© 1998 by Ralph W. Moss, Ph.D

"Be careful about reading health books.
You may die of a misprint."--Mark Twain

DeVita, VT, Jr., Hellman, S and Rosenberg, SA. Cancer: Principles and Practice of Oncology. 5th Edition, Lippincott-Raven, 1997.

NOTE: This letter was sent to Mr. Freeman, with a copy to Dr. DeVita, on March 4, 1998. As of May 21, 1998 I still had not received a reply. I also brought these criticisms up with a Lippincott-Raven editor at the ACAM meeting in Ft. Lauderdale in early May, and he promised to get back to me. But again I have not heard from him.

Mr. Stu Freeman
Lippincott-Raven Press
227 East Washington Square
Philadelphia, PA 19106-3780

Dear Mr. Freeman:

I would like to submit for your consideration a list of about three dozen errors that I have found in the 1997 edition of your textbook, DeVita, Hellman and Rosenberg's Cancer: Principles & Practice of Oncology.

I am sending this letter to you since you wrote in the Publisher's Foreword that this Fifth Edition is "the most rigorously edited and the most comprehensive textbook to have been written in oncology." In fact, I have found that the work is neither very rigorously edited nor particularly comprehensive. Most of the errors I shall point out relate to the proofreading and copy editing of the book. However, there are also some errors of omission as well. I will not even mention what I perceive to be a general bias that overstates the value to patients of conventional treatments, particularly chemotherapy. (I deal with many of these issues in my own book, Questioning Chemotherapy.)

I intend to post this letter to my Web site,, so that I can share this information with other readers of this book and encourage others to add to this list. I am also sending a copy of this letter to the attention of Dr. DeVita.

First, I would like to tell you about an experience I had almost a decade ago. At a meeting in Washington, I was confronted by an individual who claimed to have found errors in my own book, The Cancer Industry. I was quite astonished by this "revelation." It wasn't that I considered myself incapable of error. But I had especially engaged the services of an outside copy editor for that book, who went over both the facts and the spelling with an eagle eye. Wanting to learn from this gentleman's criticism, I suggested that he send me a list of his "corrections," and that I would fix any genuine errors in the next edition.

Some weeks later, I received a letter from him in which he wrote (and I have fished this letter out of my files in order to quote it verbatim), "You asked me to make a note of the mistakes I found in your book and to send it to you. I am a consultant so I will do it for you if you will pay for the service. I am good at what I do and I promise you will benefit from the annotation of the gross factual errors that abound in your book." I thought the demand for money in this context was bizarre, as were a number of his other statements. I therefore never answered it and never was the beneficiary of his alleged insights.

This came to mind when I sat down to write you about errors I have found in the DeVita book. I hope this information will be valuable to you. But I think that readers have an obligation to share such findings with authors, free of commercial considerations. In general, I want you to know that I appreciate what you have accomplished with this work. As a person who has written nine books (including one for Lippincott), and who was once a senior medical editor for a New York publisher, I can imagine the difficulty of coordinating the work of 290 contributors to produce a monumental 3,125 page text. So you have my sympathy for the extreme difficulty of your task and my congratulations for your accomplishments.

Nonetheless, I feel that something must have gone wrong in the editing process of this edition. There are simply too many errors if the book had been carefully proofread and line edited. I discovered these errors in the course of using this work over the last year. I became aware of first one, then another typo or other problem. I therefore began to keep a list of these problems at the end of the book.

Admittedly, some of these errors are small, even picayune. However, I think readers of cancer textbooks have a right to expect a great degree of accuracy; writers and editors have a responsibility to give it to them. I hope you will take this criticism in the friendly spirit in which it is offered and make whatever corrections you deem fit for the next edition.

p. 498: FOOTNOTE

Footnote no. 95 on page 498 makes reference to a paper on "Cephalotaxine esters: antileukemic advance of therapeutic failure?" JNCI 1988;80:1095. You mean "or therapeutic failure."


p. 538: "It's potential significance is even greater...."


p. 741: The same paragraph refers correctly to "erythroplakia" and then incorrectly to a nonexistent disease called "erythoplakia."


p. 758: In Table 29.2-14 the abbreviation "NS" is not defined. It could mean a number of things, e.g. no significance, but all abbreviations should be spelled out.


p. 766: In discussing the WHO types of nasopharyngeal cancer, the first column lists them by Arabic numbers and then the second column lists them by Roman numerals.



p. 767: In discussing the results of radiation therapy on nasopharyngeal cancer, the authors state that CT treatment plans "had improved local control and 5-year survival." Instead of a reference for this contestable statement we are told, "This result will not come as a surprise to most radiation oncologists." It assumes what it should have set out to prove.


p. 771: "Chemoradiotherapy...should be recommended for in the management of this disease." "For in"?


p. 1177: The text refers to a study by Reithmuller and colleagues. The footnote refers to him as Riethmuller. Actually, it's Riethhmüller.


p. 1199: the word experience is spelled "expereince."


p. 1220: the same paragraph, beginning "Additional studies revealed...", is repeated twice, leading to utter confusion.


p. 1228: Chapter 32, on cancers of the gastrointestinal tract, occupies 280 pages (nearly a tenth of the book). Yet there are only scattered references to dietary modification in relation to this disease. A single paragraph in the section on follow up of rectal cancer deals with diet and ends with the suggestion, "Ultimately, a low-fat, high-fiber should be recommended" (p. 1228). That's it.


p. 1291: "Studies have demonstrated that (1) the major cause of cancer of the renal pelvis is smoking and (2) that cessation of smoking can eliminate a large number of these tumors." The sentence, as constituted, implies that cessation of smoking is curative for existing cancers, rather than just preventative of future cancers.


p. 1747: The section heading and the index call it "dermatofibrosarcoma protuberans." But the text repeatedly reads "protruberans." Which is right? Stedman's says "protuberans."


p. 1747: In the same paragraph we are told that more than 50% of these sarcomas occur on the trunk, 20% in the head and neck, and 40% on the extremities. That's over 110%. Any explanation?


p. 2325: we are told that "the activity of fludarabine CLL was demonstrated...," the word "in" obviously has been omitted after the name fludarabine.


p. 2326: we read how scientists "demonstrated that 2-CDA was extremely active in hairy cell leukemia conducted studies in CLL."


p. 1766: In the table 38.2-10 the abbreviation "NA" is not defined. Usually this means "not available." It can also mean "not applicable."

In addition, we are told that boldface type indicates a "reported statistically significant difference between arms." But the NAs in the Rizzoli study are all boldfaced. How can statistics that are not even provided be statistically significant?


p. 1844. The paragraph reads, "Owing to the extremely poor prognosis of [MHF] chemotherapy is felt to be justified. Although data are limited, there are striking similarities in the results seen with osteosarcoma. The primary approach to treatment of [MHF] of bone is radical surgical resection combined with adjuvant chemotherapy." These thoughts are non sequential and seem to have been jumbled.


p. 2075: Footnote number 11 uses a form of citation contrary to the style of your book. It reads "141;123-134, 1995" when of course it should read "1995;141;123."


p. 2036: In the phrase "early-delayed reactions that appear within a few weeks 4 months after irradiation" the word "to" is missing between "weeks" and "4 months."


p. 2183: The text states "The cell counting method of Mann and Berard was shown to more reproducible than other methods...." The word "be" is obviously missing between "to" and "more."

p. 2183: In the same paragraph, it reads "any case with solid aggregates of centroblasts is and classified as centroblastic lymphoma." Something is clearly missing between "is" and "and."


p. 1874: Reference no. 140 is to an article in Wein Klin Wochenschr 1922;1922:509. In other words, both the date and the volume number are given as "1922." Was this 1922 article coincidentally in "volume 1922" of this journal?


p. 2547: In the text it states that "the five-year survival rate following metastasectomy ranges from 25% to 42%." The text refers us to Table 50.2-6. However, a review of this table shows that five-year survival rates range not from 25% but from 13% to 42%. This is not only an error, but the text thus overstates the value of the procedure, which could affect doctors' therapeutic decisions.


p. 2552: In their discussion of the staging of metastatic cancer of the liver, there is a discussion of stage II and stage III. It is unclear if stage I or stage IV exist and, if so, why they aren't mentioned. The authors say "it is important that there is uniformity among staging systems," yet they don't reveal exactly what their staging system consists of.


p. 2564: In the text we are told that "median survivals from the initiation of hepatic arterial therapy are 18.9 and 14.9 months, respectively." We are referred to Table 50.3-15. Yet when we check the Table itself we find that median survival following multidrug infusion is 18.8 months, not 18.9 months.


p. 2564: The text states that "Lorenz and coworkers combined HAI and intravenous administration in a study of 52 students...." I know that students go through plenty of tribulations these days, but receiving hepatic arterial infusions of chemotherapy should not be one of them. I think the authors meant to say "patients."


p. 2579: "The usual scheme includes administration of 600 to 800 cGy to either the upper middle or lower section of the body." Is there a comma missing between "upper" and "middle"? Otherwise, are we to consider "upper middle" as a scientifically precise term?


p. 2581: The text states, "Metastatic disease most often effects the vertebral bodies." Strunk and White in The Elements of Style, 3rd Edition, state that "effect" as a verb means "to bring about" or "to accomplish." They warn that it is "not to be confused with "affect," which means "to influence." A handy little book, even for medical authors.


p. 2910: The text states in reference to clinical trials that "22% believed they would derive some therapeutic benefit and only a minority really had an adequate understanding of the trial's purpose." I checked the reference (J Clin Oncol 1995;13:1062) which states that in fact 85% (not 22%) believed they would derive some therapeutic benefit from clinical trials. This changes the meaning of the discussion.


I was repeatedly disappointed by the omission of rare cancers from consideration and by their absence from either the table of contents or the index. Where are the chapters, for instance, on the following: intramedullary spinal cord metastases? Klatskin tumor of the common bile duct? cancer of the vermiform appendix? gastric leiomyosarcoma? bronchoalveolar lung cancer? cancer of the upper or lower gingiva? the ampulla of Vater? Others could be mentioned.

In addition, I found the chapter on Alternative and Complementary treatments, although an improvement over the 4th edition, woefully inadequate. You should consult my own work, Cancer Therapy, for a more even-handed discussion of some of these methods.

Again, I hope you will take these criticisms in the friendly spirit in which they are offered, and that they will be of some help to you and your authors in preparing future editions of this outstanding work.


Ralph W. Moss, Ph.D.

Ralph W. Moss, Ph.D. is director of the The Moss Reports for cancer patients. Dr. Moss is the author of eleven books and three documentaries on cancer-related topics. He is or has been an advisor on alternative cancer treatments to the National Institutes of Health, the National Cancer Institute, the American Urological Association, Columbia University, the University of Texas, the Susan G. Komen Foundation and the German Society of Oncology. He wrote the first article on alternative medicine for the Encyclopedia Britannica yearbook. He is listed in Marquis Who's Who in America, Who's Who in the World, Who's Who in the East, and Who's Who in Entertainment (as a film documentarian). This Web site does not advocate any particular treatment for cancer. We urge you to always seek competent medical advice for all health problems, especially cancer. Before consulting our site please read our full Disclaimer statement.

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