What if 100,000 more lives each year could be saved from cancer? And at what risk?

If 100,000 more Americans could be saved from cancer each year, just how much leeway would the public give physicians in providing cutting-edge, promising care? That’s the intriguing premise of a New Yorker piece by noted writer Malcolm Gladwell, examining a new book by Vincent T. DeVita Jr., an eminent but controversial cancer clinician-researcher. The onetime head of the National Cancer Institute and chief at Memorial Sloan Kettering Cancer Center in New York and the Yale Cancer Center in New Haven reflects on a career and at times angrily calls out his colleagues for their timidity in battling cancer, arguing that medicine’s standardization, institutionalization, conservatism, and bureaucracy not only hinders the fight against a nasty, complex disease but may cost lives.

DeVita, the New Yorker writes, has concluded that: “There are incredibly promising therapies out there. If used to their fullest potential for all patients, I believe we could cure an additional 100,000 patients a year.”

Instead, he says that doctors, hospitals, and medical centers dither and wait for bullet-proof evidence of the effectiveness of treatments. Or he finds that established practitioners won’t even learn about, consider, or test advances with which others have demonstrated potential. This may be for reasons as simple as the new therapies cause patients greater discomfort and they may be unhappy with their doctors as a result. It also may be that institutions have become hide-bound with best practices, fixed regimens, and internal enforcement of medical orthodoxies.

Once they find a tried-and-true, physicians expect their peers to march lock-step with a treatment and they want anything more effective tried elsewhere first so as to not disrupt their lives, the doctor says, though: “Clinical progress against a disease as wily and dimly understood as cancer, DeVita argues, happens when doctors have the freedom to try unorthodox things—and he worries that we have lost sight of that fact.”

The New Yorker also notes that clinician-researchers who push the boundaries of care and tussle with colleagues on behalf of their patients do so at their own professional risk:

Life on the innovation end of the continuum is volatile, fractious, and personal—less a genteel cocktail party, governed benignly by bureaucratic fiat, than the raucous bender where your boss passes out in a bathtub. When DeVita returned to Memorial Sloan Kettering years later, as the physician-in-chief, the hospital got better. But DeVita didn’t last, which will scarcely come as a surprise to anyone who has read his book. ‘The problem with Vince,’ the hospital’s president reportedly said, in announcing his departure, ‘is that he wants to cure cancer.’

I’ve seen both too many medical slow-pokes and cowboys who have harmed patients to feel 100% comfortable with all of what I read of Dr. DeVita’s cancer-combatting views. We’ve made great strides since the days when pioneers needed to experiment on themselves or their near and dear or to wickedly exploit others in the name of clinical-scientific advancement. Certainly the civil justice system’s efforts to ensure that practitioners seek informed consent has abetted the credibility of clinical and other medical trials. But dire forms of cancer can make patients exceedingly vulnerable, so while every profession, including mine, needs its revolutionaries to push the field forward, moderation in something as critical as medical care also isn’t something to take lightly.

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