What I Said to the Largest Convening of Cancer Researchers in the Country Yesterday:
Thank you. Thank you very, very much. You’re extremely gracious and generous.
The President, me, the whole White House, everyone that I work with in government in both parties, if they were here, they’d be standing, clapping for you — for all of you.
Dr. Baselga, thank you for allowing me to be here. It’s great to see you again. And thank you for leading the way, supporting young investigators like Sophia — and all other cancer researchers.
Dr. Lowy, I think wasn’t sure whether it was a good thing or a bad thing when he heard I was in charge of the Moonshot. He said, oh, my God, what’s this guy going to do? I have a bad habit of no one ever doubting I mean what I say, and sometimes I say all that I mean. Dr. Lowy is one of our great assets in the federal government, and I mean that sincerely. And I want to thank him for all the great work that he’s doing as head of the National Cancer Institute. Go ahead, clap for him. He deserves it.
It’s an honor for Jill and me to be here today. And we wish we could ask each of you how you decided to devote your lives to cancer research. It’s a life that you chose — and it is obviously not an easy one.
And Jill and I didn’t choose to become experts about cancer.
But like every family who faces, cancer — you tend to become — as my mother would say, a little bit of knowledge is a dangerous thing — you tend to become and try to learn as much as you can about the cancer your beloved family member is fighting. And that’s what we did when our Beau was diagnosed.
We had access to the best doctors in the world. And the more we talked to them, the more we understood that we are on the cusp of a real inflection point in the fight against cancer.
I thought I was relatively well-informed, but I really didn’t quite understand that immunology was sort of a discipline “out there” 10 years ago. I didn’t fully understand that only in the last four to five years has there been increased interdisciplinary cooperation. Only recently have various disciplines begun to work with one another. As recently as five years ago, oncologists weren’t working with immunologists, virologists, geneticists, chemical engineers, biological engineers. That’s all changed.
And you’ve given humanity a sense of hope, and I might add, expectation.
That’s why, when I announced my decision not to seek the nomination for President — and the President escorted me, came out with me in the Rose Garden when I made that announcement — it was almost a wistful thought of mine. It wasn’t a prepared initiative. I said, “I believe we need a moonshot in this country to cure cancer.” You saw in the piece done before we came out. I said, it is personal. It’s personal to so many. But I believe we can do this because there are so many breakthroughs just on the horizon in science and medicine. The things that are just about to happen I believe we can make happen — make them real if we make an absolute national commitment to end cancer as we know it.
I went on to say that Democrats and Republicans share this passion to silence this disease. And I said, “If I could do anything, I would want to have been the President that ended cancer as we know it, because I think it’s possible.”
In a bitterly divided government, I served in the Senate a long, long time. I have been in federal government for a long time, as a senator or as the Vice President. I’ve never quite seen the political situation as dysfunctional as it is today. Some of you may know, I have a reputation of being able to get along with both sides of the aisle, because I have enormous respect for the House and Senate.
But this may be the one subject — and one of the reasons I picked it — where there is absolute, unlimited bipartisan support.
One of the reasons why I thought it was so important we do what we’ve undertaken is that if we can accomplish the goal that we set we’ll give new hope and expectations to Americans about so much more we can do in the physical sciences as well.
I was with President Xi, who I know very well — I spent more time with him than any other leader in the world. And I was in Chengdu, China with him, and he asked me, can I define America for him. And I said — just he and I at dinner with two interpreters. And I said, “Yes, I can, Mr. President. In one word — possibilities.” We’re all about possibilities. Yet, right now in America, we’re not nearly as optimistic as I think we should be. I’m not talking about Democrat or Republican, I’m talking about how well-positioned America is to lead the world in the 21st century, and all the enormous breakthroughs in the various sciences that are literally around the corner.
But I want to be clear — my job and my commitment is to bring together all the human, financial, and knowledge resources we have in the world to seize this moment — to make a quantum leap, make a decade’s worth of progress in five years. As a consequence, without telling me — as you could probably tell by that video — the President announced in the State of the Union I was going to lead this new moonshot effort. I heard it the first time when the rest of the Congress heard it. I was pleased. But I must tell you, in all my years on the national stage, I was overwhelmed by the response the announcement in the State of the Union generated — not just nationally, but globally — worldwide — because he signed what is essentially an executive order giving me control over all the federal agencies and departments from Veterans Affairs to the Department of Energy, because of the computing capacity. Departments that you wouldn’t thing — you would, but most people wouldn’t think had anything to do with the moonshot to end cancer as you know it.
But I realized the first thing that I had to do was coordinate the federal government’s effort with the private sector.
And I made a commitment that I will, as I gain this information and knowledge, I will eliminate the barriers that get in your way, get in the way of science, the research and development.
And I knew I had to touch all parts of the community in the fight against cancer — to learn from all of you how we can proceed, how we can break down silos, how we can accommodate more rapidly the efforts you’re making.
I’ve literally traveled the world — thus far, visiting nearly a dozen cancer centers here in the United States — and more to go — discussing this issue with foreign governments, working out memoranda of understanding with other countries. I recently was in the Middle East, because, allegedly I have some expertise in foreign policy. I was meeting with the guy who runs the UAE — Mohammed bin Zayed. We sat down and discussed ISIS and the threat that’s immediately apparent. And with his team, the first thing he said at our dinner was, Mr. Vice President, the first thing I’d like to talk to you is about cancer. Cancer. How can we cooperate? Can we work out a memorandum of understanding how our two countries can be engaged in your effort?
We just had a Nuclear Security Summit — 50 heads of state. As we sat around the East Room at long tables with a space in the middle, the President sitting by the fireplace and me sitting with my back to the main hallway you see when he goes in for a press conference. The President started off with the 50 heads of state and said, before we begin, a lot of you asked me about Joe’s effort, and then he named four countries and said, I am prepared to work out a memorandum of understanding with them as how we can jointly proceed.
I went to Israel, met with Shimon Perez, Bibi Netanyahu, President Rivlin.
The first thing they wanted to talk about was cancer, the database that they had going back to 1961, and how can they be engaged.
I’ve heard from thousands of survivors. I met with 250 leading oncologists and researchers at the world’s leading cancer institutions — many of you who are here today. And I met with dozens of philanthropists who have invested billions of dollars — their own dollars — to engage in this fight. I’ve met with coalitions of cancer organizations that are attempting to aggregate cancer tissue genomics, patient medical records, family histories and lifestyles — in order to be able to take advantage of the supercomputing capability we have today to find answers that would take you otherwise a decade or more to find. Why does one chemotherapy work in one patient and a patient with apparently the same cancer not work?
That’s what your Project Genie is all about — and then there’s ORIEN, CancerLinQ, the Parker Institute, and the QUILT Coalition. And quite frankly, as your leader will tell you, when I met with all of the heads of each of those groups, it raises a question for me: Why is all this being done separately? Why is so much money being spent when, if it’s aggregated, everyone acknowledges the answers will come more quickly?
Today, we have supercomputers that are able to do a thousand-billion computations per second. The first person who wanted to see me after this moonshot was announced was Secretary Ernie Moniz, one of the brightest guys anybody will meet — who told me that in our national labs, we’re on the verge of supercomputer capability that will provide a billion-billion calculations per second.
Toward that end, I met with Eric Lander. A lot of you know Eric — one of the most innovative guys I’ve ever met in my life — pulling together data-technology firms that are attempting to convert data into machine-readable formats with the goal of making it more accessible for all of you researchers.
Everywhere I go, when I talk about what is possible, it becomes clearer and clearer that there are areas of consensus among all of you. And some of you heard me say this before, but I had a very, very well-educated, bright grandfather who used to — an old Irishman from Scranton named Ambrose Finnegan. He was a newspaperman. He would say, Joey, there are three kinds of politics. He said, there is church politics — as in Roman Catholic; there is labor politics, as in unions; and there’s politics. And he said, they’re difficult in that order.
I respectfully suggest what I’ve learned of late is there are four kinds of politics: Cancer politics, church politics, union politics and politics. And they’re difficult in that order.
And as Barry Goldwater said when I was a kid running for the United States Senate, “In your heart you know I’m right.”
But advances in new immunotherapies suggest that this treatment approach is poised to become a critical part of the nation’s anti-cancer strategy. Big Data and computing power together provide significant insights — can provide significant insights into how genomics, family medical history, lifestyle, genetic changes can trigger cancer.
There’s a growing recognition for the need for more team science instead of — and increased collaboration among the private sector, academia, patient foundations and the government. And everywhere I go, there’s an acknowledgement that we need new approaches to clinical trials as combination therapies become the norm for cancer treatments.
I’ll be in meetings with some of the leading folks, some of who are in the audience, and I’ll raise this. And after it’s all over, one will pull me aside and say, I hope you push this, because it’s hard for me institutionally to do some of this.
There’s so much I can talk about today, but I want to focus on how to realign, if you believe it needs to be realigned, incentives in cancer research to be able to move more rapidly and better enable you to serve the very purpose you got engaged in the first place with — patients.
I know this organization. I think it’s 106 years old, Doc, 105? The American Association for Cancer Research has been working in this field for a long, long time. And you’ve done incredible work. And you’ve focused on more support for physicians, for PhDs in associated fields and the biomedical sciences, more support for innovative cancer research, and more stable funding. The President and I agree with your objectives.
Toward that end, last year, in the 2016 budget, working with the Congress, I was — we were able to increase funding by $2 billion for the National Institutes of Health — the largest increase in a decade. The last time we were this engaged was when my friend — and I played a small part with him — Arlen Spector doubled funding for NIH. Included in that is about roughly $200,000 increased funding for the National Cancer Institute.
Then along came our budget of 2017, which I think we’ll be able to pass. We’ve asked for another $800 million, all of it this time to fight against cancer. If we succeed, it will be spread across several government agencies that have a part to play in the fight against cancer. $75 million will go to the Food and Drug Administration to fund an oncology virtual center of excellence — enable the Department of Veterans Affairs to take advantage of big data. And over $600 million will go to the National Cancer Institute for research priorities such as enhanced and early detection technology, cancer vaccine development, cancer immunotherapy and combination therapy, genomic analysis of tumor and surrounding cells, enhanced data sharing, and pediatric cancer research.
And if we do this well, we will be able to continue every year for the foreseeable future to fund a minimum of that amount of money every year. But as you all know — no, I think we can do it. I believe we can do it. We all know it takes more than money.
We also know there’s other things we have to do. And as I’ve traveled around the country and around the world since October, I constantly am importuned by leaders in the field of saying, we have to realign research incentives. What behaviors would we want to encourage and reward?
Because, believe it or not, I’ve come to understand just how difficult it is the qualify for a grant. The more outside the box — which may be the answer to some cancers — the less likely you are to get funded.
You’ve forgotten more about how difficult it is. You’ve still made enormous progress under the existing system. Let me suggest a few things that I have heard from multiple sources that may be able to further streamline the incentive process and make progress for the 16 million folks a year who are dying of cancer.
Sharing data. The way the system now is set up, researchers are not incentivized to share their data.
When I talked about this five months ago, the editor of the New England Journal of Medicine and lead editorial, which later didn’t get a lot of support for, said the following — said, data sharing could breed “data parasites.” And he went on to say why it wasn’t a good idea. But every expert I’ve spoken to says we need to share this data in order to move the process more rapidly.
Involving patients earlier in clinical trial designs and focus. Clinical trial recruitment is a huge problem.
Patients either don’t know about the trials or they’re not consulted about how trials are designed and targeted. And I don’t think it’s any wonder, even if they know what trial is available, why patients are hesitant to sign up. Only 4 percent of all the patients that cancer — are involved in a trial.
We ought to let scientists do science.
There’s an old cliché that too often grants are given for what you’ve already done rather than for what you’re doing. For example, the prostate cancer foundation — you know. For example, the prostate cancer foundation grant application — those of you engaged in prostate cancer research — is limited to 10 pages, and you get an answer in 30 days. Why is it that it takes multiple submissions and more than a year to get an answer from us?
It seems to me we slow down our best young minds by making them spend years and years in the lab before they can get their own grants. And when they do, the grant — they spend a third of their time writing a grant that takes months to be approved and awarded. This is like asking Derek Jeter to take several years off to sell bonds to build Yankee Stadium.
I’m not joking when I say this — your dedication absolutely awes me. I really mean it. I really mean it. You’ve got to really, really, really, really care. You’ve got to really want to save lives.
Fourth thing we might do is measure progress by improving patient outcomes, not just publications.
What you propose and how it affects patients, it seems to me, should be the basis of whether you continue to get the grant. And scores of your colleagues — scores — said make publications more readily available. Right now, you work for years to come up with a significant breakthrough, and if you do, you get to publish a paper in one of the top journals. For anyone to get access to that publication, they have to pay hundreds or even thousands of dollars to subscribe to a single journal. And here’s the kicker — the journal owns the data for a year. Your outfit does this.
And by the way, the taxpayers fund $5 billion a year in cancer research every year, but once it’s published, nearly all of that taxpayer-funded research sits behind walls. Tell me how this is moving the process along more rapidly.
There’s a weekly op-ed — there was an op-ed, I should say, this week in Wired Magazine by Ryan Merkley, the CEO of Creative Commons. He said — and I quote — Imagine if instead we said we will no longer conceal cancer’s secrets in a paywall journal — pay-walled journals with restricted databases, and instead make all that we know open to everyone so that the world can join the global campaign to end cancer in our lifetimes? It’s a pretty good question. There may be reasons why it shouldn’t be answered like I think it should — and I’m going to hear from you, I hope, because I’ve not made these recommendations yet. But it seems to me this matters. This question matters.
Not all vital research is published behind paywalls. For example, we have a mild interest in open-source NASA research — open-source code NASA research that was used to unblur the images of the Hubble Telescope. It was available to everyone immediately. Nobody argued about national security. Nobody argued — immediately. And guess what happened — and you may be in the audience — cancer researchers repurposed it for breast cancer screening. Imagine if that code was behind a paywall for a minimum of a year.
Nonprofits are already doing this. The Gates Foundation funds a billion dollars’ worth of research every year. And their policy is crystal clear: The results have to be free and open to anyone from the minute they are published.
The sixth recommendation I’ve received is reward the work of verification.
Verification is at the core of science. Even a lawyer like me knows that. And the way we verify is to replicate. That’s how we ultimately know whether the breakthrough actually works. But replicating published studies is not a very rewarding career move. Very few people get grants to replicate studies. So why do we give grants to people who replicate studies to verify published outcomes? We should incentivize verification.
Over a 10-year period, AMJAM scientists tried to replicate 53 landmark studies in cancer biology. Only six were able to be verified. All the characteristics of this system started years and years ago. It’s the environment we all grew up in and studied in and worked in. And yes, this system has produced enormous successes, but this is not the system, in my view, that will get us to our goal faster.
One of the goals of the Federal Cancer Task Force is to achieve in 10 years of progress — what would take 10 years of progress of preventing and treating cancer in five years. That requires a redesign among most of the experts I’ve spoken to in the cancer research enterprise.
We are committed, the President and I, to realigning government programs and spending to accelerate the work all of you great researchers are doing.
No one knows better than you: Lives depend on it. We believe in you. We really do. So do the patients.
When my son received what we all knew was a death sentence at one of the great cancer hospitals in the world — that he had stage 4 glioblastoma, we knew it was a virtual death sentence. But our whole family and he, my son, a highly decorated major veteran, attorney general of the state of Delaware — we had hope. Because so much of what you’re doing, the progress you’re making. He was in basically a trial of one — anti-PD-1 — and a virus injected into the tumor in his brain.
I was recently at Duke; a different virus injected. I met a beautiful young woman — her mind as well as her — everything about her was beautiful. She just finished nursing school after having been diagnosed with stage 4 glioblastoma. Same process, different virus. She’s cured. That’s what every single patient and parents of patients think about — what you do.
So the question I’d ask you to contemplate, because I’d like you to communicate with us, is, does it require realigning incentives, changing behavior to take advantage of this inflection point? Does it require sharing more knowledge, treatments and understanding with as many researchers as possible? Or does that slow the process up, because there needs to be other incentive motives as well that are totally legitimate?
I hope you all know it — it would be hard for you not to — but you’re one of the most valuable resources this great country has, those of you sitting in this room. So ask your institutions, your colleagues, your mentors, your administrators, how can we move your ideas faster together in the interest of patients? Every day — you know better than I — thousands of people are dying. Millions of people are desperately looking for hope, desperately looking for another day, another month, another year. I know you know this or you wouldn’t be sacrificing like you are.
I promise you that I will and I have the authority to do everything in my power to put the federal government, in the position where it is total value-added and doesn’t get in your way. You’ve got to tell me how, as many of you already have. Put the federal government in collaboration with the private sector, academic institutions, philanthropists, investors, at your service to serve your patients.
I believe together we can redesign a new system — or adjust to a new system that better supports your efforts and save lives sooner than otherwise would have been. Because I really do believe we’re on the cusp of breakthroughs that will save lives, benefit all of humanity. We have to work together. We have to give you the ability to take chances. We have to help you do what you want to do and — why you got involved: Put patients first.
I’ve been involved for 36 years in the Senate in some very complicated matters relating to national security issues, the intelligence field, the enormous capabilities we have in science and technology to serve our national security interests. And I know that there is a generic benefit in collaboration.
So I ask you a rhetorical question: Are we collaborating enough? What can we do? What can you do? You’re already doing so very much.
I’ve taken on some big assignments in my career, including most recently allocating $830 billion to be spent in 18 months — every outside group analyze it. Every independent agency points out less than two-tenths of 1 percent was waste or fraud or abuse. People said to me, why would you take on that job? Well, I know government. I understood all aspects of it. I couldn’t not after 42 years. I felt completely confident taking on almost a trillion-dollar spending program.
But this is bigger, and I know so much less.
Sometimes I find myself going to bed overwhelmed by how can I meet my responsibility. I need your help. I need honest evaluations of the kinds of changes that could be made. Because I’m absolutely confident there is more brainpower in this room than exists in many countries. You are the very best we have. And we need you badly. We need some guidance on how to make your job not easier, but more likely to meet your ends.
I want to thank you for all you do from the bottom of my heart. May God bless you all, and may God protect our troops. Thank you.