When I mentioned former FDA commissioner Andy Eschenbach the other day, I alluded to some other things about his approach that have bothered me. I thought I should follow up on that, because he’s definitely not the only one. You may or may not remember this business from 2003, where Eschenbach wanted to set a goal for the National Cancer Institute to “eliminate death and suffering” from cancer by 2015. Here’s what Science had to say at the time:
The nation’s cancer chief, National Cancer Institute (NCI) director Andrew von Eschenbach, has announced a startling new goal in the battle against cancer. His institute intends to “eliminate death and suffering” from the disease by 2015. The cancer research community is abuzz over the announcement. Some say that however well intended, the goal is clearly impossible to reach and will undermine the director’s credibility.
Von Eschenbach, who has headed the $4.6 billion NCI for a year, announced the 2015 target on 11 February to his National Cancer Advisory Board. He told board members that he did “not say that we could eliminate cancer.” Rather, he continued, his goal is to “eliminate suffering and death due to this disease.” NCI is working on a strategy to do that by discovering “all the relevant mechanisms” of cancer, developing interventions, and getting treatments to patients.
We have three years to go on that deadline, and it’s safe to say that we’re not going to make it. And that’s not because we failed to follow Eschenbach’s plan, because saying that you’re going to figure out everything is not a plan.
Now, I’m actually kind of an optimistic person, or so I’m told. But I’m not optimistic enough to think that we can eliminate deaths from cancer any time soon, because, well, because I’ve worked on drugs that have attempted to do so. As has been detailed several times here (and many times elsewhere), cancer isn’t one disease. It’s a constellation of thousands of diseases, all of which end up by showing uncontrolled cell growth. Calling cancer a disease is like calling headache a disease.
But I’m operating on a different time scale from Eschenbach. Here he is in 2006, in The Lancet:
“Think of it”, von Eschenbach says, “for thousands of years we have dealt with cancer working only with what we could see with our eyes and feel with our fingers, then for a 100 years we’ve dealt with cancer with what we could see under a microscope. Now, we have gone in 10 years to a completely different level.” This new science “is going to change how we think, it’s going to change how we approach things; it’s going to change everything.”
. . .He points to the example of testicular cancer. The development of treatments for this cancer was a great success, von Eschenbach says, but one that “took decades of trial and error, one trial after another, after another, after another”. That hit-and-miss approach is no longer necessary, von Eschenbach says. Now, if 10% of patients responded to a treatment, he says, “you take the tools of genomics and go back, reverse engineer it, and ask: what was different about that 10%? Well, they had an EGF [epidermal growth factor] receptor mutation, ah ha!”
Ah ha, indeed. Here’s more in a similar vein. The thing is, I don’t disagree with this in principle. I disagree on the scale. No one, I think, knows how to eliminate deaths from cancer other than the way we’re doing it now: detailed investigation of all sorts of cancers, all sorts of cellular pathways, and all sorts of therapies directed at them. Which is all a lot of work, and takes a lot of time (and a lot of money, too, of course). It also leads to a huge array of dead ends, disappointments, and a seemingly endless supply of “Hmm, that was more complicated than we thought” moments. I don’t see that changing any time soon. I’m optimistic enough to think that there is a bottom to this ocean, that it’s of finite size and everything in it is, in principle, comprehensible. But it’s big. It’s really, really big.
There are people who defend goal statements like Eschenbach’s. Such things force us to aim high, they say, they focus attention on the problem and give us a sense of urgency. Taken too far, though, this point of view leads to the fallacy that what’s important is to care a lot – or perhaps to be seen to care a lot. But the physical world doesn’t care if we care. It yields up its secrets to those who are smart and persistent, not to the people with the best slogans.