publication date: Apr. 25, 2016

 

AACR 2016

Biden Asks for Guidance in Leading Moonshot

“There is more brain power in this room than exists in many countries,” said Vice President Joe Biden, addressing over 4,000 members of the American Association for Cancer Research, during a speech that turned personal at times, as he laid out several suggestions for accelerating progress.

As head of the federal government’s cancer moonshot task force, the vice president listed recommendations he has received for reaching the initiative’s goal, not a cure, but completion of a decade’s worth of cancer research in five years. Recommendations include increasing research budgets across the federal government, making it easier to share data, removing paywalls around published research, and incentivizing verification of study results.

“Toward that end, last year, the 2016 budget, and working with Congress, we were able to increase funding by $2 billion for the National Institutes of Health. The largest increase in a decade,” Biden said at the association’s annual meeting April 20 in New Orleans.

The vice president told stories of how much encouragement he has received for initiative, both in Washington and internationally, and noted bipartisan support for making progress.

“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. I had a very well-educated, bright grandfather… he would say, ‘Joey, there are three kinds of politics: there’s church politics, as in Roman Catholic; there’s labor politics, as in unions; and there’s politics. And they’re difficult in that order.’

“I respectfully suggest that what I’ve learned of late is that there are four kinds of politics: cancer politics, church politics, union politics, and politics. And they’re difficult in that order.”

Biden said the White House is requesting another $800 million to support research activities across multiple federal departments as part of the anticancer effort.

“The president signed essentially what is an executive order giving me control over all the federal agencies and departments, from Veterans Affairs to the Department of Energy, because of their computing capacity. Departments you wouldn’t think—well, you would—but most people wouldn’t think had anything to do with a moonshot to end cancer as we know it.”

Biden noted his admiration of researchers who stay committed to a daunting process of applying for federal grants, saying that researchers should be spending more time on science and less time preparing applications.

“We want to let scientists do science. There’s an old cliché that too often grants are given for what you’ve already done, rather than what you’re doing. You know,” he said. “For example, the Prostate Cancer Foundation grant application, for those of you who engaged with prostate cancer research, is limited to 10 pages. 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, they spend a third of their time writing a grant that takes months to be approved and awarded. It’s like asking Derek Jeter to take several years off to sell bonds to build Yankee Stadium.

“I’m not joking when I say your dedication absolutely awes me. I really mean it. I really mean it. You’ve got really, really, really care. You’ve got to really want to save lives.”

Biden said a researcher’s publication history shouldn’t determine whether he or she receive a grant, it should be the work they do, and that the results should be made publicly available as soon as possible:

“What you propose and how it helps patients, 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,” he said. “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 to 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.”

After the research is done, the results need to be verified, Biden said.

“Verification is the core of science; even a lawyer like me knows that,” he said. “And the way we verify is to replicate. That’s how we know if a breakthrough actually works.

“Replicating published studies is not a rewarding career move…so why don’t we give grants to people who replicate published studies to verify outcomes? We should incentivize verification.

“All the characteristics of this system started years and years ago. It’s the environment we all grew up in, studied in, 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.”

The vice president, along with his wife, Jill Biden, spoke of their family’s personal fight with cancer, and the death of their son, Beau, last year.

“Jill and I didn’t choose to become experts about cancer, but like everyone who has a family member that faces cancer, you tend to become—as my mother would say, a little bit of knowledge is a dangerous thing—you tend 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.

“People said to me, why would you take on that job? I know government. I understood all aspects of it. I couldn’t not after 42 years. I felt completely confident taking on an almost 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 kind of changes that can be made.”

This week, coinciding with the AACR’s annual meeting, NCI launched an online platform for the research community and the public to submit ideas on national cancer moonshot efforts, at CancerResearchIdeas.cancer.gov. Submissions will be considered by the task force’s blue ribbon panel.

Ideas can be submitted under the following categories: cancer clinical trials; data sharing; dissemination and population sciences; immunotherapy, combination therapy, and immunoprevention; pediatric cancer; tumor evolution and progression; and others. The ideas will be considered by the task force’s working groups, and the panel plans to report its findings to the National Cancer Advisory Board later this summer.

“You are the very best we have,” Biden said during his address.

“We need you badly to give me some guidance on how to make your job—not easier—but more likely to meet your ends.”

A transcript of the vice president’s remarks follows. An AACR webcast of his speech is available here.

 

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. [Jose] 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 [Lunt, of Michigan State University], and all the other cancer researchers.

Dr. [Douglas Lowy], I think, wasn’t sure if it was a good thing or a bad thing, when he heard that 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 never doubting that I mean what I say, and sometimes though 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 he’s doing as head of the National Cancer Institute. Go ahead and 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’s obviously not an easy one.

Jill and I didn’t choose to become experts about cancer, but like everyone who has a family member that faces cancer, you tend to become—as my mother would say, a little bit of knowledge is a dangerous thing—you tend 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 fully understand that immunotherapy was sort of a discipline “out there,” ten years ago. I didn’t fully understand that only in the last four to five years there has been increased interdisciplinary cooperation. Only recently have various disciplines been able to work together. As recently as five years ago, oncologists weren’t working with immunologists, virologists, geneticists, chemical engineers, or biological engineers.

That’s all changed. You’ve given humanity a sense of hope, and, I might add, expectation.

That’s why when I announced my decision to not seek the nomination for president, and the president came out with me in the Rose Garden while I made that announcement, it was almost a wistful thought of mine; it wasn’t a proposal, or a prepared initiative. I said I believe that we need a moonshot in this country to cure cancer. I said it is personal, and it’s personal to so many, but I believe we can do this because there are so many breakthroughs just beyond the horizon in science and in medicine.

The things that are just about to happen, I believe we can 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 have wanted to be 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 a vice president—I have never quite seen a political situation as dysfunctional as 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 the Senate—but this may be the one subject, and one of the reasons I picked it, where there’s absolute, unlimited, bipartisan support. One of the reasons why I thought it was so important, to do what we’ve undertaken, is that if we can accomplish the goal that we’ve set, it will 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 [Jinping], 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, because he and I had dinner with two interpreters. And I said yes I can, mister 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 that we have in the world to seize this moment. To make a quantum leap. To make decades worth of progress in five years.

As a consequence, without telling me, as you can probably tell by that video, the president announced in the State of the Union that I’m going to lead this moonshot effort. I heard it for the first time as 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.

The president signed essentially what is an executive order giving me control over all the federal agencies and departments, from Veterans Affairs to the Department of Energy, because of their computing capacity. Departments you wouldn’t think—well, you would—but most people wouldn’t think had anything to do with a moonshot to end cancer as we know it.

I realized the first thing I had to do was coordinate the federal government’s efforts 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—that get in the way of science, research and development. And I know 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 our memoranda of understanding with other countries.

I was recently in the Middle East, because allegedly I have some expertise in foreign policy. I was meeting with [the crown prince of Abu Dhabi, Sheikh Mohammed bin Zayed Al Nahyan]. We sat down to discuss ISIS and the threats that are immediately apparent. And with his team, the first thing he said at our dinner was: “The first thing I want to talk to you is about cancer. How can we cooperate? Can we work out a memorandum of understanding on how our two countries can be engaged in your effort?”

We just had a nuclear security summit with 50 heads of state. As we sat around the East Room with long tables, with a space in the middle—with the president sitting by the fireplace and me sitting with my back to the main hallway that you see when he has 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 [he is] prepared to work out a memorandum of understanding with them on how we could jointly proceed.

I went to Israel, met with Shimon Peres, Bibi Netanyahu, and President [Reuven] Rivlin. The first thing they wanted to talk about was cancer, the database they have going back to 1961, and how they can be engaged.

We’ve heard from thousands of survivors. I’ve met over 250 leading oncologists and researchers at the world’s leading institutions, and many of you are here today. I met with dozens of philanthropists who have invested billions of dollars, their own dollars, to engage in this fight. I met 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 otherwise take you a decade or more to find. Why does one immunotherapy work in one patient and then in a patient with apparently the same cancer, it will not work. That’s what you’re Project GENIE is all about. And then there’s ORIEN, CancerLinQ, the Parker institute, and the QUILT coalition.

And quite frankly, as your leaders will tell you, when I met with 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 would 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 [of Energy] Ernie Moniz, one of the brightest guys anybody’ll meet. When he told me that, in our national labs, we’re on the verge of a supercomputer capability of a billion-billion calculations per second. Toward that end, I met with Eric Lander [of MIT], a lot of you know Eric, one of the most innovative guys I 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 all more accessible for 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. Some of you heard me say this before, I had a very well-educated, bright grandfather, an old Irishman from Scranton named Ambrose Finnegan, an old newspaperman, he would say, ‘Joey, there are three kinds of politics: there’s church politics, as in Roman Catholic; there’s labor politics, as in unions; and there’s politics. And they’re difficult in that order.’

I respectfully suggest that what I’ve learned of late is that 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 as I was a kid running for the U.S. Senate, in your heart you know I’m right.

But advances in new immunotherapies suggest that this treatment approach is poised to become a part of a nation’s anticancer strategy. Big data, and the computing power to get it, can provide significant insights into how genomics, family medical history, lifestyles, and genetic changes can trigger cancers.

There’s a growing recognition of the need for more team science 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 could 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 with in the first place: patients. I know this organization—I think it is 106 years old? 105? The American Association of Cancer Research has been working in this field for a long time. You’ve done incredible work. And you’ve focused on more support for physicians, for PhD’s in associated fields and biomedical sciences, for more support for innovative research and stable funding.

The president and I agree with your objectives. Toward that end, last year, the 2016 budget, and working with Congress, 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, when my friend, and I played a small part with him, Arlen Specter doubled funding for NIH. Included in that was about roughly $200,000 increase funding for the National Cancer Institute, and it’s all in the budget for 2017, which I think we’ll be able to pass.

We’ve asked for another $800 million, all of it this time, for the 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 a virtual oncology center of excellence. It will enable the Department of Veterans Affairs to take advantage of big data. And over $600 million will go to the NCI for research priorities such as enhanced cancer detection technologies, cancer vaccine development, cancer immunotherapy and combination therapies, genomic analysis in tumors 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 be able to fund a minimum of that amount of money every year. I think we can do it. I believe we can do it.

We all know it takes more money, we also know there are other things we have to do. As I’ve traveled around the country and around the world since October, I’m constantly importuned by leaders in the field 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 to qualify for a grant.

The more outside the box, which may be the answer to some cancers, the less likely you are to get funding. You’ve forgotten more about how difficult it is—you’ve still made enormous progress under the existing system—but 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 die of cancer.

Sharing data. The way the system is now 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, in a lead editorial, which she later didn’t get a lot of support for, said the following. She said that data sharing could breed data parasites. And she went on to say why it wasn’t a good idea. But every expert I’ve spoken to has said there’s a need to share this data to 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 the trials are designed and targeted—and I don’t think it’s any wonder even if they know the trial is available, that they’re hesitant to sign up. Only 4 percent of all the patients with cancer are involved with a trial.

We want to let scientists do science. There’s an old cliché that too often grants are given for what you’ve already done, rather than what you’re doing. You know.

For example, the Prostate Cancer Foundation grant application, for those of you who engaged with prostate cancer research, is limited to 10 pages. 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, they spend a third of their time writing a grant that takes months to be approved and awarded. It’s like asking Derek Jeter to take several years off to sell bonds to build Yankee Stadium.

I’m not joking when I say your dedication absolutely awes me. I really mean it. I really mean it. You’ve got really, really, really care. You’ve got to really want to save lives.

The fourth thing we can do is measure progress by improving patient outcomes, not just publications. What you propose and how it helps patients, 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 to 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 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 was an op-ed in Wired magazine this week by Ryan Merkley, CEO of Creative Commons. He said, and I quote, “Imagine if instead we said we will no longer conceal cancer secrets in paywalled 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 are probably reasons why it shouldn’t be answered the way I think it should, and I want to hear from you, I hope—because I have not made these recommendations yet.

But it seems to me that this matters. His question matters. Not all vital research is published behind paywalls.

For example, we have a model interest in 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 research repurposed it for breast cancer screening. Imagine if that code was behind a paywall for a minimum of a year. Non-profits are already doing this. The Gates Foundation is already funding a billion-dollars-worth of research every year. And their policies are 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 the core of science; even a lawyer like me knows that. And the way we verify is to replicate. That’s how we know if a breakthrough actually works.

Replicating published studies is not a rewarding career move. Very few people get grants to replicate studies. So why don’t we give grants to people who replicate published studies to verify outcomes? We should incentivize verification. Over a 10-year period, Amgen 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, studied in, 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 in preventing and treating cancer in five years. That requires a redesign, according to 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. Nobody knows better than you that 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 has stage IV glioblastoma—we knew it was a virtual death sentence. But our whole family, and he, my son, a highly decorated major veteran, an attorney general of the state of Delaware—we had hope, so much because of what you’re doing and the progress you’re making.

He was basically a trial of one; anti-PD1 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, everything about her was beautiful, and who just finished nursing school after being diagnosed with stage IV 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 need 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 that 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 all that 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 a position where it is total value-added, and doesn’t get in your way. You’ve got to tell me how. 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 design a new system, or adjust to a new system that better supports your efforts and saves lives sooner than otherwise would have been. Because I really do believe that we are on the cusp of breakthroughs that will save lives and 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, to put patients first. I’ve been involved for 36 years in the Senate, and there’s some very complicated matters relating to national security issues and the intelligence field. The enormous capabilities we have in science and technology to serve our national security interest. And I know—I know—that there’s 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 has analyzed it; every outside agency points out less than two-tenths of 1 percent was waste, fraud, or abuse.

People said to me, why would you take on that job? I know government. I understood all aspects of it. I couldn’t not after 42 years. I felt completely confident taking on an almost 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 kind of changes that can be made.

Because I’m absolutely confident there is more brain power in this room than exists in many countries. You are the very best we have.

We need you badly to give me 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.

 

Cover Photo by AACR.

Copyright (c) 2020 The Cancer Letter Inc.