During his final State of the Union address in January 2016, President Obama announced a plan to invest $1 billion toward a “moonshot” attempt at curing cancer. While the details of the plan are rather broad and ambiguous, it essentially provides increased funding for existing research efforts with an emphasis on data sharing and collaboration. While the biomedical research community will gladly welcome any funding increase amidst an ever-decreasing public investment in research relative to inflation, not all scientists are rushing to praise this initiative.
The moonshot initiative includes a substantial funding increase for cancer research at both the National Institutes of Health (NIH) and the Food and Drug Administration (FDA) along with additional support for efforts at the Department of Defense and Veterans Affairs. Research areas of interest highlighted by the initiative are: vaccine development, earlier cancer screening/detection, immunotherapy, pediatric cancers, and genomics. As previously mentioned, another big focus is to consolidate various efforts not only among government agencies but also between distinct cancer researchers and labs. An overall summary of the plan’s goals can be found here.
A presidential initiative for combating cancer is nothing new. President Richard Nixon in 1971 famously declared a “War on Cancer”, dedicating hundreds of millions of dollars toward cancer research and giving the National Cancer Institute unique autonomy within NIH. Over $100 billion has been spent on cancer research since Nixon’s declaration, but the results of these efforts have been mixed. While great advances have been made in certain types of cancers such as blood cancers, overall death rates due to cancer have barely declined since 1950, even when accounting for increased aging of the population. Much of the progress of cancer research investment has come in the form of advanced diagnostics for screening and detection, however it is unclear whether this has actually resulted in any significant reduction in mortality. Additionally, much of the decline that has occurred has been attributed to increased cancer prevention due to lifestyle changes such as smoking cessation (although these connections were often established by funded research).
The excellent book “The Emperor of All Maladies” by Siddhartha Mukherjee chronicles the long history of cancer treatment and the continuous pattern of hubris associated with each new “breakthrough” treatment strategy. It is not possible to simply “cure cancer”, as cancer is not only merely a catch-all term for numerous diseases defined by uncontrolled growth and there is no single causative agent or pathogen for the disease. It is therefore easy to understand why many are skeptical of this new initiative, arguing that it relies once again on false optimism and the idea that extremely complex issues can be solved by simply throwing money at them. Additionally, while researchers will always welcome additional funding, short bursts of funding increases within an overall restrictive funding environment can create investment bubbles that may ultimately lead to layoffs and abandoned projects once the initiative expires. Giant initiatives also require consulting scientists to take time away from their labwork for often burdensome administrative meetings. Instead, most scientists would prefer sustained, reliable funding as opposed to unpredictable funding peaks and valleys.
On the other hand, some aspects of this proposal do offer useful new perspective. True clinical progress within biomedical research is plagued by the need of individual labs to compete for limited grants and publication opportunities, a reality which can hinder collaboration and make researchers wary of sharing data. Consolidating research findings and resources could potentially greatly benefit efforts to improve the efficiency of cancer research investment. Centralized data sharing and increasing utilization of genomic data are also major aspects of another Obama public health initiative, the Precision Medicine Initiative (PMI). The PMI involves maintaining a national network of individual (yet anonymous) health data, including genomic information, in order to allow future research studies on the variable responses of different drugs, treatments, exposures, etc. on specific disease progression. The PMI already contained a large focus on utilizing genomic data for improved cancer treatment, so these aspects of the moonshot initiative fit nicely with existing efforts.
While the cancer moonshot initiative will surely lead to many new research findings and may help promote improved collaboration for the future, it is very easy to question whether the funds could not be better spent otherwise. Cancer research funding is primarily focused on the hope of cures and treatment for future patients as opposed to current ones dealing with the disease. While many private foundations and charitable arms of hospitals do offer non-medical services or healthcare payment support to patients and their families, one could argue that at least some of this “moonshot” money would be better served helping currently suffering patients. With so much money already invested in cancer research, a sudden large influx of funds is likely to have diminishing returns.
Federal initiatives to increase biomedical research funding are generally a positive investment, leading to economic and technological innovation in addition to the development of tangible health benefits. However, with the federal budget already so tight, the efficiency of new expensive programs must always be critically evaluated. The unbridled enthusiasm inherent in such terms as “war on cancer” and “a moonshot” to cure cancer may be important for obtaining necessary political and public support, but it also has the danger of setting us up for disappointment and leading to cynicism about future endeavors. Perhaps, instead of a moonshot, a steady stream of successful near-Earth orbits is a more admirable goal.