I'm a four-year cancer survivor, and when people inquire how I'm feeling nowadays I say "good" and sincerely thank them for asking. But some well-wishers respond awkwardly. One politician I know has me in his mental file under "cancer" and accompanies his hearty hello with "Glad you beat it!" As anyone who has had advanced cancer can tell you, this is understandable but unhelpful. It also reflects why politicians are still so out of touch about the disease.
At bottom, they don't want to face the truth, which is that they've failed to protect the lives of our citizens. If a war were killing 565,000 Americans a year (and none of our wars ever has), you'd hear more than one or two references to it at the party conventions. And we'd be doing better fighting it.
The fact is, most cancers remain incurable. Fewer than a half dozen cancer drugs show great results. So it's no wonder survivors get nervous during checkups for many years after diagnosis. The five-year survival marker used by doctors is statistically arbitrary and only partially reassuring.
Consider the case of John McCain. He underwent surgery in 2000 for stage IIa melanoma, a potential deadly skin cancer. The surgery found no dangerous spreading and McCain received no chemo or radiation. Good signs. He's been cancer-free for eight years, which is even better. But the statistics, however inexact, remain a bit unnerving. For those who stay cancer-free for five years, the probability of recurrence of stage IIa melanoma is 14 percent. The probability of death is 9 percent, which doesn't even include the many other diseases from which a 72-year-old man faces sharply increased risk of mortality. (And nearly a third of those who live past 70 will suffer some cognitive impairment.) This is why giving Gov. Sarah Palin a thorough media scrubbing isn't some left-wing media jihad. It's simple prudence.
McCain neither ignores nor emphasizes his cancer experience. He skipped a Lance Armstrong LIVESTRONG Cancer Forum in Iowa in 2007 but appeared with Armstrong in July in Columbus, Ohio, where he shared his melanoma history, advocated sunscreen and explained his Senate work pushing mammography. Press coverage was skimpy as usual (not enough conflict in cancer for reporters), in part because the event came during Barack Obama's trip abroad. So the media missed a good story about just how badly McCain wants to win this election.
In 1997, McCain was passionate on the subject of tobacco, which kills hundreds of thousands of Americans a year. He used his position on the Senate Commerce Committee to advance strong new regulation of the tobacco industry and a new federal tax on cigarettes of more than $1 a pack, with the proceeds going to smoking prevention and medical research. The bill passed the Senate but was killed in the GOP House. So presumably McCain will move on this if he's elected. Country first, right?
Well, no. McCain once angrily tossed Philip Morris lobbyist Charlie Black out of his office; today Black is one of his closest political advisers. To get nominated in the Republican Party—and to make his tax attacks on Obama stick—McCain feels he must oppose all new taxes, even one he once championed. His excuse is that he worries Congress would just use the money for other purposes, as so many state legislatures have. Instead of asserting that this would never be tolerated in a McCain presidency—that he would bring down his wrath on the wayward members of Congress—McCain punted on any new cigarette tax.
Until now, Obama has also been disappointing on cancer. While he often mentioned that his mother died in her early fifties of ovarian cancer, it was usually in the context of her having to worry about her insurance not fully covering treatment, a common problem. And though Obama won passage in Illinois of a law making insurers cover colorectal screenings, he missed both LIVESTRONG forums and didn't make cancer a campaign priority.
Then last Friday, on the day of the Stand Up to Cancer telethon, Obama finally stood up. He pledged to double funding over five years for the National Institutes of Health (which houses the National Cancer Institute), expand clinical trials, end discrimination by insurance companies against those who have had cancer (and thus can't change jobs) and improve coordination among federal agencies. McCain also used the occasion to address cancer on his Web site for the first time, but he's sketchier on the details and hasn't committed to big funding increases or any cancer initiatives beyond smoking-cessation programs.
Politicians have been slow on the cancer front partly because it's a downer, and partly because most don't seem to understand how perilous the research situation has become. It's not just that fewer than two in 10 applications for NIH grants are funded—down sharply under President Bush. It's that the wrong researchers often get the money, as Thomas Cech, president of the Howard Hughes Medical Institute, has pointed out. The system, he writes, is "risk averse." Older researchers with old-boy-network contacts receive a disproportionate amount of the funding. Cech notes that younger, less-connected but more creative researchers, the ones most likely to find cures, are leaving medical research in droves because they can't get funded.
That's where Stand Up to Cancer comes in. The funds raised by all the celebrities will be what Jerome Groopman of the Harvard Medical School calls "catalytic money" devoted to highly innovative grants and to "dream teams" of doctors who work in collaboration rather than along parallel lines. For a disease that destroys families and costs the economy $200 billion annually in lost productivity, it's the least we can do.
The new president shouldn't promise that we'll cure cancer in 10 or 20 years. That's not realistic. But he must set plausible goals, like doubling survival time for major cancers. The War on Cancer that Richard Nixon declared in 1971 has been a failure. McCain or Obama can succeed if they get passionate about the havoc that cancer wreaks, make gutsy budget and tax decisions and resolve not to claim they've "beat it" when they haven't.