Vice President Joe Biden closed the 2016 American Association for Cancer Research annual meeting in New Orleans by telling the audience what he had learned since his son, Beau, had been diagnosed with glioblastoma some 5 years ago. To cure cancer, he said, or in his words, “to make a decade’s worth of progress in 5 years,” was going to require coordinated action by government, the private sector, and academic institutions.
The vice president confidently predicted that the United States budget for 2017 would include an additional $800 million for cancer research, and went on to offer 6 suggestions to realign research incentives to maximize the return on the nation’s investment in that research.
These included sharing data, involving patients in clinical trial design, encouraging young scientists to pursue their own interests rather than repeat work that has already been done, evaluating research based on improvements in patient outcomes, making publications more readily available, and, finally, rewarding the verification of results that would advance research.
These time-tested proposals to jumpstart and streamline the research agenda are appropriate, necessary, and overdue, but even if they are put in place tomorrow, by themselves, they are not going to lead to a decade’s worth of progress in 5 years. And while increasing the budget for cancer research by nearly $1 billion is nothing to sneeze at, especially when that budget has been declining in real dollars, we must admit that these dollars represent a relatively small investment in the context of the project’s stated objective.
So what is to be done, especially at the moment when we are beginning to understand the etiology of cancer-in short, that it is not a single disease-and are developing new tools and therapies to diagnose and treat it in individual patients?
Harold Varmus, MD, former director of the US National Cancer Institute and one of the president’s science advisors, has some excellent advice on what we can do-even without increased funding. Writing in an editorial published in Science on April 8, he commends the efforts of the White House to encourage greater collaboration and information sharing, but goes on to say that the vice president could and should use his new platform to call for the alignment of the agencies within the Department of Health and Human Services to promote the integration of personalized medicine into cancer care if not healthcare generally.
In particular, Dr Varmus writes, “The administration could also exercise its regulatory authority-most potently, to direct the Centers for Medicare & Medicaid Services (CMS) to allow reimbursement for molecular profiling of cancers. That would,” he explains, “increase the data available for analysis, accelerate interpretation of genetic profiles, provide a test bed for true sharing of clinical information, and allow future coverage determinations by CMS to be made more quickly and sensibly.”
As we know and as the Personalized Medicine Coalition has argued since its launch in 2004, unless we align public policies around promoting personalized medicine, notably in the regulatory and reimbursement arenas, progress in fighting cancer will be much slower than we would like. In its letter to the vice president that followed his request for information from the precision medicine community, we contended that the core challenge to advance the field is the fact that conventional policy has treated therapeutic agents, diagnostic tests, and healthcare services as separate policy issues.
If our goal is to improve outcomes and make the healthcare system more efficient, it is important to understand that they are not. Only by so doing can we ensure that the recent progress in the annual age-adjusted cancer mortality rates in the United States, which Dr Varmus noted are down by about 1% to 2%, will continue.