Thirty years ago, confidence in U.S. science and technology soared. A victory in the space race and 2 decades of steady economic expansion had driven expectations for U.S. achievement ever skyward. Philanthropist Mary Lasker saw an opportunity to turn these newfound resources against cancer. Together with Texas Senator Ralph Yarborough, Lasker spearheaded a movement to establish a sweeping national cancer campaign.
With that optimistic backdrop, President Nixon signed the National Cancer Act into law on Dec. 23, 1971. He declared the "conquest of cancer" a national crusade, saying that the act would be seen as the most significant event of his administration.
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Thirty years removed from those days, the notion of defeating what physicians have long recognized as about 200 separate diseases seems quaint, even fanciful. Indeed, the overall cancer mortality rate kept climbing throughout the 1970s and 1980s as scientists teased cells apart molecule by molecule with evermore sophisticated tools. The deeper they went, the more daunting cancer appeared to be.
"There was excessive optimism. But I prefer that to rueful sophistication or a sense of educated paralysis," said Samuel Broder, M.D., director of the National Cancer Institute from 1989 to 1995. "Having said that, I dont think the initial act envisioned the time scales [needed to make treatment gains]."
By the mid-1980s, politicians and health policy makers were expressing disappointment in the "failed war." Cancer researchers responded by pushing the importance of basic research and articulating the complexity of the disease.
And now, just as 30 years ago, a new wave of enthusiasm is building. But while last generations boosters knew little about the opponent, todays researchers know what they are up against. "In every cancer, we need to know what part is broken before we can fix it," said Brian Druker, M.D., Oregon Health Sciences University, Portland, who rose to prominence last year as the researcher behind the star drug GleevecTM.
In some cancers, including chronic myelogenous leukemia, the broken part has been sifted out. The power of this molecular targeting became tangible with Gleevec, which blocks the action of a single rogue protein in chronic myeloid leukemia. But researchers had a head start with CML, as its root abnormality was identified in the 1960s. (See News, Jan. 5, 2000, and July 4, 2001.)
A myriad of other drugs, developed with parallel approaches, now populate laboratories around the country, awaiting human testing. For Broder, now medical director at Celera Genomics Inc., this trend resulted directly from the National Cancer Act. "Cancer research, in effect, did become the engine that drove molecular biology," he said. "You can argue that that would have happened anyway, but the fact remains that cancer led the way."
In 1992, another tangible result appeared. The ever-increasing cancer mortality trend finally reversed, as 2 decades of incremental gains in detection and treatment combined to inch the overall death rate downward. Gains against particular cancers, most notably childhood, testicular, cervical, stomach, and colorectal, have been substantial. Other types of cancer are killing more people today, some for unknown reasons (non-Hodgkins lymphoma) and others as a result of changing behavior (female lung cancer; death rates have shot up 150% since 1973).
Besides helping to drive these tangible gains, the act also revamped research priority setting. It created the Presidents Cancer Panel, a three-member force that keeps the White House apprised of progress, and the National Cancer Advisory Board, a mix of experts and laypersons to advise the Secretary of the Department of Health and Human Services and the NCI director on major initiatives.
Perhaps most significantly, the act afforded the National Cancer Institute a privileged status. The NCI director became a presidential appointee with the authority to bypass normal government procedures and present a budget directly to the White House.
The goal was to streamline bureaucracy and speed research, but it also introduced friction between the NIH director and the NCI director, according to Broder and some current NCI employees.
Nevertheless, flush with funding, cancer researchersinherently optimistic to begin withnow enthuse that their overflowing bag of genomic and molecular tools will finally realize the goals of the National Cancer Act. Brian Druker even pronounced that "Gleevec is a glimpse into the future."
Paul Rogers, former longtime Florida congressman and NIH booster, spoke for Druker and colleagues when he quoted Benjamin Franklin at a recent symposium on the acts thirtieth anniversary: "I become almost sorry that I was born so soon, that I wont know the progress 100 years from now."
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