In an earlier essay, I described how cognitive dissonance can wreak havoc with our perception of the world, especially in the case of politics. Cognitive dissonance is a psychological state in which you can believe two logically different ideas at the same time. For example, some scientists are avowed Creationists, and some people who want to help the poor, fervently vote for enormous tax breaks for the wealthy. Psychologists say that this dissonance causes internal stress and anxiety until you, yourself, create a ‘story’ that creates an acceptable way to justify the two extremes.
Depending on how you voted in 2016, you will find my earlier discussion either brilliantly insightful or insufferably condescending. But here is a topic I think we can all agree upon that suffers dramatically from this same mental affliction, namely, cancer research.
Here are the facts for 2016:
People contracting cancer……………………………. 1,685,210.
People dying from cancer…………………………………. 595,650
Cancers found in people older than 50…………………….85%
State with highest incidence rates…………………. Kentucky
State with lowest incidence rate………………………….. Arizona
Annual medical costs for cancer treatment……..$75 billion
We all agree cancer is a scary disease, and for many the mere use of this word is terrifying. Far more people die from cancer every year than from nearly all other non-disease causes of death combined. You have a one-in-two chance of getting cancer in your life and a one-in- four chance of dying from cancer in your lifetime. Your risk of dying in an airplane crash, earth quake or terrorist action is insignificant compared to your risk of dying from cancer.
Why is cognitive dissonance involved in cancer research? Because we all collectively understand the facts of cancer, but then we turn around and vote a half-hearted research budget to combat it, and then collectively shrug our shoulders that we are doing everything we can to win the war. Let’s take a look at what we are collectively doing about cancer.
The decline in NCI funding for research 2003-2014. (Credit: ASCO Connection.com)
Funding for cancer research (NCI): $5.21 billion for FY 2017. Loss of buying power since 2003: 25%. So let’s see….the annual cost for cancer treatment is $75 billion and we invest just over $5 billion to find cures. Then we have the DoD hiding $125 billion in waste at the same time they want to expand their current budget by $2.2 billion to $524 billion in FY17.
Why is it that the case made by the DoD to increase their budget, or President Trumps call to embark on a ‘new’ trillion-dollar arms race, are so much more compelling than the very obvious efforts to cure a major threat to the lifespans of most American voters? The polling statistics are also rather troubling.
In a new national public opinion survey commissioned by Research!America, an overwhelming majority of Americans (85%) say it is important for candidates running for national office to assign a high priority to increasing funding for medical research. The U.S. spends about five cents of each health dollar on research to prevent, cure and treat disease and disability, but only 56% say that is not enough. Yet, Vice President Joe Biden’s 2016 Cancer Moonshot initiative to defeat cancer earns support for a tax increase to fund cancer research among only half of the respondents (50%). Only a weak majority of Democrats (67%), and few Republicans (38%) and Independents (39%) support a tax increase to engage this war. Of those who favor a tax increase, more than half (88%) say they are willing to pay up to or more than $50 per year in taxes.
The over-all NIH, FY17 budget increase of $850 million over FY16 will support an increase of 600 research projects above FY16. From this you can roughly deduce that the added $680 million for the Cancer Moonshot in FY17 will support an additional 480 cancer-related grants. But although we do NOT want to look a gift horse in the mouth, the NCI budgets since 2003 have never kept pace with inflation. By 2014 the NCI purchasing power for cancer research had fallen behind by about $1.5 billion or 30% from where they were in 2003. Have a look at this graph below. The top line shows the funded amount and the bottom line shows the inflation-adjusted purchasing power from 2003 to 2014.
In the 45 years since Mr. Nixon signed the National Cancer Act of 1971, which launched the previous War on Cancer, NCI has spent more than $100 billion on cancer research. This, buy the way is equal to the cost of NASA’s International Space Station. Since 1946, American Cancer Society has spent more than $4.5 billion to find cancer cures and forty-seven ACS-funded researchers been awarded the Nobel Prize. A relevant question is; Will the $680 million increase proposed by the Cancer Moonshot for FY17, and hopefully similar amounts after that, be enough to tip the scales towards cures in the way that VP Joe Biden has hoped?
The FY17 $6.3 billion 21st Century Cures bill was approved by the Senate in an overwhelming 94-5 vote and will doubtless be signed into law by President Barack Obama. The 10-year funding ‘Cures’ bill made its way through Congress largely because it is packed with substantial amounts of money for enough pet projects, including a batch of Medicare and mental health reforms, to keep disparate lawmakers on board.
Although other elements of President Obama’s 21st Century Cures program will receive automatic refunding in future years, Cancer Moonshot research funding is not guaranteed. It will have to be appropriated each year. Even worse, it will be paid for in part by raiding Obamacare’s Prevention and Public Health Fund, which pays for anti-smoking campaigns and other preventive health efforts. So Congress will give us a modest increase in the cancer research budget, about 10%, but will not promise this sustained support over the long haul. Again, researchers will be placed on a year-by-year leash to get their support for carrying out complex and time-consuming research. Every grant PI will have to spend time each year arguing for the refunding of their research rather than being focused on cures. Even scientists at NASA can usually count on three-year commitments for their funding!
What can you do? The odds say you should expect to contract cancer in your lifetime. The odds also say that you will probably not have a good long-term outcome. You need to accept this and do what you can to preventively temper your lifestyle and eating habits accordingly. Then, you need to decide for yourself if you are happy with the trending for cancer research. Why do we settle for $5 billion each year to fight this war when $10 billion would be far better, especially if the funding were more stable for long-term research programs? Call your Congressperson to make this case. It may actually save your life!!
Check back here on Monday, February 13 for the next installment!
By the way, check out the 2015 Ken Burns and Barak Goodman’s PBS Special Cancer:The Emperor of all Maladies about the ins and outs of cancer research. It was narrated by Edward Herrmann while he had brain cancer. He died soon after filming completed. The program will utterly change your perspective, and get you mad as hell!
My other blogs on cancer research can be found at the Huffington Post:
Our Shamefully Wimpy War Against Cancer
Our Pathetic War Against Cancer: Part III
Our Pathetic War Against Cancer: Part III
Cancer is a dreadful disease. I am a widower because of it, and my father died of pancreatic cancer, which is about the worst way to go. However, about the time of my father’s illness, I got peripherally involved in a project. We had a chemical that was extraordinarily active, a company had the patent on it (fair enough) but it had no mechanism to use it, so it got abandoned (and in my view there was fraud involved with the funding). What it did was to kill solid tumours if only micrograms were introduced to the tumour. So some really sophisticated medical procedures would be required – outside the scope of this company. In my opinion, this leads to a disconnect – we want to get rid of cancers, but we have property rights that stops that. I think there needs to be some national, or international means of buying out property that would otherwise die.
However, on your main point, Sten, I am not sure doubling the money would be efficient. I suspect the problem is as much a shortage of ideas as of effort. We need some approach by which additional funding is available for reasonable proposals though, and for better understanding and the development of new procedures.
Thanks for your comment, as always, Ian. Sorry to hear about your many losses. I myself am dealing with non-Hodgkins Lymphoma so it is more than a theoretical issue with me as well.
The research statistics remain very grim. As money continues to become tighter in Current Dollars for basic research, the number of approved and funded grants must decline, so that many, many very good projects are unfunded, and the proposal refereeing process becomes ever more conservative and risk-averse. Even in astrophysics, you literally have to prove the end result of your research before you will be selected to carry it out in a dismal Catch-22 situation. In cancer research the situation is the same with many good ideas chasing fewer research dollars. In astrophysics, the average age of a PI that gets an accepted grant is about 35-40. In cancer research it is closer to 55. This is not just a sign of the ‘normal’ competition of ideas, it is a funding pathology created by declining budgets in real-world dollars, and the technical difficulty of working at this difficult medical frontier.