Transcripts For CSPAN2 Book Discussion On The Death Of Cancer 20160806

Good evening im the Program Director here at the Westport Library and im pleased to welcome you this evenings program. Just a few housekeeping items before we get started. He if you could please take a moment to silence your cell phones. There are cameras in the room and we are pleased to have cspan here to film this evenings program. Tonight an onstage conversation in the rupee an opportunity for audience questions at the end and im going to ask that you please wait for the mic her phone and speak into it clearly so your question can be heard. After the discussion the authors will be pleased to sign copies of their book. The books are available here and the authors will sign the books here to my right. If you could please form a line at the tables in front of the stage that would be great. And for those with a book in hand already you can just jump right into line. Thank you so much for supporting the library and its programs whether through your yearly gift toward purchasing a book at tonights program. These things all help the library to bring these wonderful programs to you. Tonight we have pioneering oncologist dr. Vincent devita who will share her personal history of one of the greatest science stories of our time, the fight agait cantor. The book, the death of cancer after 50 years in the front lines of medicine and pioneering oncologist reveals why the warren cancers wonderful and how we can get there. Its cowritten by journalist Elizabeth Devita raeburn and yes they are related. We are privileged to have the opportunity to have them both here to discuss the book which has received wide praise for its insight, craftsmanship, hope and humanity to tonight elizabeth will interview her father about his work and explore his personal story. Dr. Robbibaro underwriter the National Cancers at 21963 eventually becoming extracted and moving onto toplevel positions at memorial sloankettering cancer city and Yale University where he is currently the amy and joseph are a lot professor of medicine and professor of epidemiology. A list of this received a masters in Public Health from Columbia University and she writes about Science Health and society. Her stories have appeared in the washington post, self help, psychology today and Harpers Bazaar among other publications. Please welcome doctors devita and Elizabeth Devita raeburn. [applause] thank you all for coming. Can you hear me . I have been asked to interview my father for you which is something i have done a lot of over the course of putting this book together though most of our conversations took place over text or over scotch when they were together but we will do our best in this format to put together some of the conversations that evoke some of the comments it came out of that. I would like to choose my mother mary k. Who lived here many of these conversations. [applause] so this book is about the war on cancer and your journey through it but us people dont really know that much about how it came to be. Why dont you tell us a little bit about the back story. The war on cancer began in 1971 when the Congress Passed the National Cancer act which was signed on the 23rd of december 1971 as a Christmas Gift to the nation. It was the brainchild of mary lasker, very wealthy philanthropist who lived in greenwich nearby among other places and it was a very Controversial Program for a lot of reasons. One of which is its proposed that the National Cancer institute he taken out of the National Institutes of health and given to a separate agency. It proposed that the fda control of drugs be shifted to the National Cancer institute. It was controversial for one other big reason and that is that to get it through congress she had great influence. That can track would eradicate cancer by the bicentennial. Nobody leaves that was churn out a big mary did either. No scientist believe that was true. I think members of congress trusted mary and the press believed it for about 30 days and afterwards it went down at that particular time so was a very Controversial Program. They put 100 billion of their tax dollars into Cancer Research , so this book is really about my trek through the war on cancer. Mary had Something Like this in mind for a while that she was biding her time. What was she waiting for . Her husband died of cancer but as well come out as we talk about it in the book, theres a chapter named after mary called mary and her machine. She had a machine. She had and landers who was part of her operation and one of the reasons it was passed was and landers had an open letter to congress saying the American People telegram your congressman and congress was deluge with letters so she had this big machine. She said it in motion and it was very successful endeavor on her part. I think a lot of people would be surprised as cover that there was one patient that had a lot to do with merry stealing that it was time to start pushing forward in this act. There is some ironic coincidence. In 1969 i was sitting in my office and the phone rang and it was a chemo therapist as we called them in those days from boston, rita kelly and she said i have a patient who has gallbladder gallbladder cancer. She had been operated on by the great claude welch who was the most famous of and all surgeon in the country and he lived in washington and he worked with the congress and he wanted to know if i would take him. We were taking only the cases that we worked on so i said i really dont work with and there is nothing we could do for them at the time. There was one drug, right . There was one drug so i said thank you very much but i cant take him. 10 minutes later the phone rang and it was sidney fargo. And he said to me, he told me about the patient and he said id like you to to take human issa dr. Farber i dont work with this kind. He said you will take this patient. I was but i wasnt so i said yes i will take a patient so we took the patient and when i examined him you know im looking for lymph nodes and i felt lymph nodes under both armpits. But donald cancer doesnt go to lymph nodes under your arms. We are a biopsy that it turned out he had lymphoma and we now have a second drug treatment that we have developed for lymphoma and that was working very well. We treated him and mary lasker used that as her cue. She said have provided the missing link. Most people dont die from cancer where it starts. They die from secondary deposits elsewhere. For example women who get Breast Cancer dont die from cancer in the, they die from a chassis is. When he actually wrote the actual cancer attacked himself falling to the congress in never ask the people i suggested testify he said he needed somebody that was of believer and was very interesting. Explain what a contradiction that she was. There was nobody like her before or since. When i first met her shoes coming to the National Cancer Advisory Council with a mink coat draped over the back of the chair in a big bouffant hairdo. She would put on her makeup to get the impression may be she was just frivolous but nothing could be further from the truth she knew what was going on but when i met her, she was a director she wanted to come see me i said to worry i can take care of her she came to my office 15 minutes later she had been eating out of her hand she was very smart and very logical you could not argue with some of for logic shoes to take me around to congress with her in a lot of my experiences come from that spinach to recusant orthodox methods to read the answer goes to tell anybody about the lunch. [laughter] in the spring you have the budget hearings said she would come down and stay with her good friend in a lovely home outside of washington then she would visit the congressman and she would have dinners and lunches and youre only sitting next to somebody that had the information in that you had it was carefully planned i got a call and she said would you come today . I said i can i ian busy i have a clinic this afternoon in a very stern voice said mary once you to come. Please come. Fisa i will rearrange my schedule and how i got there a little late there was a limousine in front of the house we had the usual routine she would tell him about all of the good things and then ask me to Say Something about what we were doing and about one hour later he returned to congress mary took her coffee to the living room and i said i said that was read she said he is maggies driver the chairman of the Senate Appropriations committee who had all the money. So she saw my shock to look instead he drives maggie to work every day he drives her shopping all day and she is the last person dead she was surrounded him with people who were primed with all the information that you needed. I chuckled all the way back to my office in and he did not stand a chance. [laughter] many doctors were appalled. It was a very Unpopular Program personal the implication was that money would buy ideas. But money does by ideas. You can put money into a problem to make it work but universities wanted the money to go into the small Grant Programs because that is the way they support their faculty. They were not happy the way the money was sifted out and they didnt want anybody telling them what to do. Anything that you could agree that until very recently it would last maybe 10 years. You had a textbook on cancer it is 11. 5 pounds to get it in my backpack it is led by comparison for the layperson. What compelled you to go from writing for doctors . She said it was very clever of less so we would have somebody to chronicle what we did. The reason the book is readable she made a readable but here is another reason. To take 100 billion is a lot of money. Curve they should know something about that the way it actually happened not the imaginary flowery language. I was there at the Cancer Institute before the act was signed that in part led to it to become director of the Cancer Institute i went out to the biggest Cancer Center in the country and then to the elite university there was a unique position to describe though whole thing. Given the fact that i have a unique opportunity and did you enjoy reading that. There are some things in in how courageous it is for you did anybody caution you . Fighters six years ago i went down to mount sinai for a sabbatical for months and my good friend glen of the pioneers from chemotherapy was there so we had lunch at a little Italian Restaurant down the street he has loud ties and it is fun but then he got very serious with a the goahead and do it. But people really dont need to know those stories. So i was a little shocked. And i have not yet heard from jim holland. It was so out of character that we put the story in the book. Any responses you may get . And people seem surprised i mention names and institutions to tell the truth. To be as truthful as i can remember it. That if people complain tell them to write to their own book. [laughter] what criticism is the off hardest that has come about has been the hardest in how you respond . We were reviewed twice in the new york times. But the second to last paragraph . That they would like to see more in retaliation. But i wasnt writing a book about the whole field it was my experience. And i describe a friend of mine that we take care of how i moved from institution to institution to get access and he says that the very last that the next new drug of 3. Nine months. That in a way to me because one of my favorite depictions that he suffered from median disease. That means half the people but if you look at the curve 25 of the people were responding so i was shooting for that. And as the statistician they are statistical tools to compare studies. With the of Laboratory Science is a wonderful science. He said it is good we dont know enough to do all of these things. , you dont know enough but Laboratory Science the people who spend all their time they want to know everything before you do anything. With Cancer Treatment he dont have to do that but critical parts of the cancer cell in in the book you describe all walks of cancer. If you get them back to where they were before then you dont have to know everything. So those are the two that bothered me the most. It is understandable. It with the overflowing martinis and then to pass out in the bathtub and then these guys are your mentors. So people ask why would you show them that way so early in the book . Were you trying to say . We went to a party that we were talking about end he could walk and his dance better than those could walk on their feet. Fin but two reasons they are very important to people and throw the book i make it clear their contribution was important to describe the they were they worked very hard for you could look in his eyes to see a very intense yet there is i had to make the decision that they are so far out of the norm that we were warned when we went to the Cancer Institute stay away. And was up privilege to go there be you didnt go there in vietnam. We wanted to be there but dont get too close. That was professional but space the party so i had to make a decision will vice day but the power is allimportant but it was the right thing to do. I sent a copy of the book that maybe some of the stories and make them uncomfortable cry and i got a lovely letter and they thought that was a day important contribution and i am very fond of the me and. And indestructible. Maybe a little more mellow. A lot. In that interview itself is very interesting there was one book that he came to talk to me he put some of that in. Not all that he did not use that story. Host in 1963 can you describe the wars and when you first got there in the patients . If you got cancer if you were lucky were operated in the radio therapy was a round of but not really good machines were available. Chemotherapy was on the fringe most people did not believe in it. There was very peculiar. I was in the laboratory that supplied the faculty those that had idiots cancers in all of whom died there wasnt much excitement just testing new drugs out much hope in the other person rand but upstairs was a lot of hostility. Id you feel unhappy. There was no escaping. And dc things happening you had never seen before. Despite the fact who are these people . They were telling me something different. It is a very wellknown hematologist who was internationally known so we have to take the slides down. He would say it is crazy with their doing it and then he would say okayed the bone marrow is coming back is killing the veins but it is disappearing he says they are crazy but he is telling me it is working that is all locked in that this approach was with is of very interesting time even within the Cancer Institute to have frowns on the 12th floor to the rounds of the people from the other departments and to never hear that before in the people all around at the time with the atmosphere at that time. But what was so different in the other warda . And then to start off with Infectious Diseases the cancer drugs were considered to be worth less. To toxic drugs was considered bad medicine for was considered insane. Garett each initial stages for a different drug in a combination. It turned out to be very useful combination said they were not happy with any thought of doing anything so it is interesting time with of turmoil that is unusual to say the least. The regiment that you can apply for hodgkins disease that was interfirst dab . Because there was so much of a bad feeling we had to do a pilot trial called the pope it was a shorter study it was a little more toxic to put patients is in reverse isolation. We didnt have drugs to control loggia or vomiting so these are trying times but it worked. So we begin to face in an unusual problem we knew we needed to do something for the duration. Treating the bone marrow marrow, you continuously treat and tell the of leukemia cells are gone. If you treat Something Like collagens bone marrow is normal so you have to work around that and give it long enough to grow between treatments than remade translations to study that bone marrow and we came up with a fairly complicated schedule and my first partner in this that is an interesting story because when i first met him we did shake hands he said i want to be a dean witter of the feared nobody wanted that. [laughter] it was very unusual and sure enough he was the Youngest Team in the medical school in the country to ask what happened but we do still stay in touch. So we converted of the complex schedule. What was the biggest obstacle to get out to patients . After the first four years if that would occur it would occur said dado was very good the data was very good but if you did not believe in the chair there breadmaking 64 nothing so that schedule was very difficult and i tell the of a story of sloankettering right before i went up there as a physician in chief and they warned me to make it work that they would grill me pretty good. So i presented my a data than one after another they said the implication is that i was taking the easy cases they were taking a hard but the implication was i was putting the data so what do you do . We dont like the nitrogen so we use our own. So that was a dose that was easy to use but it makes you throw up so we cut it in half then the other causes nerve damage so we cut that back now we carefully worked our schedule to get the drug inbetween without giving the bone marrow and then two weeks between the cycle. And they said our patients come to west on the subway every dealt with them to vomit on their way home. I said tell the patients they can vomit in be cured or not and take a taxi . That was very emblematic of the problem to stick to the dosing schedule. When it went to the Memorial Hospital as physicians and chief to get an idea of some of their fears hopeful football teams that developed hodgkins 6foot 7 inches m a calculated the dose according to my schedule they said this is crazy they would not do it. I had to go to the credit to inject this giant with a dose based on service area you dont give a signal rustler this size the same dose. That im surrounded by the nurses and doctors are expecting him to fall over dead but then he went into remission but this is the problem that you have said we do still have that if you are in private practice you need measurements you can give easily in doctors look for them in those days there wasnt anything but that program. Alaska about the fdas you are pretty critical with the cancer patient so what are they getting wrong . Other day in the fda . And then somebody will be sent out to kill you. [laughter] they do a lot of good things if they approve the job the drugs rapidly but cancers are special it is the most curable chronic disease and also the most fatal those that died dont want to wait 10 years for the next new drug to come along. So they tend to rely on comparing and survival which is very difficult under the circumstances but it should be proven it is safe and if it hits the biologic target if it can pick up those mutations most of the defense is that we talk about were done in the post marketing period so we should give these tools and let them use them to come up with the new ways to cure cancer. The way to do that is to hit the target then delete the early trials for what we call phase one and phase two studies. The fda could retain the right to come in and on it but if you set up a protocol and somebody wrote a paper in some cases it will take 800 days for a protocol to be approved. And it goes through a couple more committees you go back to the system we didnt mention it yet that one of the meetings i attended was nicknamed by my colleague as the society of jabbering idiots. But it was the most exciting meeting i had ever attended the name is misleading. But you take that latest information in bring everybody together and then the next day he change the protocol now could be a hundred days away. So if you do what i said based on the basis of safety to delegate phase one and phase two you would revolutionize how you approved the drugs you know, any government that would cost less . All clients the people who run committees to have a better system the fda will not do that on their own. Believe me iran the Cancer Institute for many years. They did not give up the power it has to be squeezed out so it would take some interest from congress and get them to change. We need another a and lenders. Never went to a meeting where mary was in the audience that did not refer to her as the angel of mercy there really loved mary lasker we have no organization that comes close to be like mary lasker. What changes are in motion to look forward . People ask questions about the papers recently but the most is in immunotherapy not making much progress as well read developed one of the most successful in immunotherapy programs but they were stymied how to get the immune system to react and then in 1996 dr. Ellison discover the checkpoints federal little receptors that turn the little side down so it would not react the way were protecting ourselves to be attacked by our own as lymphocytes. Now you could develop drugs to block that cancer cells are a little piece isnt if it turned on the checkpoints cop it could turn them off so now we have the checkpoints they have been approved for melanoma and it has been changed so it is treated now i have seen Patients Living years with metastatic disease is working with lung cancer is a very difficult to merge to treat in fact, it is working pretty much every cancer it has been tried although not the same degree Breast Cancer the Response Rate is lower but it is there but were still working a details so now we have chemotherapy and immune a immunotherapy and we can mix and match but that is one other thing now we can in junior the tcells you can find a mutation the guy who did this to us a tumor that rarely responds to anything to sequenced the genial mutation that is unique to that particular cancer than the tcell that is respondent to wit they got responses nobody has ever seen that type of cancer but that is very personalized medicine to have to take the tour in sequence find the receptor to have to have very sophisticated laboratories but as time goes on i think that will be more widely available. How does the cancer act to fill its mandate . The mandate was to support about 70 to 100 billion was basic Laboratory Research and i would go with mary lasker she said that would ask the 200 million above the president s budget i said nothing that i can say can testify that she said i will only get half but sure enough we get half 5 million goes into the area talked about the other 5 million was Laboratory Research which was fighting at the times we supported research because the Smoking Cessation programs are very successful so now we can prevent hodgkins from going into malignancy in the morbidity is so much less to be older in the field has its advantages if you take Breast Cancer that difference from then and now is enormous overall 25 in this data is five years old the takes five years to collect the data so 25 percent when we measure in 2015 it will be 35 that is my estimate. Sorry supported the research and reduced the incidence and reduced morbidity and mortality the fateful mistake that dairymaid was promising to do all that by the bicentennial that was not possible if it has taken a while but the best is yet to cubbies of all happened with the old approach to treatment not even measuring the impact of the immunotherapy or targeted their peace with think were in for a very exciting time. Thank you. We have time for questions. Please use the microphone and out here as well as i would like. What do you think is the role of the pope with the treatment of cancer . Is very important we have a word that missiles have energy when you die you reach inside and outside of the cell i would see patients even responding to treatment but gave up and died so the ability to say i will do this is important motivation is important component of a patient treated with hodgkins disease that is alive today he said to me when i leave here i get the treatment for live in bethesda at the National Cancer institute there to pools by either side the symbolic keeling pools when i would leave our take my socks off and walk through the pools which do you think worked the pools are the treatment . This jedi will take all the help i can get. [laughter] thanks for your talk. My husband had esophageal counts cancer was fortunate to be operated on dr. Swanson who teaches at harvard medical school. But what progress has been made as it is a very difficult cancer and then the problem with swallowing after words has there been any progress made . Yes. You usually dont do surgery alone anymore. It is treated with chemotherapy and radiation then surgery but a lot of people unfortunately it is still difficult to treat about one quarter will be treated without surgery so that is an igneous advance. Is actually easier to give surgery and radiotherapy inky mother began this surgery am sorry. You get a better results still long way to go with esophageal. O lot has been talked about the cost of cancer care lately been even with the fda approval process wusses shortened in the new drugs were given a lot of patients dont have the means to pay for these drugs. And that is what jimmy carter which made him cancer free so howd you deal with the crazy prices . Jimmy carter by the way received radiation which i think took care of the brain lesion in that is one of the drugs that works with melanoma but the cost is complicated and many have increase the price 700 percent got what he deserved. [laughter] you have to value people but the cost is approved in the Insurance Company pays for it it is a cost to the system not to the actual payment payment but if not then it is a cost to the patients we have a system for giving drugs out when i was at the Cancer Institute that worked very well when i left to the fda blue with a way but in most cases the pharmaceutical companies picked up the cost and they are happy to do it because they said it is good enough to give but not approved then gives credit to their drug why have been on the boards and it was a very successful drug. That was 800 million. To make sure it doesnt go bankrupt. It needs a lot of discussion it is tough one way or the of their. Especially pancreatic and covariant for those that have a low success rate. But one of their reasons it is difficult to treat you dont know what is there for very long time and of varying cancer is the same way. Somebody asked me this earlier talking the newspapers about measuring the dna from the tcells that is a holy grail in then they could tell you whether or not if there was a cancer cell present it it was dash than no more treatment or advanced cancer it went into remission and they just keep measuring did you could tell when you could stop you would not to do so many cycles. I think that will happen but it will take a lot of doing. So we are hopeful. It is a tour that begins in the placenta windows two o that means no cancer cells. For pancreatic cancer is it recommended at this point to add the immunotherapy to the chemotherapy . I have not seen any data i was just ask that question in the mail. One of the reason pancreatic cancer is one of the last to test something new is very difficult to measure what is going on they are sick and dying the you cannot see the tumor so in the developed a new drug for them to measure how they are doing. Why . I dont know anybody hasnt but if i had pancreatic cancer i would knock on someones door to say i will give it a try. More than anybody else you have the unrelenting or uncompromising barriers to progress their art tiffany so when you talk about welcome glad well, it is hard to get against some of these obstacles because of the laggards of two rural what about this day and age with significant advances to have that momentum to fight the system . Had to get those people accelerated . One of the reasons i wrote the book that maybe some of the barriers come down. I would not be wanting to do that we did in about three years. It would take 15 years. And that is what they are facing and how you maintain enthusiasm if there isnt enough energy left with the Committee Reviews it is a very difficult time to put 100 billion into this. It is motivating besides cancer why is the best preventative message for cancer whether smoking or alcohol or things like that . To stop smoking . 40 of all related to cigarette smoke. If you cut that rate in half there is lots of abuse stories about bacon. [laughter] i think if you ate it every day the risk of getting bowel cancer is higher but if you would smoke and eat bacon than the risk is so much more to keep them in mind we go to those that migrate if they have a good diet have a lower incidence of cancer we know that dye it is important but we know how to manipulate there is about 35 different diets. So the one thing that we do know. The lady with the microphone determines. [laughter] hopefully there are people in the private sector that hope to avert some of that frustration and i put this up there because with the subject of alzheimers isnt to start to accompany the nonprofit into attract investors what they are doing to fight certain doctors and programs that they think potentially influence by putting money behind it. But when they put 15 million into the hands they still have to go through these tubes so that those in the up and cool pinhole. Thanks for coming. How close are we to walk into a laboratory to pull five assisis the blood coming up with a diagnosis with the dna sequencing . There are companies now specifically for that purpose it is a very difficult test to prove and it takes a long time to show your diagnosing cancer. There may be a warning if there is a false positive of 20 it is pretty hard to do. So to know how long it will take to get that done. You are more likely to see test specifically ban a test for all of them. Medical marijuana then i heard in that area of the system that is unique to mammals so we have receptors how to redo that of that department with the propaganda . The more she worked out because there were receptors for for the reason that you get high is a drug that come from plants in marijuana works we tested that and it was the fun time to walk around the halls. [laughter] does that work for help to create remission . Now there are other ways to do that in it is useful. To questions. What is all the research after cop in in the con fines of the system . So we all look at things in technology and the of think time wise since the war on cancer begin in now here we are for the next five years it could be much faster than the last 40 combined. Is an accelerated rate every issue is something new and exciting so we do two things i dont want to take too much time but some are turned into a chronic diseases without that the Cancer Institute it was fatal but now they can take a pill and live a perfectly normal life span after a while it doesnt work but there are five followup pills so that patients are living perfectly normal lives they still have the disease so you can cure them is some of the immunotherapies in some patients with lung cancer it isnt going away but it is in growing either. So i think that is the change that is going on. Is entering a lot of people because that system that we support Cancer Research there would be a Clinical Trial program and now they do very well in those and make major discoveries but that was the big point so therefore we we should not restrict the grants. [applause]