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S. Ward Casscells, MD Headshot

Fighting Cancer Is a Defense Department Obligation

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JOHN MCCAIN MADE IN AMERICA

At last week's Innovative Minds in Prostate Cancer meeting, the speakers included not only doctors, but patients. We patients also help review the grant applications of the scientists. We seek innovative proposals to cure or slow prostate cancer, or reduce its notorious pain, and the effects of treatments on sexual and mental functioning.

We celebrated the approval by the Food and Drug Administration (FDA) of denosumab, which decreases the risk of bone fractures, and of taxotere, which adds three months to life, and Provenge, which adds five months; and the expected approval this year of abiraterone and MDV 3100, which appear to add 4 to 6 months of survival. And we cheered the news that promising new medications are entering the final phases of clinical research: dasatinib, ipilimumab, cixutuxumab, sunitinib, TAK -700, tasquinimod, and XL-184.

This progress encourages more patients to enroll in clinical trials, which will increase pharmaceutical investment in this disease, and bring the best young doctors to the field.

But a silence came over the audience as one patient distributed a news release that quoted Sen. John McCain saying, "The aspects of the Defense Appropriations bill that need to be taken away, eliminated, are $300 million for medical research." He cited "$150 million for peer-reviewed breast cancer research... $80 million for peer-reviewed prostate cancer research... worthy causes, but none have anything to do with defending this country."

His comments prompted surprise, hurt, and anger, because many of the patients and doctors in the room (myself included) were veterans or active duty military -- attendance is mandatory for scientists and doctors who receive prostate cancer research funding through the Department of Defense (DoD).

It was the DoD that first required its grant recipients to work closely with patients. Not surprisingly the emphasis has been on near-term therapies rather than on the basic research pursued by the National Cancer Institute, where the focus is on molecular discoveries that may win a Nobel prize, but are unlikely to yield new treatments quickly. Consequently, almost all the testing of the new prostate cancer drugs above was supported by the DoD program and its partner the Prostate Cancer Foundation, rather than the National Cancer Institute (NCI). Disclosure: I worked at the parent National Institutes of Health for six years.

Moreover these trials have been cost-effective and timely: almost all were begun within a year of conception, (versus 2 1/2 years at the NCI). Having supervised the military health system for several years under Presidents Bush and Obama, I would like to believe these results reflect the military's focus on the mission, and on teamwork. But most of the credit goes to the men and their families, who are learning -- from the breast cancer and HIV communities, which are better funded -- to make a little noise.

But what about Senator McCain's assessment that prostate cancer research is not a core DoD mission? No one would argue that it is as essential as research on battlefield wounds or PTSD, but there is a benefit. Just consider current and former leaders who are prostate cancer survivors -- all veterans or currently serving -- like Senators Bob Dole, Ted Stevens, John Kerry, and John McCain himself; or Generals Norman Schwarzkopf, Colin Powell, and David Petraeus (and others, of equal and higher rank, have not been public about their disease). The program also supports the legendary Army cancer surgeon Colonel Dave McLeod.

And there is an obligation: in Vietnam, thousands of American servicemen were exposed to Agent Orange, which doubled their risk of prostate cancer.

Some object that "prostate cancer is a disease of old men." But it increasingly strikes men in their forties, as it did me. And all too often, grandfathers today assume the role of father, when fathers are no longer around.

Finally, there are the costs. I know there are more opportunities to find savings in military bureaucracy and superfluous weapons -- and even in medical practice -- than in medical research. But let's estimate the payback: if the 32,000 American men who will die of prostate cancer this year can receive even one of the new drugs that add four months of life, and if half are working men, and pay $15,000 a year in federal income tax, that's $80 million, enough to pay for the next year of Defense funding of prostate cancer research.

Some will be in a position to do even more. Because of Defense (and PCF) funding, and Dr Chris Logothetis at the University of Texas MD Anderson Cancer Center, I was able to continue my medical research and take care of my patients (including my fellow soldiers in Iraq), to serve in government, and start three companies that employ 1,500 taxpaying Americans. Many have done more, like former Navy Commander, NCI Director and FDA Commissioner Andy VonEschenbach. And another is likely to cure this disease.

Senator McCain: like you, we have taken our hits, but are still fighting. Lend us a hand, shipmate.

Colonel (Dr) Casscells (ward.casscells@gmail.com) is the Tyson Distinguished Professor of Medicine and Public Health at the University of Texas, and former Assistant Secretary of Defense (Health Affairs)

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