Review: Science and Politics Collide in ‘The Death of Cancer’


The scene is a wild cocktail party in Washington at the tail end of the Kennedy administration. Our innocent young narrator, new to the rituals of power, watches in fascination as one of his superiors dances by with a half-undressed woman slung over a shoulder. By the end of the evening, he has helped hoist another of his bosses, dead drunk, out of a bathtub.

Ah, politics. As it happens, though, the inebriates in question are not politicians but doctors at the National Cancer Institute, and it is our callow observer, also a doctor, who soon grows preternaturally skilled at the politics of disease. Dr. Vincent T. DeVita Jr. soars through the ranks of the cancer institute to become its director, then departs for top-level positions at Memorial Sloan Kettering Cancer Center and Yale University.

Now 80, a professor at Yale and one of the nation’s premier oncologists, Dr. DeVita has produced, with the help of his daughter, an utterly absorbing memoir, fierce and frank. Ears will burn, memories will doubtless differ on a few counts, and even his take on the particulars of cancer treatment may provoke debate. But the average reader will come away from the book with a superb basic education in all things oncological, from events on the cellular level to those in the rooms where research agendas are settled and checks are written.

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Sonny Figueroa/The New York Times

We tend to forget how recently it was that cancer care was primitive. When Dr. DeVita arrived at the National Cancer Institute in 1963, the primary treatments were surgery and radiation, both deployed with a heavy hand. Those were the days of the radical mastectomy for breast cancer, and also the occasional “superradical mastectomy,” during which the surgeon actually dissected down into a woman’s chest cavity to ream out potential disease.

Chemotherapy was new, controversial and frightening. Doctors who used it were called “chemotherapists,” one step up from alchemists. The drugs were eerie: brightly colored and toxic. One was prone to spontaneous combustion, and a bottle of it actually exploded in the car trunk of one of Dr. DeVita’s colleagues.

Small wonder that these poisons were generally administered one by one in small doses, even though they didn’t work very well that way. But a cadre of visionaries (including the two party animals in charge of Dr. DeVita) were accumulating persuasive evidence that if the drugs were combined in high doses, they might be unimaginably effective.

At the beginning, Dr. DeVita writes, he “wasn’t sure if these scientists were maniacs or geniuses.” His supervisors were heckled at meetings and called “butchers” and worse, but he was quickly persuaded by their data.

He took on Hodgkin’s disease, a lymphoma that often affects teenagers and young adults and was then considered generally incurable. His team’s unique concoction of four powerful drugs directed at the tumor’s dividing cells changed that prognosis instantly: The disease became one of the few adult cancers that could actually be cured.

But the triumph of chemotherapy for Hodgkin’s and then for many other tumors opened an interlocking series of dilemmas. In the clinic and the hospital, the new protocols demanded that doctors muster the courage to make their patients very sick in order to make them well. But how sick was too sick? The risks and benefits of the powerful treatments now needed careful, deliberate assessment at every stage of the disease.

Similar questions dogged those who developed, evaluated and regulated the drugs. How poisonous could these agents safely be? How assiduously should desperate patients be saved by their government from pharmaceutical risk?

Dr. DeVita stands firmly among those affirming cancer patients’ right to aggressive treatment. One particular exchange summarizes his philosophy: “Do your patients speak to you after you do this to them?” one skeptic asked him early on. “The answer is yes,” he replied, “and for a lot longer.”

The regulatory caution of the Food and Drug Administration has been a thorn in his side for decades: “I’d like to be able to say that as cancer drugs have become increasingly more complex and sophisticated, the F.D.A. has as well. But it has not.” In fact, he writes, “the rate-limiting step in eradicating cancer today is not the science but the regulatory environment we work in.”

He offers story after compelling story of cancer patients living long and well thanks to hard-hitting, imaginatively designed chemotherapy, now augmented by the tools of modern immunology and molecular genetics. It is here that one suspects other observers might counter with descriptions of patients not nearly so well served by similarly aggressive treatment in less virtuoso hands.

But that is a small cavil to this compelling mélange of science, medicine and canny politicking — the launch of the “war on cancer” in 1971 infused enough government and private money into the field to raise many passionate and conflicting agendas, and Dr. DeVita was in the middle of them all.

He includes a brief, piercing personal footnote: In his official cancer institute photograph, taken outdoors, a 13th-floor window is visible in the background. That was his son Ted’s room.

As fate would have it, Ted developed at age 9 a disease called aplastic anemia that is essentially the opposite of cancer: His bone marrow failed completely. He lived for eight years in a sterile bubble in that room at the cancer institute and died there at 17, still awaiting the kind of miraculous treatment his father could dispense so forcefully for others.



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