Candace S. Johnson leads America’s oldest cancer research center and Jonathan W. Friedberg leads the newest NCI-designated center. Their catchment areas are contiguous, their faculty and staff members collaborate often, and together their institutions embody the culture of NCI-designated cancer centers.
Johnson and Friedberg appear on The Directors, a monthly series on The Cancer Letter Podcast, which focuses on the problems that keep directors of cancer centers up at night.
What worries them the most?
It’s a combination of threats coming from Washington.
“I think what’s a challenge is all of these things coming together,” said Friedberg, director of the University of Rochester Wilmot Cancer Institute, who holds the Samuel E. Durand Chair in Medicine at the Department of Medicine.
“In and of itself, could we weather an indirect cost adjustment? Probably,” Friedberg said. “But if that happens at the same time as a Medicaid cut? For us, 340B is a major, major way that our medical center receives funding. If that is interrupted? And site neutrality as far as places where care is delivered and how that’s reimbursed?”
These challenges would potentially be manageable individually, Friedberg said.
“In isolation, we could probably deal with some of these things, but combined, I think it’s very, very challenging,” he said. “All of those things together could be an existential threat.”
Everyone supports cancer research, no matter who you talk to, on what side of the aisle—everybody, because it affects all of us.
Candace Johnson
What about the nearly 40% cut in the NCI budget that is being proposed by the Trump administration?
“Yes, that could be significant too. I mean, I think that I’m a little more optimistic in general. I’m a very optimistic person in how I try to handle these things,” said Johnson, president and CEO of Roswell Park Comprehensive Cancer Center, who also holds the M&T Bank Presidential Chair in Leadership.
“I’ve been in this business long enough, throughout time, paylines have gone up, they’ve gone down,” Johnson said. “I mean, I can remember a time where it was almost crazy to even submit a grant, because there was so few funds.
“So, good centers like University of Rochester and Roswell, we will still compete for funding, and we’ll get through it,” said Johnson. “Everyone supports cancer research, no matter who you talk to, on what side of the aisle—everybody, because it affects all of us.”
With widespread support for cancer research, NCI funding is bound to bounce back in due course, Johnson said.
“Everybody wants to be able to continue funding for the NCI,” she said. “And so, I’m hopeful that this is all going to come back to some of these levels where it makes it at least achievable to get a grant.”
This episode is available exclusively on The Cancer Letter Podcast—on Spotify, Apple Podcasts, and YouTube.
Steven T. Rosen, the Ted Schwartz Family Distinguished Chair in Hematologic Malignancies at City of Hope, a discussant on this episode of The Directors, said current challenges come at a time when science is being rapidly translated into patient benefits.
As an expert in lymphomas and chronic leukemias, two decades ago, Rosen expected that half of his patients would die of their diseases.
This is no longer the case.
“When I see a patient at this point, I always say, ‘My anticipation is we’re going to control and cure the disease,’” Rosen said. “That’s how confident I am in modern therapies.
“I have currently 400 active patients. I think last year, [we] had two deaths: one from disease, and one from what we call long COVID.”
The magnitude of progress Rosen sees in his practice requires resources.
“Resources are needed—there’s no question,” said Rosen, who served as director of Northwestern’s Robert H. Lurie Comprehensive Cancer Center for 24 years before moving to City of Hope and serving as the center director there for nine more years and becoming director emeritus in 2023. “And people could argue about how much should be indirects versus directs, but every dollar that would be cut from the NIH or from other funding sources will be detrimental.
“There’s no way of getting around that.”
Previous episodes of The Directors:
Robert A. Winn, director at Virginia Commonwealth University Massey Comprehensive Cancer Center, and John Carpten, the chief scientific officer and director of City of Hope Comprehensive Cancer Center, and director of Beckman Research Institute. The episode aired in February during Black History Month (The Cancer Letter, Feb. 14, 2025).
Roy Jensen, director of The University of Kansas Cancer Center, and Raymond DuBois, director of Medical University of South Carolina Hollings Cancer Center (The Cancer Letter, March 14, 2025).
Louis Weiner, director of Georgetown University’s Lombardi Comprehensive Cancer Center, and Taofeek Owonikoko, executive director of the University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center (The Cancer Letter, April 18, 2025).
Thomas J. Lynch Jr., president and director of Fred Hutchinson Cancer Center, and Howard A. “Skip” Burris III, president of Sarah Cannon Research Institute (The Cancer Letter, May 16, 2025)
Some highlights:
On the culture of cancer centers
Said Friedberg, whose center received an NCI designation earlier this year (The Cancer Letter, March 28, 2025):
Being new to the game, I continue to be awed by these meetings that I’m now attending of cancer center directors, how passionate people are about the patient, ultimately, and the importance of this national investment in science.
And I think that that combined passion will generate resiliency in a way that probably doesn’t exist in any other part of medicine. It’s why we’re viewed, certainly I could say, at a medical center level as leaders and templates as to how others should behave.”
On the plight of young investigators
Said Johnson:
It is actually probably one of the biggest threats:
Here you are, you’re in graduate school, it’s a great time, because you’re just doing science, you’re publishing, going to meetings and things.
In isolation, we could probably deal with some of these things, but combined, I think it’s very, very challenging. All of those things together could be an existential threat.”
Jonathan Friedberg
And you see your mentors, and you see the investigators in your institution sweating bullets over whether they’re going to get their grant renewed and so forth, and you think to yourself, “Oh my goodness, I don’t know that I want to get into that.”
The other thing that’s tough is that people that are just graduating right now, so they want to go and do a postdoc somewhere, and usually postdoctoral positions are easy, because there are many of them available all across the country, and a really good student can really pick where they want to go.
That’s changing, because there’s not as many postdoc positions available, and so, the competition is higher. Plus Europe, Australia, places are opening up. I’ve seen the ads. I don’t know how many people are actually availing of that, but it’s a threat. There’s no question about it.
And so, I think you have to just be as positive and optimistic, we’re going to get through this. We just have to keep going. We owe this to our patients and hopefully we can—and we don’t lose a lot of good people along the way.
On the lack of civil discourse
Said Rosen:
I think healthy dialogue is most important, that people just don’t walk into a room angry at each other and walk out angry at each other, and nothing’s been accomplished.
That, to me, is most disturbing.
But, again, I think the fundamental issue is, the majority of Americans, the majority of people around the globe agree with: people want peace. People want health. People want individuals to lead the best lives they can. Everyone wants to have respect for what they do.
Listen to the full episode on Spotify, Apple Podcasts, or YouTube.
A transcript of the podcast is available below:
Paul Goldberg: I should just do a little bit of a historical introduction here.
This is just the most amazing combination of center directors, because not only are your centers contiguous, but Roswell Park is one of the very, very, very first cancer centers in the world, depending on how you count and whether you limit to the United States. That’s a whole other presentation that we could do and we won’t, because nobody will listen.
And Dr. Friedberg is director of a cancer center that was the most recently designated by NCI.
And by the way, Roswell Park was not named by NCI originally. It was deemed in 1972, so it’s 1972 and of course, Dr. Friedberg’s cancer center is the 73rd—and you are contiguous.
So, we’ve just done the numerology and the setting up.
What’s keeping you up at night now in June 2025?
Candace Johnson: Jonathan, why don’t you go? You go first.
Jonathan Friedberg: So, obviously, I’ll say that we had a brief period of excitement of our NCI designation that sometimes makes it hard to sleep, because we’re very excited.
But in all seriousness, I think with the various funding threats, the thing that I think most about are the trainees and in that sense that ensuring that we have a future workforce.
I hear anecdotal reports from our PhD programs about decreased numbers of applications, and then postdocs that are deciding to move on into industry and non-academic places.
And I think it’s really incumbent upon us as leaders to ensure that we continue the investment in the trainees, particularly during this time where there may be scarce resources.
Candace Johnson: Yes, it’s one of the things that keep me awake as well. But I’ll add, reimbursement from our payers keeps me awake. We’re in a heavily managed-care part of the state.
You worry that you’re not going to get paid for the incredible things that you do for patients. And it makes it tough in these times of inflation, and cost of everything is going up. And so, I worry about that, so that we can continue. We’re a freestanding center, so we’re a little bit different as far as those effects.
Jonathan’s at a big medical school, so the reimbursements and changes in that, they can really be a detrimental thing for us. So, that keeps me awake a lot.
What about Medicaid? Right now, the Big Beautiful Bill is moving or not moving through the Senate. That is going to, probably, deprive 15 million Medicaid beneficiaries of their insurance.
So, how would that affect you?
Candace Johnson: Well, it would affect us, but it’s not as dramatic as it might be to some of the other hospitals in the area. But yes, it would be a significant effect. And I assume Jonathan, for you all it would be…
Jonathan Friedberg: Yes, that could be devastating. And particularly, Paul, we have a big regional network that includes seven other hospitals. Many of these are heavily rural hospital providers that Medicaid is critically important to their existence. And I think we all can agree that even outside of our system, if there is a collapse of rural hospitals, that would be very detrimental to the health in our region.
Candace Johnson: Yes.
What happens if indirect costs drop down to 15%, as the 2026 President’s Budget is proposing? Would you be okay?
Candace Johnson: Well, I think, hopefully, it won’t be an all-of-a-sudden situation, and we’ll have some time to sort of work up to that.
There are different ways throughout time, indirect costs—I’ve been at different institutions with different indirect cost structures. And so, I think, over time, we could be okay, because we could put some of the things that were now in our indirect cost rates as a part of our direct costs, and, over time, we would be okay. But if it was a sudden change in indirect costs, that would be significant—no doubt.
Jonathan Friedberg: I agree. I think that for our institution, which includes grants across all types of disciplines, that could be a huge hit in a single year.
That said, I think we remain somewhat optimistic it won’t be down to 15%. And our institution is not one of the top institutions [in terms of indirect costs], I think our current rate is 51 or 52%. So, if it comes in somewhere between 15 and 50%, I think that’s something, compared to some of the other threats, that we could endure.
Candace Johnson: Agreed.
So this is not an existential threat, none of what I’ve just described, or is it?
Jonathan Friedberg: I think what’s a challenge is all of these things coming together.
In and of itself, could we weather an indirect cost adjustment? Probably.
But if that happens at the same time as a Medicaid cut? For us, 340B is a major, major way that our medical center receives funding. If that is interrupted? And site neutrality as far as places where care is delivered and how that’s reimbursed?
All of those things together could be an existential threat.
So, I think that’s the world that we’re living in is that there’s one thing always coming up and then you put that one down.
In isolation, we could probably deal with some of these things, but combined, I think it’s very, very challenging
The 40% cut also to NCI—I was going to add that.
Candace Johnson: Yes, that could be significant too. I mean, I think that I’m a little more optimistic in general. I mean a very optimistic person in how I try to handle these things.
But I think throughout time—I’ve been in this business long enough, throughout time, paylines have gone up, they’ve gone down. I mean, I can remember a time where it was almost crazy to even submit a grant, because there was so few funds.
So, good centers like University of Rochester and Roswell, we will still compete for funding, and we’ll get through it. Everyone supports cancer research, no matter who you talk to, on what side of the aisle—everybody, because it affects all of us.
And so, everybody wants to be able to continue funding for the NCI. And so, I’m hopeful that this is all going to come back to some of these levels where it makes it at least achievable to get a grant.
Republicans actually have usually been better for NCI.
Candace Johnson: Yes, they have. You’re exactly right. If you look throughout time and presidents, that’s exactly right.
Yes. I’m talking to people on the Hill a lot these days, and what I’m hearing is that the Republicans are making those calls saying, “Hey, we’ve got to do something about this”—and we just don’t know about it.
When Democrats do it, we know about it.
Candace Johnson: Yes.
Jonathan Friedberg: I attended the Hill Day with other cancer center directors and representatives from cancer centers and together with a team from Roswell Park, we visited both Republican and Democratic representatives from throughout our districts.
People think of New York state as being incredibly blue, but when you get to our region, it’s frankly quite purple, and we have districts that are quite conservative.
And to a person, for example, Reps. Langworthy and Tenney, who cover pieces of our catchment areas, both of our catchment areas, in speaking with their teams, they are incredibly supportive of NCI in particular, and NIH more generally.
They understand the importance of that research. So, I remain optimistic that the trend that you mentioned, Paul, is going to continue.
Candace Johnson: Yes.
What about the patients? Because they’re the ones who stand to lose the most. You might lose the cancer centers. Well, that’s just brick and mortar. It’s more than that. It’s a whole lot more than that—but still.
But patients will lose their lives as a result of this, and we have not heard from them yet.
I’m wondering what happens next…
Candace Johnson: Well, I mean, I think that the Hill Day, and I couldn’t participate in it, but our Roswell delegation was a patient and some of our government affairs people that accompanied Jonathan throughout visiting Congress and the legislature.
And those patients are delivering those messages, and I think they’re the ones that need to be out there more, delivering that message. And all those people in Washington have family members and relatives that get hit by this disease. So, I think that I, too, am optimistic that we can turn the corner here.
Jonathan Friedberg: Paul, I’ll say that the COE offices in, I think, virtually every cancer center oversee community action councils or community advisory boards, they have different names. But there have been attempts and successful attempts recently at trying to get leadership from those to meet together and to form essentially a national coalition of patients and advocates around this important issue.
So, I think that you’re going to start hearing a louder and louder unified voice around the importance of this.
Candace Johnson: Yes.
Well, we put a patient on the cover [of The Cancer Letter] this week. We’ll do it again, and again, and again.
And there’s also an organization that’s starting right now that’s called Patient Action for Cancer Research that will focus on that directly. We haven’t written about it, but we will. So, it needs to start happening, and it’s happening rapidly right now, so it’s actually exciting to watch.
Candace Johnson: Yes, agreed.
Jonathan Friedberg: I think one of the issues has been that as news has trickled out, it can be very difficult to center discussions only on indirect costs at 15%. That’s a very difficult thing for patients to really understand. It has to do with some Byzantine funding and accounting that has evolved over decades.
But I think when threats are made in budgets to cut NCI by 40% ,and understanding what NCI does, and how important that is, that becomes much easier for people to understand and rally around.
And I think that’s why you’re starting to see this happen now.
You mentioned COE. You have essentially contiguous catchment areas. And so, your COE picture is going to be almost exactly, well, it would be contiguous obviously, and maybe very similar. And I would think that most of your disparities are white.
Candace Johnson: We have in Buffalo, we have a unique catchment area, somewhat distinct of the Rochester area, because we have a lot of sovereign territories, Native American sovereign territories.
And in our catchment area, we have an Indigenous cancer health department here at Roswell, led by Dr. Rodney Haring.
So, we have a little bit extra besides, and I think this is true of Rochester, their catchment area is, unfortunately, severe poverty, obesity, heavy smoking, especially in some of the rural and somewhat Appalachian areas that we have to the south.
And I think that’s true also at the University of Rochester.
So, our cancer burden here is heavy, and so, our COE is really important and it’s why we have a lot of screening initiatives. We have a lung cancer screening van that travels around our area of western New York.
And we built a Community Outreach and Engagement center in our African-American neighborhood right across the street from Roswell, using an old house that was abandoned.
We refurbished it back to its original configuration from the middle of the 1800s, and then built on a center for folks to be able to come and get not only information about screening, but also to help navigate them where they need to go. It’s been really a successful thing.
And I think the other beauty about this, about us in Rochester, is our COEs.
And we’ve been doing this for a long time is we really work together. Our population science people are really very much in-step, have grants together, and we really try to help each other in our challenges.
Jonathan Friedberg: I’ll just start by saying that building that Candace was referring to is an incredible contribution, I think, to the community, and it’s a statement as to the importance of COE at a time when those statements are important.
I think our catchment area, although we do have urban poverty, as Candace described in Buffalo, our region is even maybe a bit more rural.
We go a bit further east and south. Fourteen of the 27 counties in our catchment area are considered part of Appalachia.
So, we’ve spent a great deal of time both trying to figure out optimal care delivery and ensuring access in that broad region, as well as education regarding the demographics that Candace described with really what we find to be an extraordinarily high incidence of cancer.
Outcomes are on par with what you would expect, although I think there are certainly pockets of opportunity, because we do see disparities in certain areas.
What about registries? That’s CDC… They’re actually doing away with cancer registries program that was funded through CDC. Does that affect you in any major way?
Candace Johnson: We still have avenues through the state of New York for that. And we have a smoking cessation program, the Quitline here at Roswell Park for the state of New York.
And cessation activities were cut at the CDC, but fortunately, the state of New York has continued to support those, so that’s a very positive thing, because a lot of people still smoke, unfortunately.
Jonathan Friedberg: I’d say that the state does have a cancer action plan, and at least in the current state budgets, the one that just recently got approved, there hasn’t been disruption in that funding.
I think there’s generally felt to be importance, and, frankly, I think it’s great for the two of us to now be really working together as closely as we are. We live in a state where the majority of the population obviously lives in New York City.
And over time there’s always the concern that resources are pushed in that direction and New York City has an extraordinarily loud voice when it comes to state politics, so having enough seats at the table to represent Upstate is important, and I think we’re fortunate to be working together.
Candace Johnson: Yep. Makes us stronger together.
Aren’t you also interconnected through the EAB?
Candace Johnson: Yes.
Jonathan Friedberg: Yes.
Are you on each other’s EAB?
Candace Johnson: I was just thinking about that. I should invite Jonathan to sit on our EAB. This is an invitation right now, Jonathan.
Jonathan Friedberg: Okay.
Candace Johnson: I don’t want to beat a hole in the head, but yes, I sat on Jonathan’s EAB and was very proud and excited when they got designation, because they deserved it. They worked very hard for it.
Jonathan Friedberg: Candace has been a terrific partner, both formally through the EAB, but also informally if there were questions, if there are issues that come up when there’s big challenges, I’ve always felt I could pick up the phone.
Within an hour, I can speak to Candace, and it’s remarkably, at least to me, how often we’re aligned and how easy it is to help come up with a solution. I think I mentioned this, Paul, when we spoke earlier, but one of the most impactful sessions that we had in preparation for our site visit was when a whole team from Roswell came and essentially served as a mock site visit team.
They had recently gone through their renewals, so they were sharp and knew what the questions were going to be, and to a person, I think, our group agrees on how helpful that was.
And the best part about that is, because we’re so close, after we went through all the official site visit things, there were all these side conversations at lunch that have resulted already in some additional collaborations, visits from one institution to the other [by] either teams or individuals to give talks. And I think that our achievement of designation will only help to accelerate those types of collaborations.
Candace Johnson: Yes.
So, we just witnessed the historic moment. Will you be joining?
Jonathan Friedberg: I love the drive to Buffalo—in the summer, at least, right?
It’s only 70 miles.
Candace Johnson: Yes, it’s not that far. We have so many things already that we do together. In education, our surgical oncology fellowship program is through the University of Rochester, and has been for, I think it’s 12, 13 years now. We’re a freestanding cancer center, we’re not a university. And so we get our trainees from other universities and there are not a lot of surgical oncology fellowship programs.
Rochester didn’t have one. David Linehan, the famous surgical oncologist, had just arrived there. And so, we decided that we wanted to do this jointly with U of R, and we get incredible candidates.
They get the benefit of both of our centers for their experiences, and it really is one of the more successful, it’s an NCI-funded program and it’s a very strong thing. And then we also have a strong immunology program here with a focus on cell therapy. I recruited Renier Brentjens from Memorial Sloan Kettering.
We have a 20-room GMP facility, and Rochester and us and many others are part of.
We’re developing a consortium to try to be able to provide these therapies to the state and to folks that need them.
Jonathan Friedberg: I’d say another example of how we’ve worked together, I think to both benefits, is state funding of the Empire Discovery Institute, which essentially started as a seed funding to try to get venture capital to invest in ideas that could lead to rapid translation.
And it’s really about trying to fund intellectual property. It comes from economic development funds in the state of New York. It’s not really considered a scientific initiative from New York state standpoint. But it allows scientists at Roswell, University of Rochester, and University of Buffalo to receive funding as well as guidance on how to move compounds out of laboratories into people.
And I know both of our institutions have had funding through that mechanism, and that mechanism has been successful at garnering venture capital funding.
So, we’re optimistic for the future that that will only grow. And again, that’s an example of working together to get state funds to be moved to this part of the state and to have mutual benefit.
Candace Johnson: Yes, very successful program.
What about state funding? Is there enough that the state can actually make up for? Because, actually, also you have a very different relationship with the state, right?
Because Roswell Park gets state money, Wilmot does not. How do you see the state’s role? Will it grow? If you look at Project 2025, they’re talking about moving NIH money into block grants.
Candace Johnson: It would be silly to think that the state of New York is going to make up all the shortfall of the funding from the federal government.
But I’m hopeful that there’s going to be some creative ways that we can achieve what we’re doing now. Time will tell how that will sort out.
Jonathan Friedberg: I think state politics in New York are always very difficult to predict. We’re fortunate that the current governor is from Buffalo. I think she has a deep understanding as to the importance and the needs of upstate New York, which is unusual.
I think she’s the first governor from outside of New York City in over 100 years, or something like that. She’s up for reelection relatively soon, so we’ll have to see what happens there.
The state of New York does provide funds to us and our institution in various ways. It’s not as formalized as the funding flow that Candace is able to receive, but we do, for example, have a project going on where we’re putting up a new hospital, and the state did contribute $50 million to that.
So, they do have opportunities for capital funding, and for a period of time, they also helped us fund recruitments, particularly when people were coming from outside of the state to try again, from an economic development standpoint, to bring people in.
So, we try to work as closely as we can with the state of New York. I agree that the state has a lot of funding pressures of their own and they’re not going to be able to easily fill in, although probably compared to other states, we will have at least a sympathetic year when it comes to the importance of funding research, given how important that is across the state of New York.
If you look at the top employers in the state of New York, within the top 10, our health systems, including ours, we’re one of the top employers in the state of New York.
So, this is a very big business in the state, and that does get the attention of leaders.
Can we talk about training, about young investigators? What’s happening now? What do you see happening? What do you say to young people who are getting into this field right now?
Candace Johnson: Yes, Jonathan brought this up, and this actually is probably one of the biggest threats:
Here you are, you’re in graduate school, it’s a great time, because you’re just doing science, you’re publishing, going to meetings and things.
And you see your mentors, and you see the investigators in your institution sweating bullets over whether they’re going to get their grant renewed and so forth, and you think to yourself, “Oh my goodness, I don’t know that I want to get into that.”
The other thing that’s tough is that people that are just graduating right now, so they want to go and do a postdoc somewhere, and usually postdoctoral positions are easy, because there are many of them available all across the country, and a really good student can really pick where they want to go.
That’s changing, because there’s not as many postdoc positions available, and so, the competition is higher. Plus Europe, Australia, places are opening up. I’ve seen the ads. I don’t know how many people are actually availing of that, but it’s a threat. There’s no question about it.
And so, I think you have to just be as positive and optimistic, we’re going to get through this. We just have to keep going. We owe this to our patients and hopefully we can—and we don’t lose a lot of good people along the way.
Jonathan Friedberg: It’s such a shame that this is even a topic for discussion now.
When you ask, what do I say to people who are interested in this area? I reflect on the ASCO meeting that I just attended a week ago, where the science is just incredible.
While I was there, I reflected on my first ASCO meeting, which was many years ago, and how we couldn’t have even imagined what these sessions were about and how quickly the trajectory of improvements have been and how realistically you’re going to have a better and better time, whether you’re taking care of patients or making laboratory discoveries, just based on the investment that we’ve enjoyed over the last 20 to 30 years. So, there’s this real tension in my mind.
There’s no better time to go into this field than now.
I’m jealous of the people who are young at what they’re going to be able to see and experience in their careers, and yet, because of extenuating forces and financial struggles, it is a very, very challenging time, and people obviously react to that and hear that.
And I just think we have to continue to have laser focus on assuring that we’re making our institutions as friendly as possible to young investigators. I will say I was heartened at the cancer center directors meeting, a team from the NCI spoke about a payline that’s going to be much lower than we want it to be, but they’re continuing to have extra credit, so to speak, for the early-stage investigators, and I think that we all appreciate the importance of that.
Candace Johnson: Yes, agreed.
I saw a projection that was about 8.2, I think, or 8.3. They published it this week.
Jonathan Friedberg: Yes. Well, they told us that it was going to be at 7%, the payline, whether at the end of the year there’s money left and they’re going to contribute it, but they were setting the bar at 7%.
I think the explanation that we were given in part was that they want to be able to ensure that grants that have already been released are going to be able to be funded moving forward.
How many years of an interruption can we withstand as an enterprise—an interruption in funds?
Candace Johnson: We’ve been at seven, we’ve been lower than seven before, and we got through that.
So, I think that as long as it’s not sustained over multiple years, we should be able to come back. I think we’re very resilient, and I think as scientists, we’re incredibly innovative, and people are looking at different ways to fund their research.
People are reaching out to foundations, pharmaceutical companies. I can remember when the funding got as bad as this before, then you submitted your grants to everything and everyone that you could to try to maximize getting funding.
And those innovative people are usually successful, and so, we have to stay positive.
Jonathan Friedberg: And yes, to that positivity, I am going to say I don’t necessarily think that the next even year or two is cast in stone that it’s going to be as bad as perhaps many are projecting now.
I do think, in speaking to many, many people that this is an area that has received attention. It’s starting to receive attention in the national news media as well, and Congress ultimately sets the budget. We have to remember that, in the past, Congress has turned things around in a very favorable way toward NIH and in particular, NCI.
And I think particularly right now, NCI has been able to demonstrate return on investment, where mortality rates continue to fall, incidence rates are changing because of important prevention strategies and screening, and yet, everybody appreciates that this is still a problem that needs to be tackled.
So, I’m still hopeful even for the next year or two.
Candace Johnson: I’m with you, Jonathan,
And I actually am too, and I’m watching this from Washington, and as I do, I cannot imagine that this worst-case scenario of the 2026 budget proposal is going to happen, because really there was a 2017 budget proposal that also went.
That had a 20% cut and then indirect cost rate of 10%, which did not happen. So will this happen?
No.
And now even as we speak, Republicans are saying, “No, no, no, no, no” to the Big Beautiful Bill. So no, it’s not going to happen quite like that, I don’t believe. But then again…
Is there still spring in your step as you go to work?
Candace Johnson: I think that Jonathan’s exactly right.
The science that we have today is so exciting. I think that there’s so many things that are right at the cusp, and it is a great time to be in science, and so I am excited.
I think if I walk through the hospital and I hear those patients ringing that bell that their treatment is over and that they’re in remission, how can you not have a light step?
What we do is, I think, so exciting and fun, and we make a difference in people’s lives. So, how can you not be positive about that?
Jonathan Friedberg: One of our junior investigators who we hired in a wave of recruitment that we had to try to obtain the NCI designation, we hired her about five years ago. Her lab just had a paper that was published in Nature—and seeing her glow.
Candace Johnson: I know who you’re talking about.
Jonathan Friedberg: Right.
Oh, who is it?
Jonathan Friedberg: Jeevisha Bajaj. She’s a fantastic leukemia scientist, and she published a paper on taurine and how it impacts potentially leukemia development.
But just seeing her pride, and the work that she did, and knowing how impactful that’s going to be, that certainly puts a spring in your step.
And I will say for our entire medical center, the news in March of the NCI designation really couldn’t have come at a better time. There constantly seemed to be these threats and concerns and what was happening.
And finally, we got this good news that at some level is a blue ribbon that represents work that had been done over many years. But more importantly, it’s suggests that there is continued investment.
There is some normalcy in quotes as far as operations, and that we’re going to be able to take advantage of that and leverage that moving forward. And I think that’s enabled us to help be grounded and have people maybe shut out some of the negativity and the noise.
And it certainly has propelled me to continue to have a good step as I walk through the halls here.
Do you think the system is resilient enough to last even without NCI for a while?
Candace Johnson: I don’t think NCI is going to go away.
I mean, I think we are resilient. I think the network of all these cancer centers who we all feel exactly the same way.
This screen could be filled with other directors, and we’d all be saying the same thing. We’re going to get through this, because our patients need us, and they’re at the center of all of this.
Jonathan Friedberg: I’d say part of the evidence of that is just this conversation that we’re having today.
I mean, I think Paul, what triggered this in part was you being impressed at how Candace, 70 miles away, supported our efforts to join her institution in the ranks of NCI designated centers.
And one of the things that I’ve just been so touched at through this process, and I’ve really experienced this, is how generous everybody has been. I really felt like I had a whole national cadre of people who were rooting for us to be successful and join them, because we really do have this common enemy of cancer.
And being new to the game, I continue to be awed by these meetings that I’m now attending of cancer center directors, how passionate people are about the patient, ultimately, and the importance of this national investment in science.
And I think that that combined passion will generate resiliency in a way that probably doesn’t exist in any other part of medicine. It’s why we’re viewed, certainly I could say, at a medical center level as leaders and templates as to how others should behave.
And they are light years away from us as far as being able to get to that point.
So, sometimes we’re in this all the time—we just take all of this for granted. Having been on the outside and coming in, and seeing how important this was and how really impressive this support has been, I think is something that at least reminds me every day as to how fortunate we are to be working in this area.
I’m seeing a system where the National Cancer Program has 73 leaders, plus the NCI director, and let’s not forget, Doug Lowy is one heck of a good guy.
Candace Johnson: He’s a wonderful guy.
And so, 74 leaders and it is got to count for something. That’s kind of why we do The Directors. That’s precisely what we started it.
So, is there anything I forgot to ask? Anything I’m missing?
Jonathan Friedberg: I’ll just say one last thing, and that is our catchment areas, from a population standpoint, or maybe somewhat smaller than some of the other cancer centers that are in very large cities.
That said, I think that together, and both of us individually, have demonstrated equally important impact, both locally as far as what we’re able to accomplish for our catchment area.
And as we talked briefly about before, how important that is in this region of New York that has high incidence of cancer and a lot of challenges, but also it demonstrates that with this cancer program, we’re able to make national level contributions and I would say global contributions?
Candace’s team has done some great work with vaccines that have gone way beyond the United States, so I think that’s an important message as well that we’d like to share, that being in a city that has a population in Rochester of only about 250,000, but we serve a catchment area of over three million people because of the size and the breadth of New York.
Those are some unique challenges, but it emphasizes the importance of this National Cancer Program.
Candace Johnson: And to sort of comment further on that, we may be small, but we really are mighty, and we are not to be sort of overlooked either, because there’s incredible science at both of our institutions.
And I think leveraging that, working together as much as we can, we’re really going to make a big difference in people’s lives. So, I’m excited that Jonathan is in the club now, and I think there’s only good things that are going to come from this.
Well, thank you very much, Dr. Johnson. Thank you, Dr. Friedberg, and thank you to ASCO, our sponsor for The Directors. Thank you. That was fun.
Dr. Rosen, thank you so much for agreeing to talk with us. You know more about cancer centers than anyone, having spent most of your adult life as a director of NCI-designated cancer centers.
So, you’ve listened to this conversation with Dr. Johnson and Dr. Friedberg. My question to you is the same one I’ve asked them, which is what’s keeping you up at night?
Steven Rosen: Paul, first, thank you for including me, and it is true. I spent 35 years as a cancer center director, first at Northwestern, and then most recently at City of Hope.
I currently have no administrative responsibilities, so I’m sort of an onlooker. It’s clear that everyone’s apprehensive.
There’s been dramatic changes. That’s always unsettling.
You worry about every aspect of the cancer center program, from the fundamental research to the shared resources, to community engagement, to what I thought were important [elements] of diversity, equity, and inclusion. I think everyone feels it’s important. People may argue about how to achieve it, but the value is clear, the same as the value of the research and the profound impact it’s had.
Again, the argument can be, “How do you best allocate resources to accomplish the most?”
And we have to have an honest dialogue about that. But we can’t go back. What’s done is done.
And now, everyone is hoping that the decisions of this administration, the impact they have won’t be overly detrimental, that we’ll come to some sort of equilibrium where we can move forward in a very productive manner.
Do you feel energized by what is happening, both the science and the struggle?
Steven Rosen: Oh my God, we’ve made such remarkable progress in the last decade. In my field, the advances have been simply incredible in the treatment of lymphomas and chronic leukemias.
When I see a patient at this point, I always say, “My anticipation is we’re gonna control and cure the disease.”
That’s how confident I am in modern therapies. I have currently 400 active patients. I think last year [we] had two deaths: one from disease, and one from what we call long COVID.
And so, I am very fortunate that in the diseases I treat there have been just astounding advances.
We have challenges, obviously, in a whole spectrum of solid tumors and some of the blood cancers where we have much work to be done. And, hopefully, the administration will understand the contributions that have come from academic medical centers and appreciate what we can continue to contribute.
But resources are needed—there’s no question. And people could argue about how much should be indirects versus directs, but every dollar that would be cut from the NIH or from other funding sources will be detrimental.
There’s no way of getting around that.
What do you think those numbers would’ve looked like early in your career, for patients? Where you had two deaths? Let’s say, 20 years ago, what would the numbers look like?
Steven Rosen: Oh, at least half those patients wouldn’t have survived in the diseases I treat.
I think that that’s a fairly straightforward point. And each one of your patients, are they, are they getting to the point where they’re calling media members or their elected representatives?
Steven Rosen: Not that I’m aware of. And maybe I should encourage them all to, but not that I’m aware of.
Is there anything else that strikes you as emblematic of these times?
Steven Rosen: I think there is sincere concern about healthcare delivery, not just research. Will individuals have access to appropriate healthcare?
And I would hope that that becomes better clarified as we move forward. And I’m, again, not involved in the day-to-day discussions.
I’m an observer, and I have the same feelings that I’ve always had—that everyone should have access to healthcare, and that people shouldn’t be limited in terms of their options.
But it’s not clear to me what will happen in the next few years in that regard. I mean, there are some things that have happened that I’m hearing secondhand that are positive.
For instance, I’m told that opioid deaths are down, because of securing the border. Okay. That’s very positive. That’s wonderful.
I think healthy dialogue is most important, that people just don’t walk into a room angry at each other and walk out angry at each other, and nothing’s been accomplished.
That, to me, is most disturbing.
But, again, I think the fundamental issue is, the majority of Americans, the majority of people around the globe agree with: people want peace. People want health. People want individuals to lead the best lives they can. Everyone wants to have respect for what they do.
Regardless of where we are politically; right? Well, thank you very much.
Steven Rosen: It’s always great seeing you. And I love The Cancer Letter. I’ve been reading it from day one. And will continue.
