The Puzzle Project: Background
The Issue
Despite news reports about advances in breast cancer research, the fact remains that women diagnosed with breast cancer today face essentially the same treatment options—surgery, radiation and chemotherapy—that were offered when the War on Cancer was first declared nearly thirty years ago. And when it comes to prevention, the only options we are given are powerful pills with dangerous side effects, and surgery more drastic than that often prescribed for women with the disease. To understand why there has been so little progress in breast cancer treatment and prevention one must look at the current structure of cancer research—both how it is funded and how it is being done.
Currently, a wide range of public and private entities conducts cancer research. At the federal level alone, a number of agencies are funding breast cancer research: The National Cancer Institute, the Centers for Disease Control and Prevention, the Department of Defense, the Department of Energy, and the National Institute of Environmental Health Sciences. Many states have their own research programs and there are a number of private agencies—from the American Cancer Society to the Susan G. Komen Foundation to the Breast Cancer Research Foundation—that also fund research. Finally, pharmaceutical companies are engaged in breast cancer research as well.
While this level of interest and energy is encouraging, progress is slowed by the lack of any coordination of the work of these diverse bodies. Research being done by a drug company in California could be the same as a study being done by a research hospital in New York, or a non-profit agency in Atlanta. There is no system in place for making sure that research efforts move us forward toward effective treatments and true prevention or even that current research efforts complement each other. This inefficient use of resources delays real progress.
Another obstacle to meaningful advancement is the fact that research is largely funded in small increments, forcing scientists to work to renew their grants rather than focus on the bigger picture. Decisions are based on what’s “hot” in research or what will produce quick results and lead to more grants, academic promotion, or personal economic gain. This funding structure does not foster the type of long-range, broad look at breast cancer that is necessary to understanding its causes and how to treat it more effectively and less toxically. Instead, it has generated research focused on the human genome and molecular biology, which has promise but whose practical applications are either limited or unavailable until far into the future. With a new breast cancer diagnosis every 3 minutes, and a death from the disease every 12 minutes, we cannot afford to be patient.
The Solution: The Puzzle Project—
The Manhattan Project Revisited
The Puzzle Project is a proposed new approach for breast cancer research. It is modeled on the Manhattan Project, an effort that relatively quickly solved the challenge of the “need” for an atomic bomb. The Puzzle Project involves the creation of competitive research centers staffed with the best and brightest scientists and thinkers, with guaranteed salaries and access to the resources they need to bring us to a cure for, and prevention of, breast cancer. Here’s how it would work.
All the money now devoted to breast cancer research would be allocated to several research centers around the country. The staffs of the centers would represent a wide range of disciplines, from microbiology to Chinese medicine, from epidemiology to decision theory. These centers would be fully funded until one or more of them produced
- effective treatments for breast cancer that are not systemically toxic, and
- an understanding of the causes of breast cancer, which would permit us to take steps to prevent the disease.
The concentrated efforts of these few centers would produce results sooner than the fragmented research structure we have now. Multiple centers would ensure the competitiveness that often leads to scientific breakthroughs; and there would be the added incentive of a significant financial bonus for those who achieve each goal first.
An oversight group consisting of scientists, doctors, breast cancer activists, policy makers and industry representatives would select the staff members of the centers. The oversight group would be responsible for ongoing review of both the progress and the staffing of the centers. Staff members would be prohibited from using their work for personal or professional gain, and would understand and agree that any successful treatments discovered by the project would belong to the public. The government would develop the treatments, and the profits generated by their sale would be used to implement the policy changes necessary to eliminate the causes of breast cancer.
Pie in the sky? Maybe. Getting from where we are to where we need to be will require a lot of work and a new kind of thinking. But with over 2 million women living with breast cancer, and more and more women being diagnosed each year, isn’t it worth a try?