The Many Cancer MoonShots
By
Leonard Zwelling
In the January 22, 2016 issue of Science (p. 325), the initial phase of the Biden MoonShot is
described. Subsequently the entire issue of how to pay for it gets discussed on
February 2:
In the earlier article, care is taken to distinguish the
Vice President’s MoonShot from that of Los Angeles oncologist Patrick
Soon-Shiong to get companies with cancer immunotherapies to work on clinical
trials together and from that of Ron DePinho that is far more specific than the
Vice President aims to be. DePinho elucidates eradication targets (e.g.,
cutting colon cancer deaths 30% in 10 years). (Actually, all you need to do to
cut colon cancer deaths by far more than 30% is get everyone who needs
colonoscopy the test and proper preventative care. I bet Bernie’s plan of
Medicare for all can get that done. That MoonShot prediction is as risky as betting on
DiCaprio to win the Oscar later this month.)
We
are assured in the first Science piece
that Dr. DePinho has discussed his plans with the Vice President. Hmmm…when
will an oncologist enter that discussion to settle the queasiness in my
sensitive stomach?
So it appears, that
unlike in 1961, when only two MoonShots were competing in the whole world, now
we have at least three in the US alone. I feel better, don’t you?
Apparently paying for all of this is still a problem as
Congress can easily get involved as the White House may wish that mandatory
funds are set aside for this latest push to the moon and Congress never likes
the appropriation of funds when it would lose control over their distribution
as would be the case with a mandatory program.
Clearly,
Ellen Sigal of Friends for Cancer Research has been talking to her buddy Rick
Pazdur at the FDA and has proposed that a fair amount of money go to revamping
the regulatory mechanisms at the agency to “break down internal silos” at the
FDA. Who can argue with that? Not I. Given that it is these internal silos that
have prevented the approval of MTP in the US while its approval throughout the
rest of the civilized world has already saved the lives of many with
osteosarcoma as long as they are not Americans. I guess the FDA could use an
overhaul. If this gets it done, I am all for it.
What I cannot see is how an extra billion or two is really
going to make a difference for two reasons. First, that’s not enough money.
Second, the problem isn’t money.
It seems to me that there are two strains in modern cancer
research that are worthy of exploration.
The first and most obvious, is the legitimacy of the notion
that genomic (or other -omic) sequencing of human cancers can determine their
proper treatment using agents targeted at genome-specific aberrancies. So let’s
just say that we agree on how to sequence cancer DNA, but not we get one nationwide
group of investigators to answer that question. My guess is that the magic will
work sometimes, but not others, but the sooner the magic enters the world of
standard-of-care, the sooner the sequencing gets paid for by insurers and the
sooner the costly drugs get to those who will benefit. That is plan A. This one
needs money and the amount should be calculable. I suspect it will be far greater
than $1B.
Plan B is a bit more nebulous. It is to massively increase
the funds in the NIH pipeline so that far more basic research can be done to
unearth the mystery of the carcinogenic process.
Plan A is a focused technical application of known
knowledge. It can be priced out.
Plan B is filled with “don’t know” which is the very nature
of research. There is no amount of money that is enough, so let’s just double
what is in the pipeline now so more science gets done.
Plan A will necessitate a team effort. Something the
government could lead.
Plan B relies on the work of individuals and all the
government can do here is increase the money. I am fine with closing the entire
intramural NIH program and selling the land to real estate developers and
putting that money into bonds with the proceeds funding more RO1 grant
applications. Better yet, lease the land and take the rent money and invest in
in more science. There is no need for a clinical program in Bethesda and the
labs there should have to compete with the labs everywhere else for grant funds
which means they too can be closed and the best of the best there moved to
universities or the pharmaceutical industry.
I am fine with one MoonShot. I am fine with the peer-review
process for science funding. I am even finer with increasing the funding for
both. Let’s just be clear about what we are doing, why and what success looks
like.
Plan A: Success is defining the value of omics in the
standard care of patients with cancer or with a high proclivity for developing
cancer.
Plan B: More science and the development of the questions
for Plan C.
6 thoughts on “The Many Cancer MoonShots”
To put this in perspective, Obama is requesting $1.8B to fight the Zika virus.
The technology is more sure and the patients are younger
That's my point. We know how to address this problem; it won't require new scientific discoveries before we can take effective action. Cancer is a much more complicated problem, and yet the amount of money being allocated is significantly less. Hard to take this MoonShot seriously.
That should tell you all you need to know. This is not a real effort but rather throwing a bone to the cancer community and giving the people what they want to hear. A war on cancer ought to be like a real war–strategic, funded and intelligent. The Biden Moonshot and all the other moonshots are none of the above.
They keep thinking that they will find their keys under the light post because they can see better there, The answer may well be in the dark as of now.
To add another view point to this argument, let me take the opportunity point out something else which I hope would be of some value to the discussion so far: I am an MD Anderson employee who deals with some operations management details and insurance related tasks as is my good friend who is a melanoma cancer researcher. I have a bachelors degree and additional professional credentials and my friend is a Phd with post doctoral research credentials under his collar. I get paid 100K while the researcher friend with Phd in the 50K . I would like to think that he should get paid more than me and than a range of other job profiles, as I truly feel that his work makes a world of difference. This appears the same in relation to physicians, as quite a few of them are grossly overpaid compared to a real researcher who in my understanding is really the one who creates a good number of cancer treatment breakthroughs. The historical reality that speciality physician pay from the onset of our nation had started out quite high, in my opinion, should not be a valid reason to continue to set at that rate ignoring other related medical professional contributions to the field. Isn't it something that needs to be addressed as well ?
D;
You are not exactly accurate on a number of levels.
If your buddy is a post-doc, he is in training and that $50K is 5 times what I made as an intern training to be a physician. You may or may not be overpaid. Most administrators at Anderson are, especially the ones high in the food chain who do little and delegate much.
The docs at Anderson, by contrast, are underpaid. They are the engine that generates the revenue the pays everyone else, The researchers, while important to the future of cancer care, usually do not contribute to it as most of their findings are of heuristic interest while not being of practical use. They also do not generate any revenue of substance as they spend 100% of their direct grant dollars and the indirects do not cover the overhead costs their work generates. Biochemists and molecular biologists are largely a luxury in academia and few actually change the course of cancer care.
There is no historical precedent for specialist pay at the onset of our nation (1776) as specialists are largely a post WW2 phenomenon.
In other words, almost all of your premises are incorrect, as far as I can see and you need to do a bit more homework.
LZ