ONI sits down with Dr. Vincent DeVita
As a young boy, Vincent DeVita dissected frogs on the front steps of his parents' house in Yonkers. In the eyes of his encouraging mother, he was already a budding physician fascinated by the internal complications of life.
As a young boy, Vincent DeVita dissected frogs on the front steps of his parents' house in Yonkers. In the eyes of his encouraging mother, he was already a budding physician fascinated by the internal complications of life.
"My mother always said I'd be a doctor. Maybe seeing me dissecting frogs convinced her, but I never doubted it myself for one day," Vincent DeVita, Jr., MD, said over coffee in the light-filled high-rise apartment he keeps in Manhattan. The large windows offer panoramic views of the Hudson and the massive sweeping city below.
"I bought this place at the end of August in 2001," he said, gazing out toward downtown. The somber implication of what happened at the World Trade Center just days later briefly hung in the air.
Then he added, "It's walking distance to the opera," a great convenience for someone who has been known to attend as many as four opera performances over a single weekend.
Dr. DeVita speaks with a courtly, inward voice that belies the sense of power behind the man. He has served as director of the National Cancer Institute (1980 to 1988) and director of the Yale Cancer Center (1993 to 2003), where he is currently chair of the advisory board.
Dr. DeVita's remarkable career began across the Mason-Dixon line at William & Marya Southern culture shock for the city-smart, fast-talking New Yorkerwhere he earned his Bachelor of Science degree. He went on to George Washington University School of Medicine where, in 1961, he was awarded his MD degree with distinction.
Over the following decades, particularly at NCI and Yale, Dr. DeVita developed an instinct to fight back against critics and naysayers, who, in his mind, were entrenched in cancer dogma, slowing the pace of progress.
When Dr. DeVita first entered oncology, the argument was that chemotherapy did more harm than good, and, to a large extent, it did.
"At that time, doctors who believed drugs could cure cancer were considered modestly insane," he said. "Somebody had to show the skeptics that you could actually cure cancer with the right drugs."
First training in cardiology
Given his huge imprint in the treatment of cancer, it might surprise some that Dr. DeVita's initial specialty wasn't oncology. In the 1960s, cardiology was the center of gravity in medicine: implantable mechanical devices, heart transplants, and superstar surgeons like Michael DeBakey and Christiaan Bernard were the buzz.
Fresh from medical school, Dr. DeVita began his career as a cardiology resident, doing catheterizations and writing papers; one, in fact, was heavily cited in the literature for more than a decade.
"I'm still a pretty good cardiologist," he said offhandedly.
In 1963, he applied for positions at both the Heart Institute and NCI. However, what he called a "spectacular run-in" with the director of the Heart Institute, where he wasn't accepted, sent him on a serendipitous trip to a laboratory at NCI.
He asked the chief of pharmacology if he could work on the heart drug digoxin. "The chief, being a wise person, said, 'Sure, work on anything you like,' and suddenly I was surrounded by these maniacs doing cancer research," Dr. DeVita said.
Within 6 months, the superheated atmosphere of cancer pharmacology had "infected him," so much so that it changed the course of his life's work. He spent the next 2 years there doing clinical service and research.
"I never, for one moment, regretted going into oncology," he said.
Not long after joining NCI, Dr. DeVita would take his place in history, leading a research team that ultimately developed the four-drug MOPP regimen, which became the curative treatment for Hodgkin's disease.
"To this day," he said, "the MOPP paper is the most cited article in the history of the Annals of Internal Medicine."
Asked if MOPP was the highlight of his career, Dr. DeVita said, "There have been many highlights, but seeing people who are 40 years out after a diagnosis that prior to MOPP was essentially fatal, is certainly at the top of the list."
Bucking the trend at Yale
Bucking the established order of the day was tough. In 1965, Dr. DeVita left NCI to complete his advanced medical training at Yale. But as he tried to apply the innovations he had been working on at NCI, he found himself being "struck down" by the older professors.
He sought council from "the great" Paul Bruce Beeson, MD, chair of the Department of Internal Medicine. "Dr. Beeson could have told me to follow the established lead and do what I was instructed to do," he said, "but, instead, he told me, 'Follow your eyes, find what is meaningful in spite of the established order.'" Dr. DeVita "followed his eyes" toward innovation in cancer therapy. Asked why he chose cancer over cardiology, he said, "I saw astonishing potential in the field of oncology, and I wanted to follow the miracle."
Many years later, at a Yale dedication for Dr. Beeson, Dr. DeVita approached his former mentor, then 88 years old, and asked if Dr. Beeson remembered him. "Beeson looked at me and said, 'Why of course I do, Vin.' Then he handed me his empty glass and said, 'Can you get me another Bourbon?' I replied, 'Sure, Dr. B. What else are residents for?'" Dr. Beeson died in 2006 at the age of 97.
Personal tragedy
Even during personal tragedies, the haunting realities of modern medicine's limitations were close at hand. Dr. DeVita diagnosed his own son, Ted, with aplastic anemia in 1972. Ted battled the disease for 8 years, much of it spent in a sterile hospital room to protect him against infections, and died at age 17. His strugglealong with that of another young patient with SCIDSinspired a fictional 1976 made-for-TV movie The Boy in the Plastic Bubble, starring John Travolta.
In her critically acclaimed book, The Empty Room, Dr. DeVita's daughter, Elizabeth DeVita-Raeburn, wrote about losing her older brother, whom she described as the "ringmaster of her days."
Dr. DeVita is writing a book about the war on cancer for the lay public. Not surprisingly, his daughter, he said, is working on it with him. With an inward smile, Dr. DeVita said, "She keeps me honest about communicating on a human level with nonmedical people."
Support for palliative care
One can imagine the apprehension felt by young residents at Yale when word got out that Dr. DeVita was returning to assume the directorship.
"I was terrified. For lack of a better term, Vincent DeVita was a 'medical god,'" said Ann Berger, MD. Dr. Berger, currently chief of pain and palliative care at the NIH Clinical Center, told ONI that Dr. DeVita didn't seem quite sure of his young resident who was far too "touchy feely" for his cancer clinic.
"I was interested in palliative care, and here I was, pushing a tea cart with hats and boas down the hall to give symptom relief to the patients," she said. "At that time, Dr. DeVita didn't like the term palliative care; he felt it implied death."
During a meeting with Dr. DeVita, Dr. Berger saw the man behind the reputation, "a genuinely caring person." He went on to support her effort to establish an arts & crafts program for cancer patients, a prescient step for the times.
In conversations, several former colleagues described Dr. DeVita as a true visionary, a term rarely applied among the elite of any scientific community.
Steven A. Rosenberg, MD, PhD, chief of surgery at NCI and co-editor with Dr. DeVita of the gold standard in oncology reference, Cancer: Principles and Practice of Oncology, also spoke to ONI for this profile. "Dr. DeVita has the unique ability to see the big picture and make the connection between the lab and the cancer clinic," Dr. Rosenberg said.
During the conversation, the genuine affection for Dr. DeVita came through. Dr. Rosenberg twice repeated the phrase, "Dr. DeVita has a vision for progress," as if once weren't enough to drive home the point he wanted to make.
Dr. DeVita said he remains firmly "an optimist" in the war on cancer, despite some qualms about what he considers a movement toward guideline-driven government paradigms that may stifle innovation. He uses achievements in breast cancer therapy as an example of where optimism can lead.
"Years ago, women with all stages of breast cancer had radical mastectomies, leaving just tissue over bone and a painful swollen arm. Then they died," he said. "Look how far we've come."
