, whether he's a spy or not.
Why did you want to structure it that way?

Mr. HAMID: Well, the novel is structured the way it is, with the Pakistani
man speaking to an American who doesn't speak back, in part, because in the
world today, the media of the world today, we see a great deal of one side of
a conversation and much less of the other. So, in this case, by reversing
that, by having the American relatively silent and the Pakistani speak much
more, I was trying to play with that notion. But also, the two of them,
although you only hear one side of the conversation, they do have a
conversation, and in that conversation, the Pakistani is wondering, `Is this
American a regular American? Is he a CIA agent here to kill me or abduct me?'
And the American seems to be wondering, `Is this Pakistani just a bearded guy
who happens to be quite friendly and nice, or is he a terrorist who's here to
get me?' And that sense of mutual suspicion, which runs through the novel, for
me, is a metaphor for the mutual suspicion we have in the world, you know?
American and the West looks at the Muslim world in Pakistan and wonders
exactly this, you know, `Are you a bunch of normal people? Are you out to get
us?' And the Muslim world in Pakistan looks back at America and wonders the
exact same thing. So the novel tries to capture that sense of suspicion. So
although the novel's really just a conversation, it begins to feel more and
more like a thriller.

I won't say anything about how it ends, but I will say that people have asked
me, this Pakistani character, is he you? Is this an autobiography? And I
think that's partly to miss the point. The Pakistani character is speaking to
an American character; there's a conversation going on. And for me, that
conversation is much more what I'm about. I'm somebody who has both a
Pakistani and an American identity, and the novel tries to have a conversation
with these identities, so it's much more for myself a way to understand my
world, the Pakistani and the American parts, than it is to just tell my story.

GROSS: Let me quote what this character thinks when he watches the events of
September 11th as he sees it on television from Manila, where he's visiting.
He says, "My initial reaction was to be remarkably pleased. My thoughts were
not with the victims of the attack. I was caught up in the symbols of it all,
the fact that someone had so visibly brought America to her knees." Do you
know a lot of people who felt that way?

Mr. HAMID: I do know people who felt that way, and when we think about how
it's possible to feel that way about so obviously tragic and horrifying an
act, it's possible because we can look at television now and not necessarily
feel anything for people who are hurt or killed on television. They don't
seem real. We see so much death and destruction on television that we've
become desensitized to it. On the other hand, some people like Changez, who
feel envious towards and angry with America for the whole history of events
that has led them to feel that way, they felt only that anger expressing
itself in satisfaction and didn't feel the personal connection with the people
who were actually killed.

GROSS: When your character is visiting his family in Lahore, Pakistan, when
he's about to leave, his mother warns him, `Shave your beard,' because she
assumes that when he goes back to America, anyone who sees the beard will
associate him with fundamentalism and extremism. Would you be worried about
having a beard now in England or in the United States?

Mr. HAMID: You know I sometimes do have a beard, and it's interesting how it
changes people's reactions. It's, in my experience, not a great idea to have
a beard when you fly into--deal with immigration officers, and sometimes it's
not even a good idea to have a beard when you're walking down the street, but,
by and large, I haven't found it to be too much of a problem, particularly in
the UK, which is where I live now. People react differently to people who
have beards, and I've done it myself. I remember sitting on the Tube in
London and riding next to a Pakistani man who had a beard and began to act
very strangely on the Tube, and I had the exact same reaction that, you know,
a non-Pakistani would have. So I think this reaction to a beard is quite deep
in all of our cultures.

GROSS: You know that story that you just told, you wrote an Op-Ed about it
for one of the British papers, and you know, it's a great story because you
sit down next to this guy. There's an empty seat next to him in rush hour and
you figure, `Well, the seat's empty because people are profiling him and he
looks Pakistani,' but the guy is obviously mentally ill and not taking his
medication or not taking enough of it. That becomes clear from the
conversation. Can you talk a little bit about what it was like for you to go
through all of these different ideas about who he is and what he represents?

Mr. HAMID: Well, I sat down next to this guy, and as you say, the seat next
to him was empty, and I thought it was empty because people didn't want to sit
next to some Pakistani guy with a beard, wearing ethnic dress, and as time
passed and we began to speak, I realized that he was very unstable. I then
realized that he had this bulge underneath his shirt, which might have been a
money pouch but could have been something else as well. And as he acted more
and more erratically--it was about a year after the 7/7 Tube bombings in
London, I began to get more and more frightened and to think, you know, `Maybe
this guy really is a terrorist,' and I myself was quite surprised at how I was
able to go from a reaction of everybody's racially profiling this guy to a
reaction which was I'm doing the exact same thing over the space of just five
minutes, and I think, for me, what that taught me was that it's not that the
outside world is one way and I'm something else, I'm just like everybody else.

GROSS: Except that you're the target, too...

Mr. HAMID: Except that I'm the target.

GROSS: ...when people are profiling. Yeah. I mean, does it make you feel
any different about being profiled? I mean, that doesn't help, does it?

Mr. HAMID: Well, you know, I think as a novelist, part of what you have to
do is empathy. When you write a character, you have to imagine what it is to
be that character, and sometimes it's like this. When you find yourself
acting the way that people who upset you act, it actually helps you empathize
with people, and you realize, `I don't appreciate being the one who's always
randomly selected for searches, but I can also understand partly why it
happens.'

GROSS: In what ways have--like September 11th, the Tube bombing in London
where you've lived for the past few years, in what ways did those events
change your own sense of identity as a Pakistani?

Mr. HAMID: Well, my own sense of identity actually is a bit complicated,
because I spent a few years of my childhood in America. My father was doing
his PhD at Stanford so I was at Escondido Elementary School for a few years,
and then I went back after high school to study in America and lived there for
another decade. So there's a great deal of Americanness inside me.

I think my identity is both Pakistani and American, and in that way, the Tube
bombing and the September 11th attacks and the war on terror has been
personally very difficult for me because as someone who is naturally split
between two cultures, the fact that the two cultures are becoming so
increasingly hostile to each other makes me much more unsettled within myself.
So for example, it's difficult for me now to go to America as often as I would
like to see my friends there, but it's also difficult when I got married in
Pakistan, and so my American friends said they didn't know if it was safe
enough to come. I think for me, feeling the two worlds slip further apart has
opened up a divide, I think, inside myself.

GROSS: My guest is Mohsin Hamid. His new novel is called "The Reluctant
Fundamentalist."

We'll talk more after a break. This is FRESH AIR.

(Announcements)

GROSS: If you're just joining us, my guest is Mohsin Hamid. He's a novelist.
His new book is called "The Reluctant Fundamentalist." He's from Pakistan, has
lived in New York and now lives in London.

The president of Pakistan, Pervez Musharraf, whose term expires in the fall,
you wrote an Op-Ed about how you voted for him five years ago, in spite of the
fact that you knew he was a dictator. Why did you vote for him then and why
do you think it's time for him to leave now?

Mr. HAMID: Well, as a liberal Pakistani, I was very frightened about where
the country was going in the year 2002. You know, war had just been fought in
Afghanistan, which is right next door to Pakistan. We were hearing all sorts
of things about al-Qaeda and sleeper cells and instability. There was tension
with India. And in that environment of fear, I thought that President
Musharraf was saying the right things. He was talking about liberalizing the
country. He was in the process of freeing up the media and television
stations. And he was talking about making peace overtures to India. And I
supported those things. I think he seemed like a strong leader at a time of
great threat.

What happened since though has led me to become more and more disillusioned.
There have been enormous changes for the better in Pakistan. If you turn on
Pakistan television now, you'll see that the number one TV talk show is "The
Transvestite." There are six independent music television channels showing,
you know, Pakistani music bands. So there's a lot of liberal media out on the
air in Pakistan, much more than there used to be. But, at the same time,
there have been negative changes, and the most important negative change is
that the main political parties who have always gotten close to 90 percent of
the vote in the election and have been the country's strongest protection
against Islamic extremists have been undermined by a system where they can't
participate in power, where some of their politicians are bought off and
brought into Pervez Musharraf's parliament and other ones just sit on the side
lines. And I think, in this environment where we no longer face the
existential threat of a possible war with India or with the United States, we
have made progress economically and have a more liberal media, the time has
come for Pakistan to shift back towards a more democratic setup.

GROSS: In an Op-Ed piece, you reprinted the referendum that you voted yes to
when you voted for President Musharraf, and I thought I'd read that. It's
worded so interestingly. "For the survival of the local government system,
establishment of democracy, continuity of reforms and to sectarianism and
extremism, and to fulfill the vision of the founder of Pakistan, would you
like to elect President General Pervez Musharraf as president of Pakistan for
five years?" Talk about loaded wording.

Mr. HAMID: Absolutely. It was basically saying, you know, if you agree with
the direction of the founder of Pakistan and you want the good of the country,
you must vote for Pervez Musharraf. But I thought that he could deliver some
good for the country, and he has delivered some good. We're talking now about
proposals for compromise with India over Kashmir that we never heard before.
If you come to Pakistan today, you will see that the economy is growing very
fast. The skyline of the big cities in changing. There's an economic boom of
sorts going on. So there have been positive things. But now as he tries to
hold on to power, we're seeing all sorts of negative developments.

There are--recently in Islamabad, a group of women dressed in burkas, which is
full-face covering, which is quite unusual in Pakistan, have been protesting
and acting in defiance of the government. Near the Afghanistan boarder,
there's all sorts of Islamic militants who are acting up. And these things I
think could be better coped with by a government which actually could claim to
have the legitimacy of people, of the mass of Pakistani people, supporting it,
which Pervez Musharraf can't do.

GROSS: You live in London now, and, as we speak, 15 British sailors are still
being held by the Iranians. Is that increasing the level of tension in
England between the British and people who look like they are from the Middle
East?

Mr. HAMID: Well, I have to say, in London, my sense of the tension between
people who are looking or visibly look like they're British and people who
look like they're from the Middle East or west Asia is not that high. Even
after September 11th bombings and after the Tube attacks in London, I remember
walking off the...(unintelligible)...train from Paris the same day the Tube
attacks took place, going to meet a friend of mine in a pub, walking in with
my carry-on bag, and nobody looking twice at me. So I don't really feel that
there's that much suspicion in the way. There obviously is some, and if you
act in a strange way, you will be noticed. But I don't get the sense that I'm
so highly under suspicion. On other hand, in America, I feel a bit more of
that, and I think perhaps it's because in America, the media has done more to
frighten people than it's done here in the UK.

GROSS: Like what?

Mr. HAMID: Well, I think about the amount of coverage that we give to the
notion of terrorism and how likely it is to threaten our lives, and in
America, 3,000 people were tragically killed on September 11th, 3,000
Americans have died in Iraq, so about 6,000 Americans have died in the war on
terror. Forty-two thousand Americans die every year in car accidents, yet
when we see our car in the driveway, we don't suddenly feel a wave of fear,
and when we see the bearded man on television or on the subway next to us, we
do feel that. And that's a skewed perception. We're much more likely to be
killed by an automobile accident, by heart attack, by cholesterol than by a
terrorist, and yet, in America, in particular, and also throughout the world,
we've received so much information suggesting that terrorism is likely to kill
us, that we have an exaggerated sense of fear.

GROSS: You know how we were talking earlier about how whether you ever wear a
beard and how that complicates how people see you? I just--you'd think I
would have done this before but I didn't--I just opened the book jacket and
saw your author photo, and there you are with a beard.

Mr. HAMID: Yes.

GROSS: You know, it's funny to me that in this novel that talks about how if
you are from Pakistan and you have a beard, people might assume you are an
extremist--you didn't shave for the author photo, I see.

Mr. HAMID: Well, you know, it's funny because that author photo was taken
by, you know, typically, an American photographer who was in Pakistan to
photograph an essay I'd written for Smithsonian magazine and I happened to
have a beard at that time, and that's when he took that, and the reason why
that's the photo in the book is because it's taken on the exact same street,
in front of the exact same cafe that the novel is told at. But in Pakistan,
too, I'm seen differently when I have a beard. If I walk down certain streets
and I'm bearded, even if I'm wearing jeans and a T-shirt, in a way, I do blend
in in a different fashion than if I don't have a beard. Not that I really
encounter hostility one way or the other, but people assume certain things,
and that's what we have to bear in mind. It's not just that Americans assume
certain things about Muslims and Pakistanis, or Pakistanis assume certain
things about Americans. Everybody assumes things, and a beard is quite a
powerful symbol even in a place where many people do have beards.

GROSS: Well, Mohsin Hamid, thank you so much for talking with us.

Mr. HAMID: Thank you, Terry.

GROSS: Mohsin Hamid's new novel is called "The Reluctant Fundamentalist."

The cop show "The Shield" returns to FX tonight for season six. Coming up,
David Bianculli has a review.

This is FRESH AIR.

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

Review: TV critic David Bianculli discusses new season of "The
Shield"
TERRY GROSS, host:

The gritty cop drama "The Shield," starring Michael Chiklis, begins its sixth
season tonight on the FX cable network. TV critic David Bianculli says it
starts with intensity and keeps building from there.

Mr. DAVID BIANCULLI: Vic Mackey, the tough cop played by Michael Chiklis in
"The Shield," is as much antihero as hero. The character and the series came
to TV in the wake of "The Sopranos," and Vic was designed very much like a
Tony Soprano on the other side of the law. In the series pilot, when he
learned a fellow law enforcement officer was about to turn him in for illegal
activities, Vic shot and killed the guy during a drug raid.

The challenge for "The Shield" was to make Vic such a compelling character
that viewers didn't reject him outright. Series creator Shawn Ryan didn't
make it easy either. Vic didn't start out with that one horrible act, then
spend the rest of the series repenting. Vic's tactic worked and kept working.
Whenever someone got in the way of Vic or his strike unit crew, he would
confront them like a street version of "Survivor"--outwit, outplay, outlast.
And along the way, whenever we were about to cozy up to Vic as a decent guy
after all, he grabbed some suspect off the street and interrogated him in ways
that made Jack Bauer on "24" look about as threatening as Kenneth the intern
on "30 Rock."

So far Vic has outlasted everyone who's tried to bring him down. Two years
ago, it was a new captain, played by season-long guest star Glenn Close. Last
year, it was an internal affairs lieutenant named Kavanaugh played by Forest
Whitaker. Kavanaugh was convinced that Vic was behind the death of that
officer all those years ago, and when Vic's best friend on the force, a cop
named Lem, whom Kavanaugh was pressing as part of his investigation, was
killed by a grenade tossed into his car, Kavanaugh suspected Vic of that
murder as well. Kavanaugh became more and more obsessive last season, and Vic
responded in kind. Each of them, for the same vindictive reasons, tried to
seduce the other's ex-wife.

But last year was nothing. Between seasons of "The Shield," Whitaker won an
Oscar as Best Actor for "The Last King of Scotland," and as the new season
begins Oscar-winner Whitaker and Emmy-winner Chiklis dive into their roles
like the champions they are. Or like two grizzly bears snarling at each other
with undisguised fury--even in the precinct house where Vic sees Kavanaugh and
goes right up to him.

(Soundbite of "The Shield")

Mr. MICHAEL CHIKLIS: (As Vic Mackey) I guess I should start making my
funeral arrangements now, right, Lieutenant?

Mr. FOREST WHITAKER: (As Kavanaugh) Why would you want to do that?

Mr. CHIKLIS: (As Vic Mackey) It seems like every cop you investigate ends up
dead.

Mr. WHITAKER: (As Kavanaugh) I'm not at liberty to discuss the details of my
investigation with you.

Mr. CHIKLIS: (As Vic Mackey) Getting my best friend blown up. You coming to
my house. You're hanging...(unintelligible) and you killed Don Mink. Detail
enough?

Mr. WHITAKER: (As Kavanaugh) I know that just be the grief talking.

Mr. CHIKLIS: (As Vic Mackey) At what point do your bosses realize you're as
delusional as that sick, crazy twisted ex-wife of yours?

Mr. WHITAKER: (As Kavanaugh) I guess the same time that yours realized that
you've murdered two of your own team members.

(Soundbite of fighting, shouting voices)

Unidentified Actor: Knock it off! Knock it off! Now!

(End of soundbite)

Mr. BIANCULLI: Whitaker only hangs around for a few episodes this season.
After all, he is an Oscar-winner now. And you would think that when he
leaves, a lot of the tension in "The Shield" will leave with him. But it
doesn't. Viewers already know who really killed Lem. It's Shane, Vic's
right-hand man who mistakenly believed Lem was about to turn them all in for
past abuses.

But Vic doesn't know. Vic spends more than half of this new season searching
for Lem's killer, and while he's searching for the right reasons, his methods
and actions start out as questionable and escalate from there.

Vic is a rogue cop, but he's also a good one. Sooner or later, he has to
discover the truth. And when he does, later this season, and confronts Shane,
there's no telling what will happen. Well, there's no telling, because I
won't tell. What I will say is that when that confrontation arrives, building
on everything "The Shield" has established since the series pilot, you won't
be changing channels. Or leaning back in your chair. Or breathing.

GROSS: David Bianculli is TV critic for the New York Daily News.

(Credits)

GROSS: I'm Terry Gross.
Transcripts are created on a rush deadline, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of Fresh Air interviews and reviews are the audio recordings of each segment.