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The Truth in Small Doses: Why We're Losing the War on Cancer-and How to Win It [Kindle Edition]

Clifton Leaf
5.0 out of 5 stars  See all reviews (4 customer reviews)

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Book Description

A provocative, eye-opening history of the war on cancer, The Truth in Small Doses asks why we are losing this essential fight and charts a path forward.

OVER THE PAST HALF CENTURY, deaths from heart disease, stroke, and so many other killers have fallen dramatically. But cancer continues to kill with abandon. In 2013, despite a four-decade “war” against the disease that has cost hundreds of billions of dollars, more than 1.6 million Americans will be diagnosed with cancer and nearly six hundred thousand will die from it.

A decade ago, Clifton Leaf, a celebrated journalist and a cancer survivor himself, began to investigate why we had made such limited progress fighting this terrifying disease. The result is a gripping narrative that reveals why the public’s immense investment in research has been badly misspent, why scientists seldom collaborate and share their data, why new drugs are so expensive yet routinely fail, and why our best hope for progress—brilliant young scientists— are now abandoning the search for a cure. The Truth in Small Doses is that rare tale that will both outrage readers and inspire conversation and change.

Product Description


In this brave and important book, Clifton Leaf explains the state of cancer research today, traces the battles we have won and lost in the war on cancer, and most importantly shows the ways in which doctors, researchers, and even patients might improve what we are doing to combat this disease. Leaf s own path from cancer patient tojournalistto author is an inspiring story itself, and his book will benefit both patient and doctor alike."The Truth in Small Doses "will be the most important discovery in cancer this year. --David B. Agus, M.D., author of The End of Illness

About the Author

Clifton Leaf is a guest editor for The New York Times op-ed page and Sunday Review. A winner of the Gerald Loeb Award for Distinguished Business and Financial Journalism and a two-time finalist for the National Magazine Award, Cliff has received several leadership honors for his efforts in the cancer fight.

Product details

  • Format: Kindle Edition
  • File Size: 5726 KB
  • Print Length: 513 pages
  • Page Numbers Source ISBN: B00BSBVGXA
  • Publisher: Simon & Schuster; Reprint edition (16 July 2013)
  • Sold by: Amazon Media EU S.à r.l.
  • Language: English
  • Text-to-Speech: Not enabled
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  • Word Wise: Not Enabled
  • Average Customer Review: 5.0 out of 5 stars  See all reviews (4 customer reviews)
  • Amazon Bestsellers Rank: #477,560 Paid in Kindle Store (See Top 100 Paid in Kindle Store)
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Most Helpful Customer Reviews
2 of 2 people found the following review helpful
5.0 out of 5 stars Importantly challenging 15 Dec. 2013
By Mike
As someone who works in the development of new cancer medicines, I read a lot of books on cancer. This was the first that ever gave me real pause. First, it helps that Clifton Leaf is a journalist - the writing is remarkably readable, without a hint of dryness. There is a story told throughout. More importantly, however, is that he manages a skeptical view on the PR spin given to 'the war on cancer'. Along the way, he highlights the role that well-intentioned, but disorganised, and badly-directed, research has played in losing the war.
I immediately bought copies for everyone in my company, and recommended all my contacts in the pharma industry to read it. This isn't just a good book on the subject - it is an important book. Some of these quotes, pulled from the book, illustrate the point well:
"If the people funding our cancer research were the ones funding our first boatbuilders, Grove told me, no one would ever have sailed an ocean. "We'd still be studying the basic equations of flow dynamics," he said."
"The once-unstoppable global pharmaceutical engine that produced nearly one thousand novel drugs (known as new molecular entities, or NMEs) between 1940 and 1975III--including the bulk of cancer chemotherapies that are still in use today--can today barely reach idling speed."
"I have a personal bias against the cooperative groups, which I believe are devoted to getting significant answers to insignificant questions."
"no one knows which compounds might have worked under the right circumstances but were eliminated from consideration prematurely. No one knows which shards of therapeutic magic are resting in otherwise lackluster trials."
"Only with such comprehension, say many, can we figure out ways to stop the disease. The same can be said for the culture of cancer science: we need to know how it became the way it is before we can fix it."
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2 of 2 people found the following review helpful
5.0 out of 5 stars A seriously important book 12 Dec. 2013
Without sensationalism, without hyperbole, but with passion and rigorous scholarship, Clifton Leaf has asked and answered two important questions: why, despite a strenuous, 40-year effort to reduce the cancer burden does it remain as great as ever and continue to increase; and what can be done to change the road we're on and begin to make progress in the war on cancer? Both the problem and the proposed solutions to it are complex, systemic and challenging, and Leaf examines them thoroughly and clearly. There is no single smoking gun, and no silver bullet. But there is, potentially, a path towards the victory against cancer that thousands of dedicated scientists and billions of dollars have been deployed in seeking for so long. And, as you would expect of an award winning journalist, Leaf lays this out in compelling and engaging style. For any one interested in why we haven't beaten cancer yet, and how we might, The Truth in Small Doses is an essential and thought-provoking read.
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2 of 2 people found the following review helpful
5.0 out of 5 stars Seriously Knowledgeable Author 17 Nov. 2013
Format:Hardcover|Verified Purchase
Okay, what's so good about this book?

Well, the author has the wisdom of a survivor and that gift is priceless. The book is well researched, well written and well edited. So you really have no alternative but to obtain this book, if you want to learn about the Cancer Industry (as that's what it is, an industry) then I would heartily recommend you read this erudite and deeply insightful book.

Some alternative books on the treatment of Cancer are wacky and pure non-sense. This book on the other hand is not. It doesn't fail to recognise the importance that science (as opposed to corporate scientism) helps us to determine where we are going to trying to comprehend the very nature of disease, and cancer in particular.

I loved reading this book and will probably read it again soon, such as its ability to make you understand how Western Medicine works, warts and all.
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1 of 1 people found the following review helpful
5.0 out of 5 stars An essential read in the field 11 Dec. 2013
Like some other reviewers, I would take issue with some of the more anecdotal evidence, and some statistical issues, in this book. But that would be to focus on a few points in an otherwise highly informative and more tangential look at this huge issue for our society. Having worked in the area of cancer prevention therapeutics for some years, this book is definitely an important read to understand the breadth of approaches that could, and maybe should, be taken to tackle the growth in malignancies we are experiencing in an ever ageing population. Winning the war on cancer will take far more than the design of targeted agents that have incremental benefits on extending life in the advanced phases of the disease: we need to be far smarter than that. Read if you want to explore the other possibilities...
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16 of 17 people found the following review helpful
5.0 out of 5 stars Excellent - 16 July 2013
By Loyd E. Eskildson - Published on
One could carp about several shortcomings in Clifton Leaf's book about cancer - eg. he gets himself confused on determining appropriate statistics to use measuring progress in the War on Cancer, too many pages are devoted to anecdotal accountings, and the book's flow can be confusing. However, the more I read this book, the more I realized how complex cancer and the War on Cancer are, and that Leaf has done a marvelous job of portraying both, as well as making a compelling case that drastic revisions are required to make substantial improvements in this 44-year effort. Meanwhile, thousands of physicians and scientists conduct a mostly uncoordinated campaign (eg. 2,786 IRS recognized cancer-focused charities in 2010, plus universities, drug companies, and many of the 50 states) that has mostly succeeded only in finding tiny improvements instead of breakthroughs (overall cancer death rates in 2004 compared with 1990 in men and 1991 in women decreased by 18.4% - 80% from lung, prostate, and colorectal, and 10.5% - 60% from breast and colorectal, respectively), rewards academic achievement over everything else (published about 2 million papers), emphasizes models that have consistently proven poor predictors ('instant tumors' researchers cause in mice can't mimic human cancer's most critical trait - quick-changing DNA; tumor shrinkage is a poor predictor of cancer outcomes), and is rife with redundant work.

Leaf's digging into the topic was first demonstrated 2004 in a cover-page Fortune article - 'Why We're Losing the War on Cancer - and How to Win It'. At that time, we'd already spend close to $200 billion (now $300 billion), in inflation-adjusted dollars. Turns out, little has changed since then and the percentage of Americans dying from cancer is about the same as in 1970 and even 1950. (Age-adjusted death rates have improved slightly, but the bulge of aging baby-boomers has more than made up for that.) And most of this modest gain comes not from all the publically-funded research, but from quitting smoking and increased colonoscopies and pap smear detection that identifies pre-cancerous cells that can be relatively easily removed.

Meanwhile, optimistic data are reported regularly about improved survival rates. Turns out that most of the 'improvement' is due to earlier detection, most of the life extensions attributed to new drugs are trifling, most announcements about new drugs approved for cancer treatment arise from simple extensions of FDA approval for existing drugs in added situations, and 75% of FDA approvals are not for prolong life but temporary tumor shrinkage.

So why isn't tumor shrinkage a big accomplishment? Localized tumors are not what kill most people with cancer - its metastasis (90%), in which aggressive cells spread around the body. Yet, less than 0.5% of study proposals focused primarily on metastasis.

There is some good news - involving childhood leukemia and other childhood malignancies. The bad news, however, is that the NCI says the incidence of childhood cancers has risen 0.6%/year from 1975 to 2006 and nobody knows why. Pediatric cancer survivors also have a 6X greater chance of a second malignancy vs. those w/o the first case.

Gleevec is another bright spot, for those with chronic myeloid leukemia (CML). Unfortunately, many have generalized its success as evidence that more 'magic bullets' can be found. Leaf points out that CML involves a single gene; most cancers, especially solid tumors, are heterogeneous. Not only are any two eg. breast cancer patients liable to have different mutational signatures, they're also likely to have widely different mutations in different cells w/I the same tumor or other tumors in their bodies. Another problem is that new mutations arise as a result of treatment, and then create subsequent relapse.

Breast cancer death rates began falling in 1990, falling nearly 25% in the next ten years. (Death rates from heart disease and stroke have declined about half.) Careful analysis, however, concluded drug treatment was responsible for a bit more than half the drop, and tamoxifen (developed decades ago prior to the War on Cancer, and more recently approved for more breast cancer situations) that major contributor to that gain. The rest came from earlier detection - yet, 30% of early-stage breast cancers return, usually in other locations, though allowing the women involved to get past the initial five-year survival rate. In a 2008-published study reporting on 3,000 early- and mid-stage breast cancer patients who had completed therapy at one of the world's top cancer research hospitals and assessed cancer-free at the five-year mark, within the following ten years 20% had a recurrent lesion.

More substantive good news lies in the impact of increased Pap smears (cut the cervical cancer death rate by 80%) and colonoscopies (reduced death rates there more than any drug or therapy). Since the origin of cancer, per Michael Sporn, is an uncertain and slow-motion process, 'pre-treatment' such as done for diabetes and heart disease (lower LDL, blood pressure and blood-sugar levels, could be much more effective against cancer.) Yet, even today, half of all cervical cancers in the U.S. and an even greater share of those in the colon or rectum are not discovered until relatively advanced. And per a 2008 NCI 'progress report,' there are no validated molecular biomarker tests for the early detection of any cancer' - despite 150,000 published studies of various candidates.

The USPHS grant application guide is 260 pages long; completing the review/award process takes about a year, discourages innovation, and has brought innumerable repeated studies in numerous areas (eg. 65,000 papers on the most famous cancer-related gene - p53, since its 1979 discovery, and tens of thousands of other studies for each of a number of others). The result - researchers can spend half their time simply filling out research grants; absent their doing so and succeeding, they risk unemployment.

What to do? Leaf recommends easing the process of applying for grants - this would include reducing the layers of review and the number of funding mechanisms within the Public Health Service. Secondly, he'd like to have greater encouragement for collaboration, a more permissive environment for breakthrough ideas, and standardization of various measures of patient status and outcomes. Additionally, Leaf is supportive of greater publicity for the fact that the cancer burden is growing (the accumulation of incremental improvements notwithstanding) because of our aging population, and that its usual heterogeneity precludes simple solutions, as well as improved emphasis on attacking it earlier as is done with heart disease, stroke, diabetes, etc.
13 of 14 people found the following review helpful
5.0 out of 5 stars SEND THIS BOOK TO CONGRESS 16 July 2013
By Molly K - Published on
Truth delivers an easy to read look into the failings of the scientific, medical and -- culture surrounding the cancer fight. This book reads like The Tipping Point so if you're a Gladwell fan, this book is for you. From entertaining stories of heroes, like Denis Burkitt traveling the course of Africa on a quest to distinguish a rare cancer with a passion and a fervor that could not be cramped by the FDA or clinical trials or bureaucratic red tape; to personal victories (Leaf, himself is a survivor) to mouth-gaping human mistakes like the chapter on Counting (won't give up the spoiler); to the uplifting ending of how one might lobby for change--this book is a MUST READ! Every citizen, especially elected officials, must read this book so that they can understand the failings of the system and get involved in reforming it for the sake of the patient and for all of us who are touched by cancer. Mail a copy to your congressperson, senators, and other elected officials or send the Kindle edition to their email. I hope lawmakers and public officials read this!
9 of 9 people found the following review helpful
5.0 out of 5 stars Good stories; Good science 16 July 2013
By doaks - Published on
Format:Hardcover|Verified Purchase
I heard this author talk at TEDMED a few years ago. He is very good at making complicated science easy to understand, without dumbing it down. This book asks the question, "Why are we losing the war on cancer?" The answer is complicated-- there are different kinds of cancer, different kinds of war (diagnosis, treatment, prevention), and different ways to measure winning and losing. The author lays out the science very well, illustrating his points with stories of doctors and researchers who made important contributions to the fight, as well as some very moving stories from the patient's point of view. My mom died from cancer way too young, and I've read a number of books on the subject. If you liked The Emperor of Maladies you'll love this book. The stories made The Truth in Small Doses: Why We're Losing the War on Cancer-and How to Win It a good read, but the science really changed the way I think about cancer.
8 of 8 people found the following review helpful
5.0 out of 5 stars Paradigm Shift 16 July 2013
By tom jaeger - Published on
Format:Hardcover|Verified Purchase
Leaf's book will change the way you think about cancer and the fight to solve it's many riddles. I was both horrified by the persistence of research models that don't work, and given hope by the fact that the author is clearly and constructively showing us that the Emperor has no clothes, and that there are in fact ways to fix the problem. He explains the failures and gridlocks of the past and present, and suggests some paths forward. The writing is lucid and accessible; reads like having a good friend explain a complex problem which they are passionate about solving. We can't afford not to pay attention to this book and this author.
7 of 7 people found the following review helpful
5.0 out of 5 stars Thoroughly researched, beautifully articulated 4 Sept. 2013
By Amazon Customer - Published on
Format:Hardcover|Verified Purchase
I am a Keynesian fiscal liberal. I believe strongly in the importance of basic research in the sciences. And I work in a lab funded largely by the National Cancer Institute, and thus benefit as much as anyone from the U.S. government's spending in the "war on cancer".

In spite of all this, there have been times when I've prayed that the sequestration battle ax fall hard on our heads. This book does a good job of explaining why. I've been plagued for the past few years that we - as a field - are doing little to advance the overall understanding of cellular processes that will contribute to better diagnosis and treatment of cancer and a host of other diseases, while still managing to publish papers, get funding, and convince everyone that we are just on the edge of a big breakthrough. Research in the biomedical sciences has become about having the best toys and the resources to employ cutting-edge techniques, and not about answering questions. If we were Wall Street bankers or dot-com entrepreneurs we would have all had to find other jobs by now, because the patience of investors would be gone. Unfortunately, public funding doesn't work that way.

It was a surprise to me that the structural problems in the field were actually identified a priori before the National Cancer Act was signed into law by Richard Nixon in 1971. As described in the book, the bills' sponsors (including Ted Kennedy) originally envisaged a NASA-like foundation that would coordinate the overall effort and direct the research. Scientists objected, insisting instead that research be investigator-driven. This was essentially the model that already existed, but with more money. As explained in the book, this has led to a culture where people do not share data or materials, projects are conservative and make minuscule contributions to questions that are already long picked-over.

If I have one criticism, it's that the author does very little to "prescribe a treatment" for this problem. This is perhaps understandable, because most people seem unaware of the problem in the first place. This can be a starting point for a conversation; hopefully, not the end.
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