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The Truth in Small Doses: Why We're Losing the War on Cancer-and How to Win It Hardcover – July 16, 2013

ISBN-13: 978-1476739984 ISBN-10: 1476739986 Edition: 1st
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Editorial Reviews

From Booklist

For this eye-opening look at why the U.S. is losing the war against cancer, Leaf, the former executive editor of Fortune, interviewed more than 1,000 people over nine years. The statistics are depressing: in 2013, 580,000 Americans will die of cancer, the nation’s number-two killer for the past 75 years. And more than 1.6 million will be diagnosed. Of course, many survive. Leaf himself was diagnosed with Hodgkin’s disease at age 15. Leaf blames the failure to cure cancer on mismanagement. No one is coordinating individual research efforts or generating “get-a-man-on-the-moon” urgency. Leaf would like to see more focus on “preemption”; today only 7 percent of the National Cancer Institute budget goes to prevention. He would also like the government to fund people rather than projects, to focus less on publishing studies and more on solving problems, and to avoid awarding money to the same institutions. Siddhartha Mukherjee’s Pulitzer Prize–winning The Emperor of All Maladies (2010) got Americans talking about the stalled battle against cancer. Leaf’s book keeps the conversation on track. --Karen Springen


"The US “war on cancer” begun in 1971 has been an overall failure, argues journalist and cancer survivor Clifton Leaf. Over the past 40 years, he shows, crude deaths of US citizens from cancer have risen by 14%, although those from stroke and other killer diseases have fallen. The developing-world burden is also rising. In his exhaustively researched study probing why, Leaf points to a “cancer culture” in which scientists and medics think small, fail to coordinate results and focus on publishing rather than achieving breakthroughs."

"[The Truth in Small Doses] is the book you love so much that you write about it not simply to fill a hungry page with words but because of a genuine conviction that people need to read this thing... A fiercely written book on a fiercely urgent subject is too hard to resist."

“As a cancer patient and advocate, I applaud Clifton Leaf for so boldly pulling back the curtain on the ‘cancer culture’ to reveal why we've made limited progress toward cures. The Truth in Small Doses, a book told with the rigor of a brilliant journalist but with the heart of a cancer survivor, is certain to disrupt the conversation on the state of cancer research and inspire new approaches to win this war.”
Kathy Giusti, founder and CEO, Multiple Myeloma Research Foundation and Multiple Myeloma Research Consortium

“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 to journalist to 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

"In this lucid, convincing, and gripping book, Clifton Leaf lays out, in heartbreaking detail, why our well-intentioned war on cancer has produced such dispiriting results. Leaf's command of the science is masterful, his passion is palpable, and his critique of a broken research system is utterly convincing. But, like the best advocacy journalism, The Truth in Small Doses is ultimately inspiring, pointing the way toward a more hopeful future. It is a landmark achievement."
Jason Tanz, executive editor of WIRED

"Beautifully written, with the twists, turns and suspense of a great novel, The Truth in Small Doses tells the tale of the great individual successes and collective failure of both government and the pharmaceutical industry to impact the increasing number of cancer diagnoses and deaths in the U.S. But Clifton Leaf offers more than a history of our national cancer effort: He provides a vision and a roadmap for a creative and bold national cancer strategy."
Frank M. Torti, MD, MPH, Dean, University of Connecticut School of Medicine, former director Wake Forest Comprehensive Cancer Center and former acting commissioner of the FDA

"It matters because: We’ve been at war with cancer since 1971, and despite endless promises, are not much closer to truly winning that battle. In this refreshingly impassioned volume, Leaf explains why while offering a path forward…Perfect for: Anyone curious about the history of medicine, as well as the fraught intersection of pharmacology, public policy and the corporate world."

“[An] eye-opening look at why the U.S. is losing the war on cancer…The Emperor of All Maladies got Americans talking about the stalled battle against cancer. Leaf’s book keeps the conversation on track.”

"Through flowing prose Leaf delivers, alongside facts and data, stories on personalities involved in research, the fascinating process of solving an unusual and highly deadly cancer in Africa, and the heartbreaking realities of cancer treatment in children today. Leaf's extensively investigated treatise will resonate with researchers and patients frustrated by the bureaucratic woes he delineates. Public policy makers, grant reviewers, and pharmaceutical researchers alike must consider Leaf's indictment and proposed solutions."
Publisher's Weekly

"'Why have we made so little progress in the war on cancer?' Clifton Leaf asked Fortune in 2004. His groundbreaking story went on to describe the failures of researchers and drugmakers alike, and a system so focused on incremental improvements in the treatment of the disease that it could not arrange itself to tackle the roots of a persistent (and still growing) problem. For a decade Leaf has followed the story, and though we are no closer to ‘curing’ cancer, we can now imagine—thanks to his lucid and fascinating work—what that solution might look like. In Leaf’s brilliant new book, he reframes the challenge as one of engineering, not science. As Leaf writes, 'Science determines the limits of the possible. Engineering lets us reach them.'"

"According to Leaf, a journalist and cancer survivor, the [1971 National Cancer Act] failed because of the flawed research culture it spawned. In this history of the fight against cancer, he describes how scientists often cannot secure funding for risky research in a culture that rewards competition over collaboration."
Recommended by Scientific American

“Leaf’s book serves as a powerful call-to-action that our current system is too structurally flawed to provide the transformation in cancer care we all seek…the longer format has given Leaf room to explore the wide range of issues in more detail, and several chapters merit reading as stand-alone pieces…Leaf’s analysis is clear and accessible to scientists and non-scientists alike, and should probably be read and debated by senior executives at all oncology-focused drug companies.”

“A fascinating resource for anyone interested in understanding more about the biological mechanisms of cancer and curious about the history, politics, and ethics of the current cancer culture.”

“Provocative…his prescription is dead on.”
New York Post

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Product Details

  • Hardcover: 512 pages
  • Publisher: Simon & Schuster; 1 edition (July 16, 2013)
  • Language: English
  • ISBN-10: 1476739986
  • ISBN-13: 978-1476739984
  • Product Dimensions: 6 x 1.4 x 9 inches
  • Shipping Weight: 1.1 pounds
  • Average Customer Review: 4.9 out of 5 stars  See all reviews (68 customer reviews)
  • Amazon Best Sellers Rank: #306,790 in Books (See Top 100 in Books)

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Customer Reviews

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Most Helpful Customer Reviews

16 of 17 people found the following review helpful By Loyd E. Eskildson HALL OF FAME on July 16, 2013
Format: Hardcover
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.
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13 of 14 people found the following review helpful By Molly K on July 16, 2013
Format: Hardcover
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!
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9 of 9 people found the following review helpful By doaks on July 16, 2013
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.
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8 of 8 people found the following review helpful By tom jaeger on July 16, 2013
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.
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7 of 7 people found the following review helpful By Amazon Customer on September 3, 2013
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.
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