Archive for January, 2016
An Open Letter to Vice President Biden
RE: Cancer Moonshot Announced at State of the Unions Address
Dear Vice President Biden,
I am writing to give you some background information and perspective on the new moonshot cancer initiative designed as President Obama said to “…make America the country that cures cancer once and for all.” Here are a few thoughts:
First 70-90% of cancers have major environmental and behavioral causes and are not simply genetic or biological destiny. However, only about 6% of the NCI budget is spent on prevention. If you want to cure cancer the best way is to prevent it from happening. This has been known for a long time and the big success in cancer over the last 30 years has been tobacco control. However, there are many policy barriers to executing comprehensive cancer prevention efforts. Use your political skills to take these on.
Second, the fancy new targeted drugs that were going to strike cancer at its molecular core are not nearly as successful as envisioned. In fact they may not make much difference at all for many types of cancer. The other problem is that these drugs are expensive and don’t work very well; they are in fact toxic. When they do work, they extend life for a few months.
Third, the old idea from the 1990s and 2000s that with genomics we could understand the genetic causes of cancer has been largely disappointing. There are multiple mutations in most cancer cells, and biopsies from the same tumor in the same patient tell different molecular stories. Some people think this is going to make targeted therapy really hard if not impossible. It certainly is a cautionary tale and shows that just when people think they have cancer figured out, they don’t. It is also going to make early detection much harder than people like Jeff Bezos and Bill Gates think. When it comes to the techies and omics people channel Ronald Reagan and “trust but verify”.
Fourth, there are all sorts of issues with the experimental models to study cancer, the way basic cancer research is conducted, the clinical trial system in the U.S., and what the statistics tell us about success or lack of it. These academic and policy issues have been covered in detail by journalists like Clifton Leaf who is also a cancer survivor. They have also been known about in the academic world for a long time. You and your staff should study the history of the War on Cancer and see what “after action” lessons might be learned. A little humility might be in order here as well. In 2005 the head of the NCI boldly predicted that as a result of what has come to be branded as “Precision Medicine”, death and suffering from cancer could be eliminated by 2015. Since that time the statistics have barely budged.
In closing, there are many other facts and caveats I could add to this letter, but you are busy. However, to simply spend more resources on the same sorts of efforts that have produced such marginal gains over the last 40-50 years would simply be an exercise in fighting policy trench warfare with more trench warfare. It would also be a waste of your grief, political skills and well-deserved prestige, and the new resources. Most importantly, it would be a disservice to patients.
Sincerely, Michael J. Joyner, M.D.
P.S. in the unlikely event you or members of your staff would like to discuss the ideas outlined in this letter it would be my pleasure.
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