White House Chronicle

News Analysis With a Sense of Humor

Cancer ‘Moonshot’ Has Paltry Dollars, Losers

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By Llewellyn King

Whenever the government wants to be seen to be doing something huge, it invokes the Manhattan Project or the moon landing. So the new cancer initiative of the Obama administration is called the “moonshot.”

But it’s neither the equivalent of the Manhattan Project, which developed the atomic bomb during World War II, nor President Kennedy’s ambitious program to land a man on the moon, after the Russians appeared to have stolen a march with the launch of Sputnik, the first satellite in space.

Those programs succeeded because they were tremendous national commitments without regard to funding. The $1 billion in proposed funding for the “moonshot” cancer initiative is somewhere between modest and paltry. In the world of biomedical research, $1 billion simply doesn’t buy much.

The pharmaceutical industry estimates that it costs well over $1 billion to bring just one new drug to market. Cancer needs many drugs.

The lead agency in this new iteration of the war on cancer, declared in 1971, is the National Institutes of Health. It has an annual budget of $32 billion on which there are demands from many deserving fields of biomedical research besides cancer.

President Obama has asked Vice President Biden to lead the cancer moonshot effort. I’ve been with the vice president when he has talked about his commitment to the cause of cancer research and the death of his son, Beau, from brain cancer. His sincerity and his commitment to cancer research is palpable, but he won’t have the dollars to get the job done.

The biggest contribution to the research for a cancer cure may be the stimulation the moonshot will give to extant cancer efforts, but it’s not without a downside.

Many other diseases fear they may be undercut by the cancer initiative. In the world of biomedical research, there is finite funding and talent — and a new initiative tends to draw the best research minds. The top magnets for good biomedical researchers these days are cancer and AIDS, and many other deserving diseases lose out. Biomedical research requires stability, so that decades of a scientist’s life can be devoted to a single line of endeavor.

I follow one of the more obscure diseases, one that that has been pitiably starved of public and private funds: Myalgic Encephalomyelitis, also known as Chronic Fatigue Syndrome. Compared to any other disease affecting a large number of people (1 million victims of ME/CFS in the United States, according to the Centers For Disease Control), it has been funded so little by the government as to amount willful neglect. It receives a miniscule $5 million a year in funding.

Last year, after public and media pressure that has been applied for years, NIH Director Francis Collins announced that things would be rectified. But he didn’t mention a dollar figure; not when he made the announcement in October and not to date. No moonshot here, not even a Fourth of July firework.

Yet the suffering of those with ME/CFS is truly awful. I’ve been in the sick rooms and interviewed the few doctors who specialize in the disease, and the situation is one of unabated misery. Those who are the most affected can’t tolerate light or sound, and must pass their days in the silent dark. For years, one poor young man has had to take refuge from the disease in a modified closet. Others suffer from a world in which they’re punished for doing everyday things: A dinner with friends can mean days in bed for recovery.

There seems to be no light at the end of the victim’s physical pain and mental fog, despite decades of pleading from advocates and caregivers that some serious research be funded by NIH.

While we’ve been the world’s powerhouse in research in all sciences, biomedical is now being starved of research dollars. Recently America’s most revered virus hunter, Dr. Ian Lipkin, director of the Center for Infection and Immunity at Columbia University’s Mailman School of Public Health, has had to resort to crowdfunding. He and his deputy, Dr. Mady Hornig, can be found on YouTube eating red-hot chili peppers in an attempt to raise money for their ME/CFS research.

Dollars in across-the-board biomedical research are falling when they should be rising. Recently, NIH’s budgets have been 25 percent smaller in constant dollars than they were in 2003.

Research pays. Most of it doesn’t yield dramatic stuff, like a moonshot, but rather solid, incremental gain. In science, incremental gain is the equivalent of compound interest. But it needs sustained funding. Not rhetoric. — For InsideSources


Small Charities Tackle ‘Disruptive’ Cancer Research

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No diagnosis strikes fear into people as thoroughly as cancer. It is the sum of all fears when it comes to health.

My mother died in 1961, when treatments were few, in great pain from cancer of the uterus. Four treasured friends died of cancer more recently, but in equally awful ways; Barbara of bone cancer, Grant of colon cancer, Ian of brain cancer, and JoAnn of melanoma.

Cancer deserves its position as the most feared disease, even if it is not as lethal as it once was and many cancers can be treated. To know someone in the throes of cancer is to know something terrible. Heart disease kills more of us, but cancer is enthroned as the ultimate horror.

Yet we are, in some measure, winning the war on cancer; to medical science, it is less mysterious and more conquerable. But it has been a long battle against an implacable enemy.

The war on cancer is war with many theaters; cancer itself being a misnomer, as there are many cancers with very different profiles, rates metastasis and treatments.

So it is both puzzling and appalling that Congress has allowed funding for government biomedical research to languish and has made it subject to the blunt tool of sequestration. Less money means everything slows down; research projects are drawn out or cancelled, and scientists are discouraged.

Nothing is as fatal for research as uncertain funding. You cannot shut down a line of research and start it up again as funds become available: It blunts the picks.

Scientists at the hard-rock face of research cannot be expected to sustain commitment when they do not know if their research grants will be renewed in the next budget cycle. Lawyers can anticipate steady work, why not can cancer researchers? When we implore young people to study biomedicine, we are asking them to take up a career of uncertainty.

Enter the non-government funders, from giants like the American Cancer Society to small but determined outfits like the National Foundation for Cancer Research (NFCR).

This organization, according to its president, Franklin Salisbury, Jr., believes in “adventure funding.” Although he eschews the description, Salisbury’s efforts might be called seed funding at the genomic and molecular level; understanding the role of genes in cancers and finding the mechanisms that control cells. He emphasizes the gap between science and medicine, and the need to provide funding to bridge that gap.

Salisbury also underscores the need for regular funding, rather than large periodic and unpredictable infusions. His organization, founded in 1973 by his father, Franklin Sr., a creative entrepreneur, and Albert Szent-Györgyi, a Hungarian-born physiologist and biochemist who won the Nobel Prize 1937, has been keeping research alive for some researchers like Dr. Curt Civin of the University of Maryland Medical Center and Dr. Harold Dvorak of Beth Israel Deaconess Medical Center in Boston.

NFCR is just one — and a small one, with a $15 million annual budget — of hundreds of cancer-related charities. Its uniqueness and what it portends for the whole future of research is its willing support, within the research community, of disruptive biomedical technologies as well as its appreciation for long-term support for particular scientists. These scientists are part of establishment teaching hospitals like Massachusetts General, as well as an honors list of top universities from Harvard to Oxford and across the Pacific to China.

Increasingly, China is becoming more important in biomedical research. American dollars are finding their way into Chinese research Institutions, as a new wave of collaboration outside of traditional channels is being established. These are sometimes housed in open medicine centers, six of which NFCR supports.

With the pressure here on government funding, researchers fear the government will fund only the safe and sure projects. This is being felt across the broad range of biomedical research in the, as scientists are turned away in larger and larger numbers from the National Institutes of Health empty handed. Respected researchers are turning to innovative funding sources, including crowdsourcing. A renowned virus researcher at Columbia, Dr. Ian Lipkin, is trying to raise $1.27 million, having been turned down by NIH, by crowdsourcing

For better or worse, cancer research is going retail. — For the Hearst-New York Times Syndicate