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Jun. 29 2009 - 6:02 pm | 5 views | 1 recommendation | 14 comments

Cure cancer? We haven’t got the guts.

An excellent piece in Sunday’s New York Times, by Gina Kolata, highlights the “play it safe” grant system utilized by the National Cancer Institute (NCI) and how it has led to poor results in the battle to cure cancer.

Since Richard Nixon officially began the war on cancer in 1971, the NCI has spent about $105 billion in grants given over to those charged with solving this deadliest of humanity’s mysteries. And much of that was spent when a billion dollars was still a lot of money.

Yet, after almost 40 years of government spending, we have surprisingly little to show for it as the cancer death rate has only very slightly improved.

The cynics among us will be quick to point out that this failure should come as no surprise. Government budgets, by and large, exist to pay back and make wealthy those who put the decision makers into their positions.

Could it, therefore, be that the poor showing of government investment directed towards curing cancer is the result of the special interests earning billions selling drugs and services to meet the needs of the burgeoning cancer industry? Is this all about a cure for cancer being bad for business?

I don’t think so. If the slow progress on the part of the NCI were the result of special interest lobbying designed to hold back on the flow of government dollars to cancer research, the scientific community would be crying out for more money. For the most part, they aren’t. What we do hear from the scientists is that the government only spends its money on “safe” research designed to show some incremental improvement as opposed to funding riskier, out of the box concepts designed to produce real breakthroughs.

Even the leader of the national health establishment agrees. Dr. Raynard S. Kington, acting director of the National Institutes of Health (which includes the NCI) says,

We have a system that works over all pretty well, and is very good at ruling out bad things — we don’t fund bad research. But given that, we also recognize that the system probably provides disincentives to funding really transformative research.

VIA NEW YORK TIMES

Put another way, this country just doesn’t seem to have the the cajones to take on the kind of big risks that could spell victory in the war on cancer.

In the field of human sciences – like in almost any area of endeavor – big breakthroughs come from accidental discoveries or out of the box thinking. Great risk of failure inevitably leads to great rewards. Of course, that comes at the price of wasting money on the failures that will turn out to have been screwball ideas. Still, as Dr. Kington confirms,  if we don’t spend some money on risky research then we are incapable of moving the ball forward towards accomplishing the goal of Nixon’s war – curing cancer.

Imagine if NASA had been built on the premise that it would take small, safe steps in the nation’s efforts to explore space. Would the agency, established in 1958, have put a man on the moon in just 11 years? Great chances were taken and great casualties resulted, but we were willing to make the big moves and reaped the rewards of winning the space race.

Of course, that was then and this is now. We, as a people, are not who we were in the late ‘50s and early ‘60s.

So why does the government even bother? If they aren’t going to fight to win, why even spend the money?

Kolata sums it up nicely in her description of the National Cancer Institute.

It has become a sort of jobs program, a way to keep research laboratories going year after year with the understanding that the focus will be on small projects unlikely to take significant steps toward curing cancer.

VIA NEW YORK TIMES

Now that sounds familiar. In the effort to keep the money flowing from Congress, the government health establishment has given up on winning the war in exchange for keeping everybody working under the pretense of trying to accomplish something. Can’t you just see the NCI administrators fretting over getting Congress to approve their annual 7% increase if their failure rate was to increase a few points because they actually tried to do something?

Just like so many of the “wars” we have begun over the years, (see “War on Drugs” and “War on Poverty”), the mission objective has been lost in a sea of budgetary considerations designed to keep people in their phony baloney jobs (credit to Mel Brooks).

Of course, those in government who lost the war on drugs were not casualties of that war just as they were not the casualties of the failed war on poverty.
But the war on cancer is something very different. While government workers, elected and otherwise, can avoid drugs and poverty, a significant percentage of them will not escape cancer. Their uninspired, “business as usual” approach to the fight will, some day, end up taking them, or someone they care about, down – and many of us will go down with them.

Depressing? Absolutely. But all too real and precisely why this is one war in very serious need of a “surge” offensive.


Comments

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  1. collapse expand

    Rick I’m wondering how much the debate over embryonic stem cell research plays into this, and the general anti-science attitude of the last years.

    • collapse expand

      Brian, it is a good question. From what I can see, the problem is centered more on the NCI being very conservative and “safe” with their grants. They set up a “catch 22″ where they ask the researcher to prove the science before the science can be proven as a way of avoiding investing in research unlikely to succeed. On the other hand, they quickly agree to grants with research labs who understand the rules and have been in business with the government for a long time. The result is a lower failure ratio but, as you would expect, lowered expectations and opportunities for true breakthroughs. Most of the real breakthroughs are coming from the private sector because they are more willing to roll the dice on more risky projects with big rewards if they succeed. The government has to take a portion of their money and put it into higher risk experimentation that is more likely to produce a more dramatic result. The availability of stem cell may motivate them to do some of this, but I’m concerned that the government culture is so dependent upon remaining in the status quo that it won’t happen. It’s really a shame.Having access to the large sums of money that only government can have should provide the opportunity to make a real difference in serious illnesses like cancer, particularly when we have a stated, existing policy to find the answers.

      In response to another comment. See in context »
  2. collapse expand

    Rick, doesn’t it seem that the progress has been in identifying, diagnosing cancer, as opposed to curing it? Do you think that this approach is partly to blame, in that it drains money away from finding a cure? Or do you see it as all one enterprise?

    • collapse expand

      Susan, I’m not sure that the government programs have been as involved in identifying and diagnosis cancer as much as the private sector. Most of the diagnostic advances have been in the form of technology advances–which tends to fall within the private sector.
      You might want to have a quick look at the NCI website which identifies their priorities.
      http://www.cancer.gov/researchandfunding
      It’s not that the NCI doesn’t do anything of value with their money, as that would be overstating the situation. It’s just that they really seem to aim their grants toward research more likely to result in incremental advances rather than putting a certain amount of money into going for the “home run”. I can appreciate why they wouldn’t put all their eggs into the “go for broke” research programs. But a portion should be going towards the type of research which presents a greater opportunity to hit upon a breakthrough.

      In response to another comment. See in context »
  3. collapse expand

    Is there another country in the world taking leaps that accidentally prove inspired or thinking out of the box with greater success than the US? Most of the rest of the world was not hampered by restraints on stem cell research. Any breakthroughs on cures? Also how much of the research is put into managing cancer opposed to finding a cure.

    • collapse expand

      libtree, there are some significant advances taking place both here and around the world. The difference is that much of it is the result of private company investment. Bear in mind that other countries did not pledge a “war on cancer” – our government did. It was, and is, a highly worthwhile goal. Were the government to get more aggressive, and not consistently follow the safe route, one cannot help but believe that giant leaps would be possible. This is another example of where we set out a important governmental goal (ie. war on drugs and the war on poverty) only to fall short as the programs recede into the mediocrity of government run programs. My opinion is that it does not have to be this way. The United States used to have the capacity to commence these domestic wars and win them – doing whatever it took to succeed. As Obama pointed out in his speech yesterday, we never read in the history books about the US taking a laid back approach which was, ultimately, a heroic thing to do. We need to refocus how our government works when it comes to reaching important national goals. I can’t think of a better place to do this than the fight against cancer.

      In response to another comment. See in context »
  4. collapse expand

    I don’t disagree. I am no expert in this area but it seems that the relationship with the government programs that offer grants and universities and research centers is much like the relationship between Department of Defense and Weapon Contractors. Very cozy and wasteful. Plus let’s remember that the Republicans were not big on science staffing positions with political hacks and lobbyists who really don’t know how to evaluate the proposals before them. This country would advance mightily if we found a way to remove politics from agencies that are charged with our public health, education, welfare and environment.

  5. collapse expand

    I read the Times piece with great interest. But I’d also like to have seen some analysis as well of why certain cancers — lung, pancreatic, to name two — are so difficult to cure and are still, so often, a death sentence while others have made tremendous progress. What influences which cancers are given the most money and attention and why is progress so hopelessly slow on some of them?

    As someone whose mother, (still alive and healthy at 72,) has survived thyroid, breast and brain cancer, I selfishly live in daily fear of the Big C and am always wondering what slows, or speeds, progress in finding effective treatment/cures.

    • collapse expand

      Caitlin, while there has been progress in the treatment of lung cancer, not so much in pancreatic. The common factors in cure rates versus fairly hopeless cancers come down to how early a cancer can be discovered and how aggressive the cancer may be. Using pancreatic as an example, this particular cancer rarely presents symptoms at the earlier stages, thus there is no reason to suspect that it is going on. Unfortunately, by the time most pancreatic cancers are discovered, it is well advanced, aggressive and very difficult to impact upon. Lung cancers, discovered early, can be handled in many instances. Aggressive versus more slow growing is also a factor. I have experienced slow growing non Hodgkins lymphoma. The discovery was purely by accident and may not have been found for another five years or so if it hadn’t happened to show up on a CT scan for something else. With slow growing cancers like this, there is good news and bad news. The good news is that it is slow growing! The bad news is the cure rate is significantly lower so the opportunity for it to return following remission is greater (although often manageable for very long periods of time.) Fast growing is never a good thing, yet fast growing non-Hodgkins lymphoma has a cure rate exceeding 50%. It is a combination of early discovery and the availability of treatments that have been shown to work.
      As for what slows or speeds the progress of finding treatments and/or cures, this has much to do with “volume”. Since most of these advances come from the private sector, it only stands to reason that they will put their R&D dollars towards the largest possible consumer base. Many more women get breast cancer than pancreatic cancer. Thus, many more dollars have gone into development of drugs to treat/cure breast cancer.

      In response to another comment. See in context »
      • collapse expand

        Thanks.

        I was appalled and saddened today to see Pina Bausch’s obit; she died five days (!) after discovering she had cancer. How can you literally be at death’s door with no symptoms? Trying not to give in to my hypochondriac impulses…

        In response to another comment. See in context »
        • collapse expand

          The Chef at NYC’s Four Seasons restaurant died six days after he was diagnosed. I wondered the same thing–could you just have no symptoms? or did these people have them and ignore them?

          In response to another comment. See in context »
          • collapse expand

            Good question and I think you’ve already answered it. There are times when people are in denial of their symptoms. There are a few instances where the symptoms simply do not show up in ways that make it clear that it is cancer. Loss of energy can be explained in a number of different ways, particularly if you are one who looks to deny. Same with loss of weight and other symptoms.
            The moral to the story is that if you feel like something is wrong-check it out. You may end up wasting your time and some money…maybe even a little embarrassment. But all of that is preferable to waiting too long to face up to a problem.

            In response to another comment. See in context »
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    About Me

    I am an attorney in Southern California, and a frequent writer, speaker and consultant on health care policy and politics. To that end, I am active member of the Association of Health Care Journalists. Based in beautiful Santa Monica, California, I'm very pleased to have the opportunity to be a contributing editor to True/Slant. I've recently finished a book designed to make the health care debate understandable to the average reader, and expect it to be out in the next five months or earlier. In my 'spare time', I continue to write for television and, occasionally, for comic books.

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