This article is more than 5 years old. Information may no longer be current.
A cancer moonshot: Achieving the unattainable
Click Here to Manage Email Alerts
In 1971, President Nixon signed the National Cancer Act declaring a war against cancer, which transformed our ability to diagnose, treat and reduce morbidity and mortality from cancer.
In 2015, due to the tremendous progress in our war against cancer at the genomic and cellular level, President Barack Obama launched the Precision Medicine Initiative to revolutionize how we improve health and treat disease. This was followed by his recently announced “moonshot” to cure cancer, being led by Vice President Joe Biden.
Many of us in the cancer community tend to cringe when we hear politicians talking about curing “cancer.” We want to point out that cancer is a thousand different diseases, so how can we cure that which does not exist as a single entity?
However, what is being asked of us is not to think like scientists writing R01 grants but, rather, as visionary leaders laying out a new framework upon which the thousands of innovations to cure the thousands of diseases we call cancer can be built.
I would argue that framework is composed of two critical elements: interconnecting siloed data so that we can learn from every patient in every corner of the globe in real time, and completely restructuring the federal biomedical research infrastructure.
I look at my own center, University of Chicago, where we perform next-generation sequencing and clinically annotate thousands of tumor samples on patients with gastrointestinal malignancies. Our thoracic group does likewise, yet our two databases do not integrate with each other, let alone with others around the world.
Think about how many cancer centers and private practice sites do this as well, each using their own format, each collecting data in a slightly different way. The power of integrating those data in a standard format with mutually agreed upon annotation is limitless.
We are not at a loss for the questions we want to ask, but we are limited by the pace at which we can ask them and by the sample size limitations to evaluate the nuanced interactions that will prove critical to curing cancer.
From a public policy perspective, this is a classic collective action market failure — that is, each of us working in our own silos incentivized for individual advancement will produce a result that is suboptimal for us and for the society as a whole. The role of government is to step in when market failure exists and create the means to overcome the collective action problem.
This should be one of the primary tasks of the moonshot program: Make sure our data can be integrated and avoid the monopolizing of these data by siloed entities under the cover of “proprietary data.” There will be plenty of room for individual accolades and profit taking for those who can efficiently mine the data.
The incentives required for scientific progress rest on a stable source of funding. Scientists think and plan in time horizons that exceed 1 year. Young scientists, the ones most likely to produce the groundbreaking paradigm shifts, read the tea leaves of funding stability in making decisions about whether to pursue a career path that allows time for thought, experimentation and failure.
Our current biomedical research infrastructure is plagued by the vagaries of yearly budget and appropriation fights and a divestment in the public clinical trial research infrastructure, leaving the decision of which questions to ask and how to ask them ultimately in the hands of industry beholden to their shareholders and not necessarily the public at large.
To solve this problem, the moonshot program should move our biomedical research funding from a yearly appropriation to a fully funded 5- or 10-year trust fund, similar to the highway infrastructure fund. The role of Congress then would be to oversee the operations of the fund and hold executive branch leadership and researchers accountable to the goals set out.
The moonshot program should help define what the goals are and will certainly include a strong emphasis on cancer prevention research — the Holy Grail of eliminating most cancers — and on the public clinical trial infrastructure needed to test this research.
Curing cancer is immensely more complicated than going to the moon ... or Pluto, for that matter. However, I am convinced now more than ever that what limits us is not the imagination and intelligence demonstrated in the incredible basic science and drug development work being conducted within academia and industry, but rather the artificial barriers imposed by an inefficient market for these ideas.
If the vice president can help remove those barriers and create systems to harness the incredible intellectual energy we have in the cancer research world, then we can achieve the unattainable.
For more information:
Blase Polite, MD, MPP, is associate professor of medicine at The University of Chicago Medicine. He also is a HemOnc Today Editorial Board member. He can be reached at bpolite@medicine.bsd.uchicago.edu.
Disclosure: Polite reports participation in the AstraZeneca BEACON Strategy Council on health care and payment reform.