A skeptic’s take on the cancer moonshot

The ideas and innovators shaping health care

Feb 13, 2023 View in browser   By Erin Schumaker, Ruth Reader, Carmen Paun and Ben Leonard FOLLOW THE MONEY Biden led the cancer moonshot under President Barack Obama, and reignited it when he became president in 2021. | Evan Vucci/AP Photo President Joe Biden’s cancer moonshot is a common-ground program, not just for Republican and Democratic lawmakers but also for everyday Americans. And for good reason: Cancer is the second-leading cause of death in the U.S., according to the CDC. But a contrarian cadre of oncologists, researchers and scientists who spoke to Erin and Ruth says there’s a case to be made that the $1.8 billion Congress has appropriated for the moonshot since 2016 could have been better spent. Gilbert Welch isn't sure more funding is a good thing. “There’s so much money sloshing around,” Welch, an internist and senior investigator at the Center for Surgery and Public Health at Brigham and Women’s Hospital in Boston, said of the cancer industry. There’s no shortage of research funding: — The National Cancer Institute had a nearly $6.4 billion budget for cancer research in 2021, and its annual spend has grown since 2015. — Cancer nonprofits like the American Cancer Society also raise hundreds of millions of dollars each year. — The pharmaceutical industry has ample incentive to put money behind increasingly lucrative cancer diagnostics and therapeutics. — Research shows that, from 2010 to 2019, revenue generated from cancer medicines increased by 70 percent among the top 10 pharmaceutical companies to reach $95 billion. Who’s spending also matters: Industry accounts for two-thirds of research funding. “It’s good that they’ve got a lot of drugs that they’re testing,” said Zeke Emanuel, an oncologist, a professor at the University of Pennsylvania and a former White House adviser. “What’s bad is having industry shape the clinical research agenda because industry has a bias.” Emanuel’s solution: stronger government leadership and more nonindustry sponsors. The White House emphasizes that the moonshot’s mission extends beyond funding cancer research. It’s a priority, the administration says, but the program also focuses on: — Promoting patient navigation services to help people with cancer and caregivers navigate screenings, diagnosis, treatment and survivorship. — Continuing the public health fight against smoking by encouraging smokers to quit and nonsmokers not to start. — Updating the nation’s cancer systems to promote clinical trial networks and encourage sharing among research entities. — Funding the new Advanced Research Projects Agency for Health to drive research breakthroughs.   STEP INSIDE THE WEST WING: What's really happening in West Wing offices? Find out who's up, who's down, and who really has the president’s ear in our West Wing Playbook newsletter, the insider's guide to the Biden White House and Cabinet. For buzzy nuggets and details that you won't find anywhere else, subscribe today.     WELCOME TO FUTURE PULSE Jackson Hole, Wyo. | Andrew Zeller This is where we explore the ideas and innovators shaping health care. What could you do with an extra thumb? Use it to scroll on your devices after your other thumbs get tired? Researchers are working on prosthetics to enhance the body. We're not sure about a prosthetic that shoots glitter, though. Share any thoughts, news, tips and feedback with Ben Leonard at bleonard@politico.com, Ruth Reader at rreader@politico.com, Carmen Paun at cpaun@politico.com or Erin Schumaker at eschumaker@politico.com. Send tips securely through SecureDrop, Signal, Telegram or WhatsApp. Today on our Pulse Check podcast, host Katherine Ellen Foley talks with Erin about Biden’s cancer moonshot, the $1.8 billion that Congress has appropriated for it and the cancer researchers who are less unified about the moonshot than Washington policymakers. Listen to today’s Pulse Check podcast THE REGULATORS The DOJ has withdrawn guidance that health organizations had used to determine how they could share data. | Scott/Flickr The Department of Justice is signaling a crackdown on data-sharing among health care organizations that it says can drive up prices. The department’s Antitrust Division has withdrawn longstanding guidelines on antitrust in the sector, calling the old policy statements “overly permissive on certain subjects, such as information sharing.” “The healthcare industry has changed a lot since 1993, and the withdrawal of that era’s out of date guidance is long overdue,” Jonathan Kanter, the assistant attorney general for antitrust, said in a statement. The Clinton-era guidelines, created in collaboration with health care industry leaders, defined how the antitrust enforcers viewed anti-competitive behavior and explained how industry could share data under certain, narrow conditions called safety zones without triggering regulatory problems. At the time, regulators thought that data-sharing might lead to lower health care costs for patients, which hasn’t turned out to be the case. In a speech at a global antitrust conference earlier this month, Doha Mekki, principal deputy assistant attorney general, said that data-sharing can lead to price fixing and diminish competition. Industry isn’t happy: “DOJ’s abrupt withdrawal of the antitrust health care policy statements is unfortunate and continues the trend of the agencies straying further from established — and appropriate — precedent,” said Justin Bernick, the Hogan Lovells partner who successfully defended UnitedHealth Group’s acquisition of Change Healthcare last year against a DOJ challenge. Melinda Hatton, general counsel at the American Hospital Association, said her group was “deeply disappointed with the precipitous withdrawal of guidelines for hospitals and other health care providers and with DOJ’s unsupported assertion that some were ‘overly permissive.’”   LISTEN TO POLITICO'S ENERGY PODCAST: Check out our daily five-minute brief on the latest energy and environmental politics and policy news. Don't miss out on the must-know stories, candid insights, and analysis from POLITICO's energy team. Listen today.     DANGER ZONE A new study found a link between climate change and mental health, but it's not clear why. | AP “We have now established a high-water mark that alas could soon be eclipsed for how climate can impact mental health in a highly vulnerable country. Syed Shabab Wahid, Georgetown University Climate change could be bad for the mental health of people living in the countries most vulnerable to it. That’s not just for those worried about the Earth’s warming or victimized by severe weather. A rise in heat and humidity in Bangladesh, one of the world’s most vulnerable countries to climate change, was linked to increased levels of anxiety and depression there, a new study says. Researchers at Georgetown University, George Washington University and the World Bank found that people experiencing temperatures just 1 degree Celsius higher within the two months preceding the study had a 20 percent greater probability of an anxiety disorder and a 24 percent higher likelihood of having both depression and anxiety. What’s next: The researchers plan to study the link’s causes. The evidence suggests that high temperatures may affect a neurotransmitter in the brain that affects mood and cognitive functions. The next step is to develop and assess interventions such as offering mental health services to communities affected by climate change. “This should serve as a warning for other nations,” said Syed Shabab Wahid, the lead author and an assistant professor in the Department of Global Health at Georgetown University’s School of Health.   Follow us on Twitter Ben Leonard @_BenLeonard_ Ruth Reader @RuthReader Carmen Paun @carmenpaun Erin Schumaker @erinlschumaker   Follow us

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