Grant System Leads Cancer Researchers to Play It Safe and Forty Years’ War: Advances Elusive in the Drive to Cure Cancer are part of a series that has quite a bit to say about the scientific granting system. The author of the series is Gina Kolata. Here's how the second one above starts:
In 1971, flush with the nation’s success in putting a man on the Moon, President Richard M. Nixon announced a new goal. Cancer would be cured by 1976, the bicentennial.When 1976 came and went, the date for a cure, or at least substantial progress, kept being put off. It was going to happen by 2000, then by 2015.
Now, President Barack Obama, discussing his plans for health care, has vowed to find "a cure" for cancer in our time and said that, as part of the economic stimulus package, he would increase federal money for cancer research by a third for the next two years.
Is there something about the system itself that impedes progress? Gina Kolata seems to think so. Read on beneath the break for some more.
I have been in and out of "cancer research" as a collaborator for a good bit of my 45+ year career. My main role was making and interpreting computer models of some of the complicated systems involved in the action of chemotherapeutic agents and their distribution in the whole body as well as in tumors and other tissues. I never have been a principle investigator (PI) on a grant from NIH/NCI but have always worked directly with the PI. I have recently been involved with the grant process but have to respect the confidentiality required for such participation so will say little about my own experience. Instead I will talk through Gina Kolata's convenient voice. Here's more of what she has to say:
Cancer has always been an expensive priority. Since the war on cancer began, the National Cancer Institute, the federal government’s main cancer research entity, with 4,000 employees, has alone spent $105 billion. And other government agencies, universities, drug companies and philanthropies have chipped in uncounted billions more.
Yet the death rate for cancer, adjusted for the size and age of the population, dropped only 5 percent from 1950 to 2005. In contrast, the death rate for heart disease dropped 64 percent in that time, and for flu and pneumonia, it fell 58 percent.
Still, the perception, fed by the medical profession and its marketers, and by popular sentiment, is that cancer can almost always be prevented. If that fails, it can usually be treated, even beaten.
The good news is that many whose cancer has not spread do well, as they have in the past. In some cases, like early breast cancer, drugs introduced in the past decade have made an already good prognosis even better. And a few rare cancers, like chronic myeloid leukemia, can be controlled for years with new drugs. Cancer treatments today tend to be less harsh. Surgery is less disfiguring, chemotherapy less disabling.
That is a bad news/good news story for sure. So what more can we expect? Can we ask for a "cure"? Is it reasonable at all to compare cancer with an infectious disease like polio or small pox which we seem to have conquered? I'm sure we all wish it were.
But difficulties arise when cancer spreads, and, often, it has by the time of diagnosis. That is true for the most common cancers as well as rarer ones...
As for prevention, progress has been agonizingly slow. Only a very few things — stopping smoking, for example — make a difference. And despite marketing claims to the contrary, rigorous studies of prevention methods like high-fiber or low-fat diets, or vitamins or selenium, have failed to find an effect.
What has happened? Is cancer just an impossibly hard problem? Or is the United States, the only country to invest so much in cancer research, making fundamental mistakes in the way it fights the cancer war?
Researchers say the answer is yes on both counts. Cancer is hard — it is not one disease or, if it is, no one has figured out the weak link in cancer cells that would lead to a cure. Instead, cancer investigators say, the more they study cancer, the more complex it seems. Many are buoyed by recent progress in cancer molecular biology, but confess they have a long way to go.
There also are unnecessary roadblocks. Research lurches from fad to fad — cancer viruses, immunology, genomics. Advocacy groups have lobbied and directed research in ways that have not always advanced science.
And for all the money poured into cancer research, there has never been enough for innovative studies, the kind that can fundamentally change the way scientists understand cancer or doctors treat it. Such studies are risky, less likely to work than ones that are more incremental. The result is that, with limited money, innovative projects often lose out to more reliably successful projects that aim to tweak treatments, perhaps extending life by only weeks.
I wrote a diary yesterday asking for a real distinction between "innovative" studies and things that seem new because we simple have begun to forget too much of what has been tried in the past. If money is short, and it is by many standards, then it will be wasted when we spend it on a seemingly new idea that has been tried and shown to be a dead end or a tangent.
Here's another interesting aspect of the same idea:
A recent New York Times/CBS News poll found the public divided about progress. Older people, more likely to have friends or relatives who had died of cancer, were more dubious — just 26 percent said a lot of progress had been made. The figure was 40 percent for middle-aged people, who may be more likely to know people who, with increased screening, had received a cancer diagnosis and seemed fine.
Allow me to suggest that this "age gap" also exists among scientists in a number of important ways. We actually do have younger scientists getting excited about ideas that they see as new because they have not been adequately schooled in what was done in the past. So when the author of these articles talks about the existence of "fads" it is even more complicated than she realizes.
The article goes on to portray some of the realities of the situation from the vantage point of actual cancer patients. I'll not go into that here, but it may be more meaningful than my focus on the difficulty in finding direction when the continuity of the research history is broken up as it seems to have been.
We are possibly about to spend some money on cancer research. How much will you know about how wisely it is being spent? That should be an important question for everyone.