On September 12, 1962, President Kennedy stood in front of the country at Rice University and declared that we would go to the moon by the end of the decade. The speech galvanized the country into a major national effort, involving politicians, scientists, engineers and the general public to achieve that goal.
While President Kennedy’s plan was ambitious, it wasn’t a quixotic dream. After World War II, the US government began to invest heavily in basic research and those efforts were beginning to bear fruit. It would be an intense undertaking to engineer those discoveries into practical applications, but it was a goal within reach.
This past Wednesday, Vice President Biden made a similar plea for a Moonshot for cancer. While many might assume that he was being more hopeful than practical, the idea most probably comes from a cancer moonshot program already underway at MD Anderson. Biden is right, it is time to begin a organized and focused effort to make a final assault on cancer.
Why The Time Is Now
Over the past generation, cancer survival rates have steadily improved by about 1% per year. However, much like the space program in 1962 was preceded by discoveries in jet propulsion, information technologies and other areas, recent advances now make it possible to markedly accelerate progress and, perhaps, to cure cancer altogether.
The first major breakthrough was the Human Genome Project. Completed in 2003, it provided a map of the human genome and led to a subsequent effort, launched in 2005, to create a Cancer Genome Atlas. This, in turn has led to more targeted therapies that attack cancer cells more precisely, increasing efficacy and diminishing side effects.
Another consequence of the Human Genome Project was a number of advances in applying information technology to medicine, especially in the case of gene sequencing, which can now be done fast enough to be applied to cancer treatment. More recently, efforts like IBM’s Watson project have opened new possibilities to both medical research and patient care.
Finally, completely new ways to attack cancer have been discovered. Cancer immunotherapy, for example, helps empower patients’ own bodies to recognize and attack cancer cells. This approach, while still very new, has extended the survival of patients with advanced cancer beyond what anyone thought possible.
It is the confluence of these developments and others that led MD Anderson’s President, Ron DePinho to set up its Moonshots program in 2012. However, cancer is a problem that is much larger than any one institution and Biden’s proposal for a national effort is both apt and timely. We need a public effort that encompasess basic research, development and treatment.
Restoring Our Commitment To Basic Research
Although funding for basic science rarely grabs headlines, it has been critical to our success as a nation in the post-war world. Take a look at any staple of our technological age, from barcode scanners to iPhones, and they wouldn’t have been possible without government funded research.
This has been especially true in medicine, where the research at National Institutes of Health (NIH) and other federally funded programs accounts for a large proportion of blockbuster drugs. Unfortunately, the NIH budget has been cut drastically in recent years, greatly diminishing our ability to find new cures.
There is currently a bill before Congress called the 21st Century Cures Act, which recently passed the House, that will restore funding to the NIH, yet it still needs to pass the Senate and be signed by the President. Ensuring passage of the bill would be an important first step toward making good on the Vice President’s promise of a “moonshot for cancer.”
More broadly, we need to renew our national commitment to basic research. In recent years, there has been a veritable war on science in which government funding for research has become a convenient political target for grandstanding politicians. We can’t expect to continue to lead in medicine or any other advanced area without investing in new discoveries.
Innovating New Treatments And Cures
In The Silo Effect, Gillian Tett explained how, when working in isolation, even highly competent people often fail to notice problems and seize opportunities. She also argued that the opposite is true, that combining people with varied skills and knowledge often results in more innovation and better results.
DePinho has applied this approach to cancer research. He told me, ““At MD Anderson we introduced a new organizational paradigm. Just like the Manhattan Project or the Apollo Program we brought together experts from a wide variety of multidisciplinary teams to work on targeted areas.” So, for example, oncologists work directly with geneticists and immunologists as well as technologists and experts in other areas.
This is markedly different than the traditional approach in which researchers in specific areas pursue isolated lines of inquiry, largely independent of others working outside their fields, and it is already showing impressive results. For example, MD Anderson just announced two new drugs for prostate cancer and more effective treatments for ovarian cancer and Leukemia.
DePinho also suggested that we can apply the same principles on a national scale, by creating clear objectives and then incentivizing action through access to government resources. Through setting clear targets and encouraging cross disciplinary efforts, we are likely to accelerate progress substantially.
Overcoming The Valley Of Death
Another major issue treating cancer, or any other disease for that matter, is the long lag between scientific discovery and the clinical implementation of new drugs and treatments. Often referred to as the “valley of death,” this lag in translating new knowledge into practical applications results in higher costs and an untold number of lost lives.
To understand how insidious the problem is, consider this. Watson and Crick discovered the structure of DNA in 1953. It took another 50 years to decode the human genome and we just recently began deploying effective genomic therapies. That’s over half a century from primary discovery to practical application! And that kind of lag is more the rule than an exception.
Again, DePinho argues that a more integrated approach is key. He says, “We need to break down the silos fully to aggregate clinical and research data so that we can learn from every patient” and he has created an Institute for Applied Cancer Research to do just that. Through closer collaboration between researchers and practitioners, we can get cures to patients faster.
The Obama Administration has already instituted a similar program designed to spur adoption of advanced manufacturing techniques, so applying the concept to healthcare—and chronic diseases like cancer in particular—makes abundant sense.
Moonshots Are What Make Us The Exceptional Nation
It would be tempting to dismiss Vice President Biden’s call for a “moonshot for cancer” as that of a grieving father wanting to find purpose at the very end of an illustrious career. Yet it’s vastly more than that. A confluence of advances in genetics, immunology, information technology and other fields make a cure for cancer within our reach.
And besides the obvious reduction in human suffering, a moonshot for cancer would make us a stronger country in a myriad number of ways. Certainly, it would reduce healthcare costs, a major driver of the national deficit. It would also lead a better understanding of our own basic biology, leading to even more breakthroughs down the road.
The accomplishments of the Apollo program did not end when we reached the moon, but continue to benefit us to this day. The space program has thrown off an impressive array of more earthly technology, such as solar panels, fire resistant suits our firefighters wear, kidney dialysis and even Tempur-Pedic beds, just to name a few.
Most of all, a moonshot for cancer would show that we can still do great things as a country. The truth is that the journey is just as important—and often more important—than the destination. It has been our willingness to expand our horizons and tackle hard problems that has made us the exceptional nation.
Or, as President Kennedy put it in 1962, “We choose to go to the moon in this decade and do the other things, not because they are easy, but because they are hard, because that goal will serve to organize and measure the best of our energies and skills, because that challenge is one that we are willing to accept, one we are unwilling to postpone, and one which we intend to win, and the others, too.”
