The Fake Politics of "Curing Cancer"

Joe Biden is the latest in 50 Years of Tough-Talking Presidents With Unrealistic Promises

A lot of people were surprised when President Biden, at a White House event yesterday to promote insurers expanding access to mental health coverage, said,  “One of the things I'm always asked is, you know, why Americans have sort of lost faith for a while in being able to do big things. ‘If you could do anything at all, Joe, what would you do?’

“I said, ‘I'd cure cancer.’ They looked at me like, ‘Why cancer?’ Because no one thinks we can, that's why. And we can. We ended cancer as we know it.” '(The official White House transcript later cleaned up the president’s words, reporting he said: “We can end cancer as we know it.”)

For those of us who follow the intersection of politics and public health, Biden’s words about ‘I’d cure cancer” are not new, unique or realistic.

In his State of the Union address in 2021, Biden pledged to slash the cancer death rate by half in the next 25 years. That September, on the 60^th anniversary of John Kennedy’s “Moonshot” speech, Biden promised a “supercharged Cancer Moonshot.” It was, said Biden, an “inflection point” at which a united nation would “end cancer as we know it. And even cure cancers once and for all.”

The goal is admirable. The problem is that the idea of “curing cancer” is an over-promise made by every president since Richard Nixon declared a “war on cancer” in 1971. The moonshot metaphor, which Mr. Biden has relied upon for six years, is simply the latest in more than fifty years of presidents talking tough about cancer.

When Nixon signed the National Cancer Act, most oncologists thought it was a single disease that might eventually be treated successfully with drugs and therapeutic treatments. The hope was that a huge infusion of federal spending would kickstart the research needed to find a cure.

Nixon was the first to use the moonshot symbolism: “The time has come in America when the same kind of concentrated effort that split the atom and took man to the moon should be turned toward conquering this dread disease.”

Medical researchers realized over time that cancer is a far more complex disease with many variations. There would be no single cure but the battle against it would be more nuanced and take much longer, with some victories and plenty of setbacks. The changes in what scientists learned about cancer did not change the optimistic talk from a succession of presidents.

For many — as with Mr. Biden losing his adult son Beau to aggressive brain cancer in 2015 — cancer was personal. First Lady Betty Ford found out she had breast cancer only a month after her husband became president. Ronald Reagan underwent surgery for colon cancer a year into his second term, and two years later, Nancy Reagan was diagnosed with breast cancer. George H. W. Bush and his wife, Barbara, had lost a 4-year-old daughter to leukemia. Cancer had killed Bill Clinton’s mother; Vice-President Gore said that he and the president represented “the generation that wins the war on cancer.’' President Obama, whose mother had died of ovarian cancer, launched a “cancer moonshot” in his last State of the Union speech and tapped Vice-President Biden to run “mission control.”

The Biden Administration added $2 billion to the 2022 NCI budget, bringing it to $6.9 billion. What has all the federal funding for cancer research produced in the last 50 years?  America spends far more per capita on all healthcare, particularly cancer, yet a dozen nations that spend a fraction as much have lower cancer death rates.

Major cancer charities often are cheerleaders for the $175-billion-a-year cancer treatment industry. The American Association for Cancer Research, in its annual Cancer Progress Report, cited “unprecedented progress against cancer in the last decade,” more than 18 million cancer survivors in America, up from only 3 million in 1971.

A cancer survivor is anyone alive five years after an initial diagnosis. Screening technology has greatly improved over the decades and the industry’s holy grail is that early detection saves lives. What is not discussed is that there is no clinical evidence that early detection makes any difference in life expectancy. Screening cannot spot some fast-growing cancers. Tests cannot dependably differentiate between harmful and harmless cancers. Screening picks up tumors that if left alone would recede, not grow, or progress so slowly the patient would die of other causes before it ever caused any harm. Studies show that screening for breast and prostate cancers has led to enormous overdiagnosis and overtreatment. 

The Cancer Progress Report also boasted that “the age-adjusted overall cancer death rate has been declining since the 1990s, with the reductions between 1991 and 2019 translating into nearly 3.5 million cancer deaths avoided.”

This ignores the fact that the thirty-year decline in mortality follows more than sixty years of increases, tracking the rise and fall of smoking. While lung cancer deaths have dropped for twenty years, its death rate is still higher than it was in the 1960s, especially among women. Lung cancer remains the deadliest, killing more people every year than breast, prostate, and colon cancers combined. Even with the dramatic decline in smoking, the current mortality rate for all cancers in America is 27% higher than when the government first started collecting data in 1930.

While there have undoubtedly been some major breakthroughs in a handful of rare pediatric and blood cancers, the federal government’s war on the disease is marked by a long series of failures.

A moonshot theme might have been fitting for the crash effort to develop Covid therapies. But when applied to cancer, it reinforces the outdated idea that a single strategy might conquer a single disease. Maybe advances that are now only sketchy ideas in some biotech laboratory will prove Mr. Biden right in his quest to cut cancer deaths by half in a quarter century. Immunotherapy and more discoveries about the genetic causes of cancer may one day revolutionize treatments.

Until then, however, promising to cure the disease might be a good campaign slogan and scores well with focus groups, but it is a goal about which our national leaders should be more realistic. Biden’s latest remarks show that even if “curing cancer” is not very realistic, in Washington it is still considered smart politics.