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The Worst Brings Out the Best

Andy Von Eschenbach Samaritan Health Initiatives
June 25, 2014
The 20th Century was replete with natural and human disasters that caused society to devote itself at all costs to make the world a better place. Most noble among these efforts was our nation’s commitment to rid the world of the tragic disease called cancer.
By 1970, cancer was terrorizing almost every American family as it inflicted terrible suffering and for most patients an almost certain death sentence. Its solution was either unknown or, when known, associated with dire consequences. Cancer’s toll on society went beyond human suffering to threaten economic disaster.

But then the worst brought out our best.

Across multiple sectors the resolve emerged to foster research to understand the problem and to accelerate the development of innovative and more effective treatments. Efforts were made to mobilize resources for earlier detection and prevention and to assure we had the optimal strategies and policies in place to solve this scourge on society.

Physicians, nurses and other health care professionals—along with patient advocates, policy makers and politicians—coalesced, leading to the passage of The National Cancer Act of 1971.This extraordinary legislation codified our national agenda and vested in the National Cancer Institute the authority and resources to lead a collaborative fight against cancer.

Four decades of progress now fill libraries with new knowledge and the pipeline of innovative new therapies is growing at an exhilarating rate. Most importantly, cancer deaths are down, with cures now assured for a significant subset of the disease.

There’s more to be done and we can be optimistic about the future; however, it’s now a future darkened by the appearance of a new specter: the threat of disruption of our brain rather than our body.

From autism to Alzheimer’s, from depression and addiction to traumatic encephalopathy and Parkinson’s, all around us we are witnessing the alarming rise in neurocognitive and neuro- degenerative diseases that, just like cancer, destroy lives, disrupt families and place an ever growing economic toll on society. Once again the call has gone forth for this worst of scourges to bring out our best.

As we mobilize to meet this current challenge we can learn from both the striking similarities and differences between the challenge of cancer and the challenge of brain disorders.

An MRI scan of the research subject’s brain is displayed on a computer at Penn State’s 3T MRI facility. By collecting data through MRI scans, the
research team continues to learn more and more about age related memory loss. Flickr: Penn St.

The Parallel Path to the Brain
In 1971 when America committed to a “war against cancer” our nation mobilized its intellectual capital by expanding the funding of cancer research. We also created a unique infrastructure that today is now counts 65 National Cancer Institute-designated cancer centers that are leading the world in basic, translational and clinical cancer research. In addition we have witnessed the success of clinical trial cooperative groups, research consortia such as the Specialized Programs of Research Excellence and a myriad of other federally sponsored initiatives in cancer control.

Among many stunning outcomes of our national commitment to fight cancer has been the breathtaking acceleration of research and clinical technologies that have enabled the understanding of the disease at its genetic, molecular and cellular level—resulting in an explosion in development of innovative and more effective cancer therapies.

The success story of progress in the conquest of cancer can now serve as a paradigm for conquering the disorders of the brain and central nervous system. Embarking on a strategic plan drawn from the lessons learned in our four-decade cancer fight will assure our accelerated success in unlocking the secrets of the structure and function of the brain and the development of innovative interventions to alleviate the burden of disorders of the brain.

The exercise to understand the root causes of success in the conquest of cancer has already revealed a significant challenge and opportunity. Cancer progress was fostered by accelerating the systematic study of human clinical material. Human cancers in patients were readily deposited in the experimental laboratory while at the same time the secrets of the brain have been locked in a vault and almost totally inaccessible. Nature, in her wisdom to protect the most vital of all of our organs, encased the brain in an almost impenetrable fortress that is our boney skull. Until recently, scientists could only guess at the mystery of the functioning of the brain by examination of human tissue at autopsy or by a surgical biopsy of a brain tumor. Today a revolution in research is occurring because that limitation is no longer true. Dramatic progress in imaging and advances in laboratory technologies have dramatically changed the prospects of success in understanding the brain. The living human brain is now accessible for study!

The tools of genomics and proteomics are unlocking the secrets of blood and spinal fluid biomarkers that are indicative of the disruption of the brain structure and function. Perhaps the most astounding of all progress in tools to study the brain has been in the field of molecular and functional imaging.

Rapidly emerging modifications of magnetic resonance imaging now make possible the visualization of structure and function of the brain and its myriad of cells and circuits at amazing levels of precision and sophistication. These technologies have become our virtual microscope for the study of each and every disorder we wish to understand and remediate. And these technologies also hold extraordinary promise as therapeutics.

The scientific, medical, economic and societal imperatives of brain disorders combined with the revolutionary progress in our ability to study the living human brain now can bring out the best of us and our national resolve. We must once again:

  • Formalize a National Strategy. We must mobilize the intellectual and financial capital necessary to address this latest and perhaps greatest threat to humankind. Recently both the NIH and President Obama through the BRAIN Initiative have laid out a set of recommendations for accelerating progress in neuroscience.   This vision and the key priorities contained in these reports are being developed and will surely be debated and refined, just like similar reports and priorities on cancer were debated over 40 years ago.

  • Develop Policy and Legislative Reforms to Accelerate Investment.   Do we need to change the tax laws to accelerate and foster investment? This is a question that policy makers must consider and debate. They should also consider changes to intellectual property laws that promote the sharing of ideas and data, and modifications that allow for greater collaboration between the public and private sectors. These are pressing needs to not only expand but also coordinate our research efforts. There are exciting opportunities if we incentivize industry to share data and intellectual property in a fashion that leads to rapid development of sophisticated innovative therapies.

  • Engage the Public.   We must effectively engage the public in an effective campaign of understanding and participation in the process of clinical research and dissemination of effective interventions that prevent and treat diseases of the brain—and even potentially restore brain health.

Not until all these priorities and processes are debated, decisions are made and appropriate infrastructures are developed and put into place will our goals be achieved and economic opportunities encouraged in a way that drives even more innovative technologies and therapies to understand the brain and treat brain disorders.

All these efforts seem daunting, and they are. But the goals are achievable and we must get to work to wipe out this latest threat to our humanity. Having experienced the war on cancer first hand, I know we can succeed. The worst always brings out our best.

Andy von Eschenbach is former commissioner, U.S. Food and Drug Administration; president, Samaritan Health Initiatives; former director, National Cancer Institute.

The Worst Brings Out the Best was originally published on Ideas Lab