WARTS AND ALL

Studying the geology of Split Mountain

Wow!  Have I ever got a book tip for you!  It is important, it is timely, it is readable, and it grabs you and won’t let you go.  But I must issue a warning:  If it is important to your sense of security and general satisfaction in life to believe that the medical profession is composed dominantly of rational, scientific-minded, altruistic, consistently high-minded people, give this a pass.  This book tells it like it is, warts and all.

The book is The Death of Cancer, by Vincent T. DeVita, MD, and co-authored by Dr. DeVita’s daughter Elizabeth, who is a professional science writer.   You can buy it hardcopy from Amazon for $17.50, or for your Kindle for $15.99.  Moreover, if you wait a few months you ought to be able to pick up a like-new copy from Abebooks for $3.57, with free shipping.  However, as we all cherish small, independent local business, go buy it from your local bookstore – but only after you read my review.

DeVita is an 80-year-old oncologist who has spent 50 years in the front lines of the War on Cancer.  He has extensive clinical experience, but seems, as an administrator, to have expended most of his time and energy slogging through a sticky and malodorous, quintessentially Federal bog, inhabited by the people who control the money-tap upon which cancer research depends.  Although he once was director of NCI, he doesn’t like it much.  Likewise, he is critical – very critical – of NIH, but he saves his most explicit scorn for the FDA.  Much of the fun in this book arises from the way he illustrates problems by reference to the unforgivable and inexplicable errors of real people (although, as if alarmed that he has gone too far, he often says – in a footnote – that Dr. So and So went on to have a valuable and productive career.  You can hear his daughter saying, “Now, Dad…..).

So, anyway, I am so excited about the book that I just decided to read it again, before trying to summarize it in any detail.  However, so you won't feel cheated, here are several things to ponder.

DeVita thinks we are winning the War on Cancer, almost despite ourselves.  He is excited by progress in targeted therapy, and he is upbeat about converting deadly cancers into chronic diseases by means of chemo cocktails composed of multiple drugs.  Many of these drugs are new, and often are the results of our growing understanding of cancer-causing mutations and the biochemical pathways they use to do their dirty work.  On the negative side, he ignores cost completely.

There seems to be a distressing amount of ass-covering, turf defending, character assassination and the like going on in medicine.  I always wanted to believe that medical people were above all that.  Maybe not.

DeVita propounds one rule of behavior that should be obvious to us all, but hadn't occurred to me.  Never give up on a patient.  At the rate new drugs are being developed, if you can keep a patient alive for a few more months a cure may come along.

And finally, Dr. DeVita agrees with me that we need a Cancer Czar to allocate funding to the most productive programs.  He doesn’t think that simply drowning NCI in money, while letting it carry on as usual, will work.  Now, where have you heard that before? 

More, later.