Moonshot… or Just Moon Gazing?

In a recent issue of The Translational Scientist, Editor Charlotte Barker addressed several aspects of the “Cancer Moonshot”(1). I would like to add my perspective – that a billion dollars doesn’t even come close to what our trip to the moon cost. Back then, when a billion meant something, the moon budget was $24 billion, which in current dollars is about $200 billion. Even today, NASA’s annual budget is about $18 billion while the NCI is allocated about $5 billion. In the Apollo era, the NASA budget was around four percent of federal spending; NCI’s current $5 billion is about 0.1 percent. For a little perspective, NBA players make $3 billion collectively, and as a nation we spend more money on candy or lottery tickets than on cancer research. Of course, basketball players, candy companies, and state governments think these are fine expenditures.

Some might remember that in 2007 President Obama promised to double the NCI budget – something that never happened – and the extra billion promised by the moonshot, even if actually allocated or redirected, is a bit anemic. In either case, the value of new expenditures is based on the assumption that more money would bring proportionally more progress, which may or may not be true. Yes, every researcher would like a bigger grant, but having more may not mean consistently greater productivity –especially in the short term, as more infrastructure and people would have to be brought on line. Perhaps lab-ready is the science equivalent of shovel-ready, which is to say, research that can “immediately” and effectively be undertaken.

It’s worth noting that Vice President Biden’s commitment to this endeavor is likely associated, at least in part, with the sad loss of his son, Beau Biden, to a brain tumor. Does this suggest that if his son had succumbed to some other disease, Biden would now be championing an entirely different cause? This reflects our generally poor collective ability to rationally prioritize things. Cancer, however important, is not the overall leading cause of death; heart disease tops that list. For deaths occurring between 1 and 44 years of age, the number one cause is “unintentional injury”. Between 15 and 34 this is followed by suicide and then homicide. The focus on heart disease and cancer is actually a focus on what is killing older people.

Every area of disease tends to have champions who believe and/or assert that their focus deserves our full and immediate attention – usually while avoiding the issue of whose cause should lose out. Such promotion often includes flamboyant descriptors such as “moonshot”. But this type of narrow, and in part self-interested, focus is not limited to research. I once knew a wrist surgeon who was appropriately devoted to the importance of the wrist; I jokingly suggested to someone that the surgeon believed that the wrist came right after the brain and heart in terms of importance. “I’m not sure they would agree that the wrist would come third...” was the return quip.

In an ideal world, or indeed in a better world, rational action would not require bombastic rhetoric. If more federal money is appropriate for cancer research, then it should be provided, after a proper assessment of resources and priorities. If it can’t or won’t be provided, we should be told why.