Most people hesitate to think about cancer and the procession of toxic treatments that follow a diagnosis unless they are forced to do so. The reasons are understandable. It's a terrifying subject, and it doesn't make for great dinner conversation. But the truth is that very few of us will manage to maneuver through life untouched by the disease in some way.
This year alone, 1.5 million Americans are expected to be diagnosed with cancer. Data indicate that cancer rates are growing three times faster than the country's population. The number of new cases of cancer has risen 158 percent since 1971, when Nixon officially declared a "war on cancer."
In the new book The Truth in Small Doses, author Clifton Leaf asks why there hasn't been more success in reducing the cancer threat, considering the enormous investment in research. Nixon's "war on cancer" rallied the nation's top scientists and health officials to the cause of eliminating the disease as a major cause of death. Yet in the next 15 months, more Americans will die from cancer than all the soldiers who were killed in combat in all the wars our country has ever fought combined.
While the 40-year "war on cancer" has failed to find a cure, it has succeeded in creating a massive cancer industry into which billions of dollars are invested every year. Leaf argues that this "strange, dispiriting, dysfunctional" cancer culture has actually stood in the way of progress by stifling innovation. He argues that the cancer industry, that tense crossroads between pharmacology, public policy, and corporate interests, is fundamentally misdirected in its goals and guiding principles.
The book's author survived advanced-stage lymphoma in his teen years and went on to become the executive editor of Fortune magazine and a guest editor for the op-ed and Sunday Review sections of The New York Times. In 2004 Leaf wrote an acclaimed article about the "war on cancer" for Fortune. He spent another nine years researching and writing The Truth in Small Doses. Although Leaf is not an oncologist and admits to having failed high school biology, he has clearly done his homework on the subject. The author includes close to 200 dizzying pages of notes and references that support his provocative assertions. The book is a fascinating resource for anyone interested in understanding more about the biological mechanisms of cancer and curious about the history, politics, and ethics of the current cancer culture.
Leaf argues that the cancer culture discourages the kind of expansive thinking and collaboration that would lead scientists to genuine breakthroughs. Instead, the industry steers brilliant minds toward the goal of academic publishing. Young scientists in today's market need to publish their findings at a rapid rate in order to establish institutional credibility, win grants, and advance their career. In order to publish, researchers must contrive a specific question that can be answered swiftly through experimentation.
John Ioannidis, a Stanford University professor of medicine and health research policy, is one of the many researchers Leaf interviewed on this topic. "With the current running system, any seriously innovative idea has absolutely no chance," he commented. "What I will send out of grant applications are ideas that are pretty much mediocre. If something is more than mediocre, I'm not going to going to ask to get funded, because I know it won't get funded."
The result of this "risk-adverse," "ultra-conservative" grant system has been incremental improvements on existing treatments that have little to nothing to do with curing cancer. Most of the targeted drug therapies developed over the last four decades can only offer pain relief or extend the life of patients by months or years. But as many patients know all too well, the toxic drugs and brutal procedures used in these therapies can make the treatment as punishing as the disease. "There is little difference between the treatment and disease as pain from one melds into pain from the other," writes Leaf.
Leaf also claims that the reality of the cancer burden in the United States is not reflected in the statistics used by health officials. He suggests that the "war on cancer" has become a war of attrition "with more and more patients showing up on the front lines each year." While Leaf acknowledges the significant progress made with breast cancer, the HPV vaccine, and childhood leukemia, he claims that far too many patients are still losing their battle against the disease. Given the enormous investment in research, we should expect more.
The key to victory in the "war on cancer," Leaf believes, is not in discovering a cure but in better understanding the root cause. Currently, the National Cancer Institute invests the bulk of its money in ongoing projects that are narrowly focused. Leaf suggests that the way forward should be in funding broader research that aims to identify the environmental, behavioral, and genetic factors that are causing cancer rates to rise. That way, the disease can be prevented from developing in the first place.
I recently had the opportunity to ask Leaf about the process of writing The Truth in Small Doses. Given the grim nature of the subject, I wondered what gave Leaf the stamina to work on the book for close to a decade. Leaf told me that he received a huge number of letters from readers after the publication of his article on the subject in Fortune. Leaf found many of the letters heartrending.
"There were letters from people who were fighting for their lives or hoping that a loved one would somehow beat terrible odds," he said. Their situation made Leaf question himself. He wondered if he had helped anyone by exposing the failures of the system. He worried that he'd robbed cancer patients and their loved ones of their hope. "What gave me the right to challenge the progress of a system that had, in fact, saved my life many years before?" he asked.
The same questions returned to Leaf when he decided to further examine the full scope of the cancer crisis at the heart of this book. "But I kept telling myself that the really hopeful choice was to tell the story as I saw it. And then if not me, braver, stronger, smarter souls than I could help figure out a way to disable the barriers that were holding us back."
"That was what authentic hope looked like for me," the author explained. And that's what ultimately kept him focused on the reporting and writing.