Why We're Losing The War On Cancer And How We Can Win It
San Diego has a thriving medical research community and much of that research is directed toward finding new treatments for various forms of cancer.
However, while progress has been made to increase survival rates for some forms of cancer, many cancers remain just as deadly as they were 40 years ago. It was back then that America declared "war on cancer" sinking hundreds of billions of dollars into research.
CAVANAUGH: This is KPBS Midday Edition. I'm Maureen Cavanaugh. On this show, we frequently host scientists from San Diego's thriving medical research community to explain new breakthroughs. Much of that very much directed toward finding new treatments for various forms of cancer. Despite the inroads made in survival rates for many forms of cancer, many cancers remain just as deadly as they were 40 years ago. And it was 40 years ago that America declared war on cancer sinking hundreds of billions of dollars into research. Health writer and former cancer patient, Clifton leaf, will speak tonight at UC San Diego's exploring ethics series. His book which offers some very harsh criticism of current cancer research is called "the truth in small doses: Why we're losing the war on cancer and how to win it." Welcome. LEAF: Thank you. Great to be here . CAVANAUGH: You were diagnosed with Hodgkins lymphoma as a teenager. You were treated, are you survived. Of one would think you'd be a cheerleader for cancer research. What were in you were is wrong? LEAF: It's the height of gall for me to have been the success story from research and then to go off and criticize the system. And in fact, it's largely because I want others to have the benefit of what I got to have, which was a very collaborative research enterprise at the national cancer institute that created the synergistic treatments that cured me. When I look at where we fail, it's a complicated issue because the science is terrific. We've done a really great job. And many of those breakthroughs have come from the academic community here in San Diego broadly in California. The issue is that the burden of cancer every way you can measure it has gone up and up and up since we began this war. And that's why we got into the war. When you're looking at metrics for how to measure our success, you have to be very cold-eyed about how we've done it. CAVANAUGH: One of the points in your book is that cancer research has lost some of its urgency. And some of the urgency that we saw in, let's say the early '90s when it came to finding drugs to fight the AIDS virus. What could give that sense of urgency back to today's researchers, do you think? LEAF: Well, I think the AIDS crisis is a very good example. I remember going to the FDA and before I divide some interviews with the director and many of the deputies there, I asked the security guard outside this facility, when was the last time you had anybody out here picketing, complaining, making their voice known? And he said it was the AIDS crisis. They've never had anybody -- for all the pink ribbon wearing culture that we have, are nobody has gone to the FDA to talk about this. And I think part of that is that it's so large, it's so obvious, are the problem, that we fail to notice how immense it is. And that is a problem. When we see reports of new infectious diseases like SARS or any new kind of viral infection, we panic, and we have a global and collaborative enterprise to go and attack that. With cancer, it's so is there that it's hard to see it. CAVANAUGH: Now, you praise some cancer researchers in the past for the innovative thinking and for taking some risks. You're going to speak tonight about doctor Dennis Berket. He was an Irish researcher. LEAF: He's one of the most stories in the history of medicine, let alone in cancer medicine. He was a 46-year-old doctor, an Irish surgeon working as a missionary in Uganda. And he had a very unusual quality for a surgeon. He was missing an eye. So it was very hard for him to get into the British medical research missionary work there. But he was relentless. And what he was able to do was essentially diagnose and find a cancer that was the most common childhood cancer in all of Africa, but no one had ever recognized it before as a single tumor syndrome. And the way he did this is one of the great stories. It was a -- he did essentially a tumor safari, be a geographical biopsy through all of Africa, driving in an old Ford station wagon with two other doctors basically cataloging each case, and putting little pins on the wall, marking where it was coming from and why. And that's how he solved this amazing mystery. And it's really a great model for us to look at because it was cheap. The expedition cost less than $650, I think. And it caught us a lot about how to do science in a way that I think we've forgotten. CAVANAUGH: Well, I think a lot of people would say well, it's great to have these lone wolf researchers out there trying whatever scheme they come up with, but how do you balance the ethics of good medical practice with the kind of innovation, that kind of passion that you point to when it comes to a researcher like doctor Dennis? LEAF: Well, part of what I hope to talk about, what I hope the message that will be revealed in the book, is that there are a lot of young scientists now in the cancer research community who are forced not to be creative and not to be innovative by the day to day incentives in the cancer world. And so when you look at what scientists want to do with their lives, when they go to bed at night, they think very, very big dreams. When they go to work the next morning, the job is to get published, to have a very discrete experiment in a small experimental system, to cover ground that has been covered before, where the answers are well known, where there's nothing outrageous about it. And you have to do this over and over and over again, are spending half of their time applying for grants just to eventually get to the point where they can do something bold and innovative. So I talk about that squeezing out, it's like an intellectual squeegee on the research enterprise, and how the systems that we've put in place actually do that. Most of the book is devoted to that. I think when we talk about the Dennis Berkets, he existed before a lot of these entrenched, institutionalized systems came into play. And it's much harder for someone to go out and break out of that and do what he did, or what Sidney Farber did at Boston children's hospital. CAVANAUGH: And he invented chemotherapy. LEAF: Sure, one of the great pioneers. And in fact we would probably put him in jail for what he did today in terms of the sort of recklessness of the approach. Many of these men and women, the early pioneers, were so sold that it would be uncomfortable to look at what they did through the current lens. CAVANAUGH: One of the things in your book, the truth in small doses, you criticize the fact that most of the federal dollars for cancer research go to the same institutions year after year. Where should it go instead? LEAF: Well, the question isn't that these institutions aren't worthy. It's more of a perception about what tells us about the grants mechanism and the purity of process. This is supposed to be a blinded process. And yet what's remarkable isn't just that they're going to the very, very top institutions but all the way down the list, if you goes to the first several hundred institutions that receive any kind of funds, their place in that list is virtually unchanged from year to year. So it's almost as if there's this sort of quiet -- and it's not exactly rigged, but it's sort of rigged by the culture, by the academic culture, in which the same kinds of thinking in the same kinds of places is rewarded over and over and over again. And it's like that definition of insanity. You just keep doing the same thing over and expecting a different result. And that's really where when we see the kinds of true amazing breakthroughs, they've often come from outside of that paradigm. So platinum therapy, for example came from a young doctor working in Michigan State University. Sort of outside of the central nexus of cancer research. CAVANAUGH: I'm wondering, what do you see as the current cutting edge cancer treatment that holds promise? LEAF: Well, I'm not a doctor. But just from reading the science, I think the latest stuff on immunotherapy is exciting. I think the notion of using the body's own immune system to target and attack cells that are essentially -- that look very normal, and to find those identifiers to make them stand out as cancer has been a long and hard-fought challenge for many years. We've seen some false starts with that, or I should say some hopeful kinds of things, interferon in the '80s, wee seen it with CSF. There are macrophages, different kinds of approaches that have seemed to hold promise for a while, and then when reality comes into play, you realize it's not as simple as all that. But some of the new stuff is very exciting. CAVANAUGH: And another thing about your book too, and I thought this was very interesting, there's been a great deal of emphasis on understanding cancer, how it forms, replicates. But you say we don't necessarily need to understand it to cure it. Not necessarily to cure it, but to prevent it. CAVANAUGH: Prevent it. Treat it. LEAF: Yeah, one of the problems is I think some of the emphasis on cure, cure, cure has taken us down the wrong path. The biggest element of our national cancer burden is the fact that lots of people are getting the disease. And those people are actually being treated and in many cases overtreated. So you have to add that to the treatment burden to the overall cancer burden. And so we've done absolutely nothing, and that's not an exaggeration, to prevent the disease, to do the things that ween will prevent cancers. So if you look at our overall spending on cancer, about 7% of our national cancer budget goes to any kind of preventative work. And much, much less in the private sector because there's just no interest in that. CAVANAUGH: And preventive, do you mean smoking cessation and things like that? Or are you talking about something that's more like a medical intervention? LEAF: Well, both. There are some very straightforward behavioral things that we can do like stopping smoking which would basically cut out 1/3 of cancers. So that's critically important. There are issues about nutrition and lifestyle that we need to explore. Part of it is looking at the concept of chemo prevention. One of the ways we've been able to reduce the burden of heart disease, and this is truly an extraordinary story if you think in 2010 there were 138,000 fewer deaths from heart disease even though we have 100 million more people in the country. That's truth amazing. And we've done through that chemo prevention, for treating the precursors of heart disease like high cholesterol and hypertension. CAVANAUGH: I have to leave it there. But Clifton leaf is speaking at UC San Diego's exploring ethics series today at 5:30 at the Scripps research institute's auditorium. Heap is also a speaker at the Atlantic meets the Pacific, a joint conference at UC San Diego today through Friday. Thank you so much. LEAF: Thank you, Maureen.
The rate at which cancer treatment has advanced compared with the time, money and effort being spent on cancer research, just doesn't add up for journalist and former cancer patient Clifton Leaf.
He is the first featured speaker in the first installment of UC San Diego's 2013-14 Exploring Ethics series, titled “Overthrowing the Emperor of All Maladies: Moving Forward Against Cancer.”
Leaf will examine the study and treatment of cancer, one of the world’s most vexing medical challenges dating back to antiquity. He is author of the recently acclaimed book, "The Truth in Small Doses: Why We’re Losing the War on Cancer -- And How to Win It." The intriguing topic of his presentation, “Lessons from a One-Eyed Surgeon,” refers to a famed Irish surgeon and medical author named Denis Burkitt, whose inspiring story Leaf recounts in his book.
Leaf is also in San Diego for "The Atlantic Meets the Pacific," a joint conference hosted by The Atlantic and UC San Diego.