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

DeVita’s book, The Death of Cancer, is a personal recollection of one of the most well-known cancer specialists in the world. In a sense it is an Odyssey tale of a highly competent and prolific person who flows with his times and manages the Scylla and Charybdis of Government work. The book is well written and reflective of the man and his times. DeVita started out during the Vietnam era when any male graduating from Med School found themselves, unless otherwise excused, ready for immediate assignment to some military unit. Many of the top students were fortunate to get to go to NIH which was DeVita’s fate, and it was this flow of talent in the late 60s which made NIH and NCI one of the best institutions in the world. Thus the tale of DeVita and cancer starts here with NCI and a flow of excellent talent.DeVita describes his work on the use of multiple chemotherapy regimens and the resistance from the likes of Farber in Boston, hardly an uncommon occurrence especially in Medicine. This was the MOPP therapy that most now know as a major breakthrough in Hodgkin’s. The discussion on how he and the team managed to persist and managed to go through the then significant administrative a bureaucratic complexities is amazing.The discussion on his involvement in the “War on Cancer” and the political games is quite interesting especially for anyone who has not spent a tour of duty in Washington. There were games within games and DeVita was at times a willing participant but as see in the book and excellent observer. His description of the political gamesmanship is worth the read if nothing else. It is also worth the while for anyone seeking to grasp how Washington functions, and why it may work at times and often falls into total disarray.On p. 159 I was interested to see the interlocutory between Benno Schmidt and Jim Watson while Watson was I gather performing one of his classic poses. This also is worth the read. I have had my students return from a talk by Watson and ask me: “Does he really think Physicians and Engineers are useless?” But I gather that is Watson, a scientist at heart.On p 219 there is a great discussion of his time at MSKCC, a world renowned institution but at times falling behind in certain areas. DeVita states: “MSKCC had the potential to be the best cancer center in the world, it wasn’t” is a powerful statement and at times quite true. MSKCC has powerful backers and Board members and although it may try from time to time to be at the lead there is always the chance that it becomes insular. The lesson DeVita brings out here should be a warning for many such institutions.On p 247 DeVita discusses the recent Hanahan and Weinberg paper on Cancer, a follow on to what the two authors had written in 2000. This is a paper on the hallmarks of cancer and is looked upon as a sine qua non in the literature. DeVita lauds it at length and rightly so. Yet what this paper also shows is that we have learned a great deal but the “War on Cancer” is just getting harder the more we learn. One could argue that the recent Hanahan and Weinberg paper albeit prescient and insightful lacks the depth on epigenetic factors which we are seeing more and more in cancers. The more that is learned the more complex the disease.On p 253 DeVita discusses the inflammation relationship. We often ask what causes cancer and the more we understand inflammation the more we can see the nexus. This is a useful and important discussion as well.On p 258 DeVita makes an interesting statement:“In my opinion, when there is less than a 10% chance of the cancer recurring after a patient passes his or her cancer’s critical period, then the patient should be told, in all likelihood, he or she is cured.”This is a powerful statement and one a physician with extensive clinical experience is wont to utter. However one should parse the statement. First, how does one determine a 10% chance? In prostate cancer we can perform a prostatectomy and monitor PPSA for several years and then see a met occur. When did the 10% level occur? Second, what is a critical period? How do we define it for each cancer? Then the catch phrase of “in all likelihood” is something the patient may or most likely not hear. Cancer patients often has selective hearing.Overall the book is highly enlightening and a must read for anyone interested in the progression of cancer therapy. Also DeVita’s discussion of his battles with the FDA and Sen. Kennedy’s blatant interference with NCI if it in his opinion interfered with the FDA was quite interesting. DeVita bares the political quagmires of Washington and demonstrates that progress can often be made despite the Government overhead by dedicated and highly competent individuals.

It is indeed rare that I find a book or article so powerful that I believe that it should be widely read and discussed. Some works make valid points but are not of a nature that it impels us to rethink our previously held convictions or make us reexamine our basic understanding of a disease process. However, after reading and rereading parts of the Death of Cancer by Devita it is my conclusion that this work falls into that rare category of medical literature. I would therefore recommend that you read this book. Although this treatise is at times technical it should be well within the grasp of the lay reader.If you are going to follow my recommendation to read this work than I also make the unusual suggestion that you read the last two chapters of the book first. This is not a mystery novel and you do not have to worry that you will ruin your enjoyment of the book because you already know “who did it”. I make this suggestion especially for the non-expert lay reader who will likely be bored by some of the details in the beginning of the book. The meat of this authoritative work is in the last two chapters, the penultimate chapter is entitled the “Death of Cancer” and the final chapter is “Outrageous Fortune Part 2”. Let me explain.The first part of this book is about the history of the treatment of cancer since the 1960’s. To a great extent it is a polemic by the author castigating those involved in the treatment of cancer for their lack of progress, short sightedness, inability to think creatively, insular approach and unwillingness to innovate or accept the results of innovation. For the most part it is not a pretty picture and is in many ways disheartening. The author has an obvious bias and I am not completely certain that some of his observations and accusations should be taken at face value for it is possible that his observation reflect his own inability to understand the position of others. That is something that I am ill equipped to judge and I am sure that others with greater expertise will comment. Certainly feel free to read the book in its entirety but I want to be clear that my reason for recommending it lies in the last two chapters.The last chapters describe in a logical and clear manner the underlying pinning’s of the nature of cancer and the methods by which we can either “cure” this dreaded disease or treat it as a chronic disease disorder such as diabetes. What Devita describes is not some pie in the sky vision of a possibility of future developments. It is technologically achievable today. Perhaps most important of all is that he has a realistic plan for rapidly implementing new discoveries in the treatment of cancer for the use of the public at large.Some of the language in the final chapters is technically difficult but do not worry about that. If you do not understand a word or phrase it is likely that he will make it clear as you read further. The important point to understand is that we have now arrived at the point where we have the tools in our hands to radically change what we have been doing. This is indeed a paradigm shift. It requires a new way of thinking about a common problem and promises results that are far better than we could have expected as little as five years ago. It is a demonstration of the integration of scientific and clinical knowledge across widely divergent areas of specialization and proposes a far more advanced model of care.Some will reject the conclusions of this book because they may be either antithetical to their belief system or they view it as philosophically disingenuous. To those I would comment that if your opinion is based on hard evidence then I respect it and would appreciate further debate. However, I personally have little tolerance for those who reject these propositions based on an irrational conservatism that in essence says we do it this way because that is what we have always done it. That method of thought should be an anathema to the scientific integrity of our profession and is harmful to the public at large. For those who argue “first do no harm” it is clear that for those who desire reasonable treatment then patient autonomy trumps our individual pessimism. I am not arguing for futile care for that does violate other important medical principles. I firmly believe as a family physician that all physicians interacting with those who have serious illness have a responsibility to fully educate their patients and themselves about what is available and the consequences of making an either positive or negative decision about treatment. This book supplies some of the basic knowledge necessary to participate in that essential medical decision making process.

The history of NCI and the War on Cancer is thoroughly discussed in this book, from its inception to the present day. It's a really captivating story that extends past science to politics, lobbying and the public sentiment. The confluence of all of this makes it engaging and grandiose. There are few if any people in the world that have played as consistently an important role in where cancer research stands today as the author has.While the story is fantastic, this book dealt almost entirely with the past until the last chapter or two (if I recall correctly, the second last chapter is on in which you finally get a very technical summary of everything that has been learned about science in the past 50+ years. And then there's a brief account of recent advancements in immunotherapy. While these are not the focus of this book, and rightfully so, more pages dedicated to these topics could have been a nice addition).The writer rightfully discusses many of the shortcomings of the FDA, and highlights the problems with their approach to cancer in great detail, however he appears to sort of gloss over the solutions. This topic could surely be a book in itself, however I think even just a few more sentences dedicated to elaborating on how clinical trials could be carried out more effectively would make the arguments he set up for much more emphatic.Overall, highly recommended this book.

This book is an opportunity to look inside the world of cancer treatment in clinic (which as it turns out is less than ideal). As the author tells us, human factor plays a major role in the fate of cancer patients and the outcome is highly affected by different conflicts of interest the doctors may have. The good thing is that the field seems to be moving forward and one of the things everyone can do to improve the chances for themselves or their loved ones is to get educated on the subject and all the existing options. This book is a very good source of such education.

Vince De Vita is a giant in oncologyHis personal perspective on how to treat cancer and the key-steps to overcome this disease are inspirational and of real interest

No espere buena literatura en este libro, no espere tampoco disimulo. Espere una visión desgarrada, personal, experta, esperanzada y decepcionada a la vez de lo que es luchar contra el cáncer de verdad, en el frente de batalla de la consulta y en el despacho del Estado Mayor, en la sección de planificación, y en la investigación y desarrollo. Y espere, también, una crítica a la burocratización del sistema, a la lentitud de las agencias reguladoras, tan necesarias y tan superfluas, a la vez. Eso sí, una vez que empiece no podrá parar de leer.

Amazing book and author. I just lost my young wife to cancer. This book should be on every oncologist's and member of parliament's desk. Based on my personal painful experience, I agree with each and every comment and recommendation that DeVita makes. We are finally starting to have 21st century tools against cancer, but we are still stuck with mid-20th century medical regulations and attitudes, even more so in the UK than in the USA. This is the time to take risks in return for greater benefits; the cancer community should learn from what the AIDS community did in the mid 90's.Read it and give it to any decision makers in cancer treatment!

Story on the evolution of medical oncology and the war on cancer. Insiders view on how the US national policies on the campaign against cancer were shaped by activism and lobbying with the Government by indomitable and courageous individuals. I would recommend this book to be read by anyone interested in the fight against cancer and to get an idea of how public policy on health and diseases can be built with vision and passion.