November, 2016

Blue Moon                 Shot

By Michael J. Katin, MD

On January 12, 2016, President Obama, in his final State of the Union address, proposed a "Moonshot" to cure cancer. Not much has been mentioned on the campaign trail about cancer treatment, deferring to more serious topics such as unreleased tax returns, the Clinton Foundation, and groping, In the background, however, there has been activity, and it is possible that the pessimism expressed in February's column may have been premature even though nine months should have been enough time to see some developments.

Since other events dominated the news, there was not significant enough attention paid to a major statement by the Cancer Moonshot Task Force released on October 17, an "executive summary" of recommendations and goals generated to this point. First, it is to be noted that the persons on the Cancer Moonshot Task Force are all government officials, including the Vice-President and Secretaries of HHS, Defense, Veterans, Energy, Commerce, and Agriculture. It also includes the heads of the FDA, NIH, NCI, CDC, EPA, CMS, NASA, and OMB, among others. Jane Chu, Chairman of the National Endowment for the Arts, is also a member. Presumably this is not costing the country anything since all of these people should already be on salary. However, it appears most of the work is actually being generated by a "Blue Ribbon" panel with a membership of 28 persons from industry, academics, and private organizations, plus five ex-officio members from the government. Interestingly, Robert Califf,, MD, Commission of the FDA, is the only person on both the Task Force and the Blue Ribbon Panel (albeit ex-officio), but also deserves attention for having been on the 1969 South Carolina AAA High School championship basketball team and also having been a clinician, even being a Master of the American College of Cardiology.

We learned that the Blue Ribbon Panel met in person April 18 and July 20 and virtually on April 11 and July 13. There was then a presentation on September 7 by the Blue Ribbon panel co-chairs to the Task Force and this information was then submitted by Vice-President Biden to President Obama at a ceremony at the White House on October 17.

Included in the report are ten recommendations to "end cancer as we know it today." Although that phrasing leaves a lot to be desired, the ten recommendations involve practices and research directions that already seem to be in use anyway. For example, #1 is "Engage patients to contribute their comprehensive tumor profile data to expand knowledge about what therapies work, in whom, and in which types of cancer." This has been done for years in many formats and, in fact, has been inhibited by HIPAA regulations. #8 is: Predict response to standard treatments through retrospective analysis of patient specimens." There would be very few boomers who have not read about and demanded molecular profiling for prognoses based on retrospective analyses. #10 is "Develop new enabling cancer technologies to characterize tumors and test therapies. These include implantable microdosing drug devices and advanced imaging technologies to study cancers at extremely high resolution." It would seem these already happening. The remaining seven recommendations are more of the same. Although it probably is helpful to organize efforts, unless the government takes over and funds all these projects itself, it is unclear as to what difference this will make. It is possible that tens of millions have now been spent on honoraria, transportation, hotel rooms, refreshments, and websites to specify things that are already being done.

Of further interest, many of the members of the Blue Ribbon Panel have affiliations with private industry with potential to profit from government grants into their particular lines of interest. Fortunately, that would not possibly happen. It is also noted that a previously-legitimate cancer treatment modality was not represented in any way in any of these panels. Yes, there was not a single radiation oncologist in this group, even though the Blue Ribbon Panel included Neal Kassell, MD, chairman of the Focused Ultrasound Foundation It also needs to be mentioned that the Cancer Moonshot Task Force Staff includes two persons with JD degrees, as Executive Director and Policy Analyst, and nine other persons including four with PhDs and no MDs, since MDs don't know how to run anything involved with medicine, anyway.

Maybe it won't matter in the long term, since these projects tend to run out of gas eventually anyway. . In terms of that possibility, it is to be remembered that as a result of the original Moon project, 12 astronauts walked on the moon and so much time has passed since the most recent moon landing in 1972 that only seven of these twelve are even still alive and support to NASA for return to the moon and on to Mars has been cut back substantially. Would the same thing happen if the government took over the entire cancer Moonshot program?

I agree that it is unfair to be critical of the Blue Ribbon Panel at this early point, since they are, indeed, a blue ribbon panel. Although most of us would immediately identify "blue ribbon" with beer, and possibly pigs and apple pies at the county or state fair, the true application is more interesting. Would political correctness require a change in terminology if it were realized that the term "blue ribbon" originated from the ribbon from which the Cross of the Holy Spirit was suspended when it was awarded to the members of l'Ordre des Chavaliers du Saint Esprit, an order created by King Henry III of France in 1578? Would a name change be warranted if it were realized that the blue ribbon is a symbol used not just in the United States for awareness of colorectal cancer (and, as light blue, for prostate cancer) but internationally for awareness of chronic fatigue syndrome (or will chronic fatigue result from continued bureaucratic reconstituting. Finally, would it help if they realized that their own abbreviation for Blue Ribbon Panel on their internet address, brp, has a totally different connotation in hospital medicine?

Seriously, though, I appreciate the work the panel is doing. I hope they can take a little ribbon.

Emanuel Countdown: Dr. Ezekiel Emanuel's biographies list his birth year as 1957 but, interestingly, do not list a birth date. He has expressed that he does not wish to live past his 75th birthday. Giving him every benefit of the doubt, he will have his 75th birthday no later than December 31, 2032. Including November 1, 2016, this leaves 5,905 days to his goal.