A World without Cancer not only deserves to be read, but its ambitious call to arms deserves to become part of the ongoing health-care dialogue.
It has been more than 4 decades since our nation loaded its medical cannons and declared war on cancer, self-assured that money and American scientific resolve would lead to victory. But cancer has proved to be a humbling enemy. The war is now fought in targeted skirmishes; the weaponry is a growing array of hugely expensive biologics—a battlefield where a prolonged stalemate is considered victory.
According to Margaret I. Cuomo, MD, author of the recently published book, A World without Cancer: The Making of a New Cure and the Real Promise of Prevention, the threadbare military metaphor, “war on cancer,” has contributed to scientific attrition that has “put generals in charge who think we should start talking about living with cancer as the ‘new normal.’”
From the outset of the book, Dr. Cuomo, a board-certified radiologist, makes clear that she is not in the “turning cancer into a chronic, treatable disease” camp. Her clarion call for change is articulated in the introduction: “For years, I have been observing the ‘cancer culture’ in the United States, and I have become convinced that it is not structured to do what we most need: to determine how to prevent cancer and then implement our discoveries.”
Turn the page, and Dr. Cuomo’s ambition is distilled even further: “My driving commitment to shift the national approach to cancer from treatment to prevention is at once urgent and personal.”
The first part of A World without Cancer—using anecdotes from her years in practice and a brief history lesson—serves as a rationale for her general thesis, which unfolds in highly readable, well organized chapters, some of which might raise eyebrows within the oncology community. For instance, chapter 4, “Cut, Poison, and Burn: A Look at Today’s Treatment Options,” explicates the trials, tribulations, and successes of the three oncologic disciplines.
Although Dr. Cuomo’s reservations about the direction of oncology are visible on each page, she is never strident, tempering her concerns by noting the advances. “Nevertheless,” she concedes at one point, “imatinib can be considered a success story. If only we had more of these.”
Despite highlighting the success stories, Dr. Cuomo is quick to point out that our sluggish progress suggests we aren’t taking the right approach. She punctuates the futility of the cut, poison, and burn methodology with a quote from cancer pioneer, James F. Holland, MD, one of many luminaries who appear throughout the book. “Even one cancer cell can lead to death,” says Dr. Holland. “Relapse is always possible until we can guarantee that there are no cancer cells in the body.”
Problems and Solutions
The book gains full momentum at the midway mark, as Dr. Cuomo’s observations drill into the marrow of today’s contentious health-care debate with a chapter titled, “Paying More, Settling for Less.”HereDr. Cuomo looks at value vs cost, taking aim at some of the extravagant new biologics, a subject she hopes will resonate with doctors and policymakers alike.
To add gravitas to this argument, she brings in policy heavyweight Ezekiel J. Emanuel, MD, PhD. He comments, “We should differentiate between drugs that make a small difference and drugs that make no difference at all. A lot of cancer drugs are not worth very much in terms of prolongation of life.”
Once Dr. Cuomo has laid out the fatal flaws in the cancer care system, she sets her sights on a solution by advocating a dramatic shift of focus. “Taking on the many weaknesses to our current approach to cancer requires two broad commitments. First, our research focus has to shift from treatment to prevention.… Second, we need to look hard at the flaws in our existing research infrastructure.”
Dr. Cuomo then wrestles with the problems of our disconnected research apparatus. This is well-documented terrain, but she deftly uses the NASA approach to “set a specific goal and a specific deadline for accomplishing it,” to make her point that ironclad collaboration produces effective team science, which escalates a targeted research environment.
Even a super-energized team effort can be brought to a grinding halt, she points out, by two other culprits: failed data management and a flawed clinical trial system. Dr. Cuomo exhorts the players in the field, noting, “Career success, and the promotions that come with it, must be defined by allegiance to team science, not personal ambition.” It is a lofty goal, one that will require moon shot–like leadership to reach.
Bold New Initiative
It is cure by prevention where Dr. Cuomo finds her sturdiest footing; it is obvious that advocating prevention strategies is her bailiwick. And she wastes no time getting to the point: The long-term prevention studies are in; it’s time for action!
“After evaluating the impact of ‘research-proven strategies and interventions,’” researcher Graham Colditz, MD, DrPH, “concluded that more than half of all cancers need not occur,” she writes. Even to those long in the cancer-care trenches, it’s a sobering statistic. Dr. Cuomo gives a detailed prescription on public health dos and don’ts. To her credit it is not a lecture, but rather, a cleanly drawn blueprint on how, as a society, we can help ourselves not develop cancer.
The centerpiece of Dr. Cuomo’s prevention realignment strategy is the creation of a “bold new initiative: the National Cancer Prevention Institute (NCPI).” As part of NIH, the NCPI would “coordinate the many cloistered activities throughout the federal government and lead the way into new arenas.”
Although readers might sigh at first at the mention of yet another government agency, Dr. Cuomo makes a convincing argument that if we are truly earnest about cutting cancer deaths by more than half, the NCPI might give us the needed infrastructure to move forward. Considering the stakes, it’s worth consideration from policymakers on the Hill. Lives and huge amounts of money could be saved.
Adding another book about cancer to a long list of predecessors takes the chance that it will get lost in the crowd. However, A World without Cancer not only deserves to be read, but its ambitious call to arms deserves to become part of the ongoing health-care dialogue. ■
Click here for an interview with Margaret I. Cuomo, MD.