The first book review I wrote for this website focused on The Emperor of All Maladies: A Biography of Cancer by Dr. Siddhartha Mukherjee. I absolutely loved that book. Critics agreed, since it won the 2011 Pulitzer Prize for nonfiction. It is hard to top such a sweeping drama in terms of the breadth and depth of cancer research. Therefore, this book on cancer, The Death of Cancer, focuses more on the nuts and bolts of academic medicine in both government agencies such as the NIH and at prominent academic institutions such as Memorial Sloan Kettering Cancer Center in New York City. The story of the fight against leukemia at the National Cancer Institute (NCI) which was detailed in The Emperor of All Maladies is repeated, but this time from an insider’s view who lived through those tumultuous times. Dr. DeVita was one of the researchers involved in the first successful chemotherapeutic trials against childhood leukemia in the 1960’s and 70’s and developed a cure for Hodgkin’s lymphoma. He went on to become the head of the NCI in 1980, then became the physician in chief of the Memorial Sloan Kettering Cancer Center, and he is currently the director of the Yale Cancer Center.
A reluctant recruit to the field of oncology (he wanted to be a cardiologist), he shares the tragic case of his Aunt Violet who died of cervical cancer at age 36, whose dim prognosis was shared by most diagnosed with cancer prior to the 1970. He captures the mindset of most doctors at that time which was no possibility of cure. From that dismal beginning, he now writes in the introduction, “I believe we will see the end of cancer as a major public health issue. And we have the critical mass of knowledge to get us the rest of the way. We do face obstacles, but most of them are not scientific. Rather, they are in the form of not using what we know and the tools we already have to cure more because of a reluctance to drop outdated beliefs, bureaucratic battles among physicians and medical groups, and a Food and Drug Administration (FDA) that has not caught up with the innovations in cancer drug development.” As a physician that cares for patients suffering from cancer, a daughter of someone with cancer, and a friend of those also fighting this disease, I hope his statement will be true. The author details some of the bureaucratic and political fights that occurred in the War on Cancer thus far, and hopefully we can learn from these mistakes that were made on the way.
The famous quote, “We have met the enemy, and he is us!” embodies a major theme of this book. DeVita describes the early days at the NCI when medical oncologists were looked down upon by the surgical oncologists and the radiation oncologists. He describes some of the infighting between oncologists on drug usage and how long and what regimen was best to try on childhood leukemia. There was also distrust of the NIH from local community doctors on competition for oncology patients. Despite the barriers, the team at the NCI overcame resistance and for the first time, patients with Hodgkin’s lymphoma were cured. He details the politics in medicine and the discussions, meetings, protocols that occur behind the scenes that heavily influence patient care. To read this book is to read the shouting matches and the tepid exchanges at conferences which illustrate how medical research is chaotic and breakthroughs can be tough to get into general practice. DeVita recalls presenting at a meeting where his chemotherapy regimen that had been curing patients at the NCI was shot down by several senior doctors at Memorial Sloan Kettering because it hadn’t worked for their patients. It turns out they were not giving the exact same protocol nor the medications on a proper timetable.
Throughout his career, Dr. DeVita encounters many of the notable people who fought the War on Cancer, famously declared by President Nixon in 1971. He learns the importance of influencing Congress for federal money for funding clinical trials for cancer from Mary Lasker, the wealthy socialite who was instrumental in raising hundreds of millions of dollars for cancer research. Networking is just as important in medicine as in other field such as politics and law. Although the public may see scientific researchers as methodical and workhorse types, this book reveals that doctors and researchers are humans, and all too often, human nature injects into the scientific progress. For example, DeVita describes how James Watson, the famed Nobel laureate who first described the structure of DNA, was thrown off the National Cancer Advisory Board for his impudence and reading The New York Times during important meetings. He describes the many dinners organized to corral the physicians at the NCI to agree to restructure the whole organization of the clinical program when DeVita became the director. He also describes difficulty in getting landmark studies published in prominent scientific journals when the study may adversely affect the financial interests of the reviewers. In one particular case, the publication of the landmark trial that showed lumpectomy to be as good as mastectomy in breast cancer was delayed because surgeons feared losing mastectomy patients.
More heartbreaking than the backroom politics of medicine are DeVita’s personal struggles against cancer. He begins with his Aunt Violet’s untimely demise at age 36 to cervical cancer. His son, Ted, was diagnosed with aplastic anemia at age 9 and spends more than 8 years at the NCI as a patient. His sister ends up being diagnosed with metastatic lung cancer. He himself becomes a patient with prostate cancer while he is director of the Yale Cancer Center. All of these personal struggles with battling cancer give him a new perspective on the excruciating difficulties while waiting for a new therapy to be approved and treatments that come too late to save a patient.
This book is a fascinating inside view of the long War on Cancer in America, launched 45 years ago. For those who may wonder why cancer research is difficult, or why new drugs do not get to market earlier or why scientific progress can be slow, this is a fascinating read. Although it may cover a similar topic as Emperor of All Maladies, it tells the personal story and insight of someone who has been in the trenches with the progress and changes on this formidable disease. Cancer is essentially a war of our own bodies’ cells that mutate and turn against the normally functioning cells. In the same way, Dr. DeVita explains how the war on cancer is often complicated by personalities and competing interests, revealing challenges inflicted by the very people whose job it is to cure cancer. By exposing these weaknesses in the system, hopefully his prediction that we will win this war soon will be accurate.