“What is the use of living, if it not be to strive for noble causes and to make this muddled world a better place for those who will live in it after we are gone?”
— Winston Churchill
A recent post on this blog discussed the very real and significant progress that has been made in determining the causes of metastases. It discussed, for example, the recent patented findings of Dr. Michael Dwinell of the Medical College of Wisconsin. There are other cancer researchers examining this same area. These scientists, generally working in windowless offices with limited budgets, are all trying to find a way to slow down or stop the spread of cancer within a body and, hence, save lives. What can be more noble?
The promise is there, peaking from behind the dark shadows of metastasis. Let’s now look at the funding – or lack thereof – available to Dr. Dwinell and those other scientists who undertake this work. Is there a vehicle for sufficient funding to turn this hope into reality?
II. THE LIMITED FUNDING FOR METASTATIC RESEARCH:
A. Only Five Percent of Cancer Research Funding is Directed to Research of Metastasis:
A good starting point in this discussion is a recent article in the New York Times. Entitled “Our Feel-Good War On Breast Cancer,” the article talks about, among other things, the lack of funding for scientific research and related work on metastasis. As the article states: “According to a Fortune magazine analysis, only an estimated .5 percent of all National Cancer Institute grants since 1972 focus on metastasis.” A June 2010 article in ScienceDaily.com, discussing an editorial in the European Journal of Cancer, similarly noted that only 5% of cancer research funds are spent on metastasis research.
Let’s put that 5% figure into a proper context. The American Cancer Society states that at least 90% of all cancer related deaths are caused by metastasis. The above discussed ScienceDaily.com article similarly observes that tumor metastasis accounts for 90% of fatalities caused by this horrific disease. In other words, although only five cents of every dollar directed to funding for cancer research goes into metastasis research, nine out of every 10 cancer deaths is a result of metastasis. Those numbers are not in harmony.
B. Why are the Funds for Research into Metastasis so Limited:
There seems to be no room for argument regarding the amount of funds that are attributed to research into and the study of metastasis. The emerging question is, why are so few funds, relatively speaking, invested into the scientific examination of this topic?
Some may argue that the blame, if that is the correct word, for this discrepancy is not solely attributed to those who provide the funding. They may instead seek to point the finger at those scientists who undertake cancer research, suggesting that most scientists do not view this area as a sufficiently important topic for research. According to the American Cancer Society, for example, a member of the American Cancer Society Scientific Council points out that “fewer than 8% of researchers mention the word ‘metastasis’ in their grant applications.” The suggestion seems to be that researchers do not find this area worthy of study.
Even if true, this rationale begs the question. Those making decisions on the amount of research dollars that will support any particular research project are sophisticated individuals who are knowledgeable about cancer and the fact that the vast majority of cancer related deaths is caused by the spread of the disease from the primary site. The fact that there may be fewer researchers performing work on metastasis than many other subjects – for whatever reasons – does not justify providing so few research dollars to that aspect of cancer that is responsible for such a striking percentage of cancer related deaths.
There are possible explanations for this supposed small number of researchers who seek to study this area. Because there is a high level of difficulty in studying metastasis, a relatively large amount of research dollars are required. For example, metastasis only occurs inside the body and cannot be faithfully replicated in a petri dish in the laboratory. As Dr. Mike Dwinell of the Medical College of Wisconsin explains, modeling metastasis i) requires specific technological tools that can be very expensive and ii) can be technically challenging and unusually time-consuming – thus requiring larger grants and, quite possibly, renewals of grants. Accordingly, if a researcher fears that a grant request seeks too much funding or has a real risk of not being renewed, that researcher may decide to pursue a less expensive and time-consuming research project – and thus one more likely to be funded. In such case, both the “inspiration” and the “imagination” about which Albert Einstein refers in the quote at the outset of this post would be stifled.
Although Triumph Funding does not suggest that the challenge involved in the study of metastasis itself deters researchers, it is not unreasonable to conclude that the expense of the research, coupled with the challenges and time involved, limits the number of investigators who are in a position to study tumor metastasis. One would hope that the fact that less than 10% of researchers applying for grants seek such funding does not mean that those making decisions on funding feel it appropriate to allocate less than 10% of the funds to such epochal research.
Some may also argue that, due to the finite funding available for cancer research, it is more important to emphasize research aimed at preventing cancer than research aimed at stopping its spread once an individual contracts cancer. This requires a value judgment. Triumph Funding believes that, to arrive at this conclusion, one must essentially ignore the well-being of those cancer patients who have tumors have spread or may well spread – or most everyone who has been diagnosed. This conclusion also mistakenly assumes that, from a practical and scientific perspective, medicine is at the point that all cancer can be prevented. Indeed, despite the large funding that is rightly devoted to breast cancer awareness and prevention, many women are still diagnosed with this disease. Prevention, therefore, cannot be the only approach. The argument that society is better off working on the prevention of cancer than stopping its metastasis is succinctly addressed by a quote from Danny Welch, Chair of the Department of Cancer Biology at the University of Kansas Cancer Center, that appears in the above-mentioned New York Times article. Mr. Welch stated that “[a] lot of people are under the notion that metastatic work is a waste of time . . . because all we have to do is prevent cancer in the first place. The problem is, we still don’t even know what causes cancer. I’d prefer to prevent it completely too, but to put it crassly, that’s throwing a bunch of people under the bus right now.” What sort of society will do such to those who are gravely ill?
III. THE ROLE OF CLINICAL TRIALS IN METASTATIC RESEARCH:
Although progress is being made to understand metastasis, work is needed to develop a treatment regimen that will stop or at least slow down metastasis. Clinical trials play an important role in any such research.
Dr. Dwinell notes that, as an example, clinical trials are increasingly needed to ascertain the efficacy of either individual drugs that have just been developed or varying combinations of drugs that already had been developed – be it with a new type of cancer for which it is now felt the drugs might work or with the cancer for which the drugs had been developed. He also posits that clinical trials additionally are needed to help measure the value of the personalized treatment of patients whose tumors possess certain genetic signatures. Such a personalized approach, that is, where drugs are tailored for each patient, is a growing avenue for treating cancer. Interestingly, this is a dramatically different approach than was under consideration in 1971 when the “War on Cancer” was declared. This fact itself should be taken as a hopeful sign of progress!
Clinical trials are of critical importance because they are the final step in moving drugs from the research laboratory into patient care. A previous post on this blog explained how clinical trials set the standard of care for tomorrow. That earlier post also discussed how clinical trials can result in expedited FDA approval of a new drug or the new use of a drug – either alone or in combination with other drugs – to be used to fight cancer and, hence, to extend or save lives. The National Cancer Institute understands the role of clinical trials in identifying treatments that will address that very lethal process – cancer metastasis.
IV. INCREASED FUNDING FOR METASTATIC RESEARCH IS NEEDED:
There likely is no one who would advocate that funding research that would prevent cancer is unnecessary or of minimal importance. To the contrary, increasing awareness of cancer and trying to stop it before it finds a home in a human body is critical. Nonetheless, as noted above, so is the funding of research that examines both the causes of metastasis and the development of treatment regimens that may stop or slow down that feared spread of tumors. As with so many things, a balance is necessary. In funding decisions that literally are a matter of life and death, a balance should not be hard to reach. If we truly want to find a cure, then we cannot focus only on prevention. After all, prevention is wonderful, but it is not a “cure.”
In order for clinical trials to be undertaken to ascertain the efficacy of metastasis stopping drugs or therapies, we must make the financial commitment to more fully fund research into metastasis. It is only through research that those who labor each day in the cancer field can design new drugs that hopefully will shut-off or stop aggressively motile (and mobile) cancer cell metastasis.
As sequestration, discussed in a prior post of this blog demonstrates, it has become increasingly apparent that we as a society can no longer rely solely on federal organizations such as the National Institutes of Health (NIH) to fund research into these diseases and the cure of them. As alluded to in the earlier post on sequestration, the NIH is under severe financial constraints imposed by political gridlock, meaning those dedicated scientists who study this disease on a daily basis must find other sources of funding if they are to continue their quest for life-saving treatments. Indeed, the 2013 budget of the National Cancer Institute, one of the organizations within the NIH, is $293 million less than fiscal 2012.
Here lies what Triumph Funding and its sister, The Triumph Fund, see as a wonderful opportunity that is presented to the readers of this blog and all those concerned with the spread of cancer. Many of you know from this blog’s previous posts of the author’s profound respect for the physicians and researchers at the Medical College of Wisconsin Cancer Center. The Triumph Fund itself is a testament to its deep faith in the talent and dedication of these doctors, for it raises funds to support cancer research at the college. As this blog’s most recent post discussed, there is a local resource – one right here in Milwaukee at the Medical College of Wisconsin – that is engaging in the investigation of the fundamental mechanisms underlying and causes of the movement of malignant cells and that has made ground-breaking discoveries that should be translatable to clinical trials.
Even without the cuts caused by sequestration, there is simply insufficient funding to support the need that exists – a need established by the fact, in 2013, over 1,600,00 Americans are expected to be diagnosed with cancer and over 580,000 – almost 1,600 a day – are projected to die. Private philanthropy is one answer. Even if a loved one does not have cancer, selfless giving that supports cancer research can only make one feel as if they have engaged in an effort to improve society – and help others. For, as the above quote by Winston Churchill states, what is the use of living if not to make this “muddled world” a “better place” for those who come after us. The Triumph Fund presents a vehicle for this private philanthropy – a vehicle that is designed to help make sure this research continues despite the inability of politicians to show a genuine concern for society by putting aside petty, partisan behavior and to not allow the dubious act leading to sequestration to affect the lives of those with cancer or other serious illnesses. Other wonderful organizations, such as the Bobbie Nick Voss Laboratory at the Medical College of Wisconsin, similarly provide this vehicle.
V. CONCLUSION – HEEDING THE WISDOM OF THE LORAX:
In The Lorax, Dr. Seuss’ wonderful book that speaks to children and adults alike, the Lorax says: “Unless someone like you cares a whole awful lot, nothing is going to get better. It’s not.” The Triumph Fund’s inaugural event, Honoring The Lorax, scheduled for June 26, 2013, respects and gives homage to the wisdom and thoughtfulness of these words. It seeks donations to fund and hence promote clinical trials at the Medical College of Wisconsin – quite possibly including clinical trials that will test the efficacy of treatments being worked on at the Medical College of Wisconsin and elsewhere that may stop metastasis.
In light of sequestration and the resultant cuts to funding for cancer research, this is the time to increase one’s private philanthropic donations for research into this horrific disease. This is the time to spark the “imagination” of which Albert Einstein spoke. In donating to cancer research, you will, as Winston Churchill said, make this “muddled world” a “better” place by supporting science that extends or save lives. That is, the results of such kindness will potentially help those with cancer now and will help those who in the future will be diagnosed with cancer – in Milwaukee and elsewhere. These donations can turn into reality that promise of which this blog spoke in its previous post.