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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
The true story of the war on cancer from one of its generals Cancer touches everybody's life in one way or another. But most of us know very little about how the disease works, why we treat it the way we do, and the personalities whose dedication got us where we are today. For fifty years, Dr. Vincent T. DeVita Jr. has been one of those key He has held just about every major position in the field, and he developed the first successful chemotherapy treatment for Hodgkin's lymphoma. As one of oncology's leading figures, DeVita knows what cancer looks like from the lab bench and the bedside. The Death of Cancer is his illuminating and deeply personal look at the science and the history of one of the world's most formidable diseases. In his hands, even the most complex medical concepts are comprehensible. Cowritten with his daughter, the science writer Elizabeth DeVita-Raeburn, The Death of Cancer is also a personal tale about the false starts and major breakthroughs, the strong-willed oncologists who clashed with conservative administrators (and one another), and the courageous patients whose willingness to test cutting-edge research helped those oncologists find potential treatments. With historical depth and authenticity, DeVita reveals the true story of the fight against cancer. The Death of Cancer is an ambitious, vital book about a life-and-death subject that touches us all.
336 pages, Paperback
First published November 3, 2015
105 people are currently reading
2227 people want to read
About the author
Vincent T. DeVita Jr.
46 books10 followersAn internationally recognized pioneer physician in the field of oncology.
DeVita earned his Bachelor of Science degree from the College of William and Mary in 1957. He was awarded his MD degree with distinction from the George Washington University School of Medicine in 1961.
DeVita spent the early part of his career at the National Cancer Institute (NCI). In 1980, the president of the United States appointed him as director of the NCI and the National Cancer Program, a position he held until 1988. While at the NCI, he was instrumental in developing combination chemotherapy programs that ultimately led to an effective regimen of curative chemotherapy for Hodgkin's disease and diffuse large cell lymphomas. Along with colleagues at the NCI, he developed the four-drug combination, known by the acronym MOPP, which increased the cure rate for patients with advanced Hodgkin's disease from nearly zero to over 70%.
DeVita earned his Bachelor of Science degree from the College of William and Mary in 1957. He was awarded his MD degree with distinction from the George Washington University School of Medicine in 1961.
DeVita spent the early part of his career at the National Cancer Institute (NCI). In 1980, the president of the United States appointed him as director of the NCI and the National Cancer Program, a position he held until 1988. While at the NCI, he was instrumental in developing combination chemotherapy programs that ultimately led to an effective regimen of curative chemotherapy for Hodgkin's disease and diffuse large cell lymphomas. Along with colleagues at the NCI, he developed the four-drug combination, known by the acronym MOPP, which increased the cure rate for patients with advanced Hodgkin's disease from nearly zero to over 70%.
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May 11, 2018
Vincent DeVita spent his life improving cancer medicine and patient care beginning in 1963 when he joined the National Cancer Institute (NCI) as a trainee. He rose to become its director from 1980 to 1988. After that he became Physician-in-Chief at Memorial Sloan Kettering Cancer Center and later Director of Yale University Cancer Center. He also served as President of the American Cancer Society. DeVita saw a sea change in cancer medicine during his career from a time when the diagnosis was usually a death sentence to the recent period of breakthrough treatments. He shares his candid observations with us. DeVita is brutally honest in his assessment of medical institutions and the medical profession. He doesn’t hesitate to call people out by name or give credit to those he respects. Neither does he hesitate to take credit for his own successes. He positions himself as a fighter for the patient, for innovation and for widespread access to new therapies.
Soon after DeVita joined NCI, largely to avoid the Viet Nam draft, he found his calling in chemotherapy. At the time cancer medicine was in its infancy with few drugs which treated few diseases. Maverick doctors at NCI developed combination chemo therapy that had success against childhood Leukemia. Following their lead DiVita devoted himself to developing chemotherapy for lymphoma. Working with whoever he felt could help, he developed a four chemical chemo cocktail and protocol that sent most of his lymphoma patients into complete remission curing many. He steadily worked his way up the ranks gaining visibility when he cured a key lieutenant to Mary Lasker. Mary Lasker was a rich influential philanthropist and strong advocate for cancer research. She organized fund drives and made substantial donations to support cancer programs. Politically astute and well connected she helped shape national policy towards cancer including Nixon’s “War on Cancer.”
DeVita points out many deficiencies in the medical system that impeded progress. Doctors come in for intense scrutiny. Many hold onto old ideas. The have been trained a certain way, have years of experience practicing a certain way, have a reputation based on their techniques and are reluctant to change. This is reinforced by economics. Many are afraid to go against institutional policies fearing they will no longer get referrals. New innovations in one area, for example chemo therapy, may mean fewer patients for radiotherapists, giving them incentive to disparage chemo. Peer review means doctors with entrenched positions can delay or prevent new ideas from being published in prestigious journals.
Not only the doctor’s practice but whole businesses develop around particular treatments of a disease, from medicines to supplies to facilities to educational resources. All stakeholders have a vested interest in the status quo. Hospital, university and government bureaucracies are formed around current practice, making change difficult, and stifling innovation. Government institutions such as NIH, NCI and the FDA are perennially fighting each other for appropriations and policies that benefit their individual agency. This means belittling the efforts of the other agencies and choosing initiatives based on their ability to attract funding.
Long standing ideas become conventional wisdom. You can’t cure cancer. Medicines have to be tested and administered one at a time. A new medicine must be proven to be risk free - even before letting the sickest patients try it. This is what DiVita ran into as he began developing his chemo cocktail. After extensive testing and trials at NCI when he finally showed success, getting others to adopt his protocol was extremely difficult. It required exact dosages, timing and duration of treatment. Many skeptical doctors thought they knew better and altered the protocol when they tried it. This led to poor results which they would blame on DeVita’s therapy, significantly slowing its adoption.
A horrific example of the medical system’s dysfunction was the mass mutilation of women suffering from breast cancer which occurred well past the time when doctors should have known better. By 1988 when DeVita left NCI for Memorial Sloan Kettering, lumpectomy was clearly indicated for many women with small tumors. Yet Sloan Kettering still only performed radical mastectomies, a practice not unique to Sloan Kettering. A key idea behind the advent of chemotherapy was that cancer cells escape into the blood to metastasize elsewhere. DeVita and likeminded doctors knew in the seventies that it was wrong to perform radical mastectomies and wide area radiation when there was no indication that cancer had spread to adjacent areas. If the horse was out of and far from the barn destroying adjacent structures wouldn’t help. Rather DeVita and others proposed adjuvant chemo therapy that could find cancer cells wherever they spread. They developed statistics to show their therapy improved outcomes where radical mastectomies and radiating adjacent areas didn’t. Still it took many years for this to be widely accepted.
DeVita has special wrath for the FDA which he believes unconscionably withholds promising medicines from the desperately ill. Those that are terminally ill do not have time for a medicine to go through the many years of testing the FDA requires. While the FDA does make some compassionate exceptions on a patient by patient basis, applying to the FDA for an exception takes time, a lot of paper work, a good doctor advocate and drug company willingness. There are clinical trials, but these have limited access and, of course, you may get the standard care rather than the new medicine. Streamlining the exception process for those with terminal illnesses would benefit patients and drug development. DeVita made reasonable proposals for this but they were rejected.
The FDA approves a drug for a very specific use. Use with other drugs requires a separate approval for each combination. The FDA approval depends on whether a drug is safe and effective. Effective means that it increases survival. But early clinical trials are often done on very sick patients whose cells are resistant from prior treatments. Even statistically small improvements in these patients may mean the drug could help those less sick. DeVita also points to many cases where a drug yielded a significant period of remission adding quality time to someone’s life even though it did not increase survivability. Additional uses for many drugs are discovered after the drugs are approved, a reason to get them out into the system. Of course, these new uses must be submitted to the FDA for a new approval.
One of the key takeaways from this book is to take charge of your own care. Doctors still seem to hold a certain mystique that keeps some patients from questioning their advice and seeking other opinions. DeVita attests to case after case where standard care failed and finding the right doctor saved someone’s life. Many doctors just go down their checklist. Works in straightforward cases but if your case is unusual then search wide. Those with connections can get to the best quickly. Mary Lasker’s assistant got Dr. DiVita’s personal care because the renowned Sidney Farber, developer of the first chemo drug, methotrexate, called the young DiVita telling him in no uncertain terms, “You will take this patient.” The rest of us have to navigate a very difficult and expensive system.
Despite his deep concern about the quality of medical practice and drug development, DeVita is optimistic that we will win the battle against cancer. He is just disappointed that outdated approaches are making it take so long. It is easy to be impressed with all the new discoveries that are taking place in medicine, but it is disturbing to realize how long it takes these discoveries to become therapies available to the public. These criticisms are not new. DeVita, with his fifty years of experience and his record of accomplishment, validates them. He makes a strong case for change, but after all these years of systemic inertia it is hard to picture that change coming.
Soon after DeVita joined NCI, largely to avoid the Viet Nam draft, he found his calling in chemotherapy. At the time cancer medicine was in its infancy with few drugs which treated few diseases. Maverick doctors at NCI developed combination chemo therapy that had success against childhood Leukemia. Following their lead DiVita devoted himself to developing chemotherapy for lymphoma. Working with whoever he felt could help, he developed a four chemical chemo cocktail and protocol that sent most of his lymphoma patients into complete remission curing many. He steadily worked his way up the ranks gaining visibility when he cured a key lieutenant to Mary Lasker. Mary Lasker was a rich influential philanthropist and strong advocate for cancer research. She organized fund drives and made substantial donations to support cancer programs. Politically astute and well connected she helped shape national policy towards cancer including Nixon’s “War on Cancer.”
DeVita points out many deficiencies in the medical system that impeded progress. Doctors come in for intense scrutiny. Many hold onto old ideas. The have been trained a certain way, have years of experience practicing a certain way, have a reputation based on their techniques and are reluctant to change. This is reinforced by economics. Many are afraid to go against institutional policies fearing they will no longer get referrals. New innovations in one area, for example chemo therapy, may mean fewer patients for radiotherapists, giving them incentive to disparage chemo. Peer review means doctors with entrenched positions can delay or prevent new ideas from being published in prestigious journals.
Not only the doctor’s practice but whole businesses develop around particular treatments of a disease, from medicines to supplies to facilities to educational resources. All stakeholders have a vested interest in the status quo. Hospital, university and government bureaucracies are formed around current practice, making change difficult, and stifling innovation. Government institutions such as NIH, NCI and the FDA are perennially fighting each other for appropriations and policies that benefit their individual agency. This means belittling the efforts of the other agencies and choosing initiatives based on their ability to attract funding.
Long standing ideas become conventional wisdom. You can’t cure cancer. Medicines have to be tested and administered one at a time. A new medicine must be proven to be risk free - even before letting the sickest patients try it. This is what DiVita ran into as he began developing his chemo cocktail. After extensive testing and trials at NCI when he finally showed success, getting others to adopt his protocol was extremely difficult. It required exact dosages, timing and duration of treatment. Many skeptical doctors thought they knew better and altered the protocol when they tried it. This led to poor results which they would blame on DeVita’s therapy, significantly slowing its adoption.
A horrific example of the medical system’s dysfunction was the mass mutilation of women suffering from breast cancer which occurred well past the time when doctors should have known better. By 1988 when DeVita left NCI for Memorial Sloan Kettering, lumpectomy was clearly indicated for many women with small tumors. Yet Sloan Kettering still only performed radical mastectomies, a practice not unique to Sloan Kettering. A key idea behind the advent of chemotherapy was that cancer cells escape into the blood to metastasize elsewhere. DeVita and likeminded doctors knew in the seventies that it was wrong to perform radical mastectomies and wide area radiation when there was no indication that cancer had spread to adjacent areas. If the horse was out of and far from the barn destroying adjacent structures wouldn’t help. Rather DeVita and others proposed adjuvant chemo therapy that could find cancer cells wherever they spread. They developed statistics to show their therapy improved outcomes where radical mastectomies and radiating adjacent areas didn’t. Still it took many years for this to be widely accepted.
DeVita has special wrath for the FDA which he believes unconscionably withholds promising medicines from the desperately ill. Those that are terminally ill do not have time for a medicine to go through the many years of testing the FDA requires. While the FDA does make some compassionate exceptions on a patient by patient basis, applying to the FDA for an exception takes time, a lot of paper work, a good doctor advocate and drug company willingness. There are clinical trials, but these have limited access and, of course, you may get the standard care rather than the new medicine. Streamlining the exception process for those with terminal illnesses would benefit patients and drug development. DeVita made reasonable proposals for this but they were rejected.
The FDA approves a drug for a very specific use. Use with other drugs requires a separate approval for each combination. The FDA approval depends on whether a drug is safe and effective. Effective means that it increases survival. But early clinical trials are often done on very sick patients whose cells are resistant from prior treatments. Even statistically small improvements in these patients may mean the drug could help those less sick. DeVita also points to many cases where a drug yielded a significant period of remission adding quality time to someone’s life even though it did not increase survivability. Additional uses for many drugs are discovered after the drugs are approved, a reason to get them out into the system. Of course, these new uses must be submitted to the FDA for a new approval.
One of the key takeaways from this book is to take charge of your own care. Doctors still seem to hold a certain mystique that keeps some patients from questioning their advice and seeking other opinions. DeVita attests to case after case where standard care failed and finding the right doctor saved someone’s life. Many doctors just go down their checklist. Works in straightforward cases but if your case is unusual then search wide. Those with connections can get to the best quickly. Mary Lasker’s assistant got Dr. DiVita’s personal care because the renowned Sidney Farber, developer of the first chemo drug, methotrexate, called the young DiVita telling him in no uncertain terms, “You will take this patient.” The rest of us have to navigate a very difficult and expensive system.
Despite his deep concern about the quality of medical practice and drug development, DeVita is optimistic that we will win the battle against cancer. He is just disappointed that outdated approaches are making it take so long. It is easy to be impressed with all the new discoveries that are taking place in medicine, but it is disturbing to realize how long it takes these discoveries to become therapies available to the public. These criticisms are not new. DeVita, with his fifty years of experience and his record of accomplishment, validates them. He makes a strong case for change, but after all these years of systemic inertia it is hard to picture that change coming.
November 16, 2024
Dr. Vincent DeVita (b. 1935) is an oncologist with a storied career that includes developing novel combination therapy to effectively treat Hodgkin's lymphoma (prior to this, HL was largely an incurable death sentence) and directing the National Cancer Institute (one of the US National Institutes of Health) from 1980-1988. He's held several prominent leadership positions since, and in this 2015 memoir (cowritten by his daughter, and published when Dr. DeVita was 80), he reflects back on his 50+ year career and demonstrates a sharp intellect for the future of oncology. In fact, many of the therapies Dr. DeVita highlights toward the end of the book (CAR-T, PD-1 inhibitors) are standard-of-care for many tumors in 2024 when I read this book. I noticed a few small errors toward the end of the book when Dr. DeVita discusses precision medicine (for instance, epidermal growth factor receptor genes are named EGFRs, not EGFs -- EGFs are the growth factor ligands, and in acute promyelocytic leukemia, the abnormal fusion product is PML::RARA, not RARA itself), which were probably copy-editing misses. I appreciate that Dr. DeVita is willing to levy criticism where it's warranted -- with the FDA being the biggest target of his ire (I, too, feel like the FDA is at fault for interfering with the practice of medicine in my specialty).
I really enjoyed this memoir and snapshot of the field of oncology from the 1960s-2010s. That being said, the ideal target audience or this book is likely fellow physicians and scientists who have a practice or interest in oncology, and this book may not be as interesting or accessible for laypeople.
My statistics:
Book 280 for 2024
Book 1883 cumulatively
I really enjoyed this memoir and snapshot of the field of oncology from the 1960s-2010s. That being said, the ideal target audience or this book is likely fellow physicians and scientists who have a practice or interest in oncology, and this book may not be as interesting or accessible for laypeople.
My statistics:
Book 280 for 2024
Book 1883 cumulatively
January 12, 2016
So there's a joke in medicine: why do we bury people 6 feet deep? Answer: to keep the oncologists off of them. Well this is that guy, but he's also the developer of the MOPP regimen, and then eventually the head of the American Cancer Institute, Sloan kettering, the Yale cancer center. He's the guy who you needed to be crazy aggressive to create a field, play the politics and save thousands of lives. It's also wonderful book because of the number of people he throws under the bus, in the name of telling the truth about the best patient care. I admire that.
April 26, 2016
Begins at a galloping pace and promises to reveal controversial behind-the-scenes truth of cancer research. The middle chapters devolve into a sort of looking-back-on-my-distinguished-career memoir (naming his many colleagues, benefactors, and esteemed appointments), but DeVita's final chapters return to the theme of how cancer has been understood, misunderstood, and treated for the last fifty years. He thinks we're actually winning the "battle" and provides a lot of fascinating examples of how, while highlighting the mistakes caused by the medically-conservative old-guard. Their intransigence and resistance to changing the cancer paradigm make it difficult to explore/apply new treatments. (He takes special aim at the FDA and its role in cancer drug approval.)
Near the final quarter of the book I realized that among the scores physicians, surgeons, and scientists DeVita names and discusses, not a single one was a woman. There are some female cancer patients - young people or the wives of DeVita's friends - and a wealthy socialite (Mary Lasker) who funded and doggedly lobbied for The War on Cancer for decades. But the medical establishment he draws is entirely composed of white males. I'd begun to picture a "DOCTOR" as a white man, until DeVita's recounting of another physician's penis joke woke me up.
DeVita portrays himself as a rogue in the cancer research/treatment establishment - is he really? Just recalled that there was a New Yorker article about him published around the time of this book's release - I need to dig that up.
Near the final quarter of the book I realized that among the scores physicians, surgeons, and scientists DeVita names and discusses, not a single one was a woman. There are some female cancer patients - young people or the wives of DeVita's friends - and a wealthy socialite (Mary Lasker) who funded and doggedly lobbied for The War on Cancer for decades. But the medical establishment he draws is entirely composed of white males. I'd begun to picture a "DOCTOR" as a white man, until DeVita's recounting of another physician's penis joke woke me up.
DeVita portrays himself as a rogue in the cancer research/treatment establishment - is he really? Just recalled that there was a New Yorker article about him published around the time of this book's release - I need to dig that up.
July 28, 2016
I was astonished with how the field of cancer has evolved over the years. Being a medical student, I learn about cancer biology and some of the important cancers and their treatments. However, this book provides a totally different perspective towards the topic of cancer. That is because the writer takes you through his journey with cancer as a young physician, a consultant oncologist, the director of the National Cancer Institute, and as a cancer patient himself. Back in the days, as described in the book, cancer was synonymous with death. Hence, at that time the only options were disfiguring surgeries, amputations, or other unsuccessful treatments. Other more successful therapies started to unfold until such devastating treatments were abandoned in favor of more conservative and effective treatments.
I was also intrigued by the fact that in many circumstances, personal contacts of the writer were reached in order to get something done. It might seem naive, but I thought personal connections couldn't be as powerful when it came to medicine, especially in the US. I was wrong and as the writer noted a number of times, he had to give a call to a friend and ask for their help; it was often the only way to get past bureaucratic hurdles in the way of appropriate patient care or research publication. For example, a researcher called Burney Fisher called the author of this book (Vince) and asked him to call a friend at NEJM (a well known medical journal) and ask why his research paper was delayed. It turned out surgeons were delaying the publications of this paper because it said that what they were doing was wrong. His friend at NEJM had to follow this paper and push for its publication, which eventually occurred.
Speaking of bureaucracy, the writer heavily criticized how the system worked. A complete chapter is designed to talk about the FDA and how their tight regulations on cancer drug control is detrimental to the process of drug approbation. He explained that aspirin, a widely used drug, caused polyps in the lungs of experimental rats. Nothing like this was noted in humans. If anticancer drugs were to show these similar side affects today, they were unlikely to be approved by the FDA.
While reading the comments on this book, one reader noted that almost all of the people involved in this book were males. Not a single female physician was mentioned in the entire book! This shows how medicine has changed over the years. I believe readers can learn not only about cancer, but also about how medicine, national organizations, and countries functioned.
Finally, a good amount of medical gems are presented throughout this book. I appreciated the value and strength of clinical research and its critical implications on policy making, medical practice, and most importantly, patients' lives. Moreover, I learned a lot about the practice of medicine and the art of managing cancer patients. How prostate specific antigen (PSA) is a controversial screening test for prostate cancer, a case of fever of undetermined origin (FUO) was caused by temporal arteritis, how ATRA (a drug) causes shortness of breath by maturing WBCs and end up plugging small pulmonary capillaries, and BRAF mutations and melanoma. The final couple of chapters have excellent explanations of the pathogenesis and biology of cancer.
I recommend this book to anyone interested in the history of cancer or involved in cancer research or patient care.
I was also intrigued by the fact that in many circumstances, personal contacts of the writer were reached in order to get something done. It might seem naive, but I thought personal connections couldn't be as powerful when it came to medicine, especially in the US. I was wrong and as the writer noted a number of times, he had to give a call to a friend and ask for their help; it was often the only way to get past bureaucratic hurdles in the way of appropriate patient care or research publication. For example, a researcher called Burney Fisher called the author of this book (Vince) and asked him to call a friend at NEJM (a well known medical journal) and ask why his research paper was delayed. It turned out surgeons were delaying the publications of this paper because it said that what they were doing was wrong. His friend at NEJM had to follow this paper and push for its publication, which eventually occurred.
Speaking of bureaucracy, the writer heavily criticized how the system worked. A complete chapter is designed to talk about the FDA and how their tight regulations on cancer drug control is detrimental to the process of drug approbation. He explained that aspirin, a widely used drug, caused polyps in the lungs of experimental rats. Nothing like this was noted in humans. If anticancer drugs were to show these similar side affects today, they were unlikely to be approved by the FDA.
While reading the comments on this book, one reader noted that almost all of the people involved in this book were males. Not a single female physician was mentioned in the entire book! This shows how medicine has changed over the years. I believe readers can learn not only about cancer, but also about how medicine, national organizations, and countries functioned.
Finally, a good amount of medical gems are presented throughout this book. I appreciated the value and strength of clinical research and its critical implications on policy making, medical practice, and most importantly, patients' lives. Moreover, I learned a lot about the practice of medicine and the art of managing cancer patients. How prostate specific antigen (PSA) is a controversial screening test for prostate cancer, a case of fever of undetermined origin (FUO) was caused by temporal arteritis, how ATRA (a drug) causes shortness of breath by maturing WBCs and end up plugging small pulmonary capillaries, and BRAF mutations and melanoma. The final couple of chapters have excellent explanations of the pathogenesis and biology of cancer.
I recommend this book to anyone interested in the history of cancer or involved in cancer research or patient care.
December 31, 2015
This is a really mportant book, and I'd like it to be widely read.
But for those who won't get round to it, here's the key message: enormous progress has been made and is being made in the war on cancer, but at every turn, regulation has hampered that progress.
The FDA should not be regulating cancer treatments, because their focus is on ensuring the safety of every medication, which is irrelevant to patients whose only other option is certain death. They are "protecting" patients from side effects at the expense of their lives. (The same thing happened with AIDS treatments in the 80s).
Moreover, their protocols for assessing the value of a new treatment are hopelessly outdated - De Vita gives the example that under current FDA protocols, if aspirin were being assessed for the first time today, it would likely not be approved.
There's a heap of good news in this book about the current knowledge of, and treatments for, cancer. The science is there. Now get the bureaucrats to step aside.
But for those who won't get round to it, here's the key message: enormous progress has been made and is being made in the war on cancer, but at every turn, regulation has hampered that progress.
The FDA should not be regulating cancer treatments, because their focus is on ensuring the safety of every medication, which is irrelevant to patients whose only other option is certain death. They are "protecting" patients from side effects at the expense of their lives. (The same thing happened with AIDS treatments in the 80s).
Moreover, their protocols for assessing the value of a new treatment are hopelessly outdated - De Vita gives the example that under current FDA protocols, if aspirin were being assessed for the first time today, it would likely not be approved.
There's a heap of good news in this book about the current knowledge of, and treatments for, cancer. The science is there. Now get the bureaucrats to step aside.
November 30, 2019
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.
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.
January 31, 2016
DeVita has been at the forefront of cancer treatment since the early days of chemotherapy, and this memoir of his career is both well-written and compelling. As a medical oncologist who developed treatments and cures for numerous types of cancer, DeVita has firsthand experience in the treatment of cancer over the past half century. What makes the book particularly interesting are DeVita's insights into national cancer policy, his analysis of bureaucratic and other problems, and his prescriptions for improving the fight against cancer. Throughout the book DeVita gives examples of how we was unafraid to challenge sacred cows in medicine and how his doing so made him unpopular with some of his colleges. Yet he put his patients and their well-being over bureaucracy, and that it what makes his recommendations for improvement in policy so powerful. This book is a good companion to "The Emperor of All Maladies" by Siddhartha Mukherjee. Both are written so that a general reader can understand the medical and scientific terms.
February 23, 2016
Dr. DeVita was a major player in the "war on cancer." He describes the personalities behind the research and the political facts of life around obtaining adequate funding, explaining the nuts and bolts of good cancer research. He also includes some understandable information on how cancer cells arise and proliferate.
This is a professional memoir which might have benefited from including a bit more personal information. Dr. DeVita devotes just 2 pages to his son's treatment and ultimate death from aplastic anemia. (Aplastic anemia is not a cancer but the search for treatments is similar.) A bit more about DeVita's life outside cancer research management could have helped the lay reader understand him a bit better.
This is a book worth reading if you want to learn more about cancer and cancer research but The Emperor of All Maladies: A Biography of Cancer retains my top choice as a cancer book.
This is a professional memoir which might have benefited from including a bit more personal information. Dr. DeVita devotes just 2 pages to his son's treatment and ultimate death from aplastic anemia. (Aplastic anemia is not a cancer but the search for treatments is similar.) A bit more about DeVita's life outside cancer research management could have helped the lay reader understand him a bit better.
This is a book worth reading if you want to learn more about cancer and cancer research but The Emperor of All Maladies: A Biography of Cancer retains my top choice as a cancer book.
January 28, 2016
I was surprised by this book, written by a long-time colleague, mentor and friend of mine, Vince DeVita. I expected an historical and academic account of his career, but I also got a touching personal account of his career and life that is honest, engaging and compelling. Anyone with an interest, personal or professional, in cancer, scientific research, medicine or clinical trials will find this well-written account informative. It also pulls in the many colorful personalities Vince encountered over his career, with surprising detail and candor. A worthwhile, meaningful and memorable read.
December 7, 2015
Excellent overview of the medical fight against cancer by a doctor who has been on the front lines since the 1960s. The constant infighting and bureaucracy portrayed are discouraging, but when he reviews all the advances that have been made - it is pretty amazing. The most surprising thing to me came near the end of the book where he talked about the fight with his own cancer, in which he ignored early warning signs.
January 4, 2016
The Death of Cancer,by Dr.DeVita,Jr.
As a 92 year old family physician I practised when many of my patients died of cancer,Thanks to Dr.DeVita a true medical visionary and hero cancers are beginning to be cured.I recommend this book to be read by all medical students and sophisticated general public.All cancer lives matter thanks to Dr.DeVita,Jr.
As a 92 year old family physician I practised when many of my patients died of cancer,Thanks to Dr.DeVita a true medical visionary and hero cancers are beginning to be cured.I recommend this book to be read by all medical students and sophisticated general public.All cancer lives matter thanks to Dr.DeVita,Jr.
December 8, 2015
Overall, this was a very good read. The personal, anecdotal stories helped to draw you into the drama of the behind - the - scenes medical breakthroughs taking place. I would definitely recommend this book to others.
January 13, 2016
Very good. Really 4.5 stars, but the (admittedly deserved) self-congratulatory tone and digressions get a little distracting.
November 28, 2021
Engaging. I had no idea how vast the history of cancer treatment was.
August 3, 2025
In my last review of a medical book, I was disappointed about the lack of explanation as to why medical advances get deployed much too slowly, particularly cancer treatments.
By some strange coincidence, the next medical book I read, published a decade earlier, provides some valuable insights into those problems.
This is a memoir of both luck and skill. DeVita is uniquely qualified to describe the origins of the war on cancer, due to a career that included diagnosing patients, running clinical trials, and serving as director of the National Cancer Institute.
Pioneering Chemotherapy
The first two chapters portray DeVita as sometimes regretting that he doesn't find a way around rules that keep him from using his judgment to cure a patient, and sometimes successfully helping patients by overriding standard procedure.
He wants more experimentation, at least in cases where the prognosis is death, and seems concerned that rules are being too strictly enforced.
But he sounds different by chapter 4. By then, he has published a study describing a treatment that cures many Hodgkin lymphoma patients, at a time when most doctors were convinced that cancer was incurable.
He is then disturbed that many doctors use their judgment to modify his protocol, and complain that his protocol doesn't work. It sounds an awful lot like he's just reversed his position, and is now complaining that the doctors are using too much judgment.
Is he contradicting himself, or did I make inappropriate inferences? I suspect it's mostly me generalizing too much. He mostly wants more experimentation, but he's focused mainly on whether individual decisions were good or bad, and not generalizing much to any lesson about whether the rules should be followed more strictly or less.
This book is one man's perspective on history, not an attempt at solving the remaining problems. For much of the book, I kept grasping for big lessons, and only finding small ones.
Deployment
His story of the Hodgkin lymphoma cure (MOPP)provides some insight into why doctors got wildly inconsistent results when they claimed to have deployed it.
A bit of what went wrong is that doctors sometimes used a drug that was a favorite of the local hospital in place of one of the four drugs used in MOPP. Something is puzzling about this, but I think that mostly reflects attitudes of the 1960s that have little relevance to modern medicine.
The more serious problem was that doctors would reduce dosages compared to those used in the original trial. MOPP seems to depend on hitting the cancer hard enough to completely eradicate it. Partial damage to cancer seems to leave the remaining cancer at least as dangerous as it originally was.
Why would doctors reduce the dosage? Maybe partly because they didn't believe that cancer could be cured. But mainly because it was obvious that MOPP had terrible side effects. As in, patients couldn't take public transit home from the treatment, due to the vomiting. They might need a year to recover from the nerve damage. With the medical profession being somewhat reluctant to agree that drugs could save lives of terminal cancer patients, much less agree on how the drugs worked, doctors were reluctant to knowingly cause those side effects.
He writes (about an early, less proven version of MOPP):
I want that conservatism when I have a problem that doctors can reliably cure. I want them to follow moderately strict rules in such cases. But I want a very different attitude when the standard of care will yield poor results.
I'm guessing that either doctors find it hard to switch attitudes like that, or that medicine selects for people who are reluctant to switch away from conservatism.
DeVita seems fairly unusual in his ability to be comfortable about causing terrible side-effects while maintaining a focus on his patients' well-being.
Protectionism
A fair amount of the resistance to new cancer treatments comes from the standard problem of change being a threat to existing careers.
Radiology, surgery, and chemotherapy are very different specialties. Doctors specialize enough that their expertise can lose much of its value when advances in one of those three approaches obsoletes another one.
DeVita indicates that this was an important obstacle to adopting chemotherapy.
Theory versus Pragmatism
There's not much theory in this book. DeVita seems to mostly focus on experiments that are guided by vague intuitions. At one point he admits that he's just grasping at straws.
Some of the conflicts that he encounters seem related to the tension between pure science and applied science. Some people want to prioritize finding a complete understanding of how cancer and cancer treatments work. DeVita is too impatient for that, and wants to treat patients faster than the pure science approach allows.
DeVita has the beginnings of a theory, namely that cancer cells which survive an initial treatment become smarter, and harder to kill. That theory is good enough to produce better-than-random guesses about cancer treatments. But "smarter" seems like not quite the right word. The theory might be a bit too vague to justify frequent academic publications on which theorists thrive.
What lessons should we draw from this? It seems important to avoid becoming overconfident in a bad theory. But I don't see much in the way of a general lesson about theory versus pragmatism.
The FDA
DeVita rants against the FDA's unreasonable bias toward saying no to drugs.
His first encounter with the FDA seems to have been when he sponsored ads advocating a high fiber diet, in a way that could be interpreted as saying that a particular brand of cereal could prevent cancer. DeVita's boss refused to cave in to the FDA's threatened sanctions, and the FDA backed down.
DeVita had less success at fighting the FDA's obstacles to deploying new cancer drugs. He says that Congress never authorized the FDA to require additional trials to prove drug efficacy. He implies that safety trials typically provide enough evidence to establish efficacy.
He says the FDA sometimes unethically requires trials to compare new drugs to the standard of care in cases where the standard of care is known to result in fairly quick death.
DeVita complains about the requirement that cancer drugs be evaluated by their 5-year survival rates. Instead, he wants their efficacy evaluated at least in part by whether they cause complete remission.
It seems clear that complete remission, to the extent that it can be observed, would enable good drugs to reach the market much faster than the 5-year survival end point. I'm guessing that the FDA is reluctant to use complete remission because there's enough subjectivity in measuring it that drug companies would find ways of overstating how much remission their drugs produce. Maybe DeVita underestimates this problem because the drug trials that he has conducted were done within the government.
What I infer is that what we need is for more drug trials to be done by government agencies, such as the National Cancer Institute, whose biases are weaker than those of drug companies. In that case, it would become more appropriate to rely more on subjective judgments about how well a treatment works.
DeVita is at least half right in his criticisms of the FDA, but this book is just an overview of his beliefs. He doesn't provide rigorous enough arguments to convince fans of the FDA.
Concluding Thoughts
The book was well worth reading, even though it provided much less hope than the title led me to expect.
I suspect he overstates the benefits of chemotherapy, by focusing almost exclusively on cases where it works.
I didn't see anything here that qualifies as a plan for winning the war on cancer. For that, see Openwater, or Aubrey de Grey's WILT?.
As Scott Alexander summarized the war on cancer:
I'm going to be stubborn, and insist that we should aim for a polio-scale victory. DeVita cooperated with people who misled the public into thinking that the Nixon-era war on cancer would produce victory in five years, but he never believed in a vision with that much optimism.
DeVita claims that the economic benefits of cancer research have been more than 1000 times the cost, based on the paper THE VALUE OF HEALTH AND LONGEVITY (which I think only partly justifies DeVita's claim). I'm willing to believe that DeVita is mostly right here, and that one of the best uses of money would be to increase funding for the kinds of cancer research that DeVita has been involved in.
Yet my intuition tells me that it would be even better to shift more research money to paradigm-shifting cancer research that aims for a clear-cut victory.
By some strange coincidence, the next medical book I read, published a decade earlier, provides some valuable insights into those problems.
This is a memoir of both luck and skill. DeVita is uniquely qualified to describe the origins of the war on cancer, due to a career that included diagnosing patients, running clinical trials, and serving as director of the National Cancer Institute.
Pioneering Chemotherapy
The first two chapters portray DeVita as sometimes regretting that he doesn't find a way around rules that keep him from using his judgment to cure a patient, and sometimes successfully helping patients by overriding standard procedure.
He wants more experimentation, at least in cases where the prognosis is death, and seems concerned that rules are being too strictly enforced.
But he sounds different by chapter 4. By then, he has published a study describing a treatment that cures many Hodgkin lymphoma patients, at a time when most doctors were convinced that cancer was incurable.
He is then disturbed that many doctors use their judgment to modify his protocol, and complain that his protocol doesn't work. It sounds an awful lot like he's just reversed his position, and is now complaining that the doctors are using too much judgment.
Is he contradicting himself, or did I make inappropriate inferences? I suspect it's mostly me generalizing too much. He mostly wants more experimentation, but he's focused mainly on whether individual decisions were good or bad, and not generalizing much to any lesson about whether the rules should be followed more strictly or less.
This book is one man's perspective on history, not an attempt at solving the remaining problems. For much of the book, I kept grasping for big lessons, and only finding small ones.
Deployment
His story of the Hodgkin lymphoma cure (MOPP)provides some insight into why doctors got wildly inconsistent results when they claimed to have deployed it.
A bit of what went wrong is that doctors sometimes used a drug that was a favorite of the local hospital in place of one of the four drugs used in MOPP. Something is puzzling about this, but I think that mostly reflects attitudes of the 1960s that have little relevance to modern medicine.
The more serious problem was that doctors would reduce dosages compared to those used in the original trial. MOPP seems to depend on hitting the cancer hard enough to completely eradicate it. Partial damage to cancer seems to leave the remaining cancer at least as dangerous as it originally was.
Why would doctors reduce the dosage? Maybe partly because they didn't believe that cancer could be cured. But mainly because it was obvious that MOPP had terrible side effects. As in, patients couldn't take public transit home from the treatment, due to the vomiting. They might need a year to recover from the nerve damage. With the medical profession being somewhat reluctant to agree that drugs could save lives of terminal cancer patients, much less agree on how the drugs worked, doctors were reluctant to knowingly cause those side effects.
He writes (about an early, less proven version of MOPP):
I knew why other doctors were reluctant to follow our lead. Cancer was among the most challenging of diseases. We knew almost nothing about why it happened or how it happened, and a sense of powerlessness surrounded it ... And medicine is, by definition, a conservative field.
I want that conservatism when I have a problem that doctors can reliably cure. I want them to follow moderately strict rules in such cases. But I want a very different attitude when the standard of care will yield poor results.
I'm guessing that either doctors find it hard to switch attitudes like that, or that medicine selects for people who are reluctant to switch away from conservatism.
DeVita seems fairly unusual in his ability to be comfortable about causing terrible side-effects while maintaining a focus on his patients' well-being.
Protectionism
A fair amount of the resistance to new cancer treatments comes from the standard problem of change being a threat to existing careers.
Radiology, surgery, and chemotherapy are very different specialties. Doctors specialize enough that their expertise can lose much of its value when advances in one of those three approaches obsoletes another one.
DeVita indicates that this was an important obstacle to adopting chemotherapy.
Theory versus Pragmatism
There's not much theory in this book. DeVita seems to mostly focus on experiments that are guided by vague intuitions. At one point he admits that he's just grasping at straws.
Some of the conflicts that he encounters seem related to the tension between pure science and applied science. Some people want to prioritize finding a complete understanding of how cancer and cancer treatments work. DeVita is too impatient for that, and wants to treat patients faster than the pure science approach allows.
DeVita has the beginnings of a theory, namely that cancer cells which survive an initial treatment become smarter, and harder to kill. That theory is good enough to produce better-than-random guesses about cancer treatments. But "smarter" seems like not quite the right word. The theory might be a bit too vague to justify frequent academic publications on which theorists thrive.
What lessons should we draw from this? It seems important to avoid becoming overconfident in a bad theory. But I don't see much in the way of a general lesson about theory versus pragmatism.
The FDA
DeVita rants against the FDA's unreasonable bias toward saying no to drugs.
The rate-limiting step in eradicating cancer today is not the science but the regulatory environment we work in.
His first encounter with the FDA seems to have been when he sponsored ads advocating a high fiber diet, in a way that could be interpreted as saying that a particular brand of cereal could prevent cancer. DeVita's boss refused to cave in to the FDA's threatened sanctions, and the FDA backed down.
DeVita had less success at fighting the FDA's obstacles to deploying new cancer drugs. He says that Congress never authorized the FDA to require additional trials to prove drug efficacy. He implies that safety trials typically provide enough evidence to establish efficacy.
He says the FDA sometimes unethically requires trials to compare new drugs to the standard of care in cases where the standard of care is known to result in fairly quick death.
DeVita complains about the requirement that cancer drugs be evaluated by their 5-year survival rates. Instead, he wants their efficacy evaluated at least in part by whether they cause complete remission.
It seems clear that complete remission, to the extent that it can be observed, would enable good drugs to reach the market much faster than the 5-year survival end point. I'm guessing that the FDA is reluctant to use complete remission because there's enough subjectivity in measuring it that drug companies would find ways of overstating how much remission their drugs produce. Maybe DeVita underestimates this problem because the drug trials that he has conducted were done within the government.
What I infer is that what we need is for more drug trials to be done by government agencies, such as the National Cancer Institute, whose biases are weaker than those of drug companies. In that case, it would become more appropriate to rely more on subjective judgments about how well a treatment works.
DeVita is at least half right in his criticisms of the FDA, but this book is just an overview of his beliefs. He doesn't provide rigorous enough arguments to convince fans of the FDA.
Concluding Thoughts
The book was well worth reading, even though it provided much less hope than the title led me to expect.
I suspect he overstates the benefits of chemotherapy, by focusing almost exclusively on cases where it works.
I didn't see anything here that qualifies as a plan for winning the war on cancer. For that, see Openwater, or Aubrey de Grey's WILT?.
As Scott Alexander summarized the war on cancer:
If they’re really old, maybe they remember victories of that scale over polio and smallpox. If those were their hopes, it’s right for them to feel disappointed. But I come from a generation that doesn’t expect much, and I think the evidence suggests my low expectations have more or less been met.
I'm going to be stubborn, and insist that we should aim for a polio-scale victory. DeVita cooperated with people who misled the public into thinking that the Nixon-era war on cancer would produce victory in five years, but he never believed in a vision with that much optimism.
DeVita claims that the economic benefits of cancer research have been more than 1000 times the cost, based on the paper THE VALUE OF HEALTH AND LONGEVITY (which I think only partly justifies DeVita's claim). I'm willing to believe that DeVita is mostly right here, and that one of the best uses of money would be to increase funding for the kinds of cancer research that DeVita has been involved in.
Yet my intuition tells me that it would be even better to shift more research money to paradigm-shifting cancer research that aims for a clear-cut victory.
January 6, 2022
A little over two months ago my husband was diagnosed with stage 4 Hodgkin's Lymphoma after initially going to to the doctor thinking he had a sinus infection. We had one meeting with an oncologist via telephone, because that was the early days of the coronavirus pandemic, and though I took lots of notes, the names of the drugs and the cells and all the terms meant almost nothing to me. Rapid Google research ensued, and I was reassured that his was a "curable" cancer so I was somewhat relieved. Then he started chemo and I was fairly convinced that this torture treatment could not be right. How would I know if they were killing him instead of helping him? Was this really the best method?
Somehow along the way, I stumbled across this book, written by one of the doctors who came up with the treatment for Hodgkin's and started listening to the audio book. The book is a lot of things, but in some of the early chapters, it very clearly explains what lymphoma is, why the treatment is what it is and how they came to know this through many, many small experiments and accidental discoveries. Why six months of treatment? Why every two weeks, when that doesn't give you enough time to bounce back? Why the at-home injections? Why all the stomach troubles? All the answers are here.
What seemed like an unendurable horror show suddenly seemed like a miracle. Now at least I know the treatment, while ugly and hard to watch, is actually doing what it has to do to kill a disease that only a few decades ago was a death sentence. And yes, even the doctors think it is horrific and borderline too much to bear. ("Do your patients still speak to you after you do this to them?" is a question the author got after presenting his chemo protocol for Hodgkin's Disease to a room full of doctors for the first time.)
The author walks through the process of scientific discovery on the path to current cancer knowledge and lays out where the field is still headed. He details the bureaucratic maze that he feels is holding back advancement. He makes a strong argument against the Affordable Care Act. He names names of everyone who ever got in his way, which is kind of tedious for a layperson who has no idea who these people are. He also paints a heroic picture of renegade doctors who were called unehtical and inhumane by their peers for their early forays into chemotherapy, philanthropists who pulled all their strings to get federal funding and political support, and of the brave patients who spent the ends of their lives trying treatments that make what my husband is going through seem lightweight.
It's not exactly a narrative, and it's definitely a science and policy book not a guide to cancer treatment, so it might not be for anyone without a personal interest in the subject matter, but I found it enlightening and very helpful for understanding the why behind my husband's ordeal.
Somehow along the way, I stumbled across this book, written by one of the doctors who came up with the treatment for Hodgkin's and started listening to the audio book. The book is a lot of things, but in some of the early chapters, it very clearly explains what lymphoma is, why the treatment is what it is and how they came to know this through many, many small experiments and accidental discoveries. Why six months of treatment? Why every two weeks, when that doesn't give you enough time to bounce back? Why the at-home injections? Why all the stomach troubles? All the answers are here.
What seemed like an unendurable horror show suddenly seemed like a miracle. Now at least I know the treatment, while ugly and hard to watch, is actually doing what it has to do to kill a disease that only a few decades ago was a death sentence. And yes, even the doctors think it is horrific and borderline too much to bear. ("Do your patients still speak to you after you do this to them?" is a question the author got after presenting his chemo protocol for Hodgkin's Disease to a room full of doctors for the first time.)
The author walks through the process of scientific discovery on the path to current cancer knowledge and lays out where the field is still headed. He details the bureaucratic maze that he feels is holding back advancement. He makes a strong argument against the Affordable Care Act. He names names of everyone who ever got in his way, which is kind of tedious for a layperson who has no idea who these people are. He also paints a heroic picture of renegade doctors who were called unehtical and inhumane by their peers for their early forays into chemotherapy, philanthropists who pulled all their strings to get federal funding and political support, and of the brave patients who spent the ends of their lives trying treatments that make what my husband is going through seem lightweight.
It's not exactly a narrative, and it's definitely a science and policy book not a guide to cancer treatment, so it might not be for anyone without a personal interest in the subject matter, but I found it enlightening and very helpful for understanding the why behind my husband's ordeal.
August 27, 2016
My friend who is in the middle of her treatments for breast cancer suggested this book to me. I can see why after reading it-it is so hopeful. What a remarkable journey the cure for cancer has taken. This is my first "cancer book" so maybe I am too naive to be a good judge but I thought it was very readable and informative, in spite of the very technical information. I learned so much and found that my view of where we are in cancer research has changed from pessimistic to very optimistic. I do know there is a lot of opposition to this type of cancer treatment and more and more medical practitioners are taking a more holistic and food based approach to treating cancer. But this book really lays out the very short history and the great strides made in understanding cancer. No matter which side of the cancer treatment debate you are on, this book is an eye-opening look at medical research.
November 20, 2019
This book starts with some of the history of the NCI, and some of that history is fascinating. But this book isn’t really about cancer nor about the winning the war (DeVita’s phrase) on cancer. It’s about a hundred perceived slights. It’s about the author’s pride and his disgust with anyone who slows down his version of progress. It’s about the evils of the FDA and about who he sees blocking progress. I’ll admit I skimmed the last third, as I was simply done with his whining.
As others have noted, women are invisible in this book, or almost so. While for a good part of the author’s career it was mostly men in research and oncology, it was not ONLY men. Students are seen as impediments, for the most part. And patients? They vanish for much of the book.
Two stars is generous. One star seemed to negate the parts where DeVita centers patients over himself. Too bad that he did so little of that.
As others have noted, women are invisible in this book, or almost so. While for a good part of the author’s career it was mostly men in research and oncology, it was not ONLY men. Students are seen as impediments, for the most part. And patients? They vanish for much of the book.
Two stars is generous. One star seemed to negate the parts where DeVita centers patients over himself. Too bad that he did so little of that.
January 7, 2016
Good nonfiction books about science have a reliable author whose knowledge is evident. Great nonfiction books about science have an author who is able to relay their vast knowledge in a way that the reader can clearly understand and find themselves unable to put down. In his fascinating book about the "War on Cancer," Dr. Vincent DeVita provides a great nonfiction science book. Be warned, though. The book offers an often shocking look at how far we've come against cancer and how the true death of cancer is not dependent on finding the answers, but on sweeping away the bureaucratic nonsense that is keeping doctors from using those answers to save lives right now. Highly recommended for everyone, whether or not you've been directly touched by cancer. Chances are, if you haven't yet, you will be in the future.
July 23, 2017
Writing of the strides science and medicine, Dr. DeVita tells of the birth of using multiple drugs for combination chemotherapy. He argues that the FDA spends too much time analyzing the effects of drugs instead of releasing the drugs for use by people fighting for their lives.
He exposes some doctors' reluctance to recommend certain therapies to cancer patients because such treatment would hurt those doctors own speciality resulting in having fewer patients to care for.
Mostly his book is intended as a message of hope. Dr. DeVita shares his own personal experience with cancer and his survival. He discusses many of the new drugs and effective treatments that allow certain cancers to be cured or treated as a chronic disease like diabetes rather than a certain death sentence.
He exposes some doctors' reluctance to recommend certain therapies to cancer patients because such treatment would hurt those doctors own speciality resulting in having fewer patients to care for.
Mostly his book is intended as a message of hope. Dr. DeVita shares his own personal experience with cancer and his survival. He discusses many of the new drugs and effective treatments that allow certain cancers to be cured or treated as a chronic disease like diabetes rather than a certain death sentence.
March 10, 2016
Bureaucracy (FDA) and human nature (doctor's egos and self interest) will keep cancer alive.
March 25, 2020
Back when I started out in journalism, I covered all sorts of governmental meetings -- planning commissions, school boards, city councils, you name it. After a while, of course, it became easier to understand what was actually going on when matters came up for a vote, and though I was originally surprised (if not stunned) by some decisions, one thing soon became very clear: Once an issue was tossed into the middle of the political arena, the actual civic benefit of voting one way or another moved way down the priority list. There were personal rivalries, business decisions, family obligations and a host of other very human factors that came into play, and it quickly became obvious that the decision-makers would usually first determine how they would vote, and then figure out a way to justify it.
"The Death of Cancer" is in part a description of Vincent DeVita's battles to put patients first when governmental decisions were made about cancer research and care, and in part a history of the advances made in treatment in the past 50 years -- which means there's frustration and triumph in pretty much equal measure. (It must be said, though, that DeVita's narrative does always place him in the front lines, wearing shining armor and leading the forces of righteousness.)
The political process, of course, played out, and continues to play out, just as it has since the first hunters returned to camp with not quite enough meat and people had to figure out how to allocate a scarce resource. It's easy, of course, to just blame "politicians" and "government," but the truth is that all of us, in similar positions of power, would be swayed by our own self-interest, potential advantages to our families, and a desire to retain as much influence as possible. We might like to believe we would always be, as DeVita portrays himself, noble and above the fray, but things are never as simple as they seem -- and even though the process DeVita describes has its share of depressing detours, advances have been made and patients have been cured.
Those advances, and the patients they helped, are also described, and DeVita makes it clear just how far we've come in cancer treatment, even though most of us shy away from even thinking about perhaps the most dreaded of modern diseases. This is helped along by DeVita and co-author Elizabeth DeVita-Raeburn's skill as writers, as the pages turn smoothly and the technical details are explained clearly and succinctly.
All in all, "The Death of Cancer" is full of insights about both politics and cancer research, and on balance, it's also an optimistic view of how the American medical system has improved, both because and despite of the messy methods by which governments make decisions.
"The Death of Cancer" is in part a description of Vincent DeVita's battles to put patients first when governmental decisions were made about cancer research and care, and in part a history of the advances made in treatment in the past 50 years -- which means there's frustration and triumph in pretty much equal measure. (It must be said, though, that DeVita's narrative does always place him in the front lines, wearing shining armor and leading the forces of righteousness.)
The political process, of course, played out, and continues to play out, just as it has since the first hunters returned to camp with not quite enough meat and people had to figure out how to allocate a scarce resource. It's easy, of course, to just blame "politicians" and "government," but the truth is that all of us, in similar positions of power, would be swayed by our own self-interest, potential advantages to our families, and a desire to retain as much influence as possible. We might like to believe we would always be, as DeVita portrays himself, noble and above the fray, but things are never as simple as they seem -- and even though the process DeVita describes has its share of depressing detours, advances have been made and patients have been cured.
Those advances, and the patients they helped, are also described, and DeVita makes it clear just how far we've come in cancer treatment, even though most of us shy away from even thinking about perhaps the most dreaded of modern diseases. This is helped along by DeVita and co-author Elizabeth DeVita-Raeburn's skill as writers, as the pages turn smoothly and the technical details are explained clearly and succinctly.
All in all, "The Death of Cancer" is full of insights about both politics and cancer research, and on balance, it's also an optimistic view of how the American medical system has improved, both because and despite of the messy methods by which governments make decisions.
August 26, 2018
Wow. Really good. This is part memoir, part history of cancer research and treatment, and part prescriptive. DeVita was the longest-serving director in the history of the National Cancer Institute, working there for 26 years. Before that, he developed the first successful chemotherapy treatment for Hodgkin’s lymphoma using a combination of drugs, which was then unheard of.
Since Congress funded and launched of the war on Cancer in 1971, we have spent more than $100 billion on cancer research. Huge strides have been made, and yet there are bureaucratic regulations and outdated beliefs that hinder progress.
I enjoyed his personal stories the most. DeVita describes many of his colleagues who were hesitant to let go of long-held beliefs, determined patients who participated in research studies, and how cancer has touched him personally. Recommend this one for sure.
"... it illustrates what has been, for me, a source of perennial frustration: at this date, we are not limited by the science; we are limited by our ability to make good use of the information and treatments we already have. Too often, lives are tragically ended not by cancer but by the bureaucracy that came with the nation’s investment in the war on cancer, by review boards, by the FDA, and by doctors who won’t stand by their patients or who are afraid to take a chance."
Since Congress funded and launched of the war on Cancer in 1971, we have spent more than $100 billion on cancer research. Huge strides have been made, and yet there are bureaucratic regulations and outdated beliefs that hinder progress.
I enjoyed his personal stories the most. DeVita describes many of his colleagues who were hesitant to let go of long-held beliefs, determined patients who participated in research studies, and how cancer has touched him personally. Recommend this one for sure.
"... it illustrates what has been, for me, a source of perennial frustration: at this date, we are not limited by the science; we are limited by our ability to make good use of the information and treatments we already have. Too often, lives are tragically ended not by cancer but by the bureaucracy that came with the nation’s investment in the war on cancer, by review boards, by the FDA, and by doctors who won’t stand by their patients or who are afraid to take a chance."
did-not-finish
November 4, 2020The first three chapters or so was so interesting, I couldn't put it down. Learning about how chemotherapy improved over the years has given me the hope that one day, a cure will be created for all types of cancer. The whole world obviously needs that to happen, seeing as how many people are dying from it everyday. But as we move on to when Vince is no longer the main chemotherapist and is instead one of the figureheads for the whole war against cancer, it gets... boring. So many people's names to keep up with, and so much politics that I have no interest in. While there is the history of science and research at the beginning that I, as a reader, could appreciate and learn from, the rest of it is (at least, I think so, since I didn't even get pass the 52% mark) about how they try to get enough funds for cancer research and all (especially since most of the funds in U.S. are for other aspects that have no relation to healthcare), about their disagreement with radiation therapists and narrow-minded oncologist — even the FDA. Boring boring boring.
May 9, 2024
The author of the book is the person who has been part of revolution in cancer therapy, breaking down the shackles of bureaucracy and petty politics, egoistic behaviours at workplace to give rise to modern cancer medicine breakthrough. He laid the foundation of cancer therapy which we enjoy today.
It’s unputdownable book once you start reading.
Special part about his memoir is :- his utter unselfishness, which is visible by the fact that there was very little and cursory mention of his family and his sufferings. This shows that how much dedicated he was to the work he did despite all the odds he suffered.
He had actually dedicated with life and book to the work he had done
His straight to the point no-nonsense approach in dealing with patients on daily basis, going to all the extremes possible to get the best for his patients makes him a personality which young physicians want to emulate .
This book is also a good read for general public and it will give you the knowledge of the complexities in medical world and what can be done to improve the functioning.
It’s unputdownable book once you start reading.
Special part about his memoir is :- his utter unselfishness, which is visible by the fact that there was very little and cursory mention of his family and his sufferings. This shows that how much dedicated he was to the work he did despite all the odds he suffered.
He had actually dedicated with life and book to the work he had done
His straight to the point no-nonsense approach in dealing with patients on daily basis, going to all the extremes possible to get the best for his patients makes him a personality which young physicians want to emulate .
This book is also a good read for general public and it will give you the knowledge of the complexities in medical world and what can be done to improve the functioning.
January 20, 2018
4.5 stars. A nearly perfect blend of medical memoir, history of cancer (think Emperor of All Maladies, abridged), and explanation of how cancer functions and the strategies for defeating it. DeVita has a lively writing style and his reminisces and anecdotes demonstrate abundant humanity and sensitivity. This is a man who clearly, both in his work developing groundbreaking treatments for cancer and directly with patients, feels deeply for the people he treats and that his work in oncology is a calling. His insights into the past and current realities of cancer research and treatment, the political and hierarchical machinations, the challenges facing clinicians and patients, are eye-opening, educational, and all too often disturbing. Well worth the time of any reader, but especially those with an interest in the ongoing mission to find ways to diagnose, treat, and eventually cure cancer.
October 20, 2022
It's basically a history of the use of chemical cancer treatments, and a scathing critique of the FDA and other entities who have stood, and still stand, in the way of progress.
It makes me so glad I didn't go into the field of research science. It's all political, rather than being about what's best for humanity.
The author doesn't address much the topic of what chemo cocktails are doing to patients, as far as side effects. He only cares that it extends their lives. I'm sure he knows his stuff, but for some a rigorous treatment schedule that leaves you feeling sick for the duration of your life may not be worth it. Hopefully that's not how it is for most undergoing treatment.
It makes me so glad I didn't go into the field of research science. It's all political, rather than being about what's best for humanity.
The author doesn't address much the topic of what chemo cocktails are doing to patients, as far as side effects. He only cares that it extends their lives. I'm sure he knows his stuff, but for some a rigorous treatment schedule that leaves you feeling sick for the duration of your life may not be worth it. Hopefully that's not how it is for most undergoing treatment.
March 28, 2020
I wanted to read this book because I loved the Emperor of Maladies.
On the good side, the author goes into a lot of interesting technical detail about how chemotherapy works. But on the flip side, he trumpets his own successes A LOT. Perhaps it is deserved though - it would be interesting to read any counterarguments. Each chapter was all over the place and it was hard to keep track of all the people. I felt like this book could have been edited down significantly. Still, it was informative.
On the good side, the author goes into a lot of interesting technical detail about how chemotherapy works. But on the flip side, he trumpets his own successes A LOT. Perhaps it is deserved though - it would be interesting to read any counterarguments. Each chapter was all over the place and it was hard to keep track of all the people. I felt like this book could have been edited down significantly. Still, it was informative.
January 16, 2019
An interesting book on the development of the first chemotherapy schedules in the US and cancer treatment over time. Dr. DeVita has a truly unique understanding of cancer given his experiences throughout his career. Reading this book really gives me hope that researchers and doctors are working hard to cure cancer. Even so, DeVita clearly outlines the fact that the drive for profit and stubbornness to engage in new ways of thinking has limited therapies that are available to cancer patients.
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