Man on The Moon

I don’t usually make political statements on this blog and don’t plan on doing so anytime soon. In fact, I have little interest at the moment and 2-year presidential election cycles and endless coverage of every detail of the professional and personal lives of candidates and elected officials. Having said that, I watched the State of the Union address the other night, for the first time, well, since the last State of the Union Address. There is something about the President addressing both houses of Congress and all the attendees that I still appreciate.

Regardless of your politics or mine, I found the President’s comments tasking his Vice-President with ‘moonshot’ bid to cure cancer interesting. For the Vice-President, as with many of us who have lost loved ones to cancer, it is personal and is likely personal for nearly every American, regardless of politics, race, sex, nationality, etc… It is something we can all come together on for sure.

Or is it? Is it legitimate? 1 year in his position to cure cancer? Which cancer(s)?

Of course this is not the first time and will not be the last national address to use the “C” word to the approval of both sides of the aisle as they say. President Nixon of course declared a “war on cancer” 35 years ago with the signing of the National Cancer Act of 1971.

Roosevelt had “The War”, Kennedy had Marilyn, Nixon had the “war on cancer”, Reagan had the “war on drugs” and Bush had the “war on terrorism”.

Of course the last 35 years has seen tremendous progress in cancer research and treatments and I have been fortunate to have personally witnessed diagnoses once considered fatal to now be very treatable and in some cases curable. Improved screening, diagnostics and personalized therapies have helped millions prevent cancer or live healthier lives or live longer with cancer.

It isn’t perfect. Pancreatic cancer still evades early detection and cures. Patients with breast cancer live longer with metastatic disease that remains incurable. Small cell lung cancer remains a killer at any stage.

Nonetheless, the improved funding for cancer has been quite beneficial. In 1971, the number of cancer survivors in the U.S. was estimated at 3 million and as of 2007 had increased to more than 12 million.

In 2003, Andrew von Eschenbach, the director of the National Cancer Institute (who served as FDA Commissioner from 2006-2009 and is now a Director at biotechnology company BioTime) issued a challenge “to eliminate the suffering and death from cancer, and to do so by 2015”. This was supported by the American Association for Cancer Research in 2005 though some scientists felt this goal was impossible to reach and undermined von Eschenbach’s credibility.

Now in 2016 we have a ‘moonshot’ approach or ‘Moon Shot’ or ‘Moonshot’ depending on who/what you read. Obviously this isn’t going to happen in a year after the first known descriptions of human cancer 3,500 years ago.

But I also think it is a little disingenuous as well, the kind of rhetoric one might hear at a State of The Union address to rally behind as a country, a nation, a people.

We know the issues: Reforming the clinical trials system, improving utilization of the data systems and interoperability, readjusting the drug approval and regulation processes, improving cancer treatment and prevention, and formulating new, more specific and science-based questions. And do all of this with a SINGLE, UNIFIED, NATIONWIDE or perhaps even GLOBAL database that contains shared universally accessible data.

Sometimes the phone extensions in hospitals don’t work or we can’t interface databases between hospitals in the same system.

I am not saying we shouldn’t try but our approaches to be personal and predictive and pre-emptive and ‘moon shot’ do not seem to match up.

The 2009 economic stimulus package included $10 billion for the NIH, which funds much of the cancer research in the US and the President pledged to increase federal funding for cancer research by a third for the next two years as part of a drive to find “a cure for cancer in our time

Cancer-related federal spending of money from the 2009 Recovery Act can be tracked online. At least it can be tracked online sometimes – try recovery.gov.

Prostate cancer funding has been removed from the proposed 2016 CDC budget.

The Vice-President was quoted as saying “Over the next year, I will lead a dedicated, combined effort by governments, private industry, researchers, physicians, patients, and philanthropies to target investment, coordinate across silos, and increase access to information for everyone in the cancer community.”

Reports from several sources cite that some patients under the Accountable Care Act may not have access to “top cancer centers” with nationally recognizable names.

Metastatic breast cancer still receives a tiny fraction of all funds raised and federally funded for breast cancer research with the fewest amount of resources going to the group that needs it the most.

The war on cancer is not a single moon shot, the war has been and will be a series of battles as it has been all along with developments and incremental advances. And we should recognize this. Some battles will be won, some will be lost and the war will continue, as fragmented as it is.

Not with a scientific blitz.

And when the war is won we can focus on heart disease, Alzheimer’s, chronic pulmonary diseases, hypertension and diabetes. Those communities and interests can’t nearly be as complicated as the cancer community…