Why the cancer "moonshot" is a bad idea

[TownieDeac]

Here are a couple links for people to peruse:

HealthNewsReview
NY Times
Ars Technica

Cliffs:
Cancer is not one disease, and there's not going to be one cure for it.
We have recent history to tell us that fast injections of lots of money are a bad idea for basic research goals.
There are systemic problems in science, medicine, and technology that need to be addressed first.

My thoughts:
Scientists in particular are thrilled with this news. It sounds, on the surface, like a great idea. But cancer is more complex than we ever imagined, and the more we discover about it, the more we realize we don't know. Injecting a bunch of money in the short term accomplishes a few things: it allows us to train a lot more new scientists on the career path of PhDs > PostDocs > Associates AND it comfortably funds established labs. Both of these are, in essence bad. Unless there's a long term, sustainable plan to fund the NIH/NCI to cure cancer, this means that in a generation, we'll have a ton of trained scientists and no $ to fund them. As for funding existing labs, that too sounds good, but a little competition is a good thing here. Opening up the purse strings has traditionally meant relaxing standards for grants and outcomes.

We've already spent about $36BN on cancer. I'm not suggesting we haven't made a lot of progress, or that cancer research doesn't deserve more funding. But most of the basic research (yes, most) is not reproducible and therefore hard to build on. What should be a feedback loop between the clinic and the bench is mostly flowing in one direction. And we need to make insurance companies foot the bill for genetic testing of tumors - passing off these costs to consumers or taxpayers just doesn't make economic sense.

I work at an organization that funds (and fundraises for), promotes, and publishes cancer research. We work very closely with policymakers, scientists, and patients. Money is simultaneously the one thing keeping all this moving forward, and at the same time, a potentially dangerous force in the field if applied incorrectly.

 

[simosfrostyone]

I agree with a lot of this. But as far as "making" insurance companies pay for testing, not so much. There is far too much of that going on already. Another thing that will not help is taking away the ability of big pharma to recoup its R&D costs, which is what Hillary wants to do. Haven't even heard Obama talk about that, which is good.

 

[TownieDeac]

I agree with a lot of this. But as far as "making" insurance companies pay for testing, not so much. There is far too much of that going on already. Another thing that will not help is taking away the ability of big pharma to recoup its R&D costs, which is what Hillary wants to do. Haven't even heard Obama talk about that, which is good.

Pharma does just fine recouping costs. It's one of the most booming industries in the country. The could do to spend far less on advertising and lobbying. That's one industry that could use a lot more financial regulation (not from the FDA).

 

[simosfrostyone]

Regulation. Just can't get enough of it.

 

[ImTheCaptain]

yeah, Flint says "regulation is the worst"

 

[BobStackFan4Life]

Townie, do you have any thoughts on the Susan G. Komen foundation?

 

[PhDeac]

Regulation. Just can't get enough of it.

You prefer lawlessness?

 

[TownieDeac]

Regulation. Just can't get enough of it.

Deregulating the pharmaceutical industry is a major driver of health costs in America.

Hopefully we don't make the same mistake with biotech over the course of the next century.

 

[TownieDeac]

Townie, do you have any thoughts on the Susan G. Komen foundation?

Susan Komen, and to a lesser extent, the American Cancer Society, are basically just fundraising societies that exist to fund themselves. Cancer isn't a disease that requires "awareness" anymore. If you subscribe to the notion that charity is a zero-sum game, and that by giving to one charity, another charity is losing out on potential giving, organizations like the Komen foundation are just not very effective in the battle against cancer. I'm biased towards the research and care side of things. There is an argument to be made that the $ these foundations spend on advocacy and survivorship support is one form of "care."

I don't like demonizing these places much. Both my parents are cancer survivors, and I think a great deal of good has come out of organizations like Komen to make cancer the kind of household name disease that gets a lot of attention from Congress for funding.

There's a completely separate discussion about biomedical research funding being a zero-sum game, and that dollars going to cancer are dollars not going to other kinds of research: malaria, HIV, cardiovascular disease, neurodegenerative disease, basic research in genetics and cell biology and infectious disease, etc. It would be great if upstarts were able to enjoy Komen levels of success for autism or Parkinson's in the United States, too.

 

[simosfrostyone]

You prefer lawlessness?

Always with the straw man. Just like Obama.

 

[myDeaconmyhand]

Regulation. Just can't get enough of it.

Always with the empty, unsubstantiated anti-regulatory Republican rhetoric, just like every other mindless conservative drone

 

[simosfrostyone]

Always with the empty, unsubstantiated anti-regulatory Republican rhetoric, just like every other mindless conservative drone

You are a walking, talking liberal cliche who has never had an original thought.

 

[TownieDeac]

Do you care to back up your original point?

 

[WFcatamount22]

Susan Komen, and to a lesser extent, the American Cancer Society, are basically just fundraising societies that exist to fund themselves. Cancer isn't a disease that requires "awareness" anymore. If you subscribe to the notion that charity is a zero-sum game, and that by giving to one charity, another charity is losing out on potential giving, organizations like the Komen foundation are just not very effective in the battle against cancer. I'm biased towards the research and care side of things. There is an argument to be made that the $ these foundations spend on advocacy and survivorship support is one form of "care."

I don't like demonizing these places much. Both my parents are cancer survivors, and I think a great deal of good has come out of organizations like Komen to make cancer the kind of household name disease that gets a lot of attention from Congress for funding.

There's a completely separate discussion about biomedical research funding being a zero-sum game, and that dollars going to cancer are dollars not going to other kinds of research: malaria, HIV, cardiovascular disease, neurodegenerative disease, basic research in genetics and cell biology and infectious disease, etc. It would be great if upstarts were able to enjoy Komen levels of success for autism or Parkinson's in the United States, too.

Great points, I would love to see an effort to address mental health issues in America. Especially for Adults suffering with mental health conditions. At this point I think everybody is aware of breast cancer.

They are actually building a facility in Austin for Adults suffering with Autism, I would love to see this be more prevalent throughout the States. Not everywhere can be as progressive as Texas.

 

[myDeaconmyhand]

You are a walking, talking liberal cliche who has never had an original thought.

lol, i'm a lot of things, but cliche isn't one of them. Hell, maybe you know a lot of poor white private college educated liberals who've interned for Senate Chairman of the NRSC and prayed in the Senate chamber with Mike Huckabee and Tom Coburn.

 

[ImTheCaptain]

does huck smell like cheeseburgers?

 

[myDeaconmyhand]

does huck smell like cheeseburgers?

He was nice, but I didnt get much face time with him. Steve Largent, Bill Nelson, and Heath Schuler were the best politicians that I actually had conversations with, but thats because I was interested in them being football players and astronauts (Nelson).

 

[TownieDeac]

While we're namedropping, I've been in the room several times with some of the scientists who have been hanging out with Biden this week in Davos: Charles Sawyers, Jose Baselga, Elizabeth Blackburn. They're past and present leaders of my organization, Lasker/Nobel winners, and likely some of the smartest people on the planet. Charles Sawyers, for example, basically cured chronic myeloid leukemia.

The "information sharing" aspect of this moonshot idea is really, really important. We need to work with computational biologists and big data to overcome these problems of patient record security and other data privacy and policy needs. Leadership is sorely lacking on the data side of things because scientists don't want to join working groups on data standards - they want to do science.

I really hope this money is spent wisely and the moonshot plans get the right kinds of stewardship and advising. Perhaps the way it was sold to the public is not the same as it will be in execution.

 

[ImTheCaptain]

hm, pour says that big data and computer modeling can't help us do real science

 

[ThinkingWithMyDeac]

Charles Sawyers, for example, basically cured chronic myeloid leukemia.

I picked this out because I think it highlights the biggest problem for moonshot cure. Besides the fact that cure is probably the wrong word to begin with, cure for most cancers is thrown out where in reality delayed should probably be the better term. CML for example (known or unknown by townie that he is talking about Philly again, as its a translocation of the "Philadelphia chromosome") the drugs attributed to Sawyer aren't like take this antibiotic and you are good. The five year survival rate is still only 60% or so for those two drugs.

For a lot of aggressive cancers that people work on technology that gets them to 30%+ survival rate is consider amazing and tons of money is poured into the research. For example CAR T cells which are very hot right now. The list of problems for CAR T cells is massive yet dozens of specialized companies have popped up overnight using specifically this technology, based off some very poor survival rates and the easiest possible targets out there, non-solid blood cancers.

I think the biggest promise right now is in immuno-oncology since current regiments even for what are considered simple cancers rely on treatments that in themselves give multiple hits to people that are clearly already susceptible to the development of cancer. Yet, like I said before the excitement for the technology to survival rates doesn't align. People will be surely disappointed in the future if the purpose of all of this is to get towards most cancers being cured when in reality its delayed death of 5-10 years. Maybe not though since people love to think organ transplants are a save all and the 10-20 year survival rate for those is about 50%. Life over death I suppose.