Book reviewing can breed a sort of cynicism about the publishing business. You open the envelopes, scan the covers: He wrote another book about…Does she really think anyone cares that…Out the galleys go, onto the stoop, orphans to soak in the rain and bake in the sun. Rare (at least for me) 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.
Well, Clifton Leaf’s The Truth In Small Does: Why We’re Losing the War on Cancer – and How to Win It is precisely such a book, which is why I am writing about it for a third time. I first covered it in June, for The Wire’s summer book preview. Later, I wrote an online essay for The New Yorker comparing his book to Siddhartha Mukherjee’s The Emperor of All Maladies, a Pulitzer Prize-winning “biography” of cancer.
And now, on the day that Leaf’s book is being published, I am writing about it again. I should say that I don’t have any stake in his success. Rather, like pretty much every other American, I know people who have had cancer and have died from cancer and want the disease eradicated as quickly as possible, even if humanity has been trying to do so for 3,000 years, with only halting success. On a more selfish note, like every book reviewer I know, I think that most people who write books should be forcibly prevented from doing so, especially those who write about science. Leaf, by contrast – he was at Fortune and, more recently at The New York Times – is a terrific writer, an obvious polemicist at heart. A fiercely written book on a fiercely urgent subject is too hard to resist. Which is why I am returning to Truth In Small Doses.
Leaf’s book repeats and expands an argument he made back in 2004 in a contentious Fortune cover story. He says we are losing the War on Cancer – started by Nixon in 1971 – and losing it badly. Because our research is too slow and too cautious. Because our funding system is too bureaucratic and hopelessly moribund. Because we fear risk. Because we are more focused on understanding cancer than simply defeating it, blasting it away with every resource we’ve got.
Not everyone is going to agree with Leaf’s premises, and some may bristle at a non-scientist criticizing the complexities of medical research. My brother-in-law, an oncologist in California, criticized many of the book’s assertions. In his telling, Leaf is too quick to dismiss the progress we’ve made, too ready to disregard the promises of immunotherapy and good scientific work being done elsewhere. Others have accused Leaf of “negativism.”
Those charges may be fair. Then again, some 1.6 million Americans are told that they have cancer each year. Every president has promised to win the war, yet the fight rages on. Truth In Small Doses is a portrait of that battlefield that, like Matthew Brady's photographs from the Civil War, show the struggle with unsparing detail.
Painting: The Clinic of Dr. Gross by Thomas Eakins, via the Philadelphia Museum of Art.