The lightning rod for much of the criticism is Dr. Vincent T. DeVita Jr., 46, a pioneering chemotherapist who currently heads the federally financed National Cancer Institute. "I hate the term 'war on cancer,' " DeVita says bluntly. "Biologists studying cells are not soldiers, and doctors helping patients through chemotherapy are not involved in some kind of My Lai." Much of the flak that cancer doctors must face, he suggests, stems from a popular misunderstanding of what cancer is. "Every organ," he explains, "can have four or five different kinds of cancer. There are more than 100 cancers of the body, and you may need a 'miracle bullet' for each one." Ultimately, he believes, chemistry will be the source of those miracles. "For every disease we can cure now," he says, "there were patients who had to try something experimental. And you must realize that 90 percent of the patients who go on experimental anticancer drugs would otherwise be dead within a year. Is it better for children to die from leukemia or to go through chemotherapy, which is scary to see but which makes them well? The issue is, can you go through six months of hell to live a normal life? I think it's worth it. The most harmful thing we can do for patients is nothing."
DeVita's outlook reflects more than a pragmatic physician's approach to life or death; it reflects eight harrowing years of trying to save his own son. In September of 1972 Ted DeVita was 9. "One day he was a normal, healthy kid, and then there were lesions all over his body," says his father, then NCI's chief of medicine. "It was just an irony that we were studying aplastic anemia at the time. One look and I knew it was either aplastic anemia or leukemia. Neither was a good prognosis."
At that time 90 percent of all childhood leukemia patients died. Even more lethal was aplastic anemia, a bone marrow disorder that prevents the body from producing fresh blood cells and platelets. Tests showed that Ted was one of only 1,000 Americans each year who contract aplastic anemia. Most die because their immunological defenses against infection break down, but a handful make it through the first six months and achieve spontaneous remission. The boy's only chance lay in surviving that initial period. He was given massive blood transfusions and placed in a special germ-free room at the NCI clinic in Bethesda, Md. The 8½-by-10-foot chamber, one of some 80 in the country, is sealed except for a doorway, which is protected by a curtain of continuously flowing sterile air. Through it, Ted could see and talk to the outside world but not touch it.
Six months passed. The boy survived, but his bone marrow would not resume its normal functions. Under the circumstances, he was trapped. Leaving his enclosure would have meant certain death. Quickly, the family reoriented itself around his illness. His mother, Mary Kay, would visit in the afternoon. She would come back in the evening with his father and younger sister, Elizabeth; then DeVita would stay on alone. He taught his son to play the guitar and chess ("I don't think he'd mind me saying that I could beat him") and video games ("I could never get the hang of those"). Mostly, though, they got to know each other as few fathers and sons ever do. "He was twice as bright as I'll ever be," DeVita says. "I consulted him often about decisions I had to make, even about taking this current job. He was a good, close friend." After Ted retired for the night, his father would often remain, working on his research and writing until midnight. "For DeVita, it was sheer torture," says the boy's attending physician, Dr. Philip Pizzo. "Here was one of the leading blood specialists in the world having to face, with humility and sensitivity, not being able to apply all that he'd learned for his son." As the years passed, adds Pizzo, "it became much like the moral situation of keeping someone on a respirator."
Then, in May 1980, Ted died at 17 of complications resulting from repeated transfusions. "Mary Kay and I cherish every moment we had with him during the eight years we were able to keep him alive," says DeVita. "But did we do him any favors? Would it have been better if he had had his freedom for a few months rather than having been kept confined all that time? It's a tough question that I don't think I'll ever be able to answer." Yet as personally perplexing as the question may seem framed by hindsight, DeVita's professional convictions could not have allowed him to do anything else.
"The most tragic thing that can happen in this world is dying unnecessarily," DeVita says. The Bronx-born son of a banker and a mother who worked for an interior decorating firm, he remembers sitting on his front steps as a child, calmly dissecting frogs. "You know how Italian mothers are always saying, 'My son is going to be a doctor'?" he asks. "Well, it never occurred to me to be anything else." DeVita studied chemistry at William and Mary (chosen partly because his maternal grandfather, a master woodworker, had taken part in restoring historic Williamsburg, where the college is located). DeVita remembers facing culture shock: "I had long hair, everyone else wore crew cuts. I spoke 90 miles an hour, everyone else was slow and so laid-back."
One campus belle who didn't mind his big-city ways was Louisiana-born Mary Kay Bush. He pinned her during their junior year, and they married after graduation in 1957. Moving on to George Washington University School of Medicine, DeVita so distinguished himself as a student and as a clinical researcher that he was offered a job at the National Cancer Institute two years before he received his degree. After completing his senior residency at Yale-New Haven Medical Center, DeVita joined NCI as a senior investigator. He found special satisfaction in his work in the wards. "Many doctors like to take care of people with diseases that can be cured quickly," he says, "but I didn't mind taking care of chronically ill patients where the issue was not returning them to normal health, but keeping them alive. A little victory meant a lot."
At the time the chief weapons against cancer were surgery and radiation, but neither was effective against systemic spreading tumors or systemic cancers like leukemia. DeVita and several colleagues proposed using a sequence of chemicals to contain Hodgkin's disease, which attacks the lymphatic system. "Up to then," DeVita explains, "nobody felt you could kill cancer with drugs." But DeVita's group developed a four-chemical regimen known by the acronym MOPP. "When I first presented the results of our experiments to a meeting of researchers," he recalls, "one very distinguished man said, 'Dr. DeVita, do your patients still speak to you after you do this to them?' He thought we were killing them!" On the contrary, MOPP proved hugely effective. Of the original 198 patients treated with the drugs, 68 percent were cancer-free after five years and 63 percent after 10. Unfortunately, five percent of the patients contracted leukemia 10 years after their treatment stopped, and 80 percent of the surviving men became sterile. DeVita remembers his reaction upon being confronted by one infertile survivor: "On the one hand, I was dismayed that he had this side effect. On the other, I was pleased that he was alive to have to worry about it."
With chemotherapy suddenly an acknowledged tool in cancer treatment, DeVita was appointed head of NCI's solid tumor service in 1968; three years later he became chief of its medicine branch. Even as he coped with Ted's terrible illness, he continued his research and has published more than 300 articles in professional journals. In 1974 DeVita was named head of cancer treatment and early last year became the $60,000-a-year director of the entire institute, which has a permanent staff of 1,945 and an annual budget of nearly $1 billion.
Today DeVita, Mary Kay and Elizabeth, 15, live in a brick split-level home in Bethesda, only a mile from NCI headquarters. "We're basically quiet people," says Mrs. DeVita. "We don't go to parties much or a lot of work-related dinners." Instead, the family concentrates on activities like biking, jogging and folksinging. DeVita's personal passion is opera—he is accustomed to reading technical papers at lunch while listening to Puccini on his Walkman. However, his obsession is work.
Lately much of his time has been spent defending cancer research in general and the NCI in particular. "It's hard to report progress, because we don't have a 100 percent cure rate," he says. "But people who say the money invested in NCI is wasted just don't know what they're talking about. You cannot buy ideas, but you can use that money to put more good scientists to work." DeVita prefers not to comment on an investigation into the awarding of a $910,000 grant to a researcher who was discharged by a Boston hospital for allegedly fudging his results and altering patient records. But he has cut the number of independent studies funded by NCI and has tightened review procedures.
Still, he doesn't hesitate to act quickly when a big-money verdict has to be rendered. "Some people get very nervous when you have to make a $15 million decision in 45 seconds," he says. "But often there's no reason for waiting other than to let people think it took a decent amount of time."
Surprisingly, DeVita offers no rebuttal to charges that the NCI and the rest of the Cancer Establishment have taken too conservative an approach to research. "It's true," he says. "The system tends to exclude people on the fringe who have ideas that are radical departures. We ought to pay more attention to them." In fact, he isn't at all sure that his pioneering MOPP experiment, if proposed today, would be funded. Yet the Establishment, he believes, serves its purpose. "It's like what Winston Churchill said about democracy—it's the worst possible system but for all others. Too many people have predicted that the cancer program would be like the Manhattan Project [which developed the atom bomb] or putting a man on the moon. But you're not dealing with mathematical equations that tell you the amount of force required to propel an object into orbit. Biology is an incredibly complex field."
Undeniably, progress is being made. In the past 10 years overall survival rates have climbed from 37 to 45 percent, with especially dramatic improvement among sufferers from Hodgkin's disease, testicular malignancy and childhood cancers. These statistics are gratifying to DeVita, as are memories of cases he has dealt with personally. There was Ted clinging to life for eight gallant years. There was the recent lymphoma patient undergoing chemotherapy who, balding, gaunt and bleeding from mouth sores, cracked, "I'll be out of here and eating that spicy Thai food by the end of the week." And there was the woman who was not only dying of breast cancer but whose son had leukemia. "Her goal in life was to see him graduate from high school. I took her in an ambulance and sat with her on the side of a hill so she could see it happen," DeVita recalls. "Even those kinds of narrow goals are very worthwhile."
Saved by the Bell Reunion
The hookups, the meltdowns, the memoires
The case reveals what was really going on what they think of each other now!
