Investment in research as a national priority

The first time a nation made research a national priority was probably in 15th Century Portugal. While the Spanish built large galleons to ferry gold from the New World to Madrid, the Portuguese built small caravels to return with something more valuable: information. A National Navigational Institute was established in Sagres, where Prince Henry collated the raw data being delivered by the caravels: latitude, longitude, ocean depths, coastal landmarks, and current. Slowly, the caravels moved down the western coast of Africa, overcame the nautical and psychological obstacle of rounding the Horn, and slowly pushed up the Eastern coast. Each new voyage built on the incremental knowledge gleaned from the last and the certain knowledge of the ultimate goal. When Vasco DiGama reached India, the price of pepper in Venice plunged. A new route to the spice trade had been established, a route which did not require the payment of costly tributes at regular intervals along the land route, and a wealthy Empire which would last two centuries was established. The National Institutes of Health represent this nation's commitment to the importance of basic research. In the history of all mankind there has never been a greater, more consistent, and publically funded investment to understand the biology of human disease. Like the caravels, research laboratories and clinical trials have steadily moved forward with incremental progress toward a clearly visualized goal-the prevention and treatment of human disease. In the area of cancer research, we have clearly rounded the horn. The understanding of cancer at a basic level has now brought new targets for cancer treatment into sharper focus. We now understand cancer as a genetic disease. No longer do our therapies target a single cancer feature, uncontrolled growth. Instead, new vaccines like MART-1, gp100, p53 and ras peptides are targeting the cancer cell's ability to evade immune surveillance. Anti-angiogenesis agents like endostatin, Col-3, and angiostatin promise to inhibit the tumor's ability to make new blood vessels and convert cancer to a static, chronic disease. One advantage to these new angiogenesis inhibitors is their action against normal endothelial cells, rather than targeting the cancer itself. For this reason, the genetic plasticity of tumor cells, and their ability to develop drug resistance, is no longer relevant. The Clinton administration has recently announced its intention to add $4.7 billion to cancer research, essentially reaffirming the nation's initial investment of the National Cancer Act. The commitment could not have been better timed. When grants are funded at the 20th percentile, peer review does not work well. And when managed care makes clinical research nearly impossible, we erode the purpose of basic research and undermine the essence of our mission: the prevention and cure of human disease. The Administration's investment will prove to be wise. With the knowledge at hand, and the ability to translate this knowledge into new diagnostic, preventive and treatment approaches, we can begin to realistically vision cancer cures. A new era is at hand.