To anyone who follows science, President Barack Obama’s announcement of a “moonshot” to cure cancer last week brought on a strong sense of déjà vu. It was, in fact, the third time in less than three years that he has launched a high-profile effort to solve a complex biomedical problem.
A year ago, in his 2015 State of the Union address, Obama announced the Precision Medicine Initiative, which is intended to usher in what he called “a new era of medicine — one that delivers the right treatment at the right time.”
And in an April 2013 speech at the White House, Obama unveiled the BRAIN Initiative, which he described as “the next great American project,” designed to help figure out how the brain works.
“Think about what we could do once we do crack this code,” Obama said. “Imagine if no family had to feel helpless watching a loved one disappear behind the mask of Parkinson’s or struggle in the grip of epilepsy. Imagine if we could reverse traumatic brain injury or PTSD for our veterans who are coming home.”
Previous presidents earned headlines of their own by announcing major scientific projects. But it’s hard to think of another president who scored a similar biomedical hat trick.
“I think he’ll go down in history as one of the greatest presidents, and I think because of these things he’s doing,” said Azra Raza, a Columbia University oncologist who consulted with Vice President Joe Biden on the cancer moonshot.
Simply launching a scientific initiative doesn’t make it a success, though. Kennedy did not live to see astronauts on the moon. Likewise, it may be many years before we know just how significant Obama’s efforts turn out to be.
Cori Bargmann, a neuroscientist at Rockefeller University and co-chair of the BRAIN Initiative working group, was hesitant to speculate how science would look back on the Obama administration because, she said, its projects have less in common than meets the eye.
The BRAIN Initiative is all about building tools to let neuroscientists pursue fundamental scientific questions. “Columbus sails into the Atlantic, Galileo points his telescope at the sky,” Bargmann said by way of metaphor.
The Precision Medicine Initiative, by contrast, is basically one giant experiment to look for how different genes influence people’s health. “It’s logistics to start with — how are we going to enroll a million people?” said Bargmann.
The cancer moonshot now has the clearest criterion for success: a cure.
The specifics for how the government will get to that goal are still pretty fuzzy, though. (Indeed, the project doesn’t even have an official name). But Raza said that one crucial element of the project will need to be a major push to develop cancer vaccines that can prime the immune system of cancer patients to make precise attacks on their own tumors.
Stephen Elledge, a biologist at Harvard who won this year’s Lasker Foundation Award for his work on how cells repair damaged DNA, thinks this so-called cancer immunotherapy is indeed an exciting line of research. But scientists still have a lot more research to do in order to see how many different cancers it can treat, and how to minimize its side effects. Scientists may stumble across new features of cancer that may delay that success.
But he thinks that a moonshot is the wrong metaphor. “Going to the moon is a singular event,” he said. “We knew where we were going, we landed on it, we were there. Cancer’s not one thing. It’s hundreds of diseases.”
There’s another problem with comparing a cancer project to the moonshot: money.
NASA spent $25.4 billion on the Apollo project, which is about $200 billion in today’s dollars. Only the Panama Canal rivaled it as a nonmilitary technological endeavor. The United States was willing to invest in it partly due to Cold War rivalries with the Soviet Union and partly due to a greater support for scientific research.
“Science was exciting, and people paid attention to it,” said Rita Colwell, who directed the National Science Foundation from 1998 to 2004.
All three of Obama’s projects are far more modest. Raza anticipates the cancer moonshot would cost in the billions, but some of that money would come from collaborating partners in the insurance and pharmaceutical industries. The BRAIN and personalized medicine initiatives are smaller, with annual budgets in the hundreds of millions of dollars.
Yet even in their modest form, these projects have uncertain futures. It’s not clear that they’ll enjoy the kind of long-term support that the Apollo program had after Kennedy’s assassination. “Science is under attack,” Colwell said, and so she wouldn’t be surprised if Obama’s projects get trimmed back further under future administrations.
“Everyone is skating on thin ice,” said Elledge. “If we put someone in who decided to balance the budget, everything’s going to go away.”