Professor John Adler of Stanford University, welcome to walk the talk.

John Adler: Thank you Shekhar. Its very nice to meet you. I hope I can walk the talk.

•Shekhar Gupta: Well you have done in your business. You are the inventor of cyber knife which I believe is not a knife.

John Adler: No, well it's a metaphorical knife. And I mean the point is that modern technology has allowed us to get every bit more precise and every bit more aggressive and I think it is now crossed a threshold where we can really achieve a surgical like outcome and that's why we call it a knife.

•Shekhar Gupta: But its actually something that directs radiation in a very precise manner as if it was a very fine tipped knife.

John Adler: Exactly. I mean the radiation is the pauses so accurately and from so many different angles you can concentrate the radiation in a way that was never possible before. And I kind of liken it to a magnifying glass. You take the sun's energy is not so strong by itself but if you take all the sun's energy and converge it to a common point you can really kinda burn something and start a fire and in this case we start a fire and kill a tumor.

•Shekhar Gupta: Right but you are a good marketing person to have found this maybe if you had call it sometron??? with you know some name with nine consonants and eleven vowels.

John Adler: You know actually the first name was Neurotron. So, we called it the Neurotron 1000. But I didn't like that idea and really its important for me that conceptually I get across the idea that this is knife like. That it has the effectiveness of surgery and that it has the precision of surgery and in most people's mind surgery means something. And it implies about a physical force that is aggressive and achieves its outcome.

•Shekhar Gupta: But effectively it's a tool that bypasses both, chemotherapy and surgery.

John Adler: Yeah yeah it lives its own space. At this point I think the world is divided unrealistically all our treatments into radiation treatments, standard radiation treatments or surgery. And here what we have done is we have blending the two worlds and in the process I think we have achieved something special. So, it has the virtue of being non invasive like radio therapy but it also has the virtues of being very effective like surgery.

•Shekhar Gupta: And minimising the collateral damage if I may use that term.

John Adler: Oh Yeah yeah its pretty special.

•Shekhar Gupta: Because radio therapy burns a lot of good tissue as well.

John Adler: Yeah people end up with heads that look like yours and mine!

•Shekhar Gupta: But it is amazing you will get down with the procedure, you can ride your bicycle home. And in fact I have had several patients do exactly that, ride your bicycle to the procedure, have your brain tumor killed then ride your bicycle home. So, I know its your baby but tell me how big a breakthrough its been in the treatment of certain kinds of cancer tumors.

John Adler: Well, it is more of an evolutionary process than some of this implies. The ideas are founded on top of something called the starcatic radio surgery and the gamini invented by my Guru, Lars Laksell.

•Shekhar Gupta: Large Laksell in Stolkholm

John Adler: Yeah, he is a very famous Swedish nurse researchers. One of the great man of the twentieth century. And many of these principles come from him but what he did was, allow us …give us a technology with a frame screwed in the skull to treat brain tumors and when I studied with him I reasoned that what works well on the brain should just work well on the rest of the body. That was the intellectual framework for what I developed…

•Shekhar Gupta: You after you finished at Harvard, went to Stolkholm to work with Lars and Laksell.

What took you to Stolkholm then? Were you focussed on this field?

John Adler: No, I wanted to have a good time. So, I figured I had spent too much time …

•Shekhar Gupta: In Sweden, I thought Sweden was a bit boring for a young graduate.

John Adler: Oh Sweden is quite an adventurous place to be for a year. And so I went to Sweden, and I assumed that I would find some academic work but really for me it was important to get out of Harvard, to get out of Boston and spend the year abroad and the best thing I went there was with no specific idea in mind.

•Shekhar Gupta: And you ended up with this Gamma knife team.

John Adler: Right, right..so I was working with Lakswell and I realised that he was doing things that were magical in my eyes. Harvard men like to think they know everything but I quickly realised once I was working with Laksell that there was this whole future of radio surgery out there.

•Shekhar Gupta: So, when did you first realise that Gamma knife was a foundation I could build on.

John Adler: Within weeks of working with Laksell I said this is special but all I could do was treat a few limited brain tumors. I said if only if only we could take this kind of concept and make it work for the rest of the body. So, I spent the next couple of years trying to figure out a way to do it.

•Shekhar Gupta: I noticed it works well with hard tumors. Brain, lung, pancreas, liver.

John Adler: It works best for some of the hardest operate tumors.

•Shekhar Gupta: So, those tumors that are the deepest and the most least accessible. Those tumors that require the biggest operations to remove, that's the sweet spot of what we do. There are some tumors right now that we have pretty good treatments for and that instead radio therapy might work very well. But some tumors are not very big they are just located in some difficult to reach key areas of the body and the virtue of this is that we can now treat them in our own patient way just about, and sometimes even more effective than surgery.

Shekhar Gupta: So, can you leap from a healthy tissue. If a tumor is deep down, can you go through a healthy tissue and then give it a burst when you reach the bad guy.

John Adler: Absolutely, that bad guy tumor is right in the middle of a healthy tissue. We kill it right without disrupting any of the surrounding normal tissue. Whether you have it in the liver, in the lung.

•Shekhar Gupta: So, what kind of acceptance do you get from say surgeons and chemotherapy loyalists? Do they see this as a help or do they see this as a rival?

John Adler: Well, you know initially it was always denial. Its like the three stages of death. It starts with denial. But eventually the data speaks for itself and gradually more and more surgeons are starting to really believe in this and right now one of the most exciting clinical trials of cancer is going on in Anderson??? where they are trying to compare cyber knife for killing tumors as opposed to opening the chest and taking only lung cancers out and its all being run by some surgeons who believe perhaps we have a procedure.

•Shekhar Gupta: And in any case cancer doctors need every possible weapon in the armory.

John Adler: Well, I think its different doctors its different patients and I think patients are leading the charges as much as any because at the end of the day it's the patients who suffer the most.

•Shekhar Gupta: I was reading this was quite innovative. I believe you even borrowed technology from Missile defence.

John Adler: Yeah, yeah that's why I was very lucky when I left Sweden and I left Harvard to go to Silicon valley because it does involve some pretty cool missile technology

•Shekhar Gupta: In terms of catching a moving target because the human body moves with breathing and heart beat.

John Adler: Because at the heart of this technology its all about accuracy, its all about finding the target in a very confusing environment

•Shekhar Gupta: Like an imaging system.

John Adler: Yeah, yeah and then locking it in that target and then treating it from as many angles as possible. Cross firing those beams of radiation through the tumor.

•Shekhar Gupta: Right, how did you get to that connection?

John Adler: The connection with the cruise missiles?

•Shekhar Gupta: Yes

John Adler: Well, at the end of the day I knew the current solution we had, frames on the head was not going to do the job. We needed some way to target within the body without interrupting you know violating the body and one thing we know about is X-rays, you can make pictures, you can make some very nice pictures with X-rays. And so it really became a matter of if could you analyse in an intelligent fashion, the X-rays of the body and then determine where the body was positioned in space and that's what cruise missile technology basically gave us.

•Shekhar Gupta: Gave us the connection.

John Adler: Yeah gave us the algorithms basically the algorithms.

•Shekhar Gupta: Now, you came back to Stanford and you found some engineers to build this wonderful machine. 1987 was in the time when Venture capitalists were floating in the streets of Paulo alto.

John Adler: Yeah but they weren't coming in my direction. It was a very difficult difficult start up.

•Shekhar Gupta: But in '87 they weren't any so I believe you ran into financial trouble developing this.

John Adler: Me, I have had financial trouble for ten years. So, when the actual starting of the business was not …for me and there were a lot of attributes of what I was trying to do that weren't the kind of characteristics that venture capitalists like to see in new start up business.

•Shekhar Gupta: Such as what?

John Adler: Well, it cost three million dollars. This was not even a disposable device. Venture capitalists in the medical world, they like things which are quick and disposable.

•Shekhar Gupta: And a seven foot machine in Silicon valley, they expect things to be tiny. Tinier the better.

John Adler: Exactly, so they like the idea that you can make a little piece of metal; shape it and charge three thousand dollars for it when what I was trying to do involved even more money but it was far smaller numbers of things being made.

•Shekhar Gupta: But you had so much commitment in this dream that you left your job for some time I believe at Stanford.

John Adler: For three years.

•Shekhar Gupta: And became the CEO of your own company.

John Adler: Yeah yeah, I was crazy, I still am still crazy about the subject.

•Shekhar Gupta: And went broke.

John Adler: Yeah, I went broke. I went broke many times and my wife thought I was crazy. The family thought I was crazy but you know what sometimes even crazy people are right.

•Shekhar Gupta: And the result is a wonderful thing that we save so many lives and give so many people comfort.

John Adler: Well, I am making a lot of progress.

•Shekhar Gupta: Tell us about those days, that almost reminds me of scientists say 10th, 11th or 12th century with an idea either went bankrupt or were sent to jails or were hanged from unpleasant things.

John Adler: Well, the wife could talk to you for a week on it.

•Shekhar Gupta: You borrowed money from your friends. I believe Eight hundred thousand dollars.

John Adler: Yeah I borrowed money from friends and family. Friends of John, so only friends of John were crazy enough to put up money for this but we were able to sort of cobble together and up money for a long enough time and prove the concept. And so I am not the first person who has had this problem but it was always kind of striking that right in the middle of Silicon valley, right next to venture capitalists that this was the problem.

•Shekhar Gupta: But, you got a genuine invention in the end.

John Adler: Yeah, I think so. Sixty thousand people treated today, sixty thousand lives is pretty good.

•Shekhar Gupta: Globally acknowledged, and now the first for the India at the Apollo in Chennai, I believe.

John Adler: Yes, first. I can now say the sun never sets for the cyber knife.

•Shekhar Gupta: Right, you got them all over. But you know four million dollars is still a steep price because you will say you are successful when hundreds of thousands of patients are treated every year. When will that happen? For that to happen this is to become cheaper.

John Adler: Well, it does. It needs to be. Its not just the cost of the instrument. Its also the efficiency with which its used. And one of the good things of being at Apollo is that Apollo knows a lot about taking in expensive pieces of equipment, using it so efficiently that the cost probation comes down dramatically and that's one of the big hopes I have, expectations for this programme here in India.

•Shekhar Gupta: So, take us back to the tough days because that's fascinating. You had a cushy enough job at Stanford. You had a reputation already. You could have sold at whatever value the rights of whatever work you had done. Did you ever come close to giving up.

John Adler: Oh, a dozen times. And sometimes I wonder if I would ever do it again. I was a very difficult and emotional child, this has become my baby. You know I have two children and I look at this as my third child. And emotionally it seems I am that attached and for other people it seems almost crazy that you will feel so strongly towards an inanimate object.

•Shekhar Gupta: Towards a machine.

John Adler: It's a machine. But it's my life. It's an expression of who I am. It's my creative outlet. You know I am not Michaelanglo, I can't paint paintings. I can't write beautiful pieces of music. This is my work.

•Shekhar Gupta: I believe you were a wrestler.

John Adler: That's right.

•Shekhar Gupta: You have a real handshake ??? One of your friends said, that the reason you never gave up was because you were trained to be a wrestler.

John Adler: That's right. That's exactly right. I was never a great wrestler but I would never give up and some of my best matches were because of the fact that I would win in the last few seconds because I still wasn't going to give up. And that's my nature. I may not be very smart but I am tenacious. I don't give up.

•Shekhar Gupta: So, now you got this wonderful machine of yours, Cyber Knife and where do you go from here. And where does Cancer therapy go from here.

John Adler: Well the equipment is the first step. Its like equated to making a good violin or something. In order to show what that violin is capable of you need a great violinist. And I think we are all learning to play this violin for all different types of tumors. I mean different types of tumors in the liver, in the kidney, in the prostate. They require different type of treatment parameters, different patients selection and we are learning about that. But even more far sighted, I am intrigued by taking the principle of destroying tissue, altering tissue non evasively to treat conditions like heart abrythm and even psychiatric disorders.

•Shekhar Gupta: Can you explain it a bit more for people like me.

John Adler: Ahh, well we know that several types of very common abnormal heart beats called one of the most congree ahofrivalation ….. start because there some kind of abnormal scar tissue in the back of the heart valve. And while there are ways to catheders and opening the chest, to kind of cut that tissue out, its very expensive, very invasive; the one we are now trying to substitute out at least starting in animals using the cyber knife to just burn this tissue out.

•Shekhar Gupta: So, cyber knife could get behind all the good tissue again

John Adler: It siffs through all the normal tissue doesn't interrupt the normal tissue. And yet can effectively change the way the heart circuitry works. You really can't interrupt the abnormal circuits. And in fact I would want to take the same principles and do it in the brain for psychiatric disorders. I think if you are going to find that now no scientists have figured out over the last twenty years other better ways of …..the brain

•Shekhar Gupta: You mean you could address psychiatric problems with this.

John Adler: oh yeah, yeah. That's the holy grail. You know drugs, drugs are only so good. Drugs haven't improved and they are very non specific. We understand much better now. We are in the area of the brain now.

•Shekhar Gupta: Well, psychiatric drugs are all about suppressing the symptoms. They are not about treating.

John Adler: But the trouble is that they treat not just the area of the pathology, they treat the whole brain. Because the same receptors that is at the area of ……gy is also elsewhere. So, we are trying to just to alter marginally the area where the pathology is.

•Shekhar Gupta: But could it work, if I can push that envelope because I know that you would. Could it work in cases say of autism?

John Adler: Well no no, this is not for everything. Things like depression, obsessive compulsive disease, things like addiction. I mean there is a range of pathologies that we think we can address using radio surgery.

•Shekhar Gupta: where you can pin point the area, the tissue where the problem is coming from.

John Adler: Yeah, we know now the psychiatric disorders, kind of where the abnormal circuits are. We can see some of the pathology on specialised MRI scans, specialized pet scan and its really a matter of changing that circuitry. Now one of the ways scientists are changing that circuitry for some of these diseases is actually putting pacemakers, electrical wires down to that area of brain. Its stimulating to inhibit but that's very expensive, very invasive and so we are trying to take the next step.

•Shekhar Gupta: And you are carrying a foreign guy in your head which is not nice.

John Adler: Yeah, for the rest of your life you are going to have these foreign bodies, wires coming out of your brain. We think and the premier analysis suggest that we do the same thing with the cyber knife just marginating those areas of the brain.

•Shekhar Gupta: Professor Adler I know that this doesn't affect your own precise areas very much. You are a doctor engineer but the change in America, the excitement that there may be a lot more money coming into scientific research. That the whole stems and research area may boom. Is it exciting?

John Adler: Oh no. I think academics haven't been this happy in several years now. I think that a big part of the Obama plan is to stimulate the economy through science. And we academics expect to be some of the beneficiaries.

•Shekhar Gupta: That's a change from somebody who thought science was in conflict with God.

John Adler: Yeah, that's right. That's right. God is at the center of science. Somehow we have just disconnected that. So, it's unfortunate the last several years the way science has been treated in America. But I think you know great times are ahead and we are very exciting. I mean these are the golden areas of science and especially in your biology, my area of interest.

•Shekhar Gupta: So, you think that phase is now beginning. It's going to be a boom. India is a country that produces enormous number of biology graduates and doesn't know what to do with them.

John Adler: Well, there's untold amounts of pathology and misery out there that needs to be addressed. Now, America has been very generous with research money and I don't know that India is yet ready to kind of commit those kinds of funds. But, if they can come over for this to America, they can certainly help us out.

•Shekhar Gupta: But, India teaches the graduates to go and work with you guys out there.

John Adler: Oh, yeah yeah absolutely. My cyber knife is created by, I mean my head engineer was an Indian

•Shekhar Gupta: From India?

John Adler: Right, from India but now really moved to America.

•Shekhar Gupta: Right, but those guys have also been in trouble because of immigration issues and now Obama getting into its protectionism.

John Adler: I hope he does. The foolishness that went on over the past few years, it makes me embarrassed to be an American. I mean when I used to travel I told everyone that I was Canadian.

•Shekhar Gupta: (Laughs) Well, I have an American journalist friend who when he goes to Afghanistan uses an Irish passport.

John Adler: (laughing )…He has to learn to speak with an Irish tone also. Canadians speak more or less like me.

•Shekhar Gupta: But, even Obama has his issue about allowing too many foreigners. Too many American jobs going to foreigners whereas you should be attracting all the talent you can from where ever.

John Adler: If I was the President I would suck as much talent out of India as I possibly could. That's been the strength. I am from Silicon valley and the reason that silicon valley is because of

•Shekhar Gupta: Sitting where you are I don't think you have any problem. Because, it is the most mobilized place in the whole world.

John Adler: It is but I can tell you right now I am trying to find some very good as I call rock star engineers and they are still hard to find.

•Shekhar Gupta: You say engineers.

John Adler: Rock stars. I don't mean just engineers.

•Shekhar Gupta: Because that's a new thing you say. This year at Davos I saw at least three sessions that were about medicine and engineering. So, do we now see this incredible confluence of two sciences that were suppose to be opposites?

John Adler: I think you do, you do.

•Shekhar Gupta: In my college days you either studied to be an engineer or a doctor. You couldn't do both.

John Adler: No, no in some ways I think I like the engineering solutions to medicine are better than some of the pharmaceutical and biological systems. I mean the medical devices which the cyber knife has won is an example of how powerful the vices surgery is. You know for many years, I think for several decades we thought kills was the answer to everything.

•Shekhar Gupta: And then we thought surgery was the answer to everything.

John Adler: Well, it still is the answer to everything. It's just a new form of surgery. That's why I have to go around and confirm surgeons, that this is surgery because I want to treat their patients.

•Shekhar Gupta: So, this is just a new weapon in the armory of a surgeon.

John Adler: That's right it's a new weapon. This is surgery. The world of surgery is changing and everything you think you know about surgery is wrong. Surgery does not have to be painful. Surgery does not have to be scary.

•Shekhar Gupta: That's very reassuring for millions and millions like me who absolutely live with the dread of surgery and medicine. And you know that's why its so wonderful that you come up with something that takes away the pain and the inconvenience. So, wonderful chatting with you. And we know these are exciting times. And I think we have found a new equation now that scientists have great times when the bankers have their nightmares. Isn't it?

John Adler: (laughs) Well, I guess I hope my best times with science are ahead. I wish that the bankers had not put us through with what they have but perhaps we are grateful for now.

•Shekhar Gupta: May be it is a cue to science. Thank you very much Professor Adler. Wonderful chatting to you.

John Adler: I had fun talking to you. Bye bye.