If the Moonshot Concept Is Nonsense (And It Is), What Should We Do Instead?

If the Moonshot Concept Is
Nonsense (And It Is), What Should We Do Instead?

By

Leonard Zwelling

Richard Nixon launched the metaphor
that would not die way back in 1971, 
declaring that “the same kind of concentrated effort … that took man to the
moon should be turned toward conquering this dread disease.”

https://www.statnews.com/2016/01/15/cancer-moonshot-rhetoric/

         OK, OK, we all know that this metaphor has worn out its
welcome despite being rolled out on a regular basis. Like today, June 29.

         Vice President Biden is once again declaring a Moonshot
against cancer. The local NBC news outlet showed pictures of Ron DePinho and
Ray Sawaya associated with its report on the national Moonshot meeting at
Howard University on June 29, but it was not clear why. According to Tom
Brokaw’s interview with the Bidens, the major goals of the latest Moonshot is
to break down siloes, share data, and give hope to patients with cancer. So
let’s start there.

         Break down silos. I am assuming that there are two
kinds of silos. The first is that individuals and institutions are unwilling
to work with others for fear of losing academic credit and the second has to do
with intellectual property rights.

         How are we supposed to undermine the natural human desire
for recognition and money? I actually have no idea.

Tenure
decisions are still made based on individual accomplishment and I see no signs
that this will change.

Furthermore,
the technology development offices of most academic institutions are working
overtime to turn faculty discoveries into money without sharing that money, let alone the data, with
anyone.

Unless
we undo these incentives by allowing tenure to be given for service and group
efforts and to stop this head long run toward alternative revenue streams for
academic institutions, this will not change no matter what the Vice President
does and there isn’t all that much he can do anyway, especially with only one
billion dollars.

         Sharing data. This is something the VP could do
something about. First, demand that every electronic medical record used to
track Medicare and Medicaid patients be interoperable with all other EMRs. No
exceptions. Next, break down the stupid HIPAA laws so that data can be shared
and that includes annotated genomic, clinical and lab data. Without this, the
research cannot be done, period.

Finally,
for goodness sake put someone in charge who knows clinical research and
clinical care. Get the leadership of the cancer centers back in the hands of
real cancer doctors, not lab jockeys. Even politicians like Biden seem to have
greater insight into the problem than the current “thought leaders” of American
oncology.

         Hope. There is always human hope when compassionate
health care professionals work in favorable environments for discovery. The
push toward seeing more patients in less time due to lower reimbursement not
only lessens the quality of the medical care, it invades the time that clinical
investigators have to do research. And to think.

Knock
it off. Academic medical centers are supposed to be non-profit entities not
“margin making” juggernauts of cost and revenue.

         I really appreciate the effort the President and the Vice
President are trying to make in the War on Cancer, but how about something new?
Griping about the same old same old of silos and data sharing is yesterday’s
news. We got the problems. What’s the solution?

I
am afraid it will mean that we will have to take the money and personal rewards
out of what ought to be a team sport, but never has been.

         Or, just admit that the real solution to the cancer problem
will take hard thinking and hard work by both groups and individuals and the
success of these PEOPLE is neither predictable nor subject to central planning.
It’s still America, not the Soviet Union! In other words, we need to keep on
keeping on and go back to work and have fewer meetings about the problem the solution for which
everyone agrees we cannot agree upon.

         On a more positive note however, Vice President Biden will
be looking for work in January, so maybe he can supplant DePinho. He has the
same qualifications Ron had when he became MD Anderson President in 2011 and
surely has greater administrative skills. Besides, at least people like Biden.

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