Retooling the War on Cancer

Clifton J. Leaf; Lidia Schapira, MD


April 16, 2014

In This Article

Oncology's Deadly Caution

Editor's Note: In researching The Truth in Small Doses: Why We're Losing the War on Cancer -- and How to Win It,[1] Clifton Leaf, Assistant Managing Editor at Fortune and a longtime student of the cancer community, interviewed more than 1000 cancer stakeholders over 9 years to assess oncology's state of health in the United States. His conclusion, supported by extensive documentation, is that urgent intervention is required. In a recent interview for Medscape, Lidia Schapira, MD, Assistant Professor at Harvard Medical School, spoke to Mr. Leaf about his provocative ideas on how to get cancer research and practice off the critical list.

Dr. Schapira: In reading your book, I was struck by the way that you view oncology. How would you describe it, as a former patient and a student of the culture of oncology?

Mr. Leaf: Imagine that the cancer community is divided into 3 parts: academic research, drug development, and treatment. In the last of these -- the practice of medicine -- there is a profound sense of urgency. When you and other doctors see patients, there is an immediacy to your response and a very clear sense of the stakes, whatever action is taken. This urgency pervades the whole treatment process.

In academic research, we have what I would call a "deadly caution," a phrase that I think captures the essence of academic science in oncology. It is a bureaucratic caution that is manifest through the grants review system in which truly new or radical or innovative ideas are squeegee-ed from the process.

On the drug development side, it is similar; we are pushed into "me-too" incrementalism. Much of the caution is sensible and necessary, but a lot of it isn't. In the bureaucracy, in the paperwork, and in the choices that are made, we have erred on the wrong side.


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