Retooling the War on Cancer
Retooling the War on Cancer
Dr. Schapira: In reading your book, one almost has a sense of longing for cancer pioneers, such as Sidney Farber and Denis Burkitt, who were absolutely dedicated and brilliant cancer investigators. How can we make it possible for the current generation of passionate, brilliant cancer investigators to have a chance? What do we need to change?
Mr. Leaf: I want to make this clear, and I emphasize this in the book: We have an lot of absolutely dedicated and brilliant cancer investigators working today. I spent a decade interviewing people throughout the oncology field, and I don't think there's a smarter, more passionate, more humane group of people than those who are now engaged in the anticancer fight. But that said, we are driving many young, brilliant investigators out of cancer research, and we are at risk of losing a generation of cancer scientists if we don't fix the culture and day-to-day systems that are driving them out.
On the research side, the grants review process, for example, is set up to utterly discourage young investigators. In 1980, new investigators got their first National Institutes of Health (NIH) Research Project Grant (R01), launching their independent research career, at an average age of 36, and 4 in 10 R01s went to people under the age of 40. Today, the average age for a first-time grant is 42, and barely 10% of these awards go to someone under 40.
Investigators are forced to deal with so much nonsense
The grants application process, moreover, squeezes the lifeblood of creativity from the overwhelming majority of these projects, and forces highly trained investigators to spend half of their waking hours in mindless pursuit of these project awards, even though the NIH funds but 1 in 10. It's an insane and destructive cycle. Instead, we need to free really bright, energetic, innovative people from the chore of trying to lay out their research projects in minute detail when we know that the truth of science is that these things evolve and change as new knowledge comes into play. Our first challenge is to rethink the system of grants review so that we are funding people, not projects.
On the clinical side, investigators are forced to deal with so much nonsense when they are putting together a trial -- from having to get okays from dozens of institutional review boards, to filling out needless paperwork and ordering needless procedures, to creating limitations on the trial populations through inclusion and exclusion criteria -- that it makes trials slow to recruit and slow to get off the ground, phenomenally (and often prohibitively) expensive, and ultimately uninformative if the trial populations don't fairly represent the real patient populations for which the treatment is intended.
This cost has driven up the price of drugs -- the price of medical innovation -- to staggering heights, and it has encouraged those who can pay this admission price to pursue the least ambitious, least risky me-too agents that have the best chance of getting marketing approval. The entire process, as I write in my book, is driven by a paralyzing fear of risk, and the cost is a community-wide incrementalism that inures us to the very real danger of the fast-rising global cancer burden.
Bureaucracy Takes Its Toll
Dr. Schapira: In reading your book, one almost has a sense of longing for cancer pioneers, such as Sidney Farber and Denis Burkitt, who were absolutely dedicated and brilliant cancer investigators. How can we make it possible for the current generation of passionate, brilliant cancer investigators to have a chance? What do we need to change?
Mr. Leaf: I want to make this clear, and I emphasize this in the book: We have an lot of absolutely dedicated and brilliant cancer investigators working today. I spent a decade interviewing people throughout the oncology field, and I don't think there's a smarter, more passionate, more humane group of people than those who are now engaged in the anticancer fight. But that said, we are driving many young, brilliant investigators out of cancer research, and we are at risk of losing a generation of cancer scientists if we don't fix the culture and day-to-day systems that are driving them out.
On the research side, the grants review process, for example, is set up to utterly discourage young investigators. In 1980, new investigators got their first National Institutes of Health (NIH) Research Project Grant (R01), launching their independent research career, at an average age of 36, and 4 in 10 R01s went to people under the age of 40. Today, the average age for a first-time grant is 42, and barely 10% of these awards go to someone under 40.
Investigators are forced to deal with so much nonsense
The grants application process, moreover, squeezes the lifeblood of creativity from the overwhelming majority of these projects, and forces highly trained investigators to spend half of their waking hours in mindless pursuit of these project awards, even though the NIH funds but 1 in 10. It's an insane and destructive cycle. Instead, we need to free really bright, energetic, innovative people from the chore of trying to lay out their research projects in minute detail when we know that the truth of science is that these things evolve and change as new knowledge comes into play. Our first challenge is to rethink the system of grants review so that we are funding people, not projects.
On the clinical side, investigators are forced to deal with so much nonsense when they are putting together a trial -- from having to get okays from dozens of institutional review boards, to filling out needless paperwork and ordering needless procedures, to creating limitations on the trial populations through inclusion and exclusion criteria -- that it makes trials slow to recruit and slow to get off the ground, phenomenally (and often prohibitively) expensive, and ultimately uninformative if the trial populations don't fairly represent the real patient populations for which the treatment is intended.
This cost has driven up the price of drugs -- the price of medical innovation -- to staggering heights, and it has encouraged those who can pay this admission price to pursue the least ambitious, least risky me-too agents that have the best chance of getting marketing approval. The entire process, as I write in my book, is driven by a paralyzing fear of risk, and the cost is a community-wide incrementalism that inures us to the very real danger of the fast-rising global cancer burden.
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