Joe Biden’s Cancer Moonshot Problem

I promised myself I would never again write about Joe Biden’s Cancer Moonshot efforts in this blog.

Then I read this press briefing statement on the Moonshot’s relaunch: Fact Sheet: President Biden Reignites Cancer Moonshot to End Cancer as We Know It.

Along with its stated primary objectives…

Biden-Harris Administration Sets Goal of Reducing Cancer Death Rate by at least 50 Percent Over the Next 25 Years, and Improving the Experience of Living with and Surviving Cancer

And here I am. Ready?

Put simply, President Biden and his team are not emphasizing comprehensive prevention, including focusing on the host environment, nearly enough to achieve its stated goals.

To improve the human condition as a whole is to understand that messaging and funding comprehensive prevention requires more attention and resources than it currently receives—or is slated to receive in the relaunched moonshot.

Comprehensive prevention, when it is mainstreamed, will outperform—save more lives—than novel drug discovery activities alone.

Said differently: The emphasis on comprehensive prevention is key to many fewer cancer cases, higher quality of life—and results in a healthier financial bottom line. No matter how many medical breakthroughs in treatment come on line, comprehensive prevention will always be the biggest potential life and cost-saver of all.

Alas, comprehensive prevention is neither sexy nor a great return on investment for the constructs of business that currently exist.

Comprehensive prevention is a losing prospect for both pharma and the current incentivization paradigm for those who deliver standard cancer care.

Another drawback is that lifestyle changes appear too simple—even too much bother, for a culture which has become accustomed to taking a pill or two or seven, rather than walking a few blocks, or improving one’s sleep environment, or choosing healthier food. Too many of us make ruinous lifestyle choices that erode the world’s health far more than any disease.

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If you remember anything or share anything from this essay, let it be this:

We need cancer treatment advances for those who are suffering now, but comprehensive prevention must be the driving objective for much less of the population to have to deal with the debilitating and deadly effects of cancer.

And this:

The core goals must be achieving less cancer through comprehensive prevention, not just innovation. It’s not enough, and it’s wholly unacceptable, to be focusing on treating an increasing number of cancer patients.

This cannot be an either/or proposition. Less cancer and longer lifespans for those living with disease are not mutually exclusive.

Washington, We Have a Problem

Each year, more lives are affected by cancer. Fortunately, so they can receive treatment, folks are diagnosed at an earlier stage of cancer but, alarmingly, they are also being diagnosed at earlier ages.

A study published in JAMA looked at a half million U.S. adolescents and young adults (15-39), between 1973 and 2015, and found startling increases in various subsections of the groups—by age—across multiple cancer types. The study, dissected paragraph by paragraph, shocking in its expression of statistics, shows a dramatic increase, over time, in the amount of younger adults and youth diagnosed with cancer.

This tells us that, even with what is being done in scientific research and development, cancer continues to pervade lives. Yes, we are extending the lives of those hosting various malignancies, treating several as chronic disease—and so we should. Extending and improving quality of life for those living with cancer is critical, but we can do much more on the front end, the non-sexy and less costly end, which is comprehensive prevention.

Precision Cancer Care and Comprehensive Prevention: Not Mutually Exclusive

The good news is, there is an inexorable march toward truly personalized, precision oncology, utilizing next generation whole genome sequencing, AI-driven analysis, to inform the clinical delivery of targeted therapies, immunotherapies, and personalized vaccines.

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No doubt, these are exciting times to witness the evolution of oncology diagnostics, prognostication tools, and the next generation of therapeutics. I am near the front row, cheering loudly.

One day, hopefully in my lifetime, large randomized controlled trials designed to investigate ‘common denominator therapeutics’, agents that often extend progression-free survival or overall survival by mere weeks or a couple months—will no longer be necessary.

The future of anticancer treatment regimens will be tailor-made for the exact tumor and exact host environment. This is the true potential and promise of precision medicine and precision oncology in the years and decades to come.

But in the here and now, we’ve created an unsustainable pro-cancer environment—therefore cancer is all but unavoidable over one’s lifetime.  

We continue to over-emphasize treating tumors, often at the expense of supporting hosts. What is fundamentally absent in the relaunched moonshot is the host’s innate capacity to prevent malignant disease, to help control disease, and help ensure deep and durable remissions by becoming a horrible host to cancer.

Back to the White House briefing statement.

The sole paragraph on ‘prevention’ reads thusly: (bold emphasis is mine)

“To prevent cancer—Today, we know cancer as a disease we have few good ways to prevent. But now, scientists are asking if mRNA technology, used in the safe and effective COVID-19 vaccines to teach your body to fight off the virus, could be used to stop cancer cells when they first appear. And we know we can address environmental exposures to cancer, including by cleaning up polluted sites and delivering clean water to American homes, for example, through the Bipartisan Infrastructure Law.”

Mr. Biden and team: a few good ways? We have many excellent ways to prevent cancer! We know how to prevent a large percentage of cancer cases, especially the various lifestyle-driven malignancies like prostate, colorectal, and certain kinds of breast cancer, as well as at least 13 types that correlate with obesity. Correlation of obesity and malignant disease now represents 40% of all cancer cases.

We’ve known irrefutably, for years—and in some cases decades—about the cancer-causing effects of obesity, poor diets, sedentary lifestyles, smoking, alcohol, diabetes, environmental toxins (ground, sea, air, homes), household goods (cleaning agents, cosmetic agents), and chronic stress.

And yes, President Biden, it is possible that your son Beau’s tragic death from glioblastoma may have been a preventable case, as you have publicly observed the potential correlation with toxic burn bits.

NIH’s National Cancer Institute has published their cancer prevention overview here. The American Cancer Society guidelines for diet and physical activity for cancer prevention is here.

What it Was, Is, and Could Be

When he was Vice President, I penned this: Open Letter to Joe Biden: We Need a Cancer Prevention Moonshot. It reached his task force team and we had a nice discussion by phone. I agreed to visit with them in DC. Not long after, the initiative was scrapped, along with the Biden Cancer Institute.

A few years later, with President Biden in a position of power to relaunch the Cancer Moonshot, he has committed to stepping things up. The gravitas of creating a ‘Cancer Cabinet’ bringing together various agencies and departments to create a whole-of-government approach sounds wonderful. As does the long list of departments so critical to the potential of a well-coordinated and truly comprehensive approach to cancer prevention.  

Departments such as: environmental, agriculture, health and human services, disease control. On that note, let’s add education, which is missing. Early education, youth education, parental education will be key. Everything must be coordinated at the highest level; each stakeholder must be in the room and present… in service of comprehensive cancer prevention.

Glamorizing Technological Complexity

The approaches listed below connect deeply for biomedical, computational oncology, and bioinformatics scientists. These activities are absolutely exhilarating for pharma companies and institutions, and all those that deliver clinical therapeutics and cancer care. And most importantly, their potential impact on those hosting cancer and their loved ones.

To be clear, I strongly support all these things:

  • Next generation tumor sequencing
  • Big data and artificial intelligence-driven treatment considerations
  • Targeted therapies
  • Immunotherapies
  • Institutional data sharing
  • Earlier screenings
  • Closing inequities for diagnostics, treatment, clinical trials, expanded access to novel/investigative/off-label therapies

Let’s face it: these innovative approaches are compelling, futuristic, and tangible compared to messaging and educating around exercise, clean diets, stress reduction, restorative sleep, hydration, and the quest to hold government accountable for all things soil, water, air, farm subsidies, and food deserts.

I am not a defeatist. Innovative activities should absolutely proceed apace. But comprehensive prevention and the host environment must be recognized for the value they bring to reduce our cancer burden, our financial burden, and our emotional burden.

Comprehensive prevention and host environment must be honored.  Full stop. 

This Is How Big It Is

Not all malignancy is caused by lifestyle and environment, but it does appear that as much as 70-90% does, and therefore is largely preventable.

So here’s the ginormous, mind boggling question we should all be asking:

If, at the low-end, 70% of all cancer cases are wholly preventable, why are we spending almost all our treasure on the more exciting, innovative commercial activities to treat cancer?

If it’s impact on new cancer cases we’re after, then we need to realign our efforts and redefine potentially high impact initiatives such as the Cancer Moonshot. Less cancer does not just mean asking the question from a therapeutic point of view as in: How long can we keep folks alive who are hosting cancer?

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A future with less cancer does not only mean treating cancer as a chronic disease, with powerful novel therapeutics and procedures. It means fewer cases of cancer.

Gathering My Thoughts

  1. Cancer cells are exceptionally smart. The idea that we will ever be able to out-smart cancer to achieve so-called ‘cures’ across multiple tumor types is, well, wishful thinking. We simply cannot, long-term, out-innovate the mercurial nature that is cancer. That’s a fool’s errand.
  1. Becoming an inhospitable host to cancer—by focusing on strengthening immune function and increasing resiliency—should be the goal for every public health expert and health consumer alike.
  1. Our growing cancer epidemic is a political problem. It can only be solved by significant and sustainable investments into core areas of comprehensive cancer prevention to realize the largest impact in the shortest period of time. This does not happen without a truly whole-of-government approach that holds each department accountable for reducing the burden on citizens who are currently facing an ever-increasing pro-cancer environment.
  1. Without a massive redirection that contains significant initiatives for prevention, President Biden’s rebooted Cancer Moonshot is compromised at its foundation. As such, it is destined to leave countless lost lives and way too much heartache in its wake.

One more time: comprehensive cancer prevention is not sexy. Nor is it attractive to boardrooms and Wall Street. But if executed at the highest level it will: dramatically reduce new cancer cases and associated treatment costs; reduce absenteeism and presenteeism in the workplace; increase productivity; and greatly improve the human condition.

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