Harder Than Building a Space Station


WASHINGTON — The director of the National Institutes of Health, Harold Varmus, spoke a painful, simple truth recently when someone asked him why we can build a space station but can't cure breast cancer.

We know how to build a space station, he said, but don't know how to cure breast cancer. Money and talent, Dr. Varmus continued, should be concentrated on acquiring the knowledge that can lead to a cure. And that, he insisted, requires a research strategy that to scientifically untrained eyes may appear remote from the urgent task of curing breast cancer.

After many years of neglect, preventive cancer research has finally gained a high priority, with many studies in progress on environmental factors, including diet, in causing and preventing cancer. And the knowledge that exists about treating cancer, as inadequate as it is, has been adopted into widely used treatment techniques. But the disease rages on.

Today, the shortfall in cancer research may be in fundamental science -- painstaking inquiries into basic biological processes that often drift down blind alleys, but sometimes turn up golden bits of knowledge. Studies of cell growth in fruit flies may be as valuable as research on human cancer cells, Dr. Varmus preaches, emphasizing that the lack of a cure is attributable to scientific ignorance.

True. But the public and politics are impatient and frequently suspicious of the curious ways of science, especially in regard to the most dreaded disease. As a result, the po- The political zest for medical miracles can open the treasury,but politics alone won't produce a cure for breast cancer.

litical heat is rising for science to emphasize treatment and hurry a cure.

In this era of austere budgets, breast-cancer research is one of the few federal programs singled out for significant growth, rising from $310 million to nearly $400 million in one year, with more sure to come. Ravenous, as usual, for money, cancer researchers welcome the increases. But they also fear unrealistic expectations among politicians as well as a tendency to set priorities and goals that are out of whack with scientific realities.

The political zest for medical miracles can open the treasury, but it can also squander scarce money that could be put to better uses in health research. Two years ago, under congressional pressure, the previous management at the National Institutes of Health hurriedly put together the attractively named NIH Women's Health Initiative.

A great panorama of scientific research, calling for studies of 160,000 women over 14 years, at a cost of $650 million, the initiative was intended to make up for years of neglect in research relevant to the special health needs of women. Worried about signs of haste in putting the program together, Congress asked a committee of independent scientists to evaluate the program. The evaluation, conducted under the auspices of the Institute of Medicine, concluded that the health studies were poorly planned and, despite lavish financing, would yield paltry results.

The message was that the loudly touted initiative gave the comforting appearance of doing something beneficial for women's health but was actually siphoning off money that could used more effectively for that purpose.

In the face of a dreadful disease that afflicts people here and now, long-term basic research looks like an unreasonable indulgence -- akin to studying the chemistry of combustion when fires are raging. But the cruel statistics of cancer show that treatments for many types of the disease have barely improved over the past two decades. The reason, as scientists repeatedly explain, is insufficient knowledge.

The strategic choices were spelled out last December by Dr. Varmus in a talk to the Conference to Establish a National Action Plan on Cancer, convened by Health and Human Services Secretary Donna Shalala.

Arguing that ''we should continue to devote most of our efforts to a broad understanding of cell growth and function,'' the NIH director cautioned: ''The alternative is to decide that we now know enough about such fundamental aspects of cells that it is time to commit ourselves to improving the diagnostic and therapeutic strategies now in use or to fashioning new ones from the few pieces of the puzzle already in hand.''

Clearly, we don't know enough. And it would be calamitous if politics deluded itself into thinking we do, and pushed ahead with policies grounded in desperation and ignorance.

Daniel S. Greenberg is a syndicated columnist specializing in the politics of science and health.

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