I recently returned home from the American Association of Cancer Researchers (AACR) annual meeting held in New Orleans, La. The meeting was, as usual fantastic, but this years conclusion was by far the best I have experienced. The meeting’s closing session was reserved for remarks about the cancer “moonshot” initiative from Vice President Joe Biden.
Biden had initially talked about a moonshot for cancer following the death of his son Beau from stage 4 glioblastoma last year, but it was President Obama who formally announced it as a national priority at the State of the Union address in January and put Biden “in charge of mission control.”
I had the good fortune to have had a seat in the front row and was able to look up at the Vice President and see every facial response he made. The Vice President was introduced by his wife Jill Biden, a breast cancer survivor herself.
Biden opened by saying that he wasn’t sure if acting NCI director Douglas Lowy, MD was happy with the President’s decision to appoint him to be in charge of the Moon Shot Program.
However, the Vice President quickly launched into his plans to realign incentives and encourage collaboration between cancer researchers. He pointed out that the field is on the cusp of a real inflection point (a term he used on three separate occasions in his speech) in the war on cancer. He restated that he and President Obama were making a national commitment to end cancer as we know it, a goal that is laudable and that could change the lives of so many people.
He said that the one word he would use to define America was “possibilities,” and that he was committed to bringing together all of the available human, financial, and knowledge resources to seize this moment to make a quantum leap by accomplishing a decade’s worth of progress in half the time.
Biden shared, in a very believable way, that he and his wife were both overwhelmed by the response to the moonshot announcement. He stated that President Obama had effectively given an executive order “giving me control of all of the federal agencies and departments” from Veterans Affairs to the Department of Energy (the latter because of its computing capacity).
“I realized that the first thing I had to do was coordinate the federal government’s efforts with private sector … I made a commitment that I will eliminate the barriers that get in your way, get in the way of science, and research, and development. I had to learn from you how to break down silos to accommodate more rapidly the efforts you’re making,” he said.
In his speech he explained that the past few months have involved him in a lot of fact finding. In total, his research had discovered that the current state of affairs in cancer research had big problems.
He asked why various big data and other scientific initiatives were being done separately when everyone acknowledges that if they were aggregated the answers would come more quickly.
He went on to say that in addition to the three areas of politics he previously knew — church politics, labor union politics, and politics — he was now adding a fourth category: cancer politics.
An astute observation and a foreshadowing of what he will need to accomplish.
Biden said it was time to realign incentives in cancer research to move more rapidly to serve patients. (I applaud this approach, for what other reason do we do cancer research but for the patients). He reminded the audience that the 2016 budget increased NIH funding by $2 billion, the largest increase in 10 years.
He enumerated the NCI’s research priorities, he listed enhanced and early detection technology, cancer vaccine development, cancer immunotherapy and combination therapy, genomic analysis in tumor and surrounding cells, enhanced data sharing, and pediatric cancer research.
“And if we do this well, we will be able to continue every year for the foreseeable future to fund a minimum of that amount of money every year. We all know it takes more money.”
He asked what behavior do we want to encourage rewards, adding that he’s come to understand just how difficult it is to qualify for a research grant: “The more outside the box — which may be the answer for some cancers — the less likely you are to get funded.”
A so true statement and an accurate criticism of the current world of cancer funding.
Among his recommendations to streamline the system were:
1- Sharing data, especially since the way the system is currently set up, researchers are not incentivized to share their data.
2- Involving patients earlier in clinical trial design and focusing on clinical trial recruitment.
Letting scientists do science. Biden noted there’s an old cliché that too often grants are given for what one has already done rather than what they are currently doing. He said that young scientists spend too much valuable time working on grants and getting them approved and awarded, likening it to “asking Derek Jeter to take several years off to sell bonds to build Yankee Stadium.”
3- Measuring progress by improving patient outcomes not just publications. “What you propose and how it affects patients seems to me should be the basis of whether you should continue to get grants.”
4- Increasing the availability of information hidden behind the pay-walls of scientific journals, including the AACR (a brave comment from the Vice President given that it was the AACR that hosted him.
These paywalls include policies that the data generated by published articles become the property of the Journal for one year!
5- Rewarding the work of verification, the core of science. Verifying by replication is how science and breakthroughs work, he said, noting replicating published studies isn’t a very rewarding career move, and very few people get grants to replicate studies. “We should incentive verification.”
6- Committing to realign government programs and spending to accelerate research.
This will include asking institutions, colleagues, mentors, and administrators how can we move ideas faster together in the interests of patients.
The Vice President said, “I promise I will and I have the authority to do everything in my power to put the federal government in a position where it is total value added and doesn’t get in your way.” He pledged to have the federal government collaborate with the private sector, academic institutions, philanthropists, and investors in your service to serve your patients (the audience were cancer researchers).
Biden concluded with a rhetorical question: Are we collaborating enough and what more can we do? Hopefully, after he has really started to make things happen we will be able answer this with an overwhelming yes, the federal government has aligned itself to move things along in double time.