Fewer Moonshots, More Walks

Kim BellardIn a provocative op-ed piece, Jarle Breivik, a professor of medicine at the University of Oslo, takes aim at the National Cancer Moonshot Initiative announced earlier this year by President Obama.  Nice try, he concedes -- but the reality is: "We’re a lot better at fighting cancer. We just can’t cure it."

Is this stereotypical Norwegian pessimism or just some badly needed Scandinavian bluntness?

Dr. Breivik points out that cancer is fundamentally a disease of aging, and none of us is getting any younger.  All our efforts to improve lifespan end up putting us at risk of living long enough that we'll get some form of cancer.  We've gotten a lot better at treating cancer, and there are new developments that promise to make even greater impacts (more on that later), but as Dr. Breivik points out: "Every time we cure a person of cancer, we produce a person with an increased probability of getting cancer again. It is the Catch-22 of oncology."

We love to use terms like "moonshot" -- even Google uses it for their most ambitious projects -- but Baby Boomers are the last generation to whom it actually carries any real meaning.  That same generation is also getting into the years when cancer becomes more of a risk, so perhaps the use of it is no coincidence.  We spent the equivalent of around $200b on the Apollo program, which certainty makes the current (supposedly) $1b cancer moonshot look like doing it on the cheap....or for the PR.

 In Dr. Breivik's analysis,

The different actors are outbidding one another for attention and funding, and for more than half a century the public has been told that the cure is just around the corner....Confronted with these forces, there is little incentive for our democratically elected leaders to question the goal of the ultimate cure.

At the very least, we owe ourselves more straight talk about what we're doing.

Because, in the midst of our "war on cancer," things seem to be getting lost in the fog of the war.  A new study found that only 5% of advanced cancer patients actually understood their prognosis.  These were people who had approximately four months to live.  Thirty-eight percent had never even discussed their prognosis with their oncologist.

The lead researcher said: "We were astonished to learn that only 5 percent of this sample had sufficient knowledge about their illness to make informed decisions about their care."  "Astonished" would be a good word to use; "appalled" might be another.

It's not clear if this is due to patients not asking, or to their doctors not telling.  It is most likely some of both.  Two oncologists illustrate their dilemma in a poignant column, How Much Do You Want to Know about Your Cancer?   They can give numbers, they can speak in generalities, they can help their patients make plans, but they can't read their patients' minds about how -- or if -- they want to hear the bad news.

And it is often bad news.  In their words, for many patients they say it boils down to: "Spoiler alert: Despite all the exciting stories about progress against cancer that you’ve heard about in the news, there is no cure for most types of cancer once they have spread to other organs."

We talk about wanting to be informed patients, about taking more responsibility for our health, about being partners with our doctors and other health care professionals, but when things get scary, as they can uniquely do when it comes to our health, maybe not so much.

Maybe all this is too pessimistic.  We are making progress, to the point when many cancer patients whose post-diagnosis survival might once have been measured in months are now living for years -- sometimes apparently cancer-free.  There is particular excitement around so-called checkpoint inhibitors that help unleash the body's own immune system to fight cancer.  

Even more promising, German researchers have just published results that they believe represent a "very positive step" towards  creating a universal vaccine against cancer -- not just curing but immunizing against cancer.  That is truly the Holy Grail of cancer research.

The biggest problem is that, to date, the cost of cancer drugs has been astronomical (pun intended).  Some of the drugs can cost over $100,000 annually, making those longer lifespans not look quite as rosy, at least for the people paying that bill (that would be us, folks, one way or another).  Indeed, recent research confirms that the U.S. is getting less bang for its cancer bucks compared to other countries.  Maybe a "vaccine" will upend all the current cost-benefit calculations -- or maybe it, too, will get caught up in the big money arms race.

Imagine what a Valeant might charge for such a vaccine.

When it is us or a loved one with cancer, it often seems like no drug is too expensive, no treatment too experimental, even if it might buy only a few more months of life -- and not necessarily months with a very high quality of life.  Many of us would be willing to spend all of our savings on such options.  The problem is, we're often willing to spend everyone else's money too, and that's just not a choice we should get to make unilaterally.

All the talk of moonshots, better survival rates, and promising new treatments sometimes can lull us into a false sense of optimism.  But, hey -- Baby Boomers may not live long enough for many of them to worry about cancer.  They'll be too busy dealing with the impacts of diabetes and obesity, making them "sicker seniors" than previous generations, as NPR reported.  Unfortunately, we can make equally dubious choices about those as well.

We know our behavior can help us be healthier.  For example, new research has associated exercise with lowering the risks for 13 cancers, adding to the array of similar research findings about the impacts of healthy behaviors.  Yet the CDC says only 6% of US adults are engaging in the five health-related behaviors that are associated with preventing chronic diseases.

No wonder that Dr. Brevik concluded that, instead of moonshots against cancer, "many more lives can be saved by doing the boring stuff, like getting people to stop smoking, eat healthfully, exercise and put on sunscreen."

"Boring stuff" just doesn't get headlines the way "moonshots" do.

Fewer Moonshots, More Walks was authored by Kim Bellard and first published in his blog, From a Different Perspective.... It is reprinted by Open Health News with permission from the author. The original post can be found here.