Map of life expectancy at birth from Global Education Project.

Thursday, May 22, 2008

War on Cancer

It seems the bad news Senator Kennedy got this week has caused a lot of focus on cancer in general. Before I add to that particular chatter, let me say a word or two about Ted Kennedy. I worked for Ralph Nader just after I graduated from college, and back then Kennedy was already a force in the Senate. He was also already overweight, in perpetual need of a haircut, and not exactly abstemious, and he stayed that way until just a few years ago. In 1994, when Mitt Romney ran against him for reelection and it looked like it might be close, a friend of mine said, "Well, I voted for the bloated, alcoholic murderer, and I'm sure glad I did." Yes, he didn't always display the greatest maturity, self discipline or courage in his personal life, but he knew that his privileges and his sinecure in the Senate were not earned, and that they conferred an obligation to everyone less fortunate, and particularly the most vulnerable. He spent his life as a drum major for justice.

So, cancer. Kennedy was instrumental in providing funding for the National Cancer Institute, and in particular in launching the National Cancer Institute's major effort to defeat cancer during the 1980s through 2000. However, during the Bush years NIH has undergone a steady decline in real resources. This is what Sen. Kennedy said on March 11, at a hearing of his Committee on Health, Education and Labor:

We cannot close our eyes to the consequences of continued failure to capitalize on the progress we have made in medicine in recent years. Thanks to thoughtful research and scholarship by a consortium of universities that includes many of our nation’s leading centers of innovation, we have before us a chilling statement of where our current budget policies for NIH will lead.

The report’s conclusions are a call to action for Congress and the nation. President Faust of Harvard, one of the authors of the report, will present the findings in more detail, but even a brief review of some of the major conclusions should shock those who hear them.

Due to inadequate funding, the success rate for grant applications has dropped from 32 percent in 1999 to 24 percent today. For young researchers, the situation is even more dire. Their success rate in applying for their first independent research grants has dropped from 29 percent in 1999 to 12 percent today. That means a young researcher has just one chance in eight of getting a grant.

As a result, the age at which a researcher gets his or her first independent research grant has risen from 39 years old in 1990 to 43 years old today. Many young scientists conclude that it’s not worth the wait, and pursue other career options. Even those scientists who do get funded are forced to spend more time writing grants and less time doing research at the bench. Many turn to industry jobs where they can benefit from funding security, despite losing the freedom to pursue academic research.

Tell me about it. Don't worry, I now have funding -- or at least I think so, I'll know for sure next week. But believe me, it's been a long hard struggle. NIH now says it's funding less than 20% of applications, but I am pretty sure it's a lot worse than that. I have colleagues who have gotten percentile scores of 13 or less, and ended up not funded at all, or with drastic budget cuts. And since NIH only scores half of all applications, a percentile score of 13 means you are in the top 6 or 7 percent of applications.

Now, this is not necessarily a factor of what we ought to be spending on biomedical and other health related research. The reason this happens is because the massive expansion of the NIH budget before 2000 created a whole lot of laboratories and a cohort of young researchers who are now seeking their own grants, only to run up against a cash cow that is slowly drying up. The demand for research dollars is driven by the supply of researchers, not necessarily the public interest. I don't know what the right amount of money is to be spending on biomedical research, but it definitely has a bigger payoff than occupying Iraq or eliminating the estate tax.

Progress in the so-called War on Cancer has been incremental and frustrating. We've learned a lot about the basic science of cancer, but the clinical payoff has mostly been in the form of expensive treatments with fairly limited benefits, with certain notable exceptions. We've certainly driven down the death rate from breast, colon, cervical and prostate cancer, through screening and good old fashioned slicing and dicing, but the magic bullet remains elusive. Sen. Kennedy stands to gain a few months of life from recent advances, probably no more than that.

Sure, we could get bigger bangs for the buck by fighting tobacco addiction around the world, and other basic public health measures. But that's not where the competition for the dollars lies. It's not as if money taken away from NIH is going to buy mosquito nets and condoms for Africans. And I have always said, along with the founders of Faber College, "Knowledge is Good." I trust that next year, Sen. Kennedy will be around to see NIH funding set back on a reasonable path of growth.

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