Oncology is a grim discipline. Most new drug studies show no benefit and fail. Cancer therapies extending life by two months obtain FDA approval, and oncologists herald them as progress. Response rates of 2 and 3% win applause. The science crawls forward one small lurch at a time, starved for new data, consuming the lives of patients and the careers of researchers as it plods along.
And yet they do not give up, even if privately some may have low, dispirited moments. Oncologists rock! I don’t know if they’re unfaithful lovers as they’re labeled in Anthony Marra’s brilliant novel “Constellation of Vital Phenomena” (a must-read). I do know they are faithful to their mission.
But what is it? From the mouth of POTUS himself, we’ve recently heard of the “moonshot” to cure cancer. Vice-president Joe Biden will lead the government’s support for it. From what I understand, he has taken it seriously, and as recently as last week visited with the oncologists at the University of Pennsylvania.
What I’m sure he already understands is that there is no such thing as cancer, singular. There are thousands of different mutations giving rise to diseases we then label as the cancer of the organ in which they are found. Cancer is a genetic disease. The longer we live, the more time our genome has for potential damage. The more hazards we introduce into our environment—radiation, pollution, infection and inflammation, etc.—the greater the likelihood a cell or two will replicate out of whack. The result: cancer.
I hope the “moonshot” takes a holistic approach. Here’s what Joe Biden will likely attempt, and will have a fight on his hands with the science skeptics in the Congress to accomplish:
- Appropriate funding for basic and translational research by both the government and private entities. A capitalist approach to fighting cancer will not work. Ultimately, every cancer is a rare disease because of the specific genetic make-up of it, and there will be too little money in the therapies to make the work lucrative to the companies’ shareholders.
- Restructuring of our regulatory environment. FDA, as it stands, requires billion-dollar global clinical trials for each new treatment. As we begin to understand cancer better, and create targeted therapies based on the genetic makeup of cancers, the numbers of patients for whom the therapies would be appropriate will shrink. This will make the trials impossible to accrue. We need a new regulatory paradigm, one which supports personalized medicine.
- World-class science education in the United States schools. In a country where creationism finds itself on the same footing as the scientific method, this will be a gigantic task. We must make the effort, though, if we’re to have any hope.
- I’m pretty sure Ben Franklin really said this: “An ounce of prevention is worth a pound of cure.” It’s become such a cliché that it’s easy to gloss over it; however, any strategy to combat cancer which ignored prevention would be doomed to fail. Like sanitation was key in fighting infectious disease, addressing environmental factors will be vital in combating cancer. Anything we dump into the world which exerts stress on our genome can give us cancer: gasses degrading the ozone layer, substances increasing background radiation, toxins in the water and the air, diet choices, etc. We ignore the Earth at our own peril.
This truly will be a “moonshot.” We can help Joe by voting to elect public officials who understand what it will require and who will represent us rather than the near-term corporate interests. Do not stay home on Election Day.