The truth is that the greatest innovations in health-care delivery haven't come from federally contrived oligopolies or enormous hospital chains. Novel concepts - whether practice-management companies, home health care or the first for-profit HMO - almost always have come from entrepreneurial firms, often backed by venture capital.

It is true that some off-label drug use is based on very unsettled science and has more risks. But medicine - and not just cancer care - involves lots of hard choices. And the more serious the disorder, often the more likely it is that for every right and wrong treatment choice there are many other practical decisions painted in shades of gray.

The convergence of information technology and biology allows scientists to translate the human genome into digital data that can accelerate diagnoses and cures.

It is true that some off-label drug use is based on very unsettled science and has more risks. But medicine - and not just cancer care - involves lots of hard choices. And the more serious the disorder, often the more likely it is that for every right and wrong treatment choice there are many other practical decisions painted in shades of gray.

It's now evident that public health is part of national security.

In fast moving fields like cancer, where doctors tailor treatments based on evidence that's constantly evolving, two years can be an eternity of waiting to learn about important science. For some patients, that interval can be fatal.