COMMENTARY

Oncology and Politics: How Long Will the Honeymoon Last?

Brandon G. Smaglo, MD

Disclosures

June 27, 2016

Editorial Collaboration

Medscape &

The capstone lecture at the 2016 annual meeting of the American Society of Clinical Oncology (ASCO) was an address by Vice President Joe Biden. Following the Moonshot initiative announced by President Obama at his 2016 State of the Union address, the Vice President delivered a rallying call to the ASCO body to find a cancer cure.

In person, the Vice President is a commanding speaker. His remarks at ASCO focused on a collaboration supported by the increased sharing of research data and the announcement of the launch of the Genomic Data Commons (GDC) database into which all data obtained from the National Cancer Institute's programs will be deposited and freely accessible.

He challenged oncologists to collaborate, saying, "Imagine if you all worked together."

My immediate reaction was: "We do."

Imagine if you, the government, and the non-oncology community keep working with us.

But having a central, motivating body to facilitate smoother collaboration, such as the administration's Moonshot, is certainly welcome. A database such as the GDC requires greater coordination than what individual cancer centers and practices could manage. The Cancer Moonshot initiative is necessary for such large-scale collaborations to exist.

Having given it more thought, my response to the Vice President's challenge is: "Imagine if you, the government, and the non-oncology community keep working with us."

Ways to Keep the Momentum Going

The Obama administration is in its final months. No major campaign speeches have thus far suggested that a new president-elect would make cancer a high priority. Therefore, perhaps the best way to achieve a lasting legacy from this Cancer Moonshot is for the outgoing administration to leave a "power source" within the federal government that continues to drive these initiatives for years to come.

Naming a permanent director to the federal cancer research entity seems essential to the success of a national cancer initiative such as the Moonshot.

Certainly there are federal agencies focused on medical policy and research. But I argue that as far as cancer goes, these agencies can do better. For example, at the time of this writing, the National Cancer Institute has had an interim director for 14 months. This is in no way a criticism of Dr Douglas Lowy, who has served with excellence as interim director; he would be an excellent choice to fill the position permanently. But interim leadership will always be limited by the inability to set long-term strategy. Naming a permanent director to the federal cancer research entity seems essential to the success of a national cancer initiative such as the Moonshot.

Consider also the assets available to cancer collaboration that could be derived from the Public Health Service Commissioned Corps (PHSCC). Within the Department of Health and Human Services, over 6800 uniformed healthcare professionals have the mission to "protect, promote, and advance the health and safety of the nation."[1]

What if the next appointed surgeon general had a background in oncology?

Often we hear about the PHSCC in its role during active health scares such as the containment of the Zika virus, or in public health campaigns such as promoting physical activity to prevent cardiovascular disease. Given that cancer has overtaken cardiovascular disease as the leading cause of death in the United States,[2] surely there is room for the PHSCC to recognize cancer as a primary public health concern, particularly given the Moonshot initiative. PHSCC's role could extend beyond cancer screening to include educating cancer patients about treatment and the options to enroll in clinical trials.

To use PHSCC resources to best advantage, perhaps Surgeon General Dr Vivek Murthy could advocate the creation of a deputy surgeon general within the Corps to focus on cancer as a public health issue. Or, what if the next appointed surgeon general had a background in oncology?

Data-Sharing Beyond Borders

Of course, even if all of these federal resources were focused on cancer research, the Moonshot remains limited if it is to be an endeavor restricted only to the United States. The Moonshot takes its name from the space race of the 1960s, when there was international competition and no room for collaboration.

Achieving a cancer cure, however, will not be a state-centric achievement but rather a universal victory for humankind. To establish databases as national concerns is to be handicapped by the lack of data captured on the other side of irrelevant borders, and this will unnecessarily slow progress.

Again, international collaboration among scientists and clinicians already exists. But to have repositories for data collection that can be easily mined internationally is clearly beyond the scope of researchers to establish. To achieve such a focus combined with the requisite resources would require an international leadership collaborative.

The United Nations already leads a number of international collaborative efforts. Why not a UN cancer council? Let a diplomatic body unify by edict the pooling of the data across nations, so that the incremental advances on one part of the planet need not be redundantly repeated in another.

 
The concept that there is a subset of our country, and our world, that can be defined as the cancer community is a hindrance to the goal of eradicating cancer.
 

Such a feat would require a motivated, skilled leader at the helm. And Vice President Biden's role in the Obama Administration is drawing to a close. After a lifetime of public service, this skilled diplomat and politician, who is personally motivated to fight cancer, will have nothing but time on his hands. Perhaps if the stars align, a seat at the UN could provide him an opportunity to create an international push toward a cure for cancer. Just a thought, albeit an appealing one.

Regardless of how these political shifts resolve, the oncology community is going to continue to slog forward. Whatever we can get from a wider world, we will take. Whatever our government leaders provide, we will welcome. But the cancer community alone cannot sustain the momentum. In fact, the concept that there is a subset of our country, and our world, that can be defined as the cancer community is a hindrance to the goal of eradicating cancer. Only through the recognition by leaders and heads of state that cancer is a human issue, requiring ongoing collaborative effort to cure, will we reach the moon we shoot for.

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