Shooting the Moon on Cancer

During his final State of the Union address on January 12th, President Obama announced a “moonshot” to cure cancer and appointed Vice President Biden to lead it. The edict is reminiscent of Nixon’s 1971 War on Cancer, which was envisioned as an all-out effort to eradicate the disease by marshaling the kinds of resources and scientific knowledge that two years earlier had sent a man to the moon. By most measures we’re much better off now than we were four decades ago: cancer treatments have improved drastically, people are living longer after diagnosis, and mortality rates have been falling since their peak in the early 1990s. But as anyone who has been touched by cancer can attest—and in the United States, that’s nearly all of us—the war is far from over.

Biden, whose son died of brain cancer last year, outlined a plan that’s essentially twofold: to increase public and private resources in the fight against cancer, and to promote cooperation among the various individuals, organizations and institutions working in cancer research. The initiative will likely lead to increased funding for the National Institutes of Health, a prospect that has many scientists giddy with anticipation. But the complexities of cancer, which are now much clearer than in 1971, underscore the multiple challenges confronting us. On NPR, one researcher described how the same form of cancer can act differently in different people because of the immense number of genetic distinctions between us. And in the New York Times, Gina Kolata and Gardiner Harris pointed out that the moonshot reflects an outmoded view of cancer as one disease rather than hundreds, and the idea of discovering a single cure is therefore “misleading and outdated.”

Nixon’s initiative signaled an optimism in the certainty of scientific progress to combat a disease that many regarded with dread. In polls, articles, and letters, Americans at the time debated whether they’d want to be told of a cancer diagnosis and worried about being in close contact with cancer patients. The disease’s many unknowns generated fears of contracting it, desperation about the pain and debilitation associated with it, and plenty of unorthodox cures (this was, after all, the era of laetrile and Krebiozen).

Much has changed in the intervening decades, and if you’re diagnosed with a form of cancer today, you’d undoubtedly have a better prognosis than in 1971. But one aspect of cancer in American culture has not changed, and that’s the mystique surrounding the disease. Cancer is not the biggest cause of death in the US—heart disease takes top honors—but it remains the most feared. It occupies an outsize place in the landscape of health and wellness, suffering and death. As such, it demands a bold approach. Winning the “war on cancer” would necessitate breaking down the disease into types and subtypes: not cancer, but cancers; not cancer but ductal carcinoma in situ and acute myeloid leukemia and retinoblastoma. But this would dilute its power as a singular cultural force, an adversary that (the thinking goes) with a massive coordinated input of resources could be vanquished once and for all.

 Photo credit: Cecil Fox, National Cancer Institute

Photo credit: Cecil Fox, National Cancer Institute

Biden’s moonshot doesn’t just reproduce an outmoded idea of cancer; it is dependent upon it. It also promotes research and therapies in search of a cure at the expense of prevention, which he fails to mention a single time. Innovative new treatments that showcase scientific advancement are flashy and exciting, unlike lifestyle recommendations around nutrition or exercise, or widespread public health efforts to reduce the presence of environmental carcinogens. There’s also the issue of how to measure progress with a goal as elusive as curing cancer. Is it in decreased incidence or mortality rates? In lowering the number of new diagnoses to zero? Perhaps the moonshot should instead focus on reducing human suffering associated with cancers by emphasizing prevention and addressing inequalities that affect health and health outcomes. It’s an objective that’s unquestionably less spectacular than curing cancer, but certainly more achievable.

 

Sources:

James T. Patterson, The Dread Disease: Cancer and Modern American Culture. Harvard University Press, 1987.