On June 27, 2009, Gina Kolata’s article in the New York Times on the too safe nature of funding from the National Institute of Health (NIH) struck a chord for many of us. She opens the article with the following, “Among the recent research grants awarded by the National Cancer Institute is one for a study asking whether people who are especially responsive to good-tasting food have the most difficulty staying on a diet. Another study will assess a Web-based program that encourages families to choose more healthful foods.”

Her over all conclusion, despite the forty year war on cancer, most grants funded by the NIH on cancer will not break any new ground or make a difference in anybody’s life.

She then cited the example of one funded project that “asks whether a laboratory discovery involving colon cancer also applies to breast cancer. But even if it does apply, there is no treatment yet that exploits it.” So, who is going to see any positive result?

The NIH has spent $105 billion since President Richard M. Nixon declared war on cancer in 1971. The American Cancer Society, the largest private financier of cancer research, has spent about $3.4 billion on research grants since 1946. Despite all this money having been invested in the war on cancer there has been a shockingly small decline in the death rate from cancer, according to the FDA the gold standard for measuring success.

Some scientists view the grant system as if it were another jobs program, a way to keep research laboratories going year after year. Underlying this concept is an understanding that the labs focus will be on small projects unlikely to take significant steps toward curing cancer. One could almost say that cancer research labs need cancer to remain deadly so that they can remain in business!

However, I must say that in reality we do need to keep these labs open and functioning, other wise we will lose their expertise. Without these labs we would not be training the researchers of the future, but we need to train researchers who can make the next big step forward in curing cancer instead of researcher who reinvent the wheel. Currently the types of grants made and the training of these young researchers are as Dr. Robert C. Young, Chancellor at Fox Chase Cancer Center in Philadelphia and Chairman of the Board of Scientific Advisors, an independent group that makes recommendations to the cancer institute, characterized as oriented more to obtaining funding than to curing cancer! I thought our goal was to cure cancer, I guess I am wrong.
“These grants are not silly, but they are only likely to produce incremental progress,” said Dr. Young. The institute’s reviewers choose such projects because, with too little money to finance most proposals, they are timid about taking chances on ones that might not succeed. The problem, Dr. Young and others say, is that projects that could make a major difference in cancer prevention and treatment are all too often crowded out because they are too uncertain. In fact, it has become lore among cancer researchers that some game-changing discoveries involved projects deemed too unlikely to succeed and were therefore denied federal grants, forcing researchers to struggle mightily to continue.”

Kolata’s example took one transformative drug, “for breast cancer. It was based on a discovery by Dr. Dennis Slamon of the University of California, Los Angeles, that very aggressive breast cancers often have multiple copies of a particular protein, HER-2. That led to the development of herceptin, which blocks HER-2.

Now women with excess HER-2 proteins, who once had the worst breast cancer prognoses, have prognoses that are among the best. But when Dr. Slamon wanted to start this research, his grant was turned down. He succeeded only after the grateful wife of a patient helped him get money from Revlon, the cosmetics company.”

Even top federal cancer officials say the system needs to be changed.

“We have a system that works over all pretty well, and is very good at ruling out bad things — we don’t fund bad research,” said Dr. Raynard S. Kington, acting director of the National Institutes of Health, which includes the cancer institute. “But given that, we also recognize that the system probably provides disincentives to funding really transformative research.”

Not at all surprising, but the private NGO, The American Cancer Society follows a similarly cautious path. Last year, it awarded $124 million in new research grants, with some money coming from large donors but most from events like walkathons and memorial donations.
Dr. Otis W. Brawley, chief medical officer at the cancer society, has stated that he agrees that the entire cancer research effort is too cautious. “The problem in science is that the way you get ahead is by staying within narrow parameters and doing what other people are doing,” Dr. Brawley said. “No one wants to fund wild new ideas.” A statement like this from Dr. Brawley is scary, why has not he used his position to change this? Talking about it and doing something are two different items.

Some experienced scientists have found a way to offset the problem. They do chancy experiments by siphoning money from their other grants, but I believe that this is wrong. However, the bigger wrong is the system that forces researchers to be devious and deceitful with their funders.

The breath of fresh air in this funding problem is the Congressionally Directed Medical Research Program in the Department of Defense (CDMRP). In this program research proposals are scored up if they are high risk, but can make a significant difference in the field of cancer research. The CDMRP’s orientation could serve as an outstanding model for the American cancer Society and the NIH.

Joel T Nowak MA, MSW