Cancer Frontier: Bringing the New Sciences to an Old School

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Cancer seems to have an endless supply of people who want to write about it. Why not? It’s an intriguing subject of life and death and struggle and hope, one that touches virtually every person of a certain age. However, the bookshelves are filled with cancer survivorship books, so to stand out, an author must have an especially compelling story.

Likewise, books detailing scientific advances in the battle against cancer also abound. Then there’s Siddhartha Mukherjee’s Pulitzer Prize winning tome, The Emperor of All Maladies, which offers a biography of cancer, beginning in 1947 as Dr. Sidney Farber began his earnest research and treatment of childhood leukemia. Vying to make its place in this crowded field is a new book by noted cell biologist and President Emeritus of Memorial Sloan Kettering Cancer Center, Paul A. Marks, MD, titled On the Cancer Frontier: One Man, One Disease, and a Medical Revolution.

Career in Cancer

Written with journalist James Sterngold, Dr. Marks tells an autobiographical account of his career in cancer, beginning in his third year at the College of Physicians and Surgeons, Columbia University Medical School, New York. Dr. Marks recalls his early days on rotation in the pediatrics ward. A teenage girl diagnosed with lymphoma had captivated him with her buoyant spirit and will to live. Then came the experience shared among all young oncologists. “One day, my young cancer patient just seemed to fall asleep as she slipped into a coma and then passed away. I asked myself, was this really the best my profession had to offer?” Dr. Marks offered.

Dr. Marks continues his opening chapter reviewing background science and some historical inflection points in cancer care. Here the reader will also learn that Dr. Marks was an early skeptic about the war metaphor used to rally the scientific troops after President Nixon signed the National Cancer Act into law in 1971. By then, Dr. Marks was Dean of Columbia’s medical school. He wrote, “Wars are won and lost; this is a contest with our inner mature, our inner mechanisms. We can, in time, control them, but not ‘defeat’ them.”

So concerned about what he felt was the wrongheaded obsession with a cure, he wrote a letter to the Chairman of the President’s Cancer Panel, boldly expressing his worry. “It was an impulsive gesture … but that letter altered my career and, perhaps, helped influence the direction the ‘war’ would take.”

Science and Politics

In On the Cancer Frontier, Dr. Marks seeks to enrich the reader with the history of cancer care as seen through the experiences of an eminent oncologist, well-traveled and well-versed in both the science of cancer, false hopes and all, and the politics in the hierarchy of the oncology world. The book is also written to inform but not intimidate the lay reader. To that end, the book succeeds, largely due to the skill of journalist James Sterngold who keeps proper pacing between the expository and the anecdotal.

Since this book is lay public–friendly, what does it offer readers of The ASCO Post and others in the professional oncology community? On the cancer science front, there’s not a lot of information that will be of interest. But that gripe is small, because the true value of this book lies in the telling of stories that oncologists, especially those just entering the field, will find enlightening and fun to read.

For instance, Dr. Marks is passionate about absolute honesty in every aspect of oncology. He neatly describes a time when his passion boiled over at an informal gathering of researchers at Columbia University. “A faculty member had tried to impress us with what I believed were exaggerated data from experiments in gene expression. It seemed to me that he was on a big ego trip, so I challenged him. As the argument grew heated, I reached out, grabbing him by both arms, shaking him, and demanding that he stop massaging the data—an episode reported some years later, to my embarrassment, in the New York Times Sunday Magazine, in a cover story about my leadership of Memorial Sloan Kettering.”

Agent of Change

Given his stature as a leader and agent of change in the history of Memorial Sloan Kettering, the reader will anticipate reaching the point in the book when, in 1980, Dr. Marks becomes the first President and CEO of a unified—previously, Memorial Hospital and Sloan-Kettering Institute—Memorial Sloan Kettering Cancer Center. It’s worth the wait.

Dr. Marks gives a fly-on-the-wall description of meetings with Memorial’s then Chairman of the Board, Laurance Rockefeller, whose father, Nelson Rockefeller, was an original patron of the institution. By now, Dr. Marks had already turned down a leadership role at The University of Texas MD Anderson Cancer Center and was itching for a challenging opportunity. During a cocktail party at the Rockefellers’ suite, Laurance Rockefeller confided in Dr. Marks while showing him his art collection that included Renoir, Matisse, Picasso, and other masters.

Rockefeller whispered, “You don’t realize it, I don’t even think Mary [his wife] realizes it, but all these paintings are copies. I had the originals copied so we could place them in museums. Each copy is exactly one inch larger than the original, so they wouldn’t be confused.”

After Dr. Marks takes the position, the rest, as they say, is history. In chapter 12, one of the book’s strongest sections, Dr. Marks brings the reader into an exciting and rewarding part of Memorial Sloan Kettering’s history. The title says it all: “Enlisting a Major New Ally—the Cancer Patient.” This is when Memorial takes a lead in palliative care, bringing in Kathleen M. Foley, MD; psycho-oncology, enlisting the pioneer, Jimmie C. Holland, MD; and eventually, integrative oncology, with another pioneer, Barrie R. Cassileth, MS, PhD. This section will make every reader feel good about those on the front lines of cancer care.

Closing Notes

The book ends with the chapters “Cancer Screening as a Way of Life,” which is certain to receive its share of criticism from those who are skeptical of some of the modalities touted by Dr. Marks, and finally, “The Next Leap,” which may leave readers, at least those knowledgeable in health-care policy, a bit disappointed. Much of it is rehashed information that can easily be challenged.

That said, Dr. Marks and Mr. Sternberg set out to inform and entertain. Mission accomplished. This is a worthwhile book that should make its mark in the increasingly popular area of cancer care history. ■