EXTRA: Why Do They Invoke the Moon Shot? Because They Can!

EXTRA: Why Do They Invoke the
Moon Shot? Because They Can!

By

Leonard Zwelling

         If there was ever a doubt about the gratuitousness of the
current President of the United States, it ended with his State of the Union
message and his call to cure cancer in America.

         It is far more likely that the cancer that is the current
aspirants for the 2016 Presidency will go away than the disease cancer that
continues to plague Americans and the rest of the world will. What are the
various lesions in the President’s call for a Moon Shot to cure cancer in one
country? The same as the ones that have unhinged the current President of MD
Anderson in his comparable claim to curative intent on Holcombe:

1. Cancer is not likely to go away. It is clearly the
product of life style choices (e.g., smoking) and genes (both onco- and
otherwise). Some people undoubtedly have a proclivity to develop cancer and it
remains to be seen whether identifying them early alters their natural history
(i.e., when they will die). It may but it will take some time to work that out.

2. Treating cancer is a great idea. It will be necessary
to cure it, meaning eradicating the disease and changing its natural history in
a human who already has cancer. This is not easy but inroads are being made. It
is unlikely that the goal will be reached as quickly as the 12 years cited by
Mr. Obama between Sputnik and Neil Armstrong.

3. Preventing cancer is also possible. Screening surely
helps as with colonoscopy. My guess is that the natural history of breast
cancer, prostate cancer and perhaps lung cancer, is and can be significantly altered by better
screening. As usual, someone has to decide who will pay for what. As studies
continue to come out showing the lack of benefit from some screening (e.g.,
PSA), don’t expect insurers to rush to pick up the bill.

4. The original Moon Shot as seemingly neither Mr. Obama
nor Dr. DePinho grasps, was a political ploy to beat the Russians. It was an
extension of foreign policy and a way to wage war without firing a shot at the
enemy and President Kennedy couldn’t have cared less about the science as the
recordings from his library have revealed.

5. IF cancer is truly cured (meaning the natural history
of the disease has been irrevocably altered), all it will do is extend
Americans’ average life spans by 3.5 years (significant, especially if it is
you) and allow us to die of something else. Thus, it is not necessarily so that
curing cancer will reduce the overall health care bill in America if all the
cancer victims die later in nursing homes with Alzheimer’s Disease. In fact,
the bill could be pushed upwards by a cancer cure. That would be like the Space
Shuttle after the Moon Shot, costly and not all that useful.

Here’s
an idea for the politicians who wish to engage in medical predictions. Let the
process of scientific discovery work. Your job is to increase the funding for
it. If Mr. Obama wants to hasten the defeat of cancer here are a couple of
“shots” he might consider:

1.               
This is
not an American problem. It is a world problem. We wish to promote the best
ideas that will alter the natural history of this scourge regardless of whether
or not it comes from an American.

2.               
Close the
intramural clinical program at the NCI. Please name one thing it has accomplished
in the last 30 years.

3.               
Probably
close the basic science part too and put all that money in the RO1 pool so the
pay line goes up instead of down and the money funds the best science
regardless who signs the paycheck of those doing it.

4.               
Plan less.
If we do find the cure for cancer, it is as likely to be due to a stumble as to
a plan. Think of serendipitous breakthroughs like H.pylori,  BCRA-1, Her2, CTL4, etc. Science is not
planned all that well. Engineering is and that was what the Moon Shot was.
There was nothing to discover to get to the moon. Newton figured it all out 400
years before. We just had to want to do it and pay for it. The same is not true
with cancer. We don’t yet know enough despite what many would have you believe.

5.               
Finally,
if you really want to make a difference, Mr. President, fix the FDA system for
new drug approval and increase the size of and support for clinical research
that reaches beyond the grasp of the pharmaceutical industry. If you want to
invest in a cancer cure, invest in the clinical research infrastructure of the
nation. Make it easier, cheaper and faster to do this research and get new
treatments to patients. Loosen the constraints of over-regulation and educate a
generation of oncologists to opt to do clinical research and not have to
constantly balance this altruistic desire with their boss’s rapacious desire
for them to see more patients and generate more money.

Finally, you will have to excuse me, I don’t think
that Joe Biden is the guy to lead this. As both Mr. Obama and Dr. DePinho have
yet to learn, having a relative with cancer is neither unique nor does it
qualify anyone to lead a cancer fighting effort.

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