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26 March 2016

Cancer Moonshot? It's Not Rocket Science!

Vice President Joe Biden and Speaker Paul Ryan of
Wisconsin applaud President Barack Obama during the
State of Union address, Jan. 12, 2016 (AP Photo/
Evan Vucci, Pool) Photo:  Evan Vucci/AP
"We know a lot more about the molecular biology of normal and cancerous cells. But these knowledge gains have not translated into significantly longer survival times. Among the other forms of cancer that have seen little progress in terms of survival prospects since 1970 are brain tumours – a brain tumour claimed the life of Vice President Biden’s son in 2015 – and pancreatic cancers. Some commentators have argued that the only winners in this war on cancer are the companies forming the new medical-industrial complex around cancer therapy and research."

Cancer moonshot? It’s not rocket science!

by Carsten Timmermann, The Guardian, 16 February 2016

Last month President Obama announced a new ‘moonshot’ in the global race to find a cure for cancer. Carsten Timmermann wonders if this new shot in the ‘war on cancer’ is a good idea.

I admit I was surprised to hear that in his recent State of the Union Address President Obama pledged a new ‘moonshot’ in the race to find a cure for cancer, led by Vice President Biden at ‘mission control’. The message was: if we all work together in a targeted effort, and give researchers at the National Institutes of Health lots of money and other resources while encouraging them to collaborate closely with other cancer researchers and with industry, a cure for cancer is in sight. Haven’t we been here before? While many reports drew parallels with John F. Kennedy and the Space Race, I was reminded of a different President: in 1971, following intense lobbying by the philanthropist and campaigner Mary Lasker and her Citizens’ Committee for the Conquest of Cancer, President Richard Nixon signed the National Cancer Act, declaring ‘War on Cancer’ and promising a cure within 7 years.

The Act created a National Cancer Program and strengthened the National Cancer Institute (NCI), one of the National Institutes of Health. The role of the NCI Director, appointed directly by the President, was also strengthened. One of the principal generals in the War, he (all NCI Directors to date have been men) was tasked with creating new cancer centres, appointing advisory panels, expanding the facilities of the NCI on the NIH campus and across the country, coordinating collaboration with industry, and awarding lots of research contracts. For all this he had a massive war chest at his disposal, an annual ‘bypass budget’, which was submitted directly to the President, bypassing approval by the NIH or the Department of Health and Human Services: lots of money for a targeted research effort into finding a cure for cancer.

Who’s winning the war on cancer?

As Nixon was losing that other major war that the United States was fighting at the time, in Vietnam, critical commentators were starting to compare the two campaigns. The War on Cancer looked increasingly unwinnable. But what did it mean to ‘win’ a war on cancer? Commentators split into two main camps. Some pointed out that the all-out assault had made very little difference to patients: they could not expect to survive their cancer diagnosis for much longer than previous generations of cancer sufferers. Improvements were very gradual and mostly due to increased awareness and better referral pathways. Others celebrated the knowledge gains that had been achieved, especially with the help of molecular biology, and expected that decisive breakthroughs were just around the corner.

40 years on, do cancer sufferers enjoy longer lives? Median survival times for some cancers have indeed increased significantly since 1970, as figures compiled by Macmillan Cancer Support show, but for others they haven’t. Median survival times are more meaningful here than mortality figures. For instance, while lung cancer mortality has been going down in recent years this has very little to do with improved treatments and rather a lot with successful anti-smoking campaigns. Lung cancer is one of the forms of the disease where the targeted cancer research efforts of the past 45 years have made very little difference.

Don’t get me wrong, knowledge gains have been considerable: we know a lot more about the molecular biology of normal and cancerous cells. But these knowledge gains have not translated into significantly longer survival times. Among the other forms of cancer that have seen little progress in terms of survival prospects since 1970 are brain tumours – a brain tumour claimed the life of Vice President Biden’s son in 2015 – and pancreatic cancers. Some commentators have argued that the only winners in this war on cancer are the companies forming the new medical-industrial complex around cancer therapy and research.

But it’s not all gloom. Childhood leukaemia was declared curable by the late 1970s, thanks to the development of aggressive combination chemotherapy regimens since the 1950s. Women diagnosed with breast cancer are also very likely today to be treated successfully and survive their diagnosis for many years. There are a variety of reasons: new drugs such as tamoxifen, the recognition that it’s useful to combine different treatment modalities in a carefully choreographed treatment regime, but also the combination of better cancer awareness and the removal of stigma, leading to more timely diagnoses and referrals.

Not rocket science

The main problem with the cancer moonshot is that finding a cure for cancer is not rocket science. Rocket science is about translating a big challenge into a manageable engineering problem. When it comes to sending a man or a woman to the moon, this translation may well be complex, but it’s a lot less complex than translating better understandings of cell biology into interventions that make a difference for human beings dealing with a terrifying diagnosis, in ways that are ethically and politically acceptable. Much of modern cancer research is also in effect about turning cancer into an engineering problem: making sense of changing levels of molecules in cell cultures by translating them into flow diagrams that are reminiscent of blueprints drawn up by engineers. As a biochemistry student I used to be deeply impressed by the Biochemical Pathways chart that the Boehringer Mannheim company used to send out free of charge to anyone who requested a copy. But the history of medicine shows that macromolecules aren’t switches, cellular processes aren’t circuits, and humans – individually and collectively – are a lot more complex and far less predictable than any laboratory model.

https://www.theguardian.com/science/the-h-word/2016/feb/16/cancer-moonshot-not-rocket-science

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