The Nation's Best Investment

The Nation's Best Investment

George W. Sledge, MD, FASCO

May 09, 2011

Many thought the budget battle was over after Congress struck a deal in April to fund the government through the end of fiscal year 2011. The cancer community collectively breathed a sigh of relief when the numbers came out and the National Institutes of Health (NIH) received only a 0.8% reduction in funding — much lower than what was predicted. But even the slightest cut or flat funding means that clinical trials conducted by the NIH and NCI will have to be cut back. As we look to the 2012 budget process, the real work is just beginning.

Every year members of ASCO’s Government Relations and Cancer Research Committees, along with colleagues from sister societies (AACR, AACI, and FOCR), join together for Hill Day in Washington. On Hill Day we sit down with members of Congress and their staff to make the case for federal funding of cancer research. Some years our task is easy, and some years (this one, I expect) it is more difficult. When the country is in recession, and the federal debt ballooning in alarming fashion, getting our elected representatives to support an increase in cancer research is tough.

Tough, but one hopes not impossible, if not this year than perhaps next. What is the case?

The first part of the case is straightforward. This disease is a major killer of Americans, and a recurring one, year after year after year. It kills both Republicans and Democrats. Eliminating or significantly reducing this scourge is good for the citizens of our fair land. Government can be a blunt tool for fixing the ills of this world, but cancer research uses federal funds to mobilize that which is best in us—our questing intelligence and passion to do good—for the benefit of all.

Over the past three decades, the average five-year survival rate for all cancers has increased significantly. This has not occurred by chance, but as a result of NIH and NCI research. Federally funded clinical trials have led to enhanced prevention and screening efforts and new cancer treatments and therapies. Much of this research requires long-term, sustained funding in order to lead to the scientific breakthroughs that offer hope for patients worldwide.

An investment in cancer research not only enhances the lives of patients, it also creates jobs and spurs economic growth. In 2007, NIH and NCI funding created over 350,000 jobs and generated more than $50 billion in economic activity. NIH and NCI contribute to local economic revitalization efforts by providing funding to universities, research institutions, and smalls businesses across the country.

Why federally funded research? Why not rely on our partners in Pharma to support both basic and clinical research? This question has its roots in political ideology (government bad, capitalism good) and in practicality (why pay lots of taxes to do what the free market will do, well, for free?). There are many answers to this question. First, much of the basic research underlying the advances of the past few decades would never have come out of companies focused on quarterly returns to stockholders, and which devote a fairly tiny proportion of their budgets on true early research, and which consider the information generated proprietary, to be guarded rather than shared. Secondly, the many fine researchers that populate Pharma did not train at Pharma U. If there was no federal funding for cancer research at Harvard or MIT or Memorial Sloan-Kettering or UCSF or M. D. Anderson or the NCI or dozens of other institutions, can any serious human believe that drug companies would contain the intellectual wherewithal to conduct modern scientific research?

But the issue is a deeper one. We need federally funded cancer research because it asks and answers important questions that would never be touched by Pharma. Some of these questions have nothing to do with drugs at all. In my own field of breast cancer, the world would be worse off without the NSABP's B-06 trial, demonstrating the equivalence of breast conserving surgery with mastectomy. What drug company would ever have funded this trial, or dozens of other trials asking important questions about the diagnosis or local-regional therapy of cancer? And how many companies, given the long and uncertain path to approval, have any sustained interest in cancer prevention? Particularly when the interventions are frequently lifestyle- rather than drug-based.

And even in the realm of drugs, the Venn diagram of the public interest and the private interest overlap incompletely. Far too few companies have had any interest in comparing their shiny new toy with either the banged-up old generic or other shiny new toys, or of answering pesky duration questions, or of performing studies that would result in their all-comers drug having its market share reduced in the interest of therapeutic individualization. Nor does their interest in a drug outlast patent protection by even a microsecond. This is not a criticism of drug companies, but rather an observation of their underling reality: they answer to a different master than federally funded cancer research. Public research complements private research, and the citizenry should receive the benefits of both.

ASCO does not take any federal money, so our longstanding support of federally funded cancer research derives not from what we consider best for our organization, but from what we consider best for the care of cancer patients. We have some true allies and champions for cancer research funding on Capitol Hill. One such champion is Representative Ed Markey (D-Mass.) who ASCO and partners will be recognizing for his unwavering commitment to support cancer research. Lawmakers like Rep. Markey understand that research conducted by NIH is absolutely indispensible, and we are grateful for their continuing support.

Investing in cancer research pays big dividends for our patients and families. A summary of ASCO’s efforts will be available this week on ASCO in Action.


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