Why a "moonshot to cure cancer" is doomed to failure

A few days ago, David Bowie died of cancer. This morning I learned that the actor Alan Rickman has died of cancer. You all know the rule of threes, right? It has been satisfied, because in his state of the union address Barack Obama announced that he was going to kill American biological research, with cancer. OK, maybe that's a little strong: he was more devious about it. He announced a "moonshot" to cure cancer. It's the same thing.

US President Barack Obama isn’t going quietly. He began his final year in office by announcing a “moonshot” to cure cancer in his State of the Union address to Congress on 12 January.

The effort will be led by vice-president Joe Biden, whose son Beau died of brain cancer last year.

“For the loved ones we’ve all lost, for the family we can still save, let’s make America the country that cures cancer once and for all,” Obama said in a soaring speech that otherwise offered few new proposals. Instead, the president spent most of the address looking back at his accomplishments over roughly seven years in office.

It's not the "cancer" part of the proposal that is bad; it's a terrible disease, and we should more to combat it. It's two other words: "moonshot" and "cure".

Everyone admires John F. Kennedy's ambition in setting a specific goal for the space program, way back in the 1960s. It was smart to focus. But here's the difference: we knew where the moon was. There it is, 380,000km away, in a predictable orbit around the planet, and we had these technologies to fire off rockets that already contained the basic principles we needed to get to the moon. It was a nontrivial effort, but getting from here to there was an already specified problem.

Where is "cancer"? Can you even define the problem? Do you see a solution that you can reach by just throwing a lot of money at it and telling a team of doctors to fix it?

No, you can't. Scientists who study cancer will even tell you flat out that cancer isn't one disease, it's a multitude of diseases. It's more like a pattern of collapse of a complex structure, and there's a million different ways it can happen. A "moonshot" is a terrible metaphor for how to approach the treatment of cancer.

We don't know where we're going, so what we need is more support of basic research -- mapping the cell and genome, puzzling out the details of signaling, looking for unexpected new technologies for manipulating cells. When I hear "moonshot", what I hear is "earmark": we're not going to see an expansion of basic research, we're going to see a bigger share of the money going to translational research. We'll build even more hidebound institutions that demand their share of the budget and then allocate it conservatively to more fully explore the same old dead ends.

So "moonshot" gives me the heebie-jeebies. What about "cure"?

I will make a bold prediction. There is no such thing as a cure for cancer. We are embarking on a quest for Hy Brasil, or Shangri-La, or the Lost City of Atlantis. It misunderstands the nature of cancer to claim there might be a "cure" out there.

You might as well launch a moonshot to end entropy. Or to defeat aging. Or to cure the plague of multicellularity that causes us so many problems. You are made up of populations of cells that are dividing -- and it is the nature of your existence that cells can't be static, passive blocks -- and with each division, they accumulate errors. Inevitably. Unless you plan to cure thermodynamics, too, you can't avoid the gradual generation of tiny errors. And eventually, one or a few of those errors will cross a critical tipping point and turn a cell cancerous.

Well, actually, there is a cure that will prevent that otherwise inevitable fate: you could die of heart failure or infectious disease first, or get hit by a bus. That's what history tells us. As we fight back other causes of death, as we live longer and longer, the probability of cancer increases, because it is basically the default failure mode for the cell.

Now I know that sounds cynical and defeatist, but I'm not. I think there is a lot of hope in improving cancer treatment -- we can get better and better at stopping the progression of the disease, and repairing the damage it causes, and developing cheaper treatments with fewer side effects. These are broader and more achievable goals than finding the magic "cure" that doesn't exist. They also require broader scientific approaches than just giving lots of money to people -- intelligent, qualified people -- who are working specifically and narrowly on treating human diseases (although I also think we need to continue working on that kind of translational research, since that will give us progress in small steps).

But that's why a "moonshot" to a "cure" bothers me: it's the proposal of people with tunnel vision, who even so can't see the target they're aiming at, let alone find even the general direction they should point at.