Together, Dr. Flaherty and I look at the numbers—the result of the Avastin/Nexavar clinical trial. The average patient in his trial got fourteen months of extra life. Dr. Flaherty estimates that, without any treatment, someone at Terence’s stage of the disease would live three months. Terence got seventeen months—still within the realm of chance but way, way up on the bell curve.
There’s another bell curve that starts about where Terence’s left off. It charts the survival times for patients treated not just with Sutent, Avastin, and Nexavar but also with Afinitor and Votrient—drugs made available within the past three years. Doctors and patients now are doing what we dreamed of, staggering one drug after another and buying years more of life.
At the 2008 meeting of the American Society of Clinical Oncology, Dr. Flaherty presented the results of the clinical trial that Terence was part of. The slides and charts showed the other cancer doctors that Avastin and Nexavar work well on a wide variety of patients.
Yet of all the people who saw those slides, only Dr. Flaherty and I know that the solitary tick mark at seventeen months was Terence.
Only I know that those seventeen months include an afternoon looking down at the Mediterranean with Georgia from a sunny balcony in southern Spain. Moving Terry into his college dorm. Celebrating our twentieth anniversary with a carriage ride through Philadelphia’s cobbled streets. That final Thanksgiving game of charades with cousins Margo and Glenn. And one last chance for Terence to pave the way for someone else—or, as he might have said, for all those other poor sonsabitches.
ACKNOWLEDGMENTS
This book grew out of an article published by Bloomberg News and Bloomberg Businessweek on March 4, 2010. I would like to express my appreciation to everyone at Bloomberg for the opportunity to expand the work into this book, and most especially to editor in chief Matt Winkler.
I benefited enormously from the editorial skills of my Bloomberg colleagues, who edited, reported, nudged, critiqued, and suggested. These include Bob Blau, Reg Gale, Bob Ivry, Norm Pearlstine, Shannon Pettypiece, Ellen Pollock, Anne Reifenberg, Marybeth Sandell, Bob Simison, Josh Tyrangiel, Mike Waldholz, and Ken Wells. I owe special thanks to my colleague Chuck Babcock, whose investigative skills I leaned on so heavily in sorting through the piles of complex documents. And to Reto Gregori, who makes everything happen, everywhere, all the time.
Thanks to all my wonderful friends, family, and colleagues who read, commented on, and corrected my manuscript: Sandra Mims Rowe, John Carroll, Nikhil Deogun, Doug Blackmon, Chuck Camp, Rebecca Blumenstein, Sharon Luckerman, Sidney Rittenberg, Joan Maxwell, Abbe Fletman, Jane Hinkle, Dick and Barbara Epstein, Woody and Sandra Boyd, Charly Dickerson and Mardean Moglein, Fred and Gail Laudeman, Bill Laudeman, Dick Laudeman, Charles Laudeman, Rita Brown, Margo and Glenn Lindahl, and Miles Lindahl. Special thanks to Jane Lindahl, whose editorial assistance got me through; to my sister Alix Bennett, who always gets me through, and her daughters, Aly and Greylin; and to my mother, my brother Peter, and my sister Kathryn.
All of the doctors involved in Terence’s care were amazingly thoughtful and generous with their time and insights as I reconstructed their roles in the journey. Thanks to Ronald Bukowski, Keith Flaherty, P. Holbrook Howard, Eric Goren, Allen Gown, Scott Pierce, and Craig Turner.
This wouldn’t have been a book at all without Amanda Urban, my wonderful agent; Kate Medina at Random House, who is the kind of editor that hardly exists anymore; and Lindsey Schwoeri, who is becoming that kind of editor too.
Then there’s Don, and our improbably wonderful next chapter. And of course Terry and Georgia, who have always been the reason for everything, for both me and their dad.
PERMISSIONS
Much of the medical and cost material first appeared in articles in Bloomberg News and in Businessweek on March 4, 2010. These articles can be found here:
“Lessons of a $618,616 Death”
http://www.businessweek.com/magazine/content/10_11/b4170032321836.htm
“End-of-Life Warning at $618,616 Makes Me Wonder Was It Worth It”
http://www.bloomberg.com/apps/news?pid=newsarchive&sid=avRFGNF6Qw_w
In addition, I draw extensively on the work of three Bloomberg colleagues: Chuck Babcock, Ken Wells, and Shannon Pettypiece. I depended heavily on Chuck’s March 4, 2010, Bloomberg articles on interpreting the cost of medications (“Avastin Dose Costing $6,600 Became $27,360 in Hospital Billing,” http://www.bloomberg.com/apps/news?pid=newsarchive&sid=aXuekMxp5Yh4) and of scans (“Chest Scan Costs $550 to $3,232 in Opaque Market for Radiology,” http://www.bloomberg.com/apps/news?pid=newsarchive&sid=auQxUuJ1.Srk), as well as on Ken and Shannon’s article on the development of Sutent and other targeted therapies (“Miracle Cancer Drug Extends Life with $48,720 Cost,” http://www.bloomberg.com/apps/news?pid=newsarchive&sid=aER.9zj2HmSk). Ken’s detailed interviews with Dr. Keith Flaherty were also invaluable.
I gratefully acknowledge Bloomberg’s permission to use this material.
ABOUT THE AUTHOR
AMANDA BENNETT is an executive editor at Bloomberg News, directing special projects and investigations, and was the co-chair of the Pulitzer Prize Board. She formerly served as editor of The Philadelphia Inquirer, editor of the Herald-Leader (Lexington, Kentucky), managing editor for The Oregonian (Portland, Oregon), and Atlanta bureau chief (among numerous other posts) at The Wall Street Journal. In 1997 Bennett shared the Pulitzer Prize for national reporting with her Journal colleagues, and in 2001 she led an Oregonian team to a Pulitzer for public service. She is the author of previous books including In Memoriam (1997), The Man Who Stayed Behind (1993), and The Death of the Organization Man (1990).
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