Greg Simon, executive director of the cancer moonshot task force, addressed the FDA-sponsored workshop for Accelerating Anticancer Agent Development and Validation in North Bethesda, Md., May 4.
He discussed the goals for the moonshot initiative, how the program could fit into the next presidential administration, and how to take the project international.
Simon was a former aide to Vice President Al Gore, and later helped start FasterCures, a center at the Milken Institute. In 2009, he left to become senior vice president for patient engagement at Pfizer. Since 2012, he has been working as CEO of Poliwogg, a financial services company focused on life sciences. He was named executive director of the moonshot’s task force in March.
An excerpt of Simon’s remarks follows:
As you know, Vice President Biden lost his son to glioblastoma after a valiant fight and said he wanted to devote the rest of his life to the fight to cure cancer. Now, you know when people say they want to cure cancer, it’s not that simple. There’s not a cancer, it’s hundreds of cancers, and cures takes many forms. We know that to cure cancer, you first have to do a much better job at preventing it. We know we have to do a better job of finding it and treating it, and making sure that everybody has the same opportunity for all of those things as everybody else. And those are the issues we will be addressing.
So the president issued a presidential memorandum announcing the White House Cancer Moonshot Task Force, and “moonshot” was in the presidential memorandum, creating the position I hold now, the executive director of the task force.
Technically, the task force is a group of government agencies, about 20 of them—including, of course, NIH, NCI, DOD, VA, DOE—even the Patent Office has some great ideas for how they can accelerate the fight against cancer.
So I was minding my own business running a business in New York when I got a call from Biden’s chief of staff [Steve Riccheti], whom I’ve known for many years. As I was talking to him on the phone, this little Venn diagram converges right over my head and he said, “We need somebody who’s been in the science world and somebody who knows cancer politics and somebody who’s worked in the White House before.” And I thought, that sounds like me, and then he explains what it was and I told him I actually had cancer, which he didn’t know, and after that it was a done deal. I met the vice president, with whom I had not spent any time, and realized that this was a great vision.
When a reporter asked me, “Why would you take a job that’s only about 10 months long?” I said, “Well, number one, you must be talking to my wife. Number two, that’s about all I can take.” Working in the White House has its moments, and there’s no doubt about that—we were in the Vatican on Friday and got to see the pope, that was exciting. For the entire 12 hours that we were in Rome—you do get to fly on Air Force Two. But more than the honor of working in the White House, it’s a lot of pressure, because there’s so much to do, and not a minute to waste—so much incoming from people who want to help. I meet half a dozen people who want to volunteer every day—from inside the building, cancer survivors, as well as people all over the country. People all over the world who want to just show up and work for me in the White House—and I kind of explained that there’s a fence around it, you can’t really just do that. The passion that is out there is just unparalleled, in my experience.
So why the moonshot? Well, it just so happened that I had spent a lot of time on the space program. I was on the Science, Space and Technology Committee, so I have spent a lot of time at NASA and worked with Al Gore and President Bill Clinton to cut the deal with Russia on the International Space Station. So when people complain to me about the moonshot, I go, “Okay, okay, I know it’s an overused phrase, but let me tell you a few things about the similarities between what we’re doing and what the moonshot did.”
Kennedy didn’t say, “We’re going to study moonology for the next 10 years.” He didn’t say, “We’re going to create new programs of rocketry or the Journal of Rocket News.” He said, “We are going to put a human being on the moon and bring him back safely.” He put a human being at the center of our national effort, and that’s what made it so dramatic.
We’d already hit the moon. There were all kinds of rockets. We were like Dennis the Menace—we were throwing rockets at the moon, and they would take picture just before they crashed. So we knew how to hit the moon. The problem was how to land on the moon. So everything NASA did was around the human being.
That’s true of this as well. This is not about technology development, it is not about computing, it is not about medical records; it’s about keeping people alive without the scourge of cancer as long as we can, and all of those other things help us do it. The center of what we are doing is a human being.
The second thing that is totally analogous is that we built the biggest engine in the history of the world. And if you’ve never seen the Saturn V at the Air and Space Museum, go see it. It is massive. And you look at all the pipes and you look at all the curves and you think, “Lord, have mercy. They designed this without a computer, really? And it looks like my basement when the plumber shows up and changes everything?” But you had to have the world’s biggest engine to get off the gravity of the Earth. If you watch the Apollo Saturn V launch, you could walk faster than it left the launch pad. It leaves the launch pad so slowly you feel like you can just walk up to it and hang on, because it had a long way to go, it can afford to start slowly. And then it lifted this enormous mass that had to go all the way to the moon.
Well, we have to do the same thing. We have to build, with your help, a new engine that can escape the bureaucratic gravity that’s been holding you back since World War II. I’m born in the 1950s—most of you were probably born after that—but no matter when you were born, everything in your life and the way you do it, and the speed at which you do it in your private life, has changed dramatically in the last 30 years, but most dramatically in the last five to 10 years.
In your professional life, if you’re getting an NIH grant, or getting an NCI grant; if you’re working in your lab, it’s not changed that much. We’re still using the same system to review your ideas and give you money that we did after WWII. Everything else around you has become much faster, much more efficient.
The cancer moonshot has a straightforward goal to achieve in five years what we otherwise think would take a decade to do. If you look back 10 years ago, how many of you thought that today, we would have CRISPR technology that would make gene editing as easy as building LEGOs? How many of you thought we would have massive computers at our thumbs that can do everything that we used to have separate hardware to do? Now it’s ubiquitous, but at the time it was amazing. When you look back, whatever we thought was wrong. Now that we have incredibly fast computers and massive data and instant communication for the first time in human history, we have no idea what we can get done in 10 years.
So we might as well predict what we’re going to get done in 10 years by laying out what we want to do, and which cancers we want to cure, and which ones we want to try and turn into chronic disease, because they’d be too hard to cure, and which preventions we think can actually stick. And then when we get that dream list put together based on the technologies we have today, we need to figure out, “Well, if I can dream that in 10 years, how can I make it happen in five? What do I really need? Is it just more money?”
It’s never just more money. It’s really all about getting more people involved and learning more about people, sharing data about people, doing clinical trials with more people, treating more people and reaching more people. This is how we organize what we’re doing; keep in mind I’ve been there six weeks.
We have several levels of efforts. First is the government task force itself, which is looking at two things. First, what can we do this year through collaboration among the government agencies and government and private sector to move things faster that are already in our plan and/or things we can start right now if we work together with other people? That’s a huge focus of what we’re doing.
The second thing is, we know that a lot of things can’t happen that fast, so we need to look at what can happen, which means, per the president’s requirement, that we give him a report by the end of the year about the blueprint for next several years to make this happen. So once we’ve identified what we want to get done in five years, we owe the president a description of what that is and how we’re going to do it. The other question I get asked the most is, “What’s going to happen at the end of the year?”
Well, there are basically three possibilities: 1) Nothing. The next administration says, “Thank you very much, the White House moonshot office is over.” 2) It gets integrated into the next administration, either as a vice presidential or presidential initiative. 3) Or it becomes legislatively established, like the White House Office on HIV and AIDS or the White House National Drug Control Policy Office. All of those are possibilities, and you don’t have to wait long to find out, because once the election happens in November, whoever is president will have a transition team and they’re start figuring it out.
Now the government piece of this is trying to be a catalyst for the private sector piece of this. So we, and I, realize that the government can lead and can point a direction that the private sector has to do a lot of the execution, and make things happen by bringing private capital to the effort. We are actively reaching out to patient foundations, to universities, venture capital, banks, drug companies, biotech companies, technology companies, cloud companies, medical record companies, and just point-blank asking them, “What are you going to do to help us, and how can you do it now, and who are you going to do it with?” Because we want to focus as much as possible on collaboration, because that’s the key.
As an example, and as you know, there are data registries all over the place, and usually they are unique to the institution where they were created. They may have patient records; they may have genomic testing and outcomes information. They may have lifestyle information, clinical trial data and it may be that they’re just at the hospital where it was collected, or research institution and cancer center, and it may be that people in a given region get together and create a way to share all that information. And it may be that the big dogs, value leaders, the Division I schools get together and create a national thing where three, four or five of them share the data.
That’s not the way we’re going to do it. We’ll never going to get there from here if that’s the way we do it. How many of you would go to a bank that says, “You can pay any bill online you want, as long as it’s in your ZIP code.” Right? Who would do that? Or you go to an airline and they say, “You can fly anywhere you want, as long as it’s Chicago.” That’s not how any other part of our life works. So what’s required?
Well, money is required. But keep in mind that the government put $35 billion dollars in the Economic Recovery Act at the beginning of the Obama administration for the creation and the use and adoption of electronic medical records. When we said we’re going to spend $35 billion on medical records, we didn’t mean each person gets to create their own system and their own language—it’s a Tower of Babel nationally. That was not the plan.
The plan was to have an interconnected, intergalactic network of medical data so we can understand ourselves as a people, faster, better, cheaper, and more impactful. But instead, my online information in Sloan Kettering, and I have online information now at GW where my care has been transferred to—they had to fax my records from Sloan Kettering to GW, and they’re both online. Wow. And those are big institutions.
We know what the problem is with medical records. Yes, we know it’s going to cost you more money to share your information ubiquitously. But guess what, all these major centers, they make money. The reason you need to spend money, it’s not your data. It’s our data. It’s patient data. It belongs to the people you got it from. I’m a big proponent of, when you donate your tissue for research, you don’t get piece of the action 10 years later or somebody develops a product from that. Until we put us all together and see patterns of how we react to cancer, how we start cancer, and how we are treated for cancer. We know we have to get universities and medical centers to share their data.
My dream, which I know can be done in five years, and the vice president’s dream, is a national network in the cloud of all the data about patients that you can get, generated in the best way possible, whether it’s medical records, tissue, characterization, genomic information, so that we can start using analytical tools and artificial intelligence to turn that data into information, and then use that information to gain knowledge. So we have to make that system ubiquitous and as easy to get to for everybody as it is for anybody.
Another thing we have to do is prevention. The problem with prevention is this: you develop a cure or a therapy for something, it’s a cure or therapy forever. You do prevention today, you’ve done prevention today. It’s a renewable problem, so you have to have a renewable resource, which is people. Smoking cessation is the only thing that has really brought down mass numbers of cancer, and yet, even though smoking is lower today than it’s ever been, we know that every generation is tempted to go back up that hill and start smoking. So we’ve got to deal with tobacco cessation.
We’ve got to deal with obesity, nutrition, and the fact that there are nutrition ghettos all over the country where people don’t have easy access to good food. And we have to deal with disparities. It is not race that causes disparities, it’s place—it’s being in the wrong part of town, it’s being in the wrong part of the county, it’s being too far from any medical center. We have to make sure we’re not losing people to cancers we know how to treat, that is the most tragic of all.
I forgot to mention the most important about any kind of effort like the moonshot and that is, you have to believe this is possible. If you don’t believe it’s possible, how do you get out of bed every day? How do you, in particular, who are working on all these wonderful programs, how do you get out of bed if you don’t think things can be better? So from the beginning, we have to have a national belief that this is possible, and if we think it’s possible, then we have a responsibility, even a moral obligation, to make it happen. And that means that we have to deal with the biggest problem in the system, and that’s us.
When I say it’s us, it’s because the system that slows things down by us a long time ago, and we’re still living with it, and we need you to raise your hand and say you’re volunteering for a new system. So what do I mean? We need to change the system to give younger people grants, to give everybody faster grants, to shorten review cycles, to redo the peer review system to be more daring, to be more diverse. Have you noticed that all the new foundations never model their grant program after the NIH? I’m saying we’re wasting time, we’re wasting people, because we’re not letting young people with bold ideas try stuff, and that’s the origin of most of the big ideas in the world. I’m an old man now, so I can say this. It’s not people my age that come up with game-changing ideas. We’ve got to fix that.
The last thing is, it’s got to be international. Cancer is a human problem. It’s not an American problem, it’s not an international problem. It’s a human problem, it’s everywhere. More people die in Kenya of cancer than HIV/AIDS. We have to treat it with the same urgency as we do infectious diseases; we have to standardize the way we generate the data to make it valuable all over the world. And you say, “Golly, how do we do that all over the world? That’s so complicated.” When you travel, can you get money anywhere in the world through an ATM with your card, in your local currency? Yes, you can. And it goes right to your bank, no matter where you are, and you get a phone call, “Are you really in Azerbaijan?”
But when it comes to medical information, we go, “Oh it’s too complicated!” It’s not too complicated, it’s ones and zeros at the end of the day. So, standardized ways to generate the data, ubiquitous sharing of data without any excuses anymore, more funding around the world, not just the U.S., treating it with urgency, and making it available to all people. That has to be our mantra internationally and it’s certainly the mantra for our moonshot.
So you will be hearing from us. We will be doing a summit later this summer we’ll announce pretty soon that will focus on people who are doing collaborations in any of those areas I just mentioned. There are a lot of things out there already like data spheres and different ways of sharing data that we can grow and connect to a lot of other things.
Everybody is on “let’s go” for this. So if there were ever a time that you wanted to raise your hand to change the system and examine the way you do your work, now’s the time. There’s never been a better time. We have a vision, we have a leader in Vice President Biden who’s devoted to this for the rest of his life. We have technology as we’ve never had before, we have money to get it started at least, and we hope to get more and Congress has been very open to it.
And we have you. We have a marching army of people who know how to do what you do. I’m trying to get the government out of your way, and out of the way of everybody who has a great idea. We can do it. And if we don’t think we can do it, then we need to go into another line of job, because this is the most exciting and the most difficult area of human endeavor. I would like to see all of this succeed and surprise ourselves by being able to do in the next five years what we could only have imagined we could’ve done in ten.