There is much buzz around the word “cancer” these days,
especially when delivered in its more inspiring two-word formats, “fight
cancer”, “beat cancer”, ”cure cancer”. The words conjure up heroic images of brave
patients, many of them young children, fighting the noble fight against what
many consider humanity’s greatest foe, an out-of-control cell growth that takes
more than half a million (8.2 million worldwide) of our loved ones each year. One
cannot help but feel a communal sense of pride and achievement from hearing
news of the latest breakthroughs in diagnosis and treatment. “After all, we’re all in this together”, says
an ad for the University of North Carolina Cancer Care.
And it’s true. Chances are, we all know someone who is or
has been afflicted by this debilitating, and too often fatal, disease. And
unlike other perennial top-killers such as AIDS or malaria, which mostly affect
small subgroups engaging in risky behaviors, or exotic cultures in far away
places, cancer strikes more randomly, and strikes closer to home. We are
connected through our fears of pain, suffering, and premature death. It’s no surprise
that we feel compelled to assist in the fight, even if it’s nothing more than periodically
succumbing to guilt and sympathy when presented with a chance to donate change
at the local grocery store. And we often do much more. Stories abound in the
news of successful fundraisers and campaigns, bringing together whole cities
and neighborhoods, the old and young, Christians and Muslims, and even rival
sports teams. When “cure cancer” beckons, we answer the call, and we teach our
children to do so as well. At the forefront are our leaders in the “cure cancer”
community, including doctors, scientists, industry leaders, philanthropists,
and lawmakers. They have all joined the fight against our deadly foe, and simply
urge us forward – the next breakthrough in “cure cancer” is imminent. “Cure
cancer” unites us.
Make no mistakes, however. Cancer is a complicated beast.
Even with our brightest, most dedicated minds leading the charge, the great
majority of cancer research projects produce incremental, or anecdotal
improvements, and the best-intentioned health care regimes routinely send
patients to their deaths. Despite recent advancements in immunotherapy, stem
cells, and genomics, there is still no reliable cancer cure in sight. And
perhaps the most telling sign is that we’ve spent over $200 billion through 43
years of cancer research, and the cancer death rate is still increasing. Are we
losing the war on cancer? Perhaps. But we can at least partly blame semantics
here since “cancer” is really a family of over 100 related disorders of
abnormal cell growth. In fact, cancers are acquired and manifested in various manners,
affecting all cell types, each requiring distinct treatments and cures. Cancers
are also elusive by nature, having the capacity to evade our innate defenses. And
much like us, they resiliently evolve in the face of adversity, and can even be
opportunistic. Humankind has met its match, a complex, living entity with many
faces – an agglomeration of layers characterized by stages of unrestricted
growth, even at the price of eventual self destruction, with elusive genetic/social/political
underpinnings, and an outward appearance of uniformity. It certainly seems
natural to make comparisons, given that cancers originate from one of our own cells.
Technically, cancers are still one of our own – they’re one of us; they’re the
ones that went bad.
The “cure cancer” campaign, despite its singular pitch and
impeccable PR, also has complex underpinnings. Undeniably, we as individuals,
and as local communities, derive the greatest motivations from the elements
that unite us, as described in the first two paragraphs of this blog. However, key
players such as the universities, the pharmaceutical industry, hospitals, and government
organizations make moves based on the supply and demand of cancer treatments,
drugs, research funding, etc. – which are all inexorably tied to money. Yes, the
“cure cancer” campaign, despite all its good intentions, is still a business
where money changes hands, at the top between Big Pharma and hospitals
conducting clinical trials, and at the bottom between caregiving institutions
and patients. Consider that it costs Big Pharma a whopping $5 billion to
develop each new cancer drug. Despite the gigantic investments up front, the
two top-earners from cancer drug sales last year earned $31.3 (Roche) and $11.2
(Novartis) billion, respectively. On the other end of the spectrum, a cancer
patient pays $100,000 to $200,000 a year for drugs on slim hopes of extending
their life. Often patients are only able to extend their life for an additional
6 months to a year. What a tragic market! Some insurance companies even offer
cancer insurance, capitalizing on fears. And with so much money at stake, who
knows what goes on behind the scenes between politicians and stakeholders when
there are campaigns to be won and drugs to be dealt (read about the HPV
vaccine, Merck, and Rick Perry’s money http://www.cnn.com/2011/09/15/opinion/krumholz-beckel-perry-pharmaceutical/).
Yes, there is much money to be made in “cure cancer” and shady alliances can
benefit if cards are played just right. We saw such an affair unfold at the
University of Texas (UT) M.D. Anderson Cancer Center, one of the nations most
prominent cancer research centers and hospitals, where cutting edge clinical
trials for the latest cancer drug candidates are conducted. It was revealed in
2012 that the president of M.D. Anderson, Dr. Ronald DePinho (and his wife Dr.
Lynda Chin), had received large sums of compensation from twelve pharmaceutical
firms, players in the clinical trials ongoing at M.D. Anderson, and had
ownership stakes in seven. Can you say conflict of interest! He requested a waiver from the UT system, which allows him to continue collaborating with
three of the firms where he has ownership stakes. Of course, patients are usually blind participants and generally don’t know the
contents of their doctors’ investment portfolios. But there certainly needs to
be more transparency behind such dealings. Imagine being a cancer patient at
M.D. Anderson, having entrusted the organization with your family’s money,
emotions, and your final chances at life. Do these events make you lose trust?
Does a little bit of hope fade away?
Not only is there real moneymaking potential in “cure cancer”,
major players are flirting with fame as well. Forbes magazine carries on its
most recent cover, a story of Novartis’ CEO Joseph Jimenez. He has bought into
a new breakthrough technology called chimeric antigen receptor T-cell therapy
(CART), and is spending billions of dollars for its development. While the
financial motivations are clear, the cover of Forbes portrays Jimenez as a potential
hero/savior with the quote, “Will this man cure cancer?” Isn’t the person who
cures cancer supposed to be a selfless scientist/doctor type, one that can inspire
us and be a role model for our children? Sort of like how Dr. Neil Armstrong,
the first person to step on the moon, was a reluctant hero because he was never
comfortable with all the politics and fame attributed to the moon landing? Then
again, what if Dr. DePinho, with all his ownership stakes, finds a cure and is featured
as a hero on the cover of Nature? Is that any better? Maybe we should just
embrace Jimenez in all his capitalistic glory. The article goes on to romanticize
Mr. Jimenez. He is quoted as saying, “the pain of having to turn patients away
is such that we are going as fast as we can.” Sure enough, the man talks like a
hero. But somehow, I don’t think late term cancer patients contemplating
clinical trials are convinced that Mr. Jimenez is primarily motivated by their tragic
misfortunes.
Don’t get me wrong. As a student of the sciences, the
potential of CART excites me. And I wouldn’t mind if Mr. Jimenez or Dr.
DePinho “cured cancer”, or any other self-interested entity for that matter. It
would still be infinitely better than the prospect of not ever curing cancer. And
a viable set of cancer cures would be one of the greatest victories for
humankind, ever. But having said that, I think we, as a community, should take note
of the emerging stories in “cure cancer” – all of them, and not just the overhyped
breakthrough stories, or stories of inspiring personal battles, and successful community
fundraisers. Take a closer look. Drowned out by the shouts of unbridled
enthusiasm and bravado of “cure cancer”, there are other voices that need to be
heard.
