Map of life expectancy at birth from Global Education Project.

Monday, August 01, 2016

The Cancer Moonshot

I'm not entirely sure how much I've written about this here before, but the cancer moonshot that president Obama recently announced isn't sitting all that well with me. It will apparently re-allocate $1 billion in NIH funding to cancer research. Since congress obviously hasn't appropriated any new money, this is coming out of competing research interests.

The first problem with this idea is that, as the linked NIH fact sheet states quite clearly, cancer is not a disease. It is an umbrella term for hundreds (at least) of diseases -- quite likely it's conceptually impossible to define any finite number of cancers. Cancer means a failure of regulation of cell division such that abnormal cells proliferate. This can happen in innumerable ways to innumerable different kinds of cells. So there can never be one "cure" or one answer. Many different lines of research will lead to better approaches to different sets of people diagnosed with cancer, or to dead ends.  The mission is essentially undefined.

The second problem is that the risk of cancer rises steadily with age. While it's been a high priority (and an astonishing success story already, in fact) to effectively treat cancer in children and young adults, the vast majority of cancers occur in people who are older than 70. This means that people who are successfully treated for cancer are quite likely to come down with another, or to succumb within a relatively short time to some other cause of death. Given that available treatments so far are mostly very burdensome, have terrible side effects, and leave people with shortened life expectancies and, yes, disproportionate risk for recurrence, one has to question the cost effectiveness of making a huge investment without regard to the specific type of cancer, age of onset, or other risk.

There is hope that breakthrough technologies such as immunotherapy may ultimately benefit many people without horrific side effects but that would seem to argue against the scattershot approach of the current effort. I would like to see this discussed much more broadly, and the mission and strategy much better informed and defined. As it stands, it seems like a political stunt.

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