When cancer becomes history

Funding: A wise use of Maryland's tobacco settlement money could lead to startling advances in the treatment of the deadly disease.

March 12, 2000|By William R. Brody

THE YEAR is 2025. At the Johns Hopkins Comprehensive Cancer Center in the Harry and Jeanette Weinberg Building, oncologists meet with patients, review medical histories, analyze lab results and recommend treatment. The center is full, yet one vital factor is fundamentally different from when the building opened at the turn of the century: the patients.

They are, for the most part, much less sick -- and enjoy a far better prognosis -- than the patients of 25 years before. Many of them look perfectly healthy. Thanks to groundbreaking research at Hopkins and other cancer centers around the world, the typical cancer patient receiving care in 2025 has been diagnosed far earlier than was ever possible.

In the year 2025, it's likely that few will remember that these advances in cancer research resulted from decisions made in the year 2000. That's when Maryland's General Assembly debated ways to spend the state's share of the national tobacco settlement.

By wisely earmarking part of the money for research today, the General Assembly can make a radical change in the future. That wise decision would be apparent in the advances seen in 2025 -- advances that would make it possible for some people to receive prophylactic treatment before cancer occurs, based on their genetic blueprint and personal history.

Another advance would make it possible for cancer to be diagnosed by routine blood, urine and other tests that, in 2025, would be a standard part of the annual physical that all health plans require. When the precursors of cancer are identified, specialists employing best practices protocols consult with patients to tailor a treatment regimen least disruptive to their work and social lives. The savings to the economy of Maryland in medical expenses and sick leave would amount to millions of dollars each year. Many thousands of lives would be saved in 2025 as a result of the General Assembly's wisdom in 2000.

In fact, twenty-five years into the 21st century, many cancers would be curable; most others would be medically managed using a powerful array of highly specific drugs delivered at numerous key points in the cancer cycle.

All of this -- the tests, the drugs and other therapies, the understanding of the cancer process -- would have come about through basic and clinical research. The explosion of knowledge that coincided with the revolution in medical genetics and the clinical trials based on these discoveries would have made it all possible.

In the year 2025, as the state prepares to receive the last installment of an approximately $4 billion tobacco settlement spread out over a quarter-century, it would be able to congratulate itself for the wisdom with which it allocated the funds. But that wisdom, which would seem patently self-evident in 2025, would not have been so readily apparent in the year 2000.

At the turn of the century, there was great public debate about what should be done with the funds. The governor's novel plan to devote the bulk of the tobacco settlement to making Maryland a national leader in the fight against cancer was widely challenged, as visionary ideas often are. Many competing worthy projects were put forth. At a time when the medical system was in a state of near-collapse, some citizens questioned plans that called for spending a portion of the money for new initiatives devoted to research.

As it turned out, the decisions made in the year 2000 enabled Hopkins and the University of Maryland to conduct research that opened a new era in cancer prevention, diagnosis and treatment. Needed facilities were completed just in time to capitalize on several years of unprecedented increases in research funding from the National Institutes of Health and other agencies. At the same time, the last of the human genome was identified, and the revolutionary transformation of medicine began to take place. Many of the discoveries leading the revolution came from these laboratories. An unforeseen benefit of the research investment was the large number of biotechnology start-up companies in fields sometimes unrelated to cancer that came out of these changes, helping to transform the Maryland economy.

Maryland's General Assembly should consider the future in today's debate over the tobacco settlement. Twenty-five years from now, the decision to invest in saving lives through research will prove to have been the right thing to do. It was, after all, the lives of their children and grandchildren that state legislators were debating. Which is probably why they ultimately said yes. When the future calls, how can you say no?

William R. Brody is president of the Johns Hopkins University.

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