Wednesday, June 17, 2009

Combating Cancer

Today on New Voices, we want to present a new occasional format: Point/Counterpoint. We'll introduce a topic that has been getting a bunch of traction and then discuss in the comments section. We ask that all comments be on "point" and that there are no personal attacks.

Without further ado, our topic today is combating cancer using increased federal funds. In President Obama's April 27, 2009 speech to the National Academy of Sciences he said,
"We will devote more than 3 percent of our GDP to research and development. We will not just meet, but we will exceed the level achieved at the height of the space race, through policies that invest in basic and applied research, create new incentives for private innovation, promote breakthroughs in energy and medicine, and improve education in math and science."
He also said,
"Because of recent progress –- not just in biology, genetics and medicine, but also in physics, chemistry, computer science, and engineering –- we have the potential to make enormous progress against diseases in the coming decades. And that's why my administration is committed to increasing funding for the National Institutes of Health, including $6 billion to support cancer research -- part of a sustained, multi-year plan to double cancer research in our country."
However, a month later CQ [paid subscription necessary] reported that:
During a hearing Tuesday, House Appropriations Chairman David R. Obey, D-Wis., told Health and Human Services Secretary Kathleen Sebelius that he would not agree to dedicate extra money to cancer research in the National Institutes of Health's fiscal 2010 budget. He said he believes it is inappropriate for lawmakers to decide to fund research on one disease at the expense of others. "The result will be political chaos in an area that ought to be determined by science," he said.
That's a point and a counterpoint. Where do you stand?


  1. I have to agree with Chairman Obey on this one. I'm concerned if one disease becomes prioritized (or politicized) over others. Up to this point, the disease advocacy communities have done a good job of advocating together for increased funding overall. (Let's keep it up!) A mandate for dedicated funding could disrupt that balance. Grants should be based on the scientific review process and where projects are in the pipeline.

    I understand President Obama's passion and dedication for curing cancer. He is a strong advocate in his mother's memory. I feel the same way about finding a cure for Parkinson's disease--a debilitating disease from which my own family is afflicted. It's difficult hold an objective view based on the pipeline when a chronic, debilitating, or terminal disease affects someone you love. This is why institute funding should be determined by scientists who are able to approach project funding objectively.

  2. I don't think this has to be a politicizing situation. I think that, in advoacting for cancer research, he is going to bring a focus to R&D that hasn't been present since the doubling of the NIH budget. He is putting a face on medical research. It's easy for a budget concerned congressman to argue against research in the abstract, but it is far more difficult for them to argue against research to find a cure for cancer. This focus can also create a situation in which the NIH budget as a whole is increased. He's not taking money from other disease, he's directing money from the increase in the NIH budget. I realize that you could argue that directing the budget increase amounts to directing NIH funding, but I'd say that if the last 5 years have taught us anything it's that NIH budget increases should not be taken for granted.

    As for the patient groups, I think that there will always be advoacts who think that their disease should recieve increased funding. These people are doing excellent work and they should be advocating for more funding for thier particular disease, but I also think that they would be doing that whether this money goes to cancer research or not. Disease groups already are lobbying for more funding for thier particular disease in addition to increased NIH funding and I don't see how this intiative changes that status quo. It may create some discord, but President Obama isn't advocating for $400M to be spent on Dengue fever. It's cancer. according to the american cancer society ( it's expected to kill 565,000 Americans next year. I think that focusing on curing cancer is a legitimate goal for an administration to have.

  3. Yes, patient advocacy groups do lobby for additional funding, but most of that is determined by separate legislation. For example, the Parkinson's disease community asks for dedicated funding through and established program at the Department of Defense, not the NIH. This is done through a separate congressional add-on in the Appropriations committees.

    I saw evidence of the split among the patient advocacy community over the President's cancer statements while I was at the CAMI Medical Innovation Forum. A women representing an autism patient advocacy group began questioning Sen. Specter about a perceived lack of support for autism research in light of the President's statements about curing cancer. The visible frustration, disappointment, and resentment of the woman over cancer being prioritized above autism reaffirmed my belief that, all in all, this would be detrimental to the unity of the patient advocacy community. For this reason, I disagree with the notion that patient advocacy groups will accept the President's cancer initiative.

    I am well aware that NIH appropriations have never been completely removed from the political process. NIH appropriation legislation provides a designated amount on money for each institute. It is then left up to the institutes to spend that money as they see fit on peer-reviewed grants (with certain limitations and expectations provided by Congress). The main problem as I see it will arise if the President or Congress tells each institute to devote more of their allotment to cancer research initiatives. Unless increases for each institute can add to the entire pot, a cancer directive will take resources away from existing priorities. In my view, this is placing politics near the peer review process--something I'd like to avoid. The scientists in the peer review process are best able to determine which proposals deserve funding. Research priorities should be directed by the NIH directors and peer review scientists, not the White House.

  4. I disagree with this presumption of objectivity within the NIH regarding the distribution of grant funds. I'm not suggesting that it is a purely biased procedure, but I do think that political bias plays a role in which area receives funding and how much they receive. Politics still plays a role in the distribution of funds otherwise there funding for AIDS research wouldn't dwarf funding for the National Library of Medicine (and several other NIH institutions).

    Politics is always present in funding any government project the NIH included. The NIH and the research that they pay for does not exist in a vacuum and acknowledging that reality does not harm the agency in any way and, in this case has the potential to yield significant benefits to cancer research and research in general. I understand your concerns about creating specific disease advocacy, but I do not think that the funding of cancer research in specific is going to create a free for all in which these disease groups attack each other. I would be far more concerned if this call for spending increases in cancer research wasn't accompanied by an overall NIH budget increase designed to pay for the new focus. I tend to view this situation as a rising tide lifts all boats and an increase in the focus on the possibilities of research is welcome.

  5. I am very concerned that the call for spending increases in cancer research was accompanied by only a meager increase for the overall NIH budget. The President's proposed 1.4% increase in the overall NIH budget does not even keep pace with the rate of inflation for this research. The significant decline in funding after the Recovery funds are spent threatens NIH's ability to fund additional and on-going medical research. The entire research community would be better off with a significant, across the board funding increase that allows the peer review process to funding projects that meet the objectives of their institutions. The peer review boards are better able to determine the merits of the proposed projects, and should not be directed to funding projects simply because of the President's cancer initiative.

  6. Let's say that the President's call to cure cancer is handled in an adult fashion which focuses on the depth and bredth of the research needed in order to make something like that a reality. Suppose that, instead of just pouring money into the NCI, the money gets spread evenly among the various types of research necessary. Suppose also that this dsitrubtion is left soley in the hands of the NIH.

    Would that be something you might be interested in?

    I bring this up because whatever our disagreements, I tend to favor more focus on research and not less. We all want to double the budget, but that's not that easy to do I think that it's admirable that the President has set forth this extremely bold goal and is willing to spend money on it. I don't think that should be stifled, but rather supported. I think we can all agree that the curing of cancer is probably a net positive for society as a whole. So why not try? Why not set bold seemingly unreachable goals and then try to meet them? Why not say you're going to the moon and then land there

  7. Leaders and representatives (of nations, states, agencies, etc.) usually have certain issues on which they want more attention and/or funding focused. This kind of situation is likely to be thorny, but not new.

    What will determine whether this is a net benefit is its actualization. Research into treatments for cancer can reveal potential treatments for or more information about other diseases. For instance, some studies have found HPV (and thus the risk of cervical cancer) to be more common in women with HIV. The gene PTEN, linked to various types of cancer, has also been proposed to be involved with autism.

    While there is much to learn in each of the aforementioned examples, there is also a great deal of possibility in them than could be borne out by the proper focus on a well-rounded and honest approach to this initiative.