ice President Joe Biden spoke with STAT on Friday about the cancer moonshot: what he’s learned about cancer politics, the importance of cancer prevention, and what he plans to do next.
He also addressed Hillary Clinton’s recent health and the accompanying media scrutiny, saying he thought she’d “handled it pretty well.” Biden was himself once a candidate with a serious medical history; he nearly died of a brain aneurysm in 1988 and released nearly 50 pages of medical information in the 2008 campaign.
“I think I may be different than most of my colleagues overall,” Biden said. “I’ve just found that, in my career, just transparency and disclosure works the best, even when there’s bad stuff.”
During the interview, Biden was accompanied by Greg Simon, the executive director of the task force overseeing the cancer research initiative.
The full conversation is below, lightly edited for readability and length.
I wanted to start off by asking you about the future of the moonshot because a lot of people who I talk to, who want this to succeed, say: ‘You know, this is great, but if we don’t keep it going beyond the end of the year, we’re not going to accomplish what we want to accomplish.’
One way or another, we, I, are going to keep this going. I guarantee you. To my surprise, surprise in the sense it was of out of the blue, when I was taking Hillary to my hometown of Scranton and showing her around her grandpop’s hometown, too, she announced to several thousand people at a rally that, “I’m gonna ask Joe to continue to run the moonshot for my administration if I win.”
Whether I do that or not explicitly, I don’t know yet. There’s a number of institutions and potential foundational work that’s out there as well. I’ve been meeting with an awful lot of people. What I’ve committed to do is, I’m going to stay involved in this effort as long as I’m alive. And there’s nothing indispensable about me, I’m not trying to make it like only I can do it.
But one of the things that I’ve figured out, I didn’t believe at first, that I can bring to the dance here, is that I’m able to gather people up and I’m able to help break down barriers and the good news is that I think whether they’re oncologists, universities, drug companies, patients, they know the depth of my commitment and passion, so I think that gives me some credibility to say things you might not otherwise be able to say or do.
Well, I know you try to be humble about it and your own role. But people I talk to say that the fact you’ve become so focused on this is important and does help drive a conversation about it and a lot of emphasis on it.
What would it take or what kind of role would you want to have if you were to stay on in a Hillary Clinton administration?
Well, I’m not going to stay on in the administration. What Hillary talked about is, as I understood it, me being able to have the same authority over elements of her administration from the outside that I have now from the inside, to be able to coordinate those efforts.
We haven’t talked about it yet. And, as my mother would say, I’m not counting my chickens before they’re hatched in terms of I think she’s going to win. But I’m also meeting, Greg and I met with a billionaire philanthropist who has invested hundreds of millions of dollars in this effort. He rode to the airport with me in another city I was in recently, asking me whether I would stay engaged and involved and taking over some or at least engaging with existing philanthropic efforts relating to cancer.
I’m meeting with some of the leading people in the country, leading scientists in the country have asked to meet with me to talk about what role I might play post-January 2017. So I’m going to stay engaged, exactly how I don’t know yet.
OK. I have to ask about the other side of this equation. Donald Trump hasn’t talked a lot about medical science. I don’t think he’s talked about the cancer moonshot specifically at all. He has talked a little bit about the reality of scarce resources when it comes to federal spending on medical research.
What do you think a Trump presidency would mean for the moonshot specifically and for medical science more generally?
Well, look, I hope that if he were to somehow pull this off, I mean this sincerely now, I would hope he would bring, attract, out of just pure patriotic necessity, some very good minds to let him know that there is a lot of money we’re spending in the federal government, billions of dollars on medical research, and there is a consensus.
And I’m hopeful that we will get significant funding, additional funding for the moonshot this year. There are leaders in the United States Senate, Republicans like the senator from Tennessee, Lamar Alexander. Congressman [Fred] Upton. Not just Democrats, but Republicans who understand that this is not the time to do what the Freedom Caucus guys are doing. The Freedom Caucus guys are arguing we shouldn’t even invest in preventing Zika. “It’s not the government’s role.”
I don’t think he’s that crazy. You know, we can afford all this.
I took note today that you emphasized prevention several times. Because something I’ve heard a lot and my colleagues have heard a lot from folks in the cancer community is they were a little concerned at the outset that prevention wasn’t being given enough priority. Have you heard those concerns and are you responding to that?
Oh yeah. Oh no, we have. We’ve met all over the country with the prevention community. Here’s the thing: Prevention, a lot of it is not rocket science. We know that if we had cessation of smoking in America, you’d save millions of lives.
We know that everything relating to the environment, from the water you drink to the air you breathe to the soil that you till, has a real impact on, an environmental impact on causing cancers or exacerbating cancer.
But that takes political will. We know there’s a relationship between obesity and stomach fat and cancer. But they require national movements that are to change culture and change the attitude, which we support strongly.
What we’re focused on in the moonshot is there are still going to be people, 50 percent of the people out there or more, who are going to get cancer that have nothing to do with the fact they’ve ever smoked or been exposed to smoking, that have nothing to do with the environmental impacts, that are genetically consequential to their genetic makeup.
So the research, there are two kinds of research. A little bit like what you guys do in researching how to expand your footprint. I’m not being a wise guy now. The way everything from a university researches how to recruit, to attract students, that’s the research that is designed to impact on public opinion and public behavior, public perception. That’s really important.
But the main focus of what we’re doing beyond encouraging that kind of mindset change, is there’s another aspect to prevention. And that is detection. And the acquisition of essentially vaccines to prevent. So you know, measles vaccines are prevention, they prevent people from getting measles. You still want to put yourself in a position where you’re not exposed to measles, you’re in good health, you don’t get run down, etc. But so there are things that relate to prevention, like access to screening, like the thing we did with the Cleveland Clinic, where if we, for example, have screening for lung cancer made more available, more equitably distributed, in neighborhoods where we know there’s concentrations, then we can prevent as well.
So there’s the generic prevention pieces, like don’t smoke, don’t drink 20 Big Gulps in a day and don’t end up with four layers of fat tissue around your belt line. That’s one category and that’s critically important and we support those efforts.
The second category is the prevention technologies. For example, Greg met when I left L.A. at the last thing I did, how many people? [Greg Simon: “About 15 people.”] Fifteen people representing blood biopsy initiatives. The good news was, there was some collaboration going on among them now, partnerships and learning from each other. But blood biopsies can prevent invasive biopsies, but by finding a marker in your blood. But they can also prevent cancers. Some cancers are so slow-growing that they take two, five, 10, 20 years to grow and with these blood biopsies it leaves the potential that you can prevent them from ever occurring by detecting a marker in the system and treating that now.
There’s also new technologies. Like we were out at Huntsman, and they did a lot of great work on hereditary cancers, particularly colon cancer. And so what they figured out is that they found markers in the genomic makeup of individuals. They go back and encourage people, in terms of prevention, do you have history of this in your family, how often do you have it, how many generations, that makes you more susceptible, come in and get this test for the marker. Oh, what’s the marker called for the likelihood for colon cancer? [Greg Simon: “Lynch syndrome.”] Lynch syndrome.
Oh right, which was in the Blue Ribbon Panel report.
But they were doing that out at Huntsman, right? So I met a guy, for example, he was encouraged to have these colonoscopies, but also they detected Lynch syndrome in his family history. And they said, “Well, you’re likely to be somebody who’s going to get it, so here’s what you do.” Instead of waiting until you’re 50 to get a colonoscopy, you should be getting one when you’re 19 or 20 or 17, and you can take preventative action from ever getting to the point that you get colon cancer.
So there’s a lot going on that relates to early detection and new technologies and refining old technologies that can get early on, for example, the onset of lung cancer, the onset of other cancers. That’s a long answer to your question, that there are basic fundamental prevention techniques that — just don’t do it.
You talk a lot about cancer politics as well. I know that’s been a favorite thing of yours to mention when discussing the moonshot. I’m curious, more than six months in at this point, have you gotten any specific evidence that the culture is really starting to change and when the vice president isn’t watching, people are going to continue to act differently?
I’ve been stunned. I did not expect things to move quite as rapidly as they have. One of the people I appointed to the Blue Ribbon Panel, a really first-rate guy, one of the few I knew personally because he treated me for something else, head of a leading medical school, a department in a medical school. And Greg went to talk to something he’s working on, and he said to me: “I wanted to call you and tell you what a great job Greg did.” He said: “Joe, I want to tell you. When you put me on that Blue Ribbon Panel,” he said, “I was flattered.” But he said: “I know all the guys on there. I thought there would be just nothing but pushback.” He said: “I’ve never seen as much collaboration in my life. It stunned me.”
I can give you, and Greg, and Don [Graves], can probably give you more examples of, a dozen examples of people who have said, “Whoa, I didn’t think we’d get this far.” Like you had nine drug companies, or seven drug companies, agreeing to make available for basic research all of the drugs they’ve developed, all of the therapies they’ve developed. So you as a young researcher come along and use any of their drugs for multiple therapies, what do you call it? [Greg Simon: “Combination trials.”] Combination trials, etc. Because what we’ve done is we’ve worked out essentially a licensing agreement ahead of time.
It’s like you go and put money in a jukebox and you play a song by whomever, you don’t have to get anybody’s license to the singer to play the song. A license arrangement has already been made. Well, now it’s gone from, what, in terms of the number of drug companies [Greg Simon: “I think it’s upwards of 20.”], now there’s 20. That would have never happened before. They’re figuring out, hey, look, maybe cooperation can be a win-win for us. If this kid comes along and finds the use of my therapy and another therapy, we already have a licensing deal, I’ll make money off of that.
So I’m not saying all of a sudden there’s this selflessness that’s occurred. But the medical culture, I think, was a little embarrassed, at least in my view, because I don’t think they realized how different their culture was than other sciences. I remember down speaking to five, six thousand members of the AACR, I think it was that many. A gigantic number.
And I said, you know, guys, I said, the kind of example I used today. “If we give an astronomer to study the effects of zero gravity on longevity, and they finish their report, they have to immediately make it available to the whole world. You guys, you guys hide it. You don’t do anything with it. First of all, half of you aren’t reporting like you’re supposed to report for these clinical trials. Secondly, some of you, even in your report, you don’t give any detail. What you’re doing is you’re hiding behind publications for a year, the publications cost from $20,000 to $100,000 a year to subscribe to some of these outfits. Then you don’t give the whole megillah here. So what’s with you guys?”
And I fully expect we’re going to get booed. And when I said, “And ability to qualify for grants from NIH depends not totally on your scholarship or your ingenuity. It depends on whether or not you have somebody’s already recognized, already has a laboratory, and then even then there’s no sharing.” When some breakthrough comes, it doesn’t come as the Simon-Biden. I’m the young guy — I wish I were — Greg Simon, he’s a well-known guy, and I contributed a lot to it. I don’t get recognition and the recognition comes from publication.
And so there’s a whole culture that I really think a lot of these guys went like: “Oh well.” I mean, they kind of knew but they didn’t know. Quite frankly, I think sometimes holding the mirror up can have a pretty profound impact. My sense is, for example, when the New England medical journal, I talked about the big data. The guy says, I’m paraphrasing, “Biden’s encouraging data parasites.” Well guess what, he got the living crap kicked out of him. I didn’t say a word. I never met the guy. It was all some mea culpa, mea culpa, mea maxima culpa. I’m sorry, I’m sorry, I’m hardly sorry.
By the way, a lot of these guys and women at outfits like Anderson and others — they’re under enormous pressure, implicit pressure, not to share because they want it to come out of Anderson. Well, if they share, and it’s like now, Anderson and Jefferson in Philly, that’s not, no. I joked before, you might have heard this story, if you have, stop me — the story about Lawton Chiles, Senator Chiles.
I don’t know that I have heard that one.
Well, he was a great guy, he got elected in 1970s. His nickname was Walkin’ Lawton. He was smart as hell. He used to talk about that he was the he-coon, meaning raccoon, among Cajun boys. He would talk about, he would downplay, he’s just a good old cracker and everything. Smart as hell. Went on to be governor as well in Florida.
I remember in 1973, he got elected in ’70, he had been insurance commissioner in Florida. We’re riding over in the subway in the Senate, to go to the escalator. You know the subways have the plastic shield in the front. Subway comes to a stop and the escalator’s there. At the top of the steps, to my recollection, was Ben Bradlee of the Washington Post and Woodward and Bernstein standing at the end of the escalator. And he turns to me, he said: “Joe, why do I get the feeling that those boys are looking at me like I’m a Pulitzer Prize about to be won?” I’ll never forget that.
Well, an awful lot of the guys and women I met sort of walk by the mirror and go: “Nobel Prize.” You don’t usually win the Nobel Prize in their minds by sharing. I’m exaggerating to make a point, but I really do think two things are happening.
I think one, there’s a recognition that, just their sense of obligation and the reason why they took the Hippocratic oath, the breakthroughs are on the horizon and they’re more likely to occur faster if there is collaboration. But two, I think they’re realizing that there is plenty of credit to go around. That they can be part of something bigger, rather than waiting to be the only guy or woman on the stage. They can be part of something that’s much, much bigger. I don’t know how to explain it better than that.
By the way, I can’t prove anything of this. It’s just instinct.
We may be kidding ourselves, but there’s a lot less pushback now on me. Maybe it’s because they think I’m going to go away, maybe they think this is just a phase of the moon. I don’t know. But I don’t think so. I’ve just got a feeling. I think by the president looking to me to do this now, it’s allowed me, because I have a platform and because I’m not running, to really raise the public profile and give people hope that we can actually do something.
Because so many people, I haven’t gone and looked at the polling data lately, but you ask people, I bet if you ask them three years ago, do you think we can cure cancer? You get: “Well, I don’t know.” Whatever that number was five years ago, I bet you it’s two, three, four times that now. Just because, it’s like: “Oh, oh maybe. OK, maybe. Maybe.”
Would you indulge me one non-moonshot question? I feel obligated to ask about this because of the news of the last week. You have an extensive medical history, and in 2008 you released a lot of medical records detailing that.
I’m curious if you’ve spoken with Secretary Clinton about her recent health.
No, I haven’t had a chance.
How do you think she’s handled it?
Well, I think she’s handled it pretty well in the sense that she’s laid out everything from, you know, what happened when she fell, what happened with the blood clot, that she’s taking Coumadin. I had a pretty extensive medical history. And the reason I put it out is because a lot of people with my medical history didn’t make it. And I wanted to make sure people know that what I had you either fix or die. You know what I mean? But if you fix it, you fix it. But I gave all my records.
But then again, look, I have a different, I don’t know. I think I may be different than most of my colleagues overall. I’ve just found that, in my career, just transparency and disclosure works the best, even when there’s bad stuff.