An 86-year-old patient recently said to me, “I’m not old, I have just been around a long time.” I sort of related to that last week at our first-ever Division of Hematology-Oncology Book Club meeting. In a prior “Letter From the Editor,” I mentioned that the first book on the list was going to be The Emperor of All Maladies. I provided copies to the fellows, who were asked to be prepared to discuss the character who made the greatest impression on them. One fellow who, unfortunately, was unable to make the event, had wanted to talk about the author, whom he had developed a surprising dislike for based on some things he had read online. I will have to have him fill me in sometime hence. At the book club meeting, I first asked the fellows for their overall impression of the book. Those that attended all enjoyed the book on various levels. They felt that it gave them a perspective on where the field came from that they had never imagined. They were impressed by the way that cancer was almost anthropomorphized into a tangible enemy, such that even those without cancer, notably Mary Lasker, took up the sword and valiantly attacked. I had requested that each fellow choose a different character to discuss, but the message did not get across. However, it was not Sidney Farber who was repeatedly selected. For some reason, they all seemed to focus on figures from the world of breast cancer. The character that engendered the most interest was, surprisingly, the surgeon Halsted, and for a variety of reasons: first, that one man wielded such power, and had such a presence that he made or destroyed careers at will. Another fellow was impressed by the increasingly radical nature of his surgical procedure, despite disfiguring thousands of women who still recurred and died from their disease. A consequence of the More Is Better delusion was the misguided and wasteful decade of stem cell transplants for breast cancer. The fellows were dumbfounded by the temerity/dishonesty of the likes of a Bezwoda, with the resulting resources and patient hopes, and lives, wasted. Another fellow was impressed by Dennis Slamon because of his perseverance in getting a biotechnology company interested in Herceptin. One other was interested in that “minor figure,” a chap named Gianni Bonadonna, who had pioneered adjuvant therapy for breast cancer and was able to bridge the chasm between surgeons and medical oncologists. “Minor?!” I blurted out incredulously, and informed them of his other enormous accomplishments, such as ABVD for Hodgkin lymphoma.
Perhaps the most compelling part of the book to me was how, with imagination, creativity, and sheer will, they were able to conduct innovative clinical trials, often revolutionizing therapeutic paradigms. Certainly, not all were winners, but things got done. Now we are faced with an executive committee, then off to a working group, reporting back to a steering committee, and then must precede up to higher levels of administrative committees, not to mention a CRC and an IRB—and back and forth like the silver ball being pummeled around in a pinball machine. Then there is the new Medidata RAVE system, which is delaying activation of studies by up to 6 months. The years we waste, the lives that are lost. The ever-increasing precautions intended for “patient protection,” which even the first-year fellows realize are to the detriment of progress. Perhaps these obstacles are responsible, in part, for the failure to realize the goals of the National Cancer Act, signed by Richard Nixon more than 40 years ago.
The general conclusion was that it would be highly unlikely for others of the presence of a Farber, DeVita, Canellos, Carbone, Frei, or Freireich to emerge from the piles of regulations on medical research and, with shrinking support, lead the charge.
At the end of the event, I passed out the copies of The Immortal Life of Henrietta Lacks that I had purchased for them. If they were dumbfounded by the Emperor and its occasional new clothes, I can hardly wait to see the jaws drop with Henrietta’s saga. Next time, wine and cheese will be served.
Until next month . . .
Bruce D. Cheson, MD