Fighting spirit: AMNews interviews Ron Davis, MD

Less than two months ago, American Medical Association President Ron Davis, MD, told the AMA Board of Trustees that he had been diagnosed with pancreatic cancer.

Dr. Davis, 51, is continuing to serve as president. But he has reduced his duties to focus on treatment and spend time with his family. He said he realizes that pancreatic cancer has a high death rate, but he plans to be one of the survivors.

"I'm going to fight this thing. My fighting spirit has been reignited," said Dr. Davis, of East Lansing, Mich., who is making his battle public through a personal Web page at CarePages.com.

His wife, Nadine, believes that her husband one day will stand before the Association's House of Delegates and talk about winning his battle against cancer.

"I feel it's going to be a great success story," she said. "We are fighting. I'm praying and believing."

AMNews recently interviewed Dr. Davis. Here are excerpts:

AMNews: Why did you decide to make this a public battle?

Dr. Davis: As the president of the AMA, I have a very prominent and visible position in American medicine. People expect to see the AMA president out and about, giving speeches, interviewing with the media, being quoted in print. I knew that I would have to decrease the level of my activity in the AMA significantly for the foreseeable future to focus on my health and treatment, and to be with family. People would want to know, "Where is the AMA president? What is he doing? Why am I not seeing him as visibly as I have in the past?"

I didn't want the grapevine or the rumor mill to carry the message, because often the message gets distorted or only part of it gets out there, and it may take a long time to find its way to the medical hinterlands. That's one reason why I wanted to be very open about this. But another is when you consider the whole idea of using a CarePage to bring your community of caring together, it just makes much more sense to be open about it. ... I found in talking to people about it, either in medicine or outside of medicine, few people are aware of the existence of this tool.

AMNews: Is it tougher to be a patient who is a doctor?

Dr. Davis: I guess it could cut both ways. In one respect, I know about disease and treatment. I can perhaps better anticipate what lies before me. When I have a discussion with my physician about genetic markers, for example, or when I face a procedure like [endoscopic retrograde cholangiopancreatography], I know something about it. I'm not starting from scratch. And while I may need to bone up on some of these issues because I haven't followed the literature consistently, at least I'm starting from a point of much more knowledge than a typical patient.

I guess the flip side of the coin is that maybe I know too much, and knowing statistics on survival and life expectancy and those sorts of things can be a disadvantage.

AMNews: How do you stay optimistic when you know pancreatic cancer has one of the worst chances of recovery?

Dr. Davis: There was one interesting piece of scripture that I referred to in one of my updates that a close colleague of mine shared with me that speaks to this issue: "Trust in the Lord with all your heart and lean not on your own understanding," from Proverbs. My interpretation was that I should ignore the statistics on the prognosis for pancreatic cancer but instead put my faith in God. I've made the point that the statistics on survival from pancreatic cancer are not good, but they're not zero. Some people do survive this horrible disease, even for advanced pancreatic cancer.

When I look at my own situation -- I'm 51 years old, in otherwise good health, with access to the best medical care that we have in the United States -- I think my odds are as good as, if not better, than those of others to be one of the survivors. That's what I hope and expect to happen. This is a new type of challenge, but I'm going to address it in the same way I've addressed other challenges in my life and in my career, and that is to pull out all stops and to use every weapon that I can find to achieve a successful outcome.

AMNews: How are you balancing work, family and treatment?

Dr. Davis: Family and treatment go hand in hand, because family support is critically important in dealing with a serious illness. Nevertheless, family life should not be consumed by a total focus on illness, so we cherish our time doing normal family activities such as watching movies, going to sporting events and eating out. Balancing work and family responsibilities is never easy, but I've always tried to find the right balance through prioritizing and delegating -- which I'm relying on now more than ever before.

AMNews: Why is it important to keep everyone notified about your illness and treatment through CarePages?

Dr. Davis: I started posting notes shortly after I went to the doctor for the first time because we knew from day one that something very serious was going on. That very first day I saw him, we got blood tests, which were very abnormal. And then we got an emergency CT scan, which showed the mass in the region of the head of the pancreas as well as some lesions on my liver. We knew we were dealing with a serious illness that I would be battling for quite some time, and having become familiar with the CarePage tool, the thought occurred to me immediately that I should set up one of these.

AMNews: What are some benefits of having this site to update family and friends?

Dr. Davis: Much of my career has been built around educating patients and populations about important health issues. There are some important issues that I think I can continue to communicate about, perhaps even more effectively through this situation than I have in the past.

I saw two major benefits to come from this tool. One is to allow for much more efficient communication among us and our huge families and our very large circle of friends and colleagues. If [my wife and I] were to do that communication the old-fashioned way by telephone, one or both of us would be on the phone 24/7. The other major asset is that it allows the coalescing of a community of caring around the patient and his family, so that many, many people can share their thoughts, their prayers and their suggested medical treatment. A lot of people are recounting survival stories either of themselves or loved ones, or people they know.

Nadine and I, or our children, can go on the CarePage and read all of those messages of love, hope or prayer. Those can be very therapeutic in lifting our spirits or strengthening our resolve to fight this disease with every ounce of our energy. With any kind of serious or chronic illness, there will be ups and downs in physical health or emotional well-being. Having a readily available source of inspiration just waiting for us to take advantage of at any time can be enormously valuable and therapeutic.

AMNews: You mentioned that genetics may have played a role in your illness.

Dr. Davis: It turns out that I have three people in my family who have had breast, ovarian or stomach cancer. When that came out in my medical history, [my doctor, Robert Wolff, MD] felt that medical history, plus a few other factors, pointed toward this most likely being due to a genetic mutation. The others are that this family history of genetic mutation is also associated with eastern European ancestry as well as Jewish heritage, and I have both of those. The other common risk factors for pancreatic cancer are smoking, alcohol abuse and high-fat diet. I have none of those. I have spent most of my career fighting for and promoting healthy lifestyles and following them myself, especially in regard to tobacco prevention and control.

In some cases, [insurers] will pay for genetic testing, but there's a danger in insurance companies having this information, because they may consider it a preexisting condition and they may up your premiums. They may not cover family members without genetic testing, so you get into a whole problem in adverse selection and unaffordable insurance. There are some laws that protect against genetic discrimination. Many states do have legislation on that; some states do not. There's some federal legislation on this. But in many cases, the protections fall short, and as a result, many people who should be getting genetic testing are not because of fear of discrimination in insurance or in employment.

AMNews: Why do you think more funding is needed for pancreatic cancer research?

Dr. Davis: Pancreatic cancer is No. 4 in death rate [among the top five cancers] but a distant No. 5 in funding for research. If you look at the stats, you have something like 34,000 new cases of pancreatic cancer each year and 31,000 deaths each year. That's because most of the people who get it die within a couple years, whereas with breast cancer, you have a lot of survivors. Colon cancer has survivors. So a lot of the survivors are the ones who are strong advocates [for funding].

Treatments for pancreatic cancer aren't nearly as effective as the treatments for other kinds of cancer, so clearly we need more research. We need to put more funding into finding better treatments. I hope to be advocating visibly for that as I deal with this disease. Obviously, as a preventive medicine physician, I'm going to be speaking strongly for prevention in avoiding the risk factors for pancreatic cancer, too. Pancreatic cancer is getting less funding for research than other cancers, and I think that disparity needs to be corrected.

AMNews: What do you want to be your legacy at the AMA?

Dr. Davis: I hope my legacy at the AMA will be that I've pushed the envelope to help ensure that the AMA, on a daily basis, fulfills every word of its mission statement -- to promote the science and art of medicine and the betterment of public health. The AMA has often not received the recognition it deserves for its programs and policies in public health. As a preventive medicine physician, I hope I've been able to help the AMA advance its public health agenda in a meaningful way.