The Sloppy Mess That Is The US Cancer Program: Was DePinho On To Something?

By

Leonard Zwelling

There is a national cancer program. There has been one since the federal legislation of 1971 that began the War on Cancer. However, I defy anyone to tell me exactly what it is. For if we have a national cancer program, it certainly is falling far short of our programs to build the atomic bomb, get to the moon, or sequence the human genome. Each of these was a focused government project that accomplished its goals under tight time lines in less than ten years. I guess you can’t say the same for the cancer program. Why not?

The Manhattan Project, the Apollo Project, and the Human Genome Project all had in common the knowledge of most of the science needed for success. Each needed a huge investment in money and human capital to complete and each had magnificent leadership in the White House and atop the projects. You really cannot say that of the cancer program.

During my time on Capitol Hill, a piece of new legislation was introduced to reauthorize the cancer program. It was the Kennedy-Hutchison Bill called ALERT (I describe this in my newly revised book, The Premature Birth of ObamaCare which we hope to have out in a few months). It never got to committee, despite the sympathy engendered on both sides of the aisle following Senator Kennedy’s brain cancer diagnosis. Some aspects of the bill, like cancer prevention being covered by insurance, did make it into the ACA, but the bill itself was a list of “asks” by various factions of the cancer community and really was a smorgasbord not a true plan to conquer cancer.

Why is there still not a functioning national cancer program?

Let’s start with the obvious. Unlike the three projects listed above, the basis for the cure for cancer is still not known. It is even possible that the science needed doesn’t exist yet. Might it take quantum computing to solve the complex, multivariate analyses needed to make sense of genomic and clinical data from real patients? Maybe. Will further amazing breakthroughs in immunology set the stage for a cure? Perhaps. Or could it be at the intersection of biology, physics, mathematics and engineering that the real solution is found? All possible.

The point is that there is no point in creating a program like the Manhattan Project or Moon Shots for cancer. It’s too soon. We may just have to continue to Braille along semi-sightless until we come upon the basis of a major push in one direction to cure cancer. In the meantime, we may have to maintain our multifaceted sloppy efforts to unearth the tools to find the cure. The toolbox is full, but it may not yet contain the tools needed to solve the problem.

That being said, was Dr. DePinho right in declaring his Moon Shot effort as a single institution press to solve multiple clinical cancer problems? I think the answer here is yes and no.

If an institution of the power of MD Anderson could get organized to pool its resources to solve even some part of the cancer problem, that could be of benefit. But, and here’s the big but, the institution cannot also be a classical academic place where every faculty member sets his or her own agenda and is the CEO of ME Incorporated.

I believe that was what Dr. DePinho was trying to do, but he was doing it at the wrong place. His Moon Shot ideas were not crazy. They were just crazy to try at MD Anderson.

So, in summary, there is no coherent national cancer program and probably ought not be until we learn as much about cancer as we knew about splitting atoms, flying into space, and sequencing genes when we attempted that science.

Second, under the current state of understanding, if one group of scientists wanted to organize themselves to make efficient progress as a team, that might work. But that’s not academic medicine. (And I don’t know many scientists who would sign on short of a real war as in WWII). That’s the pharmaceutical industry’s job.

So Dr. DePinho wanting to create a drug company at MD Anderson made sense. It just didn’t make sense at MD Anderson.

I hope this explains where we are. I can’t wait to see where Dr. Pisters will take us. But his best first step might be to dump the Moon Shots nonsense and get back to science.

Leonard Zwelling