“Aiming High”-A True
Change In The Battle Against Cancer Or A Likely Description Of The Conditions
of The Authors Of The New England Journal
Of Medicine
Editorial (374:1901-1904, 2016)?

By

Leonard Zwelling

         The May 19 edition of the NEJM leads with a guest editorial by Douglas Lowy and Francis
Collins, the current leaders of the NCI and NIH, respectively. It is called
“Aiming High—Changing the Trajectory for Cancer.”

         The piece lauds President Obama and his Cancer Moonshot Czar
Designate Vice President Biden for their renewed effort to jump-start progress
in the 44-year old War on Cancer—again! Oy!

         It wasn’t bad enough that the President of MD Anderson Ron
DePinho pitched the same analogy in 2011, but now these guys are doubling down
with a national version of the comparison of the eight-year success that was the
project to land a man on the moon with the latest attempt to end the scourge of
cancer. This is just silly. Rocketry did not start in 1960, so it was a long trip to get to the moon, not eight years. The eight years was the development part of the R and D. I am not sure we are up to the D of R and D in cancer yet.

         First of all, the authors are talking about meager amounts of
money, even compared to DePinho’s projects. At most, about $1 billion will be
pumped into the budgets of the NIH and FDA and yet again, as with Stand Up 2
Cancer and Anderson’s Moonshots, cooperation among those who have not worked
together in the past is given as a key. That’s baloney. Cancer biologists of
all stripes will work with whom ever they perceive as helpful in filling the gap they observe between their current state of don’t know and a
meaningful treatment strategy. To think that somehow money alone can fix this
is absurd.

         Humans need to get comfortable with a few facts before they
write checks for such endeavors. Here are a few:

1. Everybody dies

2. Eliminating cancer would alter the average time of
death for Americans by 3.5 years. This is not bad, but it’s not like it will
change evolution. Altering the damage done by the various forms of dementia
might be a more worthy target. 

3. Old people get cancer. See numbers 1 and 2.

4. We can alter the death rate from some cancers with
what we know now. No new research needed. Colon cancer deaths should be as rare
as flagrant polio in kids. Just get everyone the screening and interventions
needed to head off detection at an advanced stage, by detection at the polyp
stage. Ditto breast cancer and cervical cancer. Prostate may be possible, too.

5. The genomic abnormalities that are thought to
characterize cancer can be either the cause or the effect—or both. The
underlying defect can be a consequence of aging and overriding genomic
instability that lead to the mutations. Cancer cells want to live forever, too. Just like you. They just
have a more efficient method of pushing evolution to arrive at a cellular
biochemistry that just won’t die until the organism hosting the aberrant cells
does.

If
these guys really want to affect the survival rates from cancer by means other
than those already accomplished, here are some ideas.

1. Put all the money in the RO1 pool.

2. Close the intramural program at the NIH, especially
the costly clinical one that has not made a meaningful contribution to human
subjects research in decades. Put that money in the RO1 pool, too.

3. Fully fund the FDA. Get the drug companies out of the
mix with regard to the users’ fees and allow full-fledged competition for
prices within the Medicare system.

4. Flood the cities with money to screen everyone for
cancers whose detection leads to life saving interventions and do them.

5. Attack the obesity epidemic in the schools with more
physical education, home economics, and sex education to prevent sexually
transmitted diseases from turning into cancers. HPV vaccination should not be
optional.

Cancer
has become what the infrastructure of America has become. Underfunded, taken
for granted, and not identified as the national problem it really is. We no
more have the best medical system than we have the best railroads or airports.
We need to get over ourselves.

I
understand that Drs. Lowy and Collins are public servants who work for the
President and the Cancer Czar. They have to write articles like this.

We
don’t have to believe them though.

Leonard Zwelling