THE TRUTH IN SMALL DOSES: Part 1

A new Physical Therapist

I am not going to try to be funny or clever in this blog; the subject is, for me at least, too important for any of that.  I am going to try to distill some of what I have so far gleaned from reading The Truth in Small Doses, by Clifton Leaf. 

I have been reading cancer- and biology-related books for several years now.  Most of them have been worthwhile, and one, Nessa Carey’s book on epigenetics (which I have mentioned several times previously) is close to essential reading for any non-biologist who wants to wrap his or her mind around modern concepts in genetics.  I have read Carey’s book twice, and may start it again within a few months.  Leaf’s book I certainly will read again and – something I haven’t done in many decades – take notes.  For someone like me who is deeply concerned with the lack of progress in the so called “War on Cancer”, Leaf’s book is essential; a game-changer.  I urge you all to, at least, consider reading it.  It isn’t easy and it isn’t fun – but it’s very important.  You can download it to an iPad for $12.99, or you can pick up a new hardbound copy through Abe Books for $5.73.

Leaf is not a biologist, but rather a science writer who has published in Fortune magazine, and elsewhere, I imagine.  He has spent many years (indirect evidence suggests nine) studying the workings of our cancer “War” and looking for probable causes of its tepid success.  Some of the things he discusses and, especially, some of his suggestions are very like things that have been rattling around in my head for quite a long time.  I am going to do a systematic book report on this item in the middle-distant future, after I have gone through the book again.  What I will write below are some themes and impressions that occur to me at the moment – in no particular order.

We can’t eliminate cancer by simply smothering it in money.  The money has to be properly directed.  We may need an overall administrative structure; like a biochemical NASA.  However, from my perspective, curing cancer is vastly more difficult than reaching the moon.  The problem is far more diverse; not one “problem”, but many.

As presently organized, the NIH/NCI “protocol” for doling out money is needlessly tedious and complicated.  One result is that cancer PIs spend far too much time writing grant proposals, at the expense of time spend on actual science.

The NIH/NCI “culture” discourages innovation and what Leaf calls “risk-taking”, but rather rewards cautious, incremental science – science that aims at making slight, sometimes wholly insignificant, fiddling “improvements” in existing protocols.  No home-runs allowed; bunts are welcome.

There is implicit in the way the system works an almost religious adherence to the phrase: “First, do no harm.”  However, there are harms of commission (you administer an experimental drug to a very sick patient and he dies) and then there are harms of omission (you  deny an experimental drug to a very sick patient, on the grounds that it might do something harmful – and he dies anyway.)   Which sin is worse?

Okay, that is enough for now.  I will do a much better job in a few months, after I have re-read the book and thought a bit more about its message.