Dr. Mark Lewis brings together a rare combination: a clinician’s steady hands, a personal history shaped by cancer, and the mind of a systems thinker. Trained at top institutions and now practicing in Utah, his approach to oncology is rooted in empathy, guided by evidence, and sharpened by a clear-eyed understanding of the barriers that stand between medical knowledge and patient outcomes. For Dr. Lewis, the biggest obstacles in cancer care are not just scientific—they are logistical: delays, opaque rules, and misaligned incentives that obstruct the delivery of treatments clinicians already know how to use.

PoliticIt Radio – In This Life (Dr. Mark Lewis Song)

---

A Childhood X-Ray That Changed Everything

Dr. Lewis’s worldview was shaped early. When his family immigrated to the United States, a routine public health chest X-ray—intended to screen for tuberculosis—revealed an unexpected abnormality in his father’s lung. That image launched a medical cascade ending in a lung cancer diagnosis. The surgery that followed bought seven additional years of life, imprinting on young Mark a profound respect for medicine’s power—and its limits.

That experience planted the seeds of a career devoted to oncology. The path took him from Rice to Baylor College of Medicine, through clinical work at MD Anderson and oncology training at the Mayo Clinic, and ultimately to Utah, where he and his wife—also a physician—joined Intermountain Healthcare. The move reflected both professional alignment and a desire to raise their family in a place whose community values and natural beauty fit their own.

---

Why Are More Young Adults Getting Cancer? A Three-Part Explanation

One of Dr. Lewis’s striking observations is the rising incidence of certain cancers—particularly colon cancer—among younger Utahns. To explain this, he invokes a modern, multifactorial model common in the work of thinkers like Siddhartha Mukherjee: cancer results from the convergence of genetics, environmental exposures, and stochastic (random) events.

This framework helps explain why Utah, with its unique founder populations, may see different disease patterns. In populations descended from relatively few early settlers, subtle genetic risks can amplify across generations—not deterministically, but enough to nudge some individuals closer to disease thresholds.

But genetics alone does not explain the rise in early-onset cancers. Environmental factors play a critical role, and one variable stands out in emerging research: antibiotic exposure in childhood and adolescence.

Dr. Lewis references a major U.K. study that used centralized national health records to compare young colon cancer patients with matched controls. Among all variables assessed, early antibiotic exposure was the single consistent differentiator.

Antibiotics can disrupt the gut microbiome—an ecosystem essential to immune regulation and inflammation. Altering it during key developmental windows may have long-term implications, helping explain cases like the 22-year-old colon cancer patient whose identical twin remains healthy. Genetics identical; outcomes dramatically different.

---

Oncology’s Turning Point: From Bloodletting to Precision Medicine

To place modern medicine in context, Dr. Lewis compares early chemotherapy to outdated practices like bloodletting—treatments once rational, later seen as crude. Traditional chemotherapy’s indiscriminate cell-killing is still vital for many cancers, but oncology is shifting toward approaches that spare healthy tissue:

• Targeted therapies: Drugs designed to block precise molecular abnormalities
• Immunotherapies: Harnessing the body’s own immune system
• Genomic sequencing: Mapping tumor DNA—three billion letters long—to match patients with treatments
• AI and computational tools: Identifying patterns and treatment pathways invisible to human cognition

These advances already save lives. Dr. Lewis describes a Utah patient with pancreatic cancer—previously considered uniformly fatal—whose genomic testing revealed a targetable mutation. After failing IV chemotherapy, the patient entered a prolonged remission on a single oral medication.

The science exists. The challenge is delivering it on time.

---

Where the System Breaks: Prior Authorization and Preventable Harm

Dr. Lewis is unequivocal: the main gap in oncology today is not discovery, but implementation.

Prior authorization—intended to ensure appropriate use of costly therapies—often becomes a barrier that delays treatment, undermines trust, and causes avoidable harm. Two principles define his critique:

1. Timeliness

Professional guidelines expect cancer treatment to begin within roughly two weeks of diagnosis—the “brain to vein” window. Delays beyond this are not bureaucratic inconveniences; they can shift a patient’s odds of cure.

2. Transparency

Patients deserve clear explanations of denials, with specific steps to fix them. Opaque or circular processes compound fear at the worst possible moment.

“If I tell you we’re going to start treatment in two weeks and I don’t, it eats away at the foundation of our relationship.”

The harms are real:

• Psychological injury: The waiting period is often more agonizing than the treatment itself.
• Clinical deterioration: Some cancers progress measurably during delays.
• Avoidable hospitalization: Denials of supportive medications (such as anti-nausea drugs) lead to emergency visits that cost more—and harm more—than the medication would have.

One example borders on absurdity: approving chemotherapy but denying modern anti-emetics, essentially guaranteeing the patient will become too sick to continue treatment.

“Things have to be tolerable before they can be effective.”

---

The Hidden Problem: Outdated Standards and Mismatched Peer Review

When denials occur, clinicians are routed to peer-to-peer reviews. Yet reviewers may not be oncologists, and insurance formularies often lag behind rapidly evolving standards of care. This mismatch leads to inappropriate denials and delayed appeals—problems invisible to policymakers but deeply felt by patients.

---

A Practical Blueprint for Reform

Dr. Lewis’s recommendations are modest but transformative:

• Immediate, specific transparency when treatments are denied
• Fast turnaround times, especially for oncology
• Specialty-matched peer reviewers
• Clear, streamlined appeal pathways

None of these eliminate prior authorization; they simply make it accountable and patient-centered.

He also argues for public metrics comparing insurers on timeliness and transparency. Market forces could then reward payers who minimize delays.

---

Balancing Innovation and Fiscal Responsibility

Dr. Lewis acknowledges that breakthrough therapies are often expensive and that insurers must prevent misuse. Some rare conditions—such as paroxysmal nocturnal hemoglobinuria—rightly require treatment at expert centers due to cost and complexity.

At the same time, federal rules prohibit kickbacks, meaning clinicians have no financial incentive to prescribe one therapy over another. Smart oversight is necessary; arbitrary barriers are not.

Policy should strive for fiscal stewardship without defeating care.

---

Closing the Practice Gap: Implementing What We Already Know

Dr. Lewis emphasizes a sobering truth: science is not the limiting factor—delivery is.

Coordinating sequencing, pharmacy, scheduling, supportive care, and insurance approvals requires systems built for speed and clarity. Education must keep pace with emerging literature. Patients need emotional and practical support that makes treatment tolerable.

The goal is simple: remove friction so evidence-based care reaches patients quickly and consistently.

---

Compassion as a Clinical Principle

For Dr. Lewis, compassion is not sentimental—it is operational. Oncology requires trust, and trust requires:

• predictable timelines
• supportive care
• transparent communication
• denials explained with dignity

Compassion reduces complications, lowers costs, and strengthens the therapeutic bond essential in cancer care.

---

A Hopeful Future—If Systems Can Keep Up

Dr. Lewis is optimistic. Precision therapies, immunotherapy, and computational medicine are transforming outcomes once considered hopeless. But these advances will remain unrealized without matching reforms in care delivery.

His prescription rests on three pillars:

1. Transparency
2. Timeliness
3. Protection of the clinician-patient relationship

Aligning systems around these principles will improve outcomes while maintaining fiscal stability.

“If we stopped everything we know about cancer right now and just implemented what we do know, we would save 60,000 to 70,000 lives per year.”

The work ahead is not only scientific—it is logistical, ethical, and organizational.

---

Practical Takeaways for Clinicians, Payers, and Policymakers

Clinicians

• Document rationale with guideline references
• Request specialty-matched reviewers
• Seek supportive care authorizations concurrently

Payers

• Implement rapid-review oncology pathways
• Match reviewers to specialty
• Publish transparent metrics

Policymakers

• Advance transparency standards
• Support access to molecular testing
• Fund research on early-life exposures

---

Final Thought

The future of oncology will not hinge on one breakthrough discovery but on the system’s ability to deliver known lifesaving treatments quickly and compassionately. When clinicians, payers, and policymakers design care around urgency and dignity, innovation becomes practice—and practice becomes progress.

Dr. Mark Lewis’s message is clear: compassion and competence are not rivals. Together, they close the practice gap, improve outcomes, and restore trust to one of medicine’s most sacred relationships.