He Won His Battle With Cancer

(2 of 3)

Whatever optimism researchers have is tempered by the fact that money is tighter. Funding for the NCI has been flat during the past three years of the Bush Administration, at about $4.8 billion. "One of the things that happens when money gets tight is that everything gets more conservative," says Dr. Curtis Harris, an NIH cancer researcher.

What's more, the lean times come in a period when the cost of research has outpaced inflation, so there's a double hit. The NIH has a "pay line" of roughly 14%, meaning it hands out only that percentage of the total money requested. Just 1 in 10 grant proposals it considers "meritorious"--that is, worthy of funding--gets a payout.

There are opportunity costs to this system. Collaboration suffers as scientists guard their work to keep the money coming. Because the funding process favors experienced grant writers, young investigators can lose out. Such friction and lack of funds, some argue, are causing a brain drain to Singapore and other regions that are actively seeking to develop their biotech industries. "The incentives are totally misaligned. The repetitive nature of funding the same universities and the same people--all of these things add up to the stagnant position that we're in," says Doug Ulman, president of the LAF and chairman of the Director's Consumer Liaison Group at NCI.

The Politics of Cancer

No one in Washington is in favor of more cancer. But attempts to expand the NIH's budget or get separate funding from Congress have been stymied by internecine fighting among cancer groups. Armstrong tells of vice-presidential candidate Joe Biden's frustration at being besieged by cancer-site advocates--lung, breast, blood--and those for other terrible diseases, each unwilling to let dollars pass to another without an argument. "Within that group, you have a lot of fighting, hogging, people trying to elbow each other out," says Armstrong. The legislators' message to these groups is simple: Get your acts together.

Last year Armstrong persuaded the advocate community in Texas to play nice in support of a referendum to spend $3 billion fighting cancer over the next 10 years. The passage of the proposal was a huge victory in a spend-wary state, and perhaps it was a model for others. The program makes cancer prevention and screening key components, which saves the state money in the long run.

This year Armstrong has tried to make cancer an election issue. He got Senator John McCain to attend the Livestrong Cancer Summit earlier this year. McCain, a skin-cancer survivor, committed to increasing spending but not to a specific amount. Senator Barack Obama has committed to doubling the budget for fighting cancer as part of a broader reform of health care. Certainly the frail, failing Senator Ted Kennedy's dramatic speech at the Democratic Convention, coming in the midst of his battle with brain cancer, underscored the point.

Even with a new President inclined to increase spending, throwing money at the problem isn't the answer. "There is no strategic plan," says former Senator Bill Frist, a heart and lung surgeon before he entered politics. Frist voted to double NIH funds in 1998 but wouldn't recommend it again without a better road map. There are numerous federal agencies that cover cancer, for instance, and less than complete coordination among them.

Frist says the scientific and advocacy communities need to agree to a five-year "business plan" with specific targets and measurable goals. "If you put together a good long-term strategic plan, and it was supported by the scientific community," he says, "it would be funded." That is a goal of the Kennedy-Hutchison cancer bill, which could get to the Senate floor this fall. It proposes no less than a complete overhaul in cancer policy. "We need to integrate our current fragmented and piecemeal system of addressing cancer. Front and center in our current system are the troubling divisions that separate research, prevention and treatment," Kennedy said in a Senate hearing in June.

The New Paradigm

These are precisely the kinds of challenges that gave rise to Stand Up to Cancer, the advocacy group organized by CBS newscaster Katie Couric and eight other women, all of them connected to Hollywood, including Spider-Man producer Laura Ziskin, who has breast cancer. Says Couric, who lost her husband and sister to cancer: "It was clear to me and other people that this borders on the ridiculous. You ask yourself: What can be done?" SU2C has a scheduled Sept. 5 launch with an unprecedented three-network simulcast, hosted by Couric, Brian Williams and Charles Gibson. It features a roster of stars, including a performance by cancer survivor Melissa Etheridge and a film by Errol Morris (who produced Standard Operating Procedure, an acclaimed documentary about Abu Ghraib abuses). "I will make you laugh," says Ziskin, who produced the show. "I will definitely make you cry." But so, too, would any name-your-disease telethon.

It's what happens next that is different. SU2C will not distribute funds to research institutions. Instead, it will assemble dream teams of scientists across disciplines and institutions, and they will work collaboratively on projects designed to deliver a product of sorts--as opposed to an academic paper--within a defined time period. Says Ziskin: "They can only get funded if they can produce a treatment."

To vet and choose the projects, SU2C has recruited a high-powered scientific advisory committee chaired by Phillip Sharp, a Nobel Prize--winning cancer researcher at MIT. The selected projects will then be monitored by the American Association for Cancer Research. "What I hope to do is identify areas where we could accelerate progress, particularly in areas where there's need--ovarian, pancreatic, glioblastoma," says Sharp.

Additionally, 20% of the funds raised will go to higher-risk projects with potentially greater paybacks. It's a science version of throwing it long. "If you run the same play every time, you're not going to win the game," says Armstrong. One of SU2C's advisers was the late Judah Folkman, a famed cancer scientist whose pathbreaking theory that tumors grow via angiogenesis (creating their own blood supply) was resisted for decades. "There may be other Judah Folkmans out there," says Ziskin. "We don't want them wandering around for 40 years."