The Death of Cancer: After Fifty Years on the Front Lines of Medicine, a Pioneering Oncologist Reveals Why the War on Cancer Is Winnable--and How We Can Get There by Vincent T. DeVita Jr.
My rating: 5 of 5 stars
Like most people, I've seen firsthand the havoc that the big "C" can inflict not only individuals but also on their families. In addition to treating dozens of patients who suffered from cancer, I recently watched my brother-in-law lose his own battle with cancer at the age of 52.
It's always struck me as bizarre that when we hear about a mass shooting or terrorist attack, we are overcome with a sense of imminent fear. Our hackles are raised and we are on high alert. And we mourn the victims, memorialize their deaths. But the truth is that for most of us the real enemy isn't a deranged shooter or radical extremist. Our killer and our deaths won't make the evening news. Because for about half of us the real threat lives inside of us.
I've always wondered what would happen if the time and energy we put into the gun control debate were instead targeted toward a bigger threat like cancer. This is not to diminish the issue of guns and gun violence, but rather to put the discussion into perspective.
The thing that makes cancer so difficult to treat is that cancer cells aren't some external invader like a virus or bacteria. They are our own cells. Rogue cells that turn against us.
In The Death of Cancer, DeVita takes us on a journey that explores the war on cancer, a national initiative that started in the 1960s and one that has yet to be won. In the process, he highlights the obstacles that we face, many political and institutional, and some driven by egos, doctors stuck in the past and unwilling to move forward for whatever reason.
DeVita speaks with disdain about our inability to make the bridge between science and its practical application. And if there is a villain in his story, it is the FDA, which he paints as a huge barrier to our progress. He acknowledges the importance of some oversight, but accuses the FDA of a sort of group think that in an effort to protect people from an untested drug, deny them the one shot at life they've got. After all, as he points out, when it comes to treatment, these patients are going to die sooner than later, and many would take a chance on a drug that had yet to go through the grueling approval process if it gave them a shot at a cure, or even just kept them alive long enough for the next drug to be discovered.
He believes, and I agree, that when you are dealing with something like cancer, you've got to consider what is at stake. We are talking about patients who are fighting for their lives. You have to be aggressive and be willing to take a chance, for many a last chance.
DeVita started his career at the NCI (National Cancer Institute) where he eventually developed a chemotherapy cocktail for those with Hodgkin's lymphoma that led to a cure, building on treatments that were already being given to patients with leukemia. Back then, the idea of using a combination of chemotherapeutic drugs was considered aggressive and radical, barbaric even. Up until that point, tumors were removed with disfiguring surgeries or exposed to radiation as a means of eradicating the cancer with marginal success. Most cancer patients died, sooner rather than later.
DeVita seems to blame many of our missteps on egocentric doctors who either consciously or unconsciously saw these new treatments as a threat to their livelihood. He also attributes a lack of progress to good old fashioned bureaucracy and, at times, poor management of our cancer centers, and he should know. In addition to working at the NCI, he eventually became the director. He served as director of the National Cancer Program, chief physician of the renowned Memorial Sloan Kettering Cancer Center, and the director of Yale Cancer Center. He is also a former president of the American Cancer Society and the coeditor of a cancer textbook.
Ironically, he is also a cancer survivor, after being diagnosed with advanced prostate cancer and successfully treated at the end of his career.
This is really a fascinating read. In addition to providing the reader with a timeline and history for the evolving treatment of cancer, he brings attention to the many barriers, some physical and some ideological, some understandable and some ludicrous, that we've faced to get where we are. And while he admits that we haven't quite won the war, and that maybe we never will, we've still made significant progress, not only in establishing cures but also in developing treatments that keep people alive in the absence of a cure. In a nutshell, the prognosis continues to get better and better.