publication date: Mar. 17, 2017

Conversation with the Cancer Letter

Nancy Davidson: This is the time for investment, not for retreat

Nancy DavidsonFirst, Congress should follow through on increasing the NIH budget by $2 billion in fiscal 2017, said Nancy Davidson, president of the American Association for Cancer Research.

Second, the House and the Senate should craft appropriations bills that will provide robust, sustainable, and predictable increases for fiscal 2018, said Davidson, executive director and president at Seattle Cancer Care Alliance, senior vice president and director of the Clinical Oncology Division at Fred Hutchinson Cancer Research Center, and professor and Head, Division of Medical Oncology at the University of Washington School of Medicine.

While some insiders declare Trump’s budget proposal dead on arrival, Davidson said AACR will not be complacent.

“We are taking this incredibly seriously. I don’t think we have any choice but to do so,” Davidson said. “This is the first budget from the Trump Administration. I think it gives us some ideas about the priorities. I think we need to take the strongest possible stance right now.”

Davidson spoke with Paul Goldberg, editor and publisher of The Cancer Letter.

 

Paul Goldberg:

As you look at this budget proposal, what do you think?

Nancy Davidson:

I am horrified. I think we are all horrified. The magnitude of these cuts is really shocking, Paul. Particularly when you look at this time at our ability to really capitalize on cancer research moving into improved cancer care. To me, there is tremendous disconnect between what we have seen in this budget and what the opportunities are. And I think that this budget would severely jeopardize the progress we are making right now to prevent and treat cancer.

 

PG:

What do you see happening at your institution if this budget were adopted?

ND:

At the Fred Hutch, we are one of the top cancer centers in the country. We are one of the most reliant on federal funding, which has allowed us to accomplish so much. So, I think we would see a substantial decrease in some of the efforts that we are trying to fund things like cell-based therapies.

This would inevitably have negative effects on patients. I don’t think that we can expect that the private sector or the philanthropic sector are going to be able to fill in these gaps. This is really the responsibility of the federal government to make these investments, because they lead to improvement of health for all of our citizens.

 

PG:

Let’s say four years from now or eight years from now, when a new administration comes in and decides to recapture the lost ground, would that even be possible?

ND:

I think it would be extremely difficult, Paul. You know, medical research isn’t something that you can turn on and off like a faucet. The teams that are brought together to do this kind of sophisticated work—once you disaggregate them, it’s very hard to bring them together again.

The other important thing is that we have a pipeline of investigators, doctors, researchers that we have to continuously develop. And you can’t take a break from that pipeline and then anticipate that four years from now or eight years from now, when the faucet is turned back on, you will be able to regain that lost momentum.

This is very heavily dependent, of course, on ideas from people, and these ideas develop from having sustained, robust and predictable funding from NIH.

Our AACR position for this year is that we would like Congress to provide a $2 billion increase for NIH in FY 2017, this spring. And we obviously call on Congress to be firmly against the budget proposal that we have just seen.

 

PG:

Are you being assured that this budget proposal is dead on arrival, that this will not pass?

ND:

Assured by whom?

 

PG:

By folks in Congress. Are you taking this so seriously that you believe that there is an actual possibility that this will become the budget?

ND:

We are taking this incredibly seriously. I don’t think we have any choice but to do so. This is the first budget from the Trump Administration. I think it gives us some ideas about the priorities. I think we need to take the strongest possible stance right now.

As you know, over the past few years, Congress had been working in a bipartisan fashion very supportive of medical research and cancer research specifically. We hope that we continue to be in that same place and that Congress will also be strongly opposed to this budget and we could figure out ways to undo this potential damage.

 

PG:

By folks in Congress. Are you taking this so seriously that you believe that there is an actual possibility that this will become the budget?

ND:

Paul, we are oncologists. There is always hope. But hope requires resources, and resources in this case means that we are reliant on substantial funding from NIH and NCI to improve the health of Americans.

 

PG:

How does AACR intend to respond to this?

ND:

We’ve already been out today with what we think is a very strong statement. We had the good fortune that we will be in Washington, D.C., in just two weeks for our annual meeting. This is our 110th anniversary meeting.

It’s an opportunity for over 20,000 people to be in Washington to talk about the progress that we have made in cancer, the opportunities that are out there, and how we can capitalize on them.

It’s also an opportunity for us to reflect on what will be lost with the kind of cut we are talking about. I hope we will be able to articulate the importance of NIH funding in all this, that it’s an investment in our future, and that it’s critical to improve and extend lives.

And I also hope we will be able to articulate that the cost of cancer is billions of dollars, and we think that cancer research is a way of trying to reduce these costs that are associated with cancer.

I want to remind you that AACR also plays a key leadership role in the Rally for Medical Research Hill Day, which will be held on Sept. 14. I think that will be an opportunity for the entire medical community to come together and ask Congress to push back on this FY2018 proposal and to really articulate the importance of robust, sustainable and predictable funding increases.

 

PG:

This proposal starts a war on multiple fronts—can’t even count them all—foreign policy, EPA—everything. So, it’s going to be a war on all fronts against the administration’s budget. The level of lobbying that will be taking place on the Hill is going to be astonishing.

ND:

We’ll be there. We obviously believe that human health has to be an absolute priority for any administration.

 

PG:

Just a few months ago, Congress passed the Cures act, and was looking seriously enough at the moonshot.

ND:

I think we have to hope that the members of the current Congress will be very much like the members of the last Congress, who were very supportive in a bipartisan way of the importance of medical research and cancer research.

 

PG:

Today, at the White House press briefing, Sean Spicer noted “duplicity” at NIH. He repeated that several times. I think he might have meant “duplication.” You are an insider. You’ve been a reviewer, an advisor. Do you see either duplicity or duplication at NCI?

ND:

I don’t think that there is any evidence to suggest that there is duplicity. Nor do I think that there is any duplication except, you might appropriately hope, for replication, which is, of course, one of the tenets of evidence-based science. 

 

PG:

Let me read to you from the budget proposal:

“The budget includes a major reorganization of NIH’s Institutes and Centers to help focus resources on the highest priority research and training activities, including: eliminating the Fogarty International Center; consolidating the Agency for Healthcare Research and Quality within NIH; and other consolidations and structural changes across NIH organizations and activities. The budget also reduces administrative costs and rebalance federal contributions to research funding.”

Where is that idea coming from—that there is a need to consolidate and reshuffle the institutes? Is this coming from the inside of the scientific establishment, or is it coming from some ideological sources?

ND:

I am not familiar with the information that would lead to those statements. I would return to the message that, if anything, these important places are underfunded at a time when we have such great opportunity for advance.

So rather than cutting in order to “restructure,” I think we have to come back and ask Congress for a $2 billion increase for NIH for FY 2017 and to push back on the 2018 budget.

This is the time for investments, not for retreat.

Copyright (c) 2017 The Cancer Letter Inc.