Mooning cancer

Buzzing aroundBuzzing around Tranquility Base.

We can only applaud a big push to add resources for attacking cancer, but it’s a mistake to call this newly announced federal initiative a moonshot. We won’t land on the cancer cure moon in a decade.

Never mind what it says about our society that our only common metaphor for a large successful national effort is more than a half-century old. The metaphor doesn’t work here.

The actual moon shot built on existing engineering. And the National Aeronautics and Space Administration created its infrastructure from scratch. That’s not possible in our health system, and its irrationalities are increasingly slowing down the grand march toward more personalized medicine.

If the space program had been run like our current health system, computers at Mission Control in Houston and the launch site at Cape Canaveral would not have talked to each other.

Promising efforts like the American Society of Clinical Oncology’s CancerLinQ program are threatened by our inability and unwillingness to share clinical data. As Otis Brawley, chief medical and scientific officer for the American Cancer Society, wrote this week in STAT, “real or perceived privacy issues, along with difficulties connecting disparate electronic health records, may scuttle it.”

As cancer research rockets ahead in the lab, clinical studies may lag years or decades behind. We can take steps to speed them up, but there’s no quick fix.

If NASA had worked like our medical system, the rocket engine makers would have charged whatever they liked. Contrast that with the famous quote from astronaut John Glenn about how he felt before liftoff: “you were sitting on top of two million parts — all built by the lowest bidder on a government contract.”

And if we had run space like medicine, all engineering decisions would have been second-guessed by non-engineers.

The world’s largest cancer center, MD Anderson in Houston, launched its own Moon Shots cancer program three years ago. The initiative helped MDA raise about $300 million, sharpen its priorities and add a few important efforts. And it seems to have achieved progress in a few fairly narrow treatment areas. That’s good news and about what we should expect so far.

There’s nothing theoretical to me about the suffering that cancer inflicts on human lives. I’m happy to see our vice president bringing in the best and brightest to plan an initiative, and especially to figure how to connect the data silos.

But we need another metaphor to help us conceptualize the effort. (And no, not the War on Cancer.) Maybe we can try a title based more closely on another major healthcare initiative (Obamacan? Bidencare?). Grand national projects can live or die by their metaphors.