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Preparing for the journey to the moon
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“Giant steps are what you take, walking on the moon.”
– The Police
The cancer challenge has received considerable and welcome attention in the media in recent months.
Following word of increased funding for the NCI, President Barack Obama announced his “moonshot” concept to cure cancer.
In a statement released during the State of the Union, Vice President Joe Biden — who will spearhead the initiative — said the goal is to “double the rate of progress,” making a decade’s worth of advances in 5 years.
Reaction to the moonshot announcement has been, to say the least, mixed.
Many cancer organizations have reacted enthusiastically, taking the opportunity to endorse the president’s thinking, offer support, and showcase the efforts and interests of their particular entity.
However, the reaction hasn’t been universally positive, as some organizations expressed skepticism over the lofty and ambitious goal to double the rate of advances.
Whether these organizations offered support for or raised doubts about the moonshot concept, they seem to have used the opportunity to promote their own agendas.
There is nothing wrong with that, as we all seize opportunities when we can. But, because an underlying principle of the moonshot is to break down silos, increase collaboration and be inclusive of as many stakeholders as possible, it was a bit disappointing to see primarily parochial responses from many of our respected national groups.
‘Small-picture’ response
Also disappointing, in my opinion, were reports in the press of a meeting in January that included 15 leading cancer experts and members of the vice president’s staff. The press coverage of this event suggested this was a useful exchange of ideas; but, on the whole, there are — appropriately — few who believe this initiative will result in a cure for all cancers by the end of the decade.
A report of the meeting in The New York Times suggested concepts of collaboration, data sharing and coverage for the costs of genomic testing were discussed. This is great — these are issues that need urgent attention and action, especially as the pace of discovery of new molecular targets and new targeted agents increases.
What I have found disappointing so far has been the relatively “small-picture” response to the vice president’s “big-picture” vision. The moonshot concept, as I understand it, is challenging us to think beyond our traditional paradigm of biomedical research and recognize that multiple other disciplines and stakeholders, with completely different perspectives on cancer from our own, are essential to advance progress.
The need to engage diverse expertise and experience to address cancer was brought home to me in brochures released for World Cancer Day on Feb. 4, which likely passed largely unnoticed by most of us who help care for patients with cancer.
As far as I can tell, the day is intended to raise global awareness of the cancer challenge, particularly among health policy makers, legislators and individual citizens.
The document produced in support of the event — titled “Inspire Action, Take Action” — addresses what can be done at an individual and policy level to reduce the cancer burden; promote healthy behaviors that reduce cancer incidence; increase access to cancer prevention and cancer treatment; and ensure the many medical, psychosocial and economic needs of cancer survivors are addressed.
The take-home message from this document for me is that biomedical research is still the bedrock on which we rely for new discoveries, but more rapid progress requires that we leave our comfort zone and think of collaborations with individuals with a much broader range of expertise.
The welcome trends we have seen in breaking down silos with big data projects and multi-institutional collaborative studies will need to expand to a broader group, perhaps including legislators, employers, insurance companies, patient advocates, electronic health record vendors ... and so on.
Need for collaboration
The value of embracing diverse viewpoints and expertise into solving problems is well established and the subject of substantial literature. It also is very enlightening and instructive.
For the past 18 months, I have been fortunate to be a part of the Utah Cancer Action Network (UCAN).
We have been working on the development of the Utah Comprehensive Cancer Prevention and Control Plan for 2016 to 2020. The plan — published in January — is intended to be a roadmap for health care providers, local health departments, community-based organizations, employers, schools, policymakers and citizens to help reduce the burden of cancer in our state over the next 5 years.
We have highlighted priority areas for action and set some ambitious goals. We are now working on implementation of the plan.
This has been a truly rewarding experience for me. UCAN combines the expertise of stakeholders from multiple backgrounds — including health care providers, patient advocates, health insurance companies, educational organizations, cancer charities, community health workers, research organizations and more — and has shown me the power of combining individuals of diverse backgrounds and expertise to address a problem.
This is a fine example of how crossing traditional silos and exposing an issue to multiple perspectives can produce new approaches and, hopefully over the next 5 years, measurable results.
There are some early adopters of the moonshot concept.
On the same day as the State of the Union address, the creation of the National Immunotherapy Coalition was announced at the J.P. Morgan Health Care Conference. This initiative represents a collaboration between big pharma, biotech, payers, employers, academia, community oncologists and others to launch large-scale, early-phase trials of molecularly driven immune therapies. Whether this venture will be a success remains to be seen, but it does represent an attempt to transcend the traditional barriers to collaboration and engage multiple stakeholders — an approach we should applaud.
We will see how advances in cancer prevention and care play out over the next 5 years. Though few of us believe the moonshot will deliver its promise in that time, we should all support the bold, big-picture goal of a new approach and use this opportunity to think afresh and think outside the box.
As Sting has explained, it takes giant steps to walk on the moon.
References:
Kolata G and Harris G. ‘Moonshot’ to cure cancer, to be led by Biden, relies on outmoded view of disease. The New York Times. Jan. 13, 2016. Available at: www.nytimes.com/2016/01/14/health/moonshot-to-cure-cancer-to-be-led-by-biden-relies-on-outmoded-view-of-disease.html. Accessed Jan. 21, 2016.
Page, SE. The difference: How the power of diversity creates better groups, firms, schools and societies. Princeton, New Jersey: Princeton UP; 2007.
Utah Cancer Action Network. 2016-2020 Utah comprehensive cancer prevention and control plan. Available at: www.ucan.cc/wp-content/uploads/2015/12/State-Cancer-Plan_Final_for-web-1-25-16.pdf. Accessed Feb. 1, 2016.
World Cancer Day. “Inspire action, take action.” Available at: www.worldcancerday.org/sites/wcd/files/atoms/files/WCD2016_FactSheets_WeCan_Inspire-TakeAction_Screen_EN.pdf. Accessed Jan. 21, 2016.
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John Sweetenham, MD, is HemOnc Today’s Chief Medical Editor for Hematology. He also is senior director of clinical affairs and executive medical director at Huntsman Cancer Institute at the University of Utah. He can be reached at john.sweetenham@hci.utah.edu.
Disclosure: Sweetenham reports no relevant financial disclosures.