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COLUMNISTS
TODAY'S STORIES
08.04.2008
Do Breasts Starve the Baby?

Appearing Monday on the Ellen DeGeneres show, Hillary Clinton made another bold campaign promise: to cure breast cancer within a decade. If elected, she pledged a $300 million annual commitment to research into the disease, which killed some 40,000 women last year and is said to afflict 240,000 individuals annually.

Breast cancer research is certainly a worthy cause--not least because the hundreds of thousands of women who are stricken with it represent hundreds of thousands of families for whom the female center is vital. But it has been a watershed set of decades for breast cancer researchers, who find the funding game lucrative indeed. Aside from the robust support of federal institutes like the NIH, Americans have privately dropped millions of dollars into campaigns similar to Clinton's, that promise to do right by our cousins, aunts, and sisters. And the orgy of pink that marks October as Breast Cancer Awareness Month--handbags, teabags, bracelets and mugs--keeps ill women in our minds year-round.

As a result, we are very, very good at handling the threat of breast cancer. The high incidence of breast cancer (compared with, say pancreatic cancer) notwithstanding, past large-scale investments in the disease have given most oncologists a clear, flexible battle plan when it comes to this particular cancer. I say this from personal experience watching my mother work with countless terrified and sick patients. Over the last several years, clinical research (2375 ongoing studies) has shown that a strategic combination of medication, radiation and surgery can get a hold on all but the most aggressive late-stage forms of breast cancer. Counseling for genetic and behavioral risk factors has made diagnosis and treatment even more precise.

I point this out not to suggest that breast cancer funding is starving the baby. If it were, it wouldn't be doing so alone. Prostate and colon cancers, for some, also sap great amounts of federal and private giving. But the lack of funding for other, less media-friendly (and I hate to turn a life-threatening illness into a PR machine) diseases like multiple myeloma or osteosarcoma--not to speak of sickle-cell disease or asthma, or anything--make such financial favoritism seem against the interest of general scientific knowledge.

Clinton's breast money will be funneled toward the NIH, the National Cancer Institute, and the Medical Research Program run by the Defense Department. Frankly, (and back to the campaign) I'd love to know Elizabeth Edwards' response to this initiative and the general debate on resource allocation in medical research. Perhaps we'll see her blogging about it from the Center for American Progress, which she has just joined as a senior fellow.

--Dayo Olopade

Posted: Tuesday, April 08, 2008 5:49 PM with 7 comment(s)

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aeromonas said:

Oy vey.  I absolutely HATE the politicization of health sciences research funding.  It so fucking inefficient.  You'll fund a whole army of schleppers whose dead-end research proposals can be tweaked so that they appear relevant to breast cancer while other scientists with promising proposals in other areas go begging.

And the promise of a "cure" for breast cancer is fairly bogus.  Most breast cancers are already curable with current methods.  And regarding the ones that aren't--the cancers that are metastatic at diagnosis or the minority that metastisize after definitive treatment for early cancer--the prospect of a true cure is fairly remote, though even for those developments in the past decade have already led to greatly improved the prospects for patients, doing for metastatic breast cancer something analagous to what antiretroviral treatment has done for HIV/AIDS, converting it from a rapidly fatal death sentence to a chronic disease.  

To tell you where I'm coming from, my mother was diagnosed with breast cancer with nodal mets at 42, underwent a modified radical mastectomy and chemotherapy and was lucky enough to survive, and right now an old friend from my college days is dying from metastatic breast cancer.  I know its a serious disease.  But every day I treat patients with other common diseases just as serious, and it bugs me to no end to see how just because a particular disease differentially effects a particular political constituency, it becomes a target for differential government research funding.

April 8, 2008 9:08 PM

DSM said:

great post aermonas

- cures for metastatic  cancers won't be found by drum banging politicians and copy cat bandwagon scientists. - higher risk and more innovative research  funding support is what we need,

April 8, 2008 10:06 PM

williamyard said:

I have spent much of the last six years reading and editing technical documents related to cancer, and after awhile it gets you to wondering.

Like, 'sup, cancer? What's the deal? What are you, anyway? The body, bubbling up out of itself? the twisted wreckage after an unseen, parallel universe skids across lanes, then slams into ours?

Tumors can't grow much larger than the size of a pea unless they get nutrition and get rid of waste, so they tell us to grow them some new blood vessels, and we comply. This transaction is, in my view, one of the most fascinating in all of science, and also one of the most horrific. Nature is full of parasites and hosts; cancer combines the two into handy one-stop shopping.

And then there's the business about cancer not allowing our cells to die; rather, they turn cancerous, and we die. Immortality guaranteeing mortality. Cancer, the randy Zen master, smiles demurely and allows "Turns out I can have my cake and eat it, too. And a fish *does* need a bicycle. And, in most cases, someone can't go back in time and kill their own grandfather, but in your case I'll make an exception."

"Don't thank me! I'm only doing my job."

April 8, 2008 11:00 PM

Bursack said:

Great post.  Very refreshing.

April 9, 2008 9:05 AM

ritebrother said:

aeromonas-

You've hit the nail on the head.  I myself compete for NIH funding.  I have mixed success - some proposals have gotten funded, others have not.  What you say describes the dynamic very accurately.  Tenure-track research faculty are under extreme pressure to procure federal funding so that they can cover their salaries, support graduate students, and contribute to the institution's overhead pot (the current F&A rate at my institution is now a whopping 44%).  It is one of the primary conditions of getting tenured.  It's very frustrating to have been trained in a certain discipline, and to have developed a research program in a certain area (mine is the regulation of pituitary hormones), only to have political whims constantly shifting the programmatic priorities of the NIH institutes.  Unfortunately, with the dire state of current NIH funding (which has been sliding backwards for several years, such that the average success rate for R01 proposals at most institutes in now less than 10%), there is often no choice but to adapt one's reseach program to increase the chances at funding.  But, as you imply, it is often a ham-handed shoe-horning of the reaseach into a funding directive that does not necessarily warranted scientifically or clinically.

April 9, 2008 11:53 AM

dhauck said:

Speaking as one who constantly must swim upstream against this "orgy of pink" (my wife and I raise money to fight pancreatic cancer, which killed my father) I have to say, I hope she succeeds.  If Hillary can (pace aeromonas) cure breast cancer, then maybe I can finally convince some donors that people actually do die from other diseases, no, really, they do.

April 9, 2008 1:12 PM

psantillana said:

My ex-husband, the crassest man I've ever met [I say that with some awe], had a theory that breast cancer got disproportionate attention because men out there want to keep the tits on their women. Don't shoot the messenger, ahem, national conversation, etc.

April 9, 2008 1:58 PM