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Why a ‘Cancer Moonshot’ Is The Wrong Analogy

Editors’ Note: The following blog post first appeared on Forbes.com.

Photo courtesy NASA

Photo courtesy NASA

In his seventh and last State of the Union address on January 12th, President Barack Obama announced a “moonshot” with the goal of making “America the country that cures cancer once and for all.”

The “moonshot” program is to be led by Vice President Joe Biden, whose son Beau died last May of brain cancer at the age of 46. Biden has been working with the National Institutes of Health and the Congress to increase funding for cancer research by $1 billion over five years. The goal of the program is to accelerate research to accomplish ten years of work in five years.

The cancer moonshot is predicated on the idea that recent advances in genomics and precision medicine have brought us to an “inflection point,” where game-changing progress is within reach. In order to unleash this progress, proponents argue, it is crucial to foster collaboration, rather than competition, between researchers and to promote the sharing of data in centralized databases to which qualified researchers have access. The new infusion of funds would make it possible to sequence a large number of genomes from cancer specimens in order to speed up the testing of drugs targeting specific types of cancer.

These are worthy goals, and, in fact, they are already being acted on under the auspices of a number of cancer research organizations.

There is good reason to be excited and optimistic about the promise of new approaches to treatment involving the targeting of specific mutations that appear to drive the growth of specific cancers. However, in time cancer cells tend to become resistant to the specific drug and devise ways to break out.

Unleashing the immune system’s capacity to fight cancer — as exemplified by the ability of the drug Yervoy to eliminate melanoma in 20% of clinical trial patients for more than a decade — is perhaps the most exciting new development. Nevertheless, one should not underestimate how much work lies ahead.

Although the moonshot has been endorsed by some of the leading figures in biomedicine and cancer research, others worry that a simplistic public relations campaign directed at politicians and the public overpromises and gives the public the wrong idea, setting us up for inevitable disappointment and disillusionment.

Cancer is not a single disease but a myriad of diseases, occurring in different tissues and characterized by different types and subtypes, each with a different genetic make-up. To speak of a cure for cancer makes no sense to anyone who knows anything about cancer.

Furthermore, the inflated language obscures a number of important issues.

First, even if the $1 billion is appropriated in 2017, this is a modest amount of money compared to the $32 billion for cancer research in the present fiscal year.

Second, the focus on exciting new therapies eclipses the less glamorous but more certain additional yield in reducing cancer that can be obtained through continued emphasis on prevention.

Third, even if new “miracle” therapies are developed, given current conditions, one has to worry that their truly astronomical cost will put them out of reach of all but the wealthy.

Finally, in spite of the PR and talk of “a cure,” Francis Collins, the director of the National Institutes of Health, who welcomed the new initiative, made it clear that we are talking about accelerating “incremental” progress, rather than being on the point of delivering a cure.

Putting a man on the moon in the 1960s was an engineering feat that depended on the known physics governing the motion of celestial bodies and rocketry. Compared to that problem, the biology of cancer is staggeringly complex. Every time we think we have made a game-changing discovery, we find new layers of complexity.

It’s better to level with the public and be straight about the magnitude of the challenges, while stressing the real and exciting progress that is being made, without overselling it.

Advertising moonshots and setting deadlines to defeat cancer once and for all only trivializes the problem and misleads the public with false hopes.

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