Historical lessons for ARPA

This is an interesting counter-perspective to the narrative on “war on cancer”. I think it is critical to break from your echo chambers and understand the ideas behind why a specific policy initiative were pushed out.

Biden’s Plan to ‘End Cancer’ Borrows From an Old, Flawed Playbook

Congress approved, and the president signed into law, a bill allocating a $1 billion budget for Biden’s new research enterprise: the Advanced Research Projects Agency for Health, or ARPA-H, which aims to develop novel approaches to treat and prevent not just cancer, but also diseases like Alzheimer’s and diabetes. It’s an agency with curious historical inspiration, modelled on the Defense Advanced Research Projects Agency, or DARPA, a semi-independent agency developed in 1958 and steeped in the Cold War culture of secretive high-tech military projects

There are several advocates who believe ARPA will be the solution to “stalemate” in the war on cancer. However, as the COVID-19 pandemic has shown, there are other healthcare issues ahead. Biomedical research is shouldered by the taxpayers’ funding, while pharma companies derisk themselves from failure and prefer the acquisition mode. This is a known problem. Monopoly in the drug purchase (through “pharmacy benefit managers” and vertically integrated insurance chains) precludes any innovation in pricing. This is the US healthcare model that everyone understands, and there have been clarion calls to “fix it”. Barring this, there is ample evidence that the funding crunch doesn’t hold back innovation – institutional mandates and lack of cross-disciplinary research does. Committees are beholden to PR push and research teams, because the blame of failure is more sacrosanct than actual outcomes. Hence, there is a tendency to “play-safe”.

Here’s more for the context:

The research supported under the National Cancer Act — focused primarily on the molecular biology of cancer — did facilitate some breakthroughs. It led, for instance, to the discovery of oncogenes, genes that can transform a cell into a tumor cell. But ultimately, Nixon’s war on cancer was lost. Cancer was not conquered in time for the country’s bicentennial, as many thought it could be, just as it is still not conquered now. The promise that a deep dive into the molecular structure and function of the cell could solve the mysteries of cancer proved unfulfillable.

I still see a persistence to understand “molecular pathogenesis” followed by “personalised recommendations” which haven’t turned true. I was flipping through a dossier for a lab, pushing its “molecular testing”, but they had no mention of the appropriate controls. The lab reports come with separate pages of disclaimers, making it difficult, if not impossible, to understand the context. Well, the current early stage trials on breast cancer are trying to “refine the possibilities” of treatment but what problem are they trying to solve?

Oncogenomic pathogenesis is critical to understand the basis of disease, I agree. However, clinical application needs to flow in hand too.

A recent policy paper explaining ARPA-H’s agenda gives some reason to hope that it may be more attentive to the societal causes that BCA and other organizations highlighted. But the structure of ARPA-H is worrying: The choice to locate its model in the quintessential research apparatus of the Cold War period, DARPA, seems dangerously poised to double down on the approach that ultimately made Nixon’s war on cancer, as one commentator put it, a “medical Vietnam.” Indeed, the president’s recent remarks suggest that the government’s fundamental philosophy toward cancer — grounded in a false sense that cancer could be cured if only there were more money, less oversight, more innovation, and more high-risk research — hasn’t changed much since Nixon. Curing cancer is still medicine’s most prized pursuit, a goal imbued with nationalism and simplistic notions of success and failure.

The linked policy paper is behind the paywall. Nevertheless, we still require a revisit to the actual concerns and balance the funding priorities.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.