Of Mice and Men: The Delay in Finding a Cure for Cancer
“As happens sometimes, a moment settled and hovered and remained for much more than a moment. And sound stopped and movement stopped for much, much more than a moment.
Then gradually time awakened again and moved sluggishly on. The horses stamped on the other side of the feeding racks and the halter chains clinked. Outside, the men’s voices became louder and clearer.”
― John Steinbeck, Of Mice and Men. Published February 25, 1937
The National Cancer Institue is the largest funder of cancer research in the world. Last year, the NCI budget topped $7 billion.
The amount of research that the NCI is able to “buy,” however, is actually decreasing. In a 2023 blog post, the acting director of the NCI, explained that although the NCI budget was over $7 billion, the buying power fell by 13% ($1.1 billion) due to rising costs. As we all have experienced, a 2024 dollar just doesn’t buy what it used to. The same is true in research.
These monetary shortfalls are compounded when Congress approves “stopgap” measures or continuing resolutions. These bills provide a “flat” budget that contains the same amount of funding as the previous year. “A flat budget is effectively a decreased budget,” the interim director explained.
This flat budget status quo puts pressure on NCI officials who must decide which research deserves a piece of their limited resources:
Is it better fully fund a “safe” project by an established researcher that will likely result in an incremental improvement?
Or take a chance an innovative idea to cure a rare cancer proposed by an untested investigator?
With limited taxpayer dollars and the eyes of Congress watching every penny, should the NCI gamble?
In Congress, are the political gains produced by brinksmanship worth delays in funding a cure for cancer?
As is true of many institutions, the story of how the NCI was formed explains our successes and failures in finding a cure for cancer. It explains much of why we treat cancer the way we do and why we aren’t further along the road to a cure.
On August 5, 1937, President Franklin Delano Roosevelt signed the National Cancer Act. This established the National Cancer Institute with a mandate to investigate the cause, diagnosis and treatment of cancer. It was the first time Congress appropriated funds towards a non-infectious disease. The act included funding for buildings, programs and research. (Click on the picture to hear rare audio footage of FDR speaking at the NCI dedication ceremony.)
For a decade, the NCI comprised basically two buildings, a lab that contained mostly rats and an office building. For this reason, many joked that that the NCI was dedicated only to curing cancer in mice.
In 1944, Congress passed the Public Health Service Act which consolidated all government funded health programs, including the NCI, under the National Institutes of Health. Congress also allocated $25 million build a dedicated space that would combine scientific research with clinical care.
The 14 floor, 2.5-million-square-feet NIH Clinical Center was constructed using seven million bricks. This first of its kind research hospital contained 5,000+ rooms, nine miles of corridor, fifteen outpatient clinics and a Department of Laboratory Medicine - all housed in a space the size of a football field. Floors were split with patient rooms on one side and laboratories on the other. The idea was that clinical care should inform research and vice versa.
Delayed by the United States’ entrance into World War II, the Clinical Center welcomed its first patient (a Maryland farmer with prostate cancer) on July 6, 1953. The cancer program housed at the Clinical Center marked the first full-scale, government funded, clinically focused research program in cancer.
I wrote about one of the Clinical Center’s earliest successes last year.
Why Your Doctor is Leaving You
Despite this investment, through the 1960’s, the pessimism surrounding cancer prevented all but true believers from trying to find a cure. Most physicians rightfully referred to chemotherapy as “poison” due to the awful side effects and lack of supportive care measures. Most steered clear.
As former NCI director, Dr. Vincent DeVita, described it “the main issue of the day was whether cancer drugs caused more harm than good. Talk of curing cancer with drugs was not considered compatible with sanity.”
Thanks to the efforts of physicians like DeVita and others, by the 1970’s, chemotherapy was capable of producing significant responses, called remissions, in children with leukemia and young adults with lymphoma. Young patients who previously faced a death sentence, were now returning home to their families.
By 1974, the NCI was using mice to screen 40,000 potential chemotherapy compounds a year. Virtually all standard chemotherapy in use today came from this program.
Just a decade later, the magic bullet for “liquid” or blood related cancers like childhood leukemia and Hodgkin’s lymphoma was established. With a previous mortality rate of 100%, multi-drug chemotherapy treatment for these terrifying diseases had cut that by half. Oncologists, parents and patients rejoiced, but these dramatic successes did little to move the needle in the overall cure of cancer.
Why?
Solid tumors (those originating in organs like lung cancer, breast cancer and colon cancer) make up about 85% of human malignancies. The remarkable cures in the small number of people diagnosed with leukemia and lymphoma did not translate into significantly more cancer survivors. Surgery continued to be the mainstay of treatment for the vast majority of cancers through the 1980’s.
But the “high” associated with the successful treatment of childhood leukemia lingered for decades. Surely, if researchers funded by the NCI just kept looking, they could find the magic bullet for the more common cancers.
The moment of tremendous success is where cancer research settled and hovered for over fifty years: desperately searching for the perfect poison, the magic bullet, that would result in the same dramatic cures that those doctors saw in children with leukemia. Only recently has cancer research, as Steinbeck described, “awakened again and moved sluggishly on.”
Less Radical
is the story of how a Jewish kid from Pittsburgh became the world’s expert in breast cancer. In this six-episode series, I will take you into the operating room, the White House and the halls of Congress to show how one man fought for patients and found a better way to cure cancer.
We will cover Fisher’s contributions to our modern understanding of cancer and how Washington politics toppled him from the height of power and ruined his career, an experience that haunted him until his death.
The production team at Yellow Armadillo Studios has done a terrific job of crafting an experience that captures Fisher’s persistence in the face of seemingly insurmountable hurdles.
I look forward to hearing your reactions to his struggles, his brilliance and his legacy which reflect the conversations we’ve been having here at Cancer Culture