In his usual, no-holds-barred, rambling way, Nobel Laureate James Watson takes cancer research in general and the National Cancer Institute (NCI) in particular to task for the failure in the War on Cancer and the continued research funding focus on the genetics of cancer in an Op-Ed for the New York Times. Interesting timing given my previous post. Watson identifies several problems with the current state of affairs and lurches from one to another in his piece. First, NCI ignored his recommendation back in the 1970's to focus more on basic cancer research rather than having its almost singular focus on clinical studies. To this day this advice has not been fully taken to heart, as NCI has been quite slow to embrace applying genomics to cancer.

Second, chemotherapy agents targeting specific genetic pathways most often do not cure cancer, just prolong life until other affected pathways in the tumor take over and progress the cancer. Thus, multi-drug approaches are necessary but current FDA regulations prohibit such efficacy tests. After lamenting our inability to test drugs in combination, he says that such an approach probably will not work anyway and what we need is a focus on biochemistry, i.e., what happens after that mutated DNA is converted into proteins. That is, it through understanding the differing chemical reaction networks in normal and cancer cells that we might be able to find drugs that prevent cancer cells from behaving like cancer cells, targeting the larger processes in the cell that enable uncontrolled growth rather than disabling specific cancer pathways.

Watson's second point concerns the funding for innovative research. The recession has led to a reduction in venture capital for biotech firms. Additionally, larger firms (and now even smaller ones) have been shying away from the high risk, high reward projects that could lead to real breakthroughs for some time.

Before concluding, Watson takes a direct shot at the current NCI leadership, calling NCI a "largely rudderless ship in dire need of a bold captain who will settle only for total victory". Watson closes by encouraging President Obama to appoint a new director from among the nation's top cancer researchers; one that will expand cancer research beyond its current genetic focus, will invest in the high risk, high reward projects that currently are not being funded, and increase the speed at which drugs are developed and tested.

I am not sure what to make of all of it. We need more high risk and fundamental research, but not in genetics even though we know relatively little about the genetic basis of the vast number of diseases called cancer. We need to lessen NCI's clinical focus but must speed clinical testing of new drugs. It seems the next NCI director will have a tough time pleasing James Watson.