Ronald A. DePinho, MD
In the past 10 years, we have made remarkable advances in how we fight cancer. One of the most powerful new tools in our arsenal is cancer immunotherapy, which reawakens our own immune system to produce stunning results for many suffering from advanced cancer.
Immunotherapy saved President Jimmy Carter’s life. After being diagnosed with advanced melanoma that had metastasized to his brain, in addition to surgery and radiation, President Carter received a new immunotherapy, pembrolizumab (Keytruda). What would have been a story of death within months has instead turned into a story of survival with no signs of cancer recurrence.
Support of Biomedical Research
This paradigm shift in cancer treatment has its roots in the pursuit of basic knowledge of how the immune system is regulated, an advance made possible by our nation’s support of biomedical research. For decades, the National Institutes of Health (NIH), America’s federally funded research engine, has led the world in producing Nobel Prizes in medicine, technology advances, and treatment breakthroughs that have generated trillion-dollar industries and revolutionized the way we care for patients—and the pace is only accelerating.
Of the approximately 15 immunotherapy drugs currently on the market, 5 were approved by the U.S. Food and Drug Administration (FDA) just this past year. In my decades-long career as a clinician/researcher, I believe this is the first time there is real potential for very sick patients with cancer to experience long-term survival or even a cure for their disease. Our understanding of cancer and the ability to treat it as a disease of the genome—rather than the disease of a specific organ—is greater than ever before. Imagine a future world where vaccines could prevent cancer.
Science Is the Answer to Finding Cancer Solutions
Much of the current national debate on health care has focused on optimizing the existing health-care delivery system so that we can better accommodate the massive medical needs of our population—a need that is projected to increase dramatically as our population ages. In the United States, cancer incidence alone is expected to increase by about 50% by 2030.1 While improving the health-care delivery system is essential in the near term, it is vital we not lose sight of the need for game-changing treatment breakthroughs and technologic innovations that will create a more effective and sustainable health-care system for our nation in the long term. Robust investments in science are an irreplaceable ingredient to provide long-term solutions to the health-care problems we face, especially in life-threatening diseases like cancer. Science is the answer to finding those solutions.
Prior to the recent bipartisan spending deals approved by Congress to boost NIH funding in Fiscal Year (FY) 2016 and FY 2017, federal funding for biomedical research had been declining for years. The budget for the NIH has eroded by approximately 20% since 2003 due to cuts and inflation, hampering its ability to fund cutting-edge research just as we are on the cusp of more cures for cancer.
Failure to invest in the NIH will have long-term consequences for America’s global leadership in the 21st century.— Ronald A. DePinho, MD
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Breakthroughs that you read about every day in the news don’t happen by accident, and they rarely occur after the first scientific experiment. Cancer breakthroughs emerge only after many years of diligent work and investment by the NIH. And that investment of public funding for scientific research and development not only provides financial resources to the scientific community but has a ripple effect on the wider economy as well.
The best example of a high return on scientific investment is the Human Genome Project. According to a study2 by Battelle Technology Partnership Practice, a global research and development organization committed to science and technology for the greater good, NIH’s investment of $3.8 billion to sequence the human genome has returned over $1 trillion to the overall economy so far, while revealing new fields of medicine and creating high-paying jobs in the exploding biotech industry.
Today, thanks to those investments, new technologies are allowing us to analyze the genomes of patients—and their cancers—and then tailor therapies specific to those patients’ individual tumors. We can even protect patients before cancers emerge by combining our growing understanding of behavioral and genetic risk factors for the disease with regular screenings and early interventions. Past investments in these kinds of research and development projects made today’s scientific promise possible, and they made the United States the undisputed leader in the life sciences.
Maintaining America’s Leadership in Research
Failure to invest in the NIH will have long-term consequences for America’s global leadership in the 21st century. As federal funding for research has dried up, young researchers have been forced to leave the United States for other countries—or to leave the field altogether. China is currently investing $9 billion to outpace us in genomic sequencing and is expected to surpass U.S. investment in all research and development by 2020. China already has leapfrogged ahead of the United States in supercomputing technology.
ACT for NIH: Advancing Cures Today, a nonpartisan effort to advance biomedical research in the United States, and the research community’s engagement of our leaders in Congress have stirred action. As noted earlier, Congress increased NIH’s budget by $2 billion in FY 2016 and FY 2017, the first back-to-back funding increase in more than a dozen years. And this past year, Congress passed the 21st Century Cures Act with overwhelming bipartisan support, providing $4.8 billion over 5 years to accelerate specific areas of highly promising research at NIH, including the national Cancer Moonshot initiative.
However, our engagement of the Administration and members of Congress must continue. The President’s proposed budget for FY 2018 calls for a nearly 20% reduction in NIH spending as well as an immediate cut of $1.2 billion for 2017. This position no doubt rests on the Administration’s goal to stimulate reductions in bureaucracy and regulatory burden, which stifle innovation and increase administrative overhead costs. Shifting precious dollars from administrative spending to lifesaving science should be a high priority, and a thoughtful approach will require a good faith engagement between government and academia to avoid academic institutions from reducing or retiring their solution-generating research programs.
Everyone in the research community is stressed by the fast-paced and information-intensive news cycle, but there also exists a climate for thoughtful dialogue with key decision-makers. There are many NIH champions in Congress. Senators Roy Blunt (R-MO) and Patty Murray (D-WA) and Representatives Tom Cole (R-OK) and Rosa DeLauro (D-CT) were successful in getting a $2 billion increase for NIH in the FY17 budget. The successive increases in 2016 and 2017 show that our strategy of engagement works.
Let us keep in mind that the President stated in a November video, “Whether it’s producing steel, building cars, or curing disease, I want the next generation of production and innovation to happen right here, on our great homeland, America, creating wealth and jobs for American workers.” Let us engage the administration in dialogue that conveys the importance of science in the pursuit of disease cures.
A couple of examples provide a clear and sobering account of why robust funding for the NIH is critical to our future. Consider the following health-care costs on the federal budget: today, 1 out of 3 Medicare dollars is spent on diabetes care; and 1 out of 5 Medicare dollars is spent on Alzheimer’s disease care. Indeed, in the absence of a cure for Alzheimer’s, increasing incidence of the disease is projected to cost our nation more than $1 trillion by 2050—in today’s dollars. That’s twice what we currently spend to defend the nation. That strain on the federal budget will only worsen as the baby boomers age. Investing in research now is our only path forward.
Poised to End Cancer
Curing cancer is possible, and preventing disease is possible, but only with sustained investments in NIH research. It is important that the science and medical community engage fully in this debate. Make your voices heard. If we wish to remain the preeminent nation for finding cures and treatments for deadly disease, we cannot flat-fund or reduce NIH’s budget, because as all physicians and researchers know, the march of disease waits for nothing.
The President and our leaders in Congress have the opportunity to Make American Research Great Again. Those investments will save lives, create jobs, protect our national security, and ensure America continues to lead the world in scientific discovery. Our scientists are poised to end cancer as we know it. Now let’s give them the resources to bring lifesaving cures from the laboratory to the bedside. ■
Disclosure: Dr. DePinho is Vice Chair of ACT for NIH: Advancing Cures Today, a nonpartisan campaign to advance biomedical research in the United States.
Ronald A. DePinho, MD, is Professor of Cancer Biology and Past President of The University of Texas MD Anderson Cancer Center in Houston, and Vice Chair of ACT for NIH: Advancing Cures Today, a nonpartisan campaign to advance biomedical research in the United States.
Disclaimer: This commentary represents the views of the author and may not necessarily reflect the views of ASCO.
1. International Agency for Research on Cancer: GLOBOCAN 2012: Estimated cancer incidence, mortality and prevalence worldwide in 2012. Available at www.aicr.org/press/press-releases/us-cancer-cases-rising.html and from globocan.iarc.fr. Accessed May 25, 2017.
2. Battelle Technology Partnership Practice for United for Medical Research: The impact of genomics on the U.S. economy. Available at www.unitedformedicalresearch.com/wp-content/uploads/2013/06/The-Impact-of-Genomics-on-the-US-Economy.pdf. Accessed May 25, 2017.