Science and Politics

Prostate cancer is a major threat to men's health. Adult men in the United States have a 1 in 6 chance of being diagnosed with it in their lifetime. This compares with a 1 in 13 chance of being diagnosed with lung cancer, 1 in 17 with colon cancer, 1 in 68 with leukemia, and 1 in 81 with stomach cancer. Once diagnosed with prostate cancer, 1 of every 5 men will die from it. In 2005 this translated to an estimated 29,528 deaths, one every eighteen minutes.

Since the American population is aging, the problem will almost certainly worsen. In 2005, approximately 234,000 men were initially diagnosed with prostate cancer; in 2025, the number is projected to be 384,000 men, and in 2045, to be 452,000 men. The projected future costs of prostate cancer are astronomical.

Given these numbers, one might expect that the United States government would long ago have organized a serious effort to uncover the causes of, and better treatments for, prostate cancer. In 1971, in his State of the Union message, President Nixon proposed ''an intensive campaign to find a cure for cancer.'' He affirmed that ''the time has come when the same kind of concentrated effort that split the atom and took man to the moon should be turned toward conquering this dread disease.'' In what subsequently came to be known as the war on cancer, the federal government poured billions of dollars into these efforts, with private industry and donations through organizations such as the American Cancer Society adding more billions. According to a 2004 estimate of cancer research expenditures, ''Americans have spent, through taxes, donations, and private R and D [research and development], close to 200 billion, in inflation-adjusted dollars, since 1971.''1

Prostate cancer has received less than its share of research funds and attention. In the mid-1990s, breast cancer research received approximately seven times more in federal research funds than prostate cancer, despite the fact that approximately the same number of women and men were so diagnosed each year. By 2005 this discrepancy had been reduced, so that breast cancer received approximately twice as much federal funding per diagnosed case.

Prostate cancer research in the United States is supported almost exclusively by three organizations: the National Cancer Institute; the Prostate Cancer Research Program, under the U.S. Department of Defense; and the private Prostate Cancer Foundation, founded by financier Michael Milken.

THE NATIONAL CANCER INSTITUTE

The National Cancer Institute (NCI) is part of the National Institutes of Health (NIH), located in Bethesda, Maryland. Federally funded, its budget for 2006, at more than $5 billion, has doubled since 1997. Despite its massive budget, many have criticized the NCI for the same reasons other NIH institutes have been criticized: the application process for research grants is unnecessarily cumbersome and lengthy; it focuses too much on basic research and not enough on research that is likely to help those who currently have cancer; and it is extremely conservative, so that researchers who are innovative and think outside the box do not get funded. As noted in one analysis of the NCI:

Somehow, along the way, something important has gotten lost. The search for knowledge has become an end unto itself rather than the means to an end. And the research has become increasingly narrow, so much so that physician-scientists who want to think systemically about cancer or the organism as a whole—or who might have completely new approaches—often can't get funding.2

Another shortcoming of the NCI has been its lack of leadership or coordination of cancer research efforts at the national level. Each university and cancer research center gets a piece of the federal budgetary pie and goes off to its own private corner to eat it. Nobody has been putting the pieces together, which has slowed down progress— on prostate cancer as much as on other forms of cancer. Prostate cancer sufferers were hopeful that more progress would be made between 2002 and 2005, when Andrew von Eschenbach was the director of the NCI. He had been diagnosed with prostate cancer and his father had died from it. Changing the course of this federal behemoth, however, proved to be a difficult task.

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