ERRORS IN THE DEVITA CANCER TEXTBOOK
© 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
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
I intend to post this letter to my Web site, www.ralphmoss.com, 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
p. 771: "Chemoradiotherapy...should be recommended for in the management
of this disease." "For in"?
WHAT'S IN A NAME?
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."
REPETITION OF MATERIAL
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
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?
THOUGHTS OUT OF ORDER
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.
WRONG FORM OF CITATION
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
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."
TO BE OR NOT TO BE
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
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
STUDENTS OR PATIENTS?
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
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.
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