Cancer Efforts Face Setback as Ongoing Challenges to Scientific Authority Continue

Consider the following and then ask yourself if you can imagine more difficult circumstances for scientific and public health leadership in America: first, the most highly respected infectious disease specialist in the United States in a virtual mud-slinging war of words with a physician member of the United States senate, and second, the chairman of the Department of Chemistry at one of the nation’s leading research universities being found guilty of felony charges by a court in Boston.¹

Prominent articles published in major national newspapers have outlined in excruciating detail the communication deficiencies emanating from—what had been until the recent past—the most important public health organization in the world, the CDC.^2,3 However, concerns with the status of the public health community in this country are not limited to the CDC, with the total number of individuals across the nation responsible at a local level for these activities decreasing from 184,000 in 2008 to 153,000 at the present time.⁴

A final, most disquieting observation is that during the ongoing COVID-19 pandemic—which just exceeded the loss of more than 900,000 American lives—the United States has been without a permanent leader of the FDA for more than a year. It was not until February 2022, that the Senate committee narrowly confirmed the appointment of the remarkably experienced, talented, and trusted individual, Robert M. Califf, MD, MACC, to this vitally important position.⁵

These events appear against a background of the remarkable scientific and organizational outcome associated with the stunning efforts of the American academic, pharmaceutical, and health care industries, which resulted in the rapid creation, mass production, and distribution of hundreds of millions of doses of extremely safe and effective COVID-19 vaccines, with the pending approval of a vaccine product for infants aged 6 months to 5 years in limbo after new data has been requested from the FDA delaying a scheduled advisory meeting.⁶

Yet this country falls far behind other developed nations in the percentage of its population who have received essential COVID-19 vaccinations and leads the world by substantial figures in the number of COVID-19–related deaths.⁷ It is also relevant and frustrating to acknowledge that in a pandemic that knows no state or regional boundaries, different decisions with potentially profoundly impactful societal consequences are left to local/state officials (ie, when and where outside or inside masking will be required or whether mandates for vaccination or testing will be implemented). Appeals of such mandates are being made to a fragmented US court system whose legal opinions (excluding the United States Supreme Court) are limited by geography and may be quickly and radically changed by a higher court, with an almost certain future appeal to an even higher court.

Individuals in the scientific community have acknowledged deficiencies in the provision of strong leadership and solid communication during the pandemic, with recent commentaries noting concerns with scientific integrity⁸ and suggestions of unhelpful infighting between critical national public health agencies.⁹

Despite such appropriate statements, we also see the departing leader of the National Institutes of Health lamenting that in the current political environment, “objective truth is under attack,” with the unfortunate additional commentary, “[in regard to] COVID-19, this has taken the form of unsubstantiated claims about the origins of the disease-causing coronavirus.”¹⁰ Such rhetoric is most unhelpful, especially in view of the complete absence of Chinese government cooperation regarding its viral laboratory in Wuhan¹¹ and admittedly controversial but quite disquieting evidence regarding the activities and actions of members of the international scientific community in this complex series of events.¹²

What are the effects of this scientific turmoil on the cancer establishment, patients, and the future of cancer care? In direct response to this question, one must note the impact of the COVID-19 pandemic on the care and outcomes of patients with cancer. A recent study involving more than 2500 patients with cancer with a SARS-CoV-2 infection demonstrated the infection’s substantial effect on their care, survival, and risk of long-term effects, including respiratory symptoms and fatigue.¹³

Scientifically flawed and operationally delayed or ineffective approaches to ending or mitigating the pandemic will only prolong and potentially worsen the now-known negative clinical effect on cancer treatment resulting from this serious viral infection. In addition, the pandemic has resulted in a delay in the performance of cancer surgery, as revealed in a prospective international study involving 15 tumor types.¹⁴ The effects of such delays on cancer-related survival remain to be defined in future studies.

It is also notable that President Joseph R. Biden has recently announced an initiative to reduce the risk of cancer death by 50% within the next 25 years.¹⁵ Unfortunately, this laudatory and strikingly ambitious goal comes without a specific request of Congress for additional cancer research funding or enhanced delivery of care. Rather, the focus appears to be on optimizing screening and likely encouraging cancer prevention strategies.

Realistically, the only possible way this goal can even be approached is to substantially increase and enact effective societal efforts in cancer prevention, including smoking cessation, weight reduction (with evidence the obesity epidemic has only worsened during the pandemic¹⁶), and the widespread use of known and to-be-developed highly effective cancer vaccines (eg, human papillomavirus, hepatitis).

However, any such multidecade campaign to change habits or decrease recognized resistance to any form of vaccination will require a major increase in societal trust for the scientific and public health communities in this country, as well as in its leadership. In fact, the level of trust in governmental agencies and interpersonal trust (among individuals for the anticipated activities of others) has been suggested to be a critical factor in the objectively measured success in COVID-19 preparedness among 177 countries examined.¹⁷

Is this goal stated by the president realistically achievable? For the good of our entire society, it is not unreasonable to conclude that failure in this effort is not an option.

References

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2. LaFraniere S, Stolberg SG, Weiland N. For C.D.C.’s Walensky, a steep learning curve on messaging. New York Times. January 5, 2022. Accessed February 9, 2022. nyti.ms/3uEqugj
3. Schwartz F. Embattled CDC rethinks pandemic response after criticism of guidelines. Wall Street Journal. January 28, 2022. Accessed February 9, 2022. on.wsj.com/3rBupZE
4. Wallace M, Sharfstein JM. The patchwork U.S. public health system. N Engl J Med. 2022;386(1):1-4. doi:10.1056/NEJMp2104881
5. Robert M. Califf confirmed as commissioner for the US Food and Drug Administration. Duke University School of Medicine. February 15, 2022. Accessed February 16, 2022. bit.ly/3rSbVEk
6. Coronavirus (COVID-19) update: FDA postpones advisory committee meeting to discuss request for authorization of Pfizer-BioNTech COVID-19 vaccine for children 6 months through 4 years of age. News release. FDA. February 11, 2022. Accessed February 16, 2022. bit.ly/352d03c
7. Holder J. Tracking Coronavirus vaccinations around the world. New York Times. Updated February 9, 2022. Accessed February 9, 2022. nyti.ms/34y6dOV
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9. Topol E. It’s not too late. Science. 2022;375(6578):245. doi:10.1126/science.abo1074
10. Collins FS. Lessons learned from leading NIH. Science. 2022;375(6577):123. doi:10.1126/science.abn7743
11. Page J, Hinshaw D. China refuses to give WHO raw data on early Covid-19 cases. Wall Street Journal. February 12, 2021. Accessed February 9, 2022. on.wsj.com/3Ji2gww
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13. Pinato DJ, Tabernero J, Bower M, et al; OnCovid study group. Prevalence and impact of COVID-19 sequelae on treatment and survival of patients with cancer who recovered from SARS-CoV-2 infection: evidence from the OnCovid retrospective, multicentre registry study. Lancet Oncol. 2021;22(12):1699-1680. doi:10.1016/ S1470-2045(21)00573-8
14. COVIDSurg Collaborative. Effect of COVID-19 pandemic lockdowns on planned cancer surgery for 15 tumour types in 61 countries: an international, prospective, cohort study. Lancet Oncol. 2021;22(11):1507-1517. doi:10.1016/S1470-2045(21)00493-9
15. Fact sheet: President Biden reignites Cancer Moonshot to end cancer as we know it. News release. The White House. February 2, 2022. Accessed February 9, 2022. bit.ly/3oFthlJ
16. Khubchandani J, Price JH, Sharma S, Wiblishauser MJ, Webb FJ. COVID-19 pandemic and weight gain in American adults: a nationwide population-based study. Diabetes Metab Syndr. 2022;16(1):102392. doi:10.1016/j. dsx.2022.102392
17. COVID-19 National Preparedness Collaborators. Pandemic preparedness and COVID-19: an exploratory analysis of infection and fatality rates, and contextual factors associated with preparedness in 177 countries from Jan 1, 2020, to Sept 30, 2021. Lancet. Published online February 1, 2022. doi:10.1016/S0140-6736(22)00172-6