Founder and Chairman, The Prostate Cancer Foundation and FasterCures/The Center for Accelerating Medical Solutions
The minute I walked in the door, I knew something was wrong. My wife waited until I took off my coat and sat down at the kitchen table. "I got some bad news today," Lori began. "Mom has cancer." We talked for hours about what it meant and what we could do to help. It was 1972, only a year after President Nixon had declared "war on cancer," and many of us thought that a concerted national effort could lead to a cure in the same way that President Roosevelt's targeting of polio and President Kennedy's quest to put men on the moon had succeeded.
Over the next 20 years, I acquired an extensive layman's knowledge of cancer in the process of supporting research and seeking effective treatments for my mother-in-law's breast cancer and, later, my father's malignant melanoma, and the cancers of several other close relatives. By 1982, my brother and I had assembled a professional staff to formalize our philanthropy through our family charity, the Milken Family Foundation. Working closely with the foundation's medical and scientific advisors, we became very familiar with the leading-edge work of our grant recipients. We were inspired by the progress of such pioneers as Dennis Slamon in breast cancer, Bert Vogelstein in cancer genetics, Owen Witte in leukemia, Steven Rosenberg in gene therapy, Lawrence Einhorn in testicular cancer and many other recipients of the foundation's cancer research awards.
By the time I was diagnosed with advanced prostate cancer in 1993, I thought I knew a lot about cancer. So the shock of my diagnosis was compounded by the realization that I knew almost nothing about prostate cancer. How could I have spent two decades working with cancer researchers and possess so little knowledge of this disease that had already spread from my prostate to my abdominal lymph nodes? How could I not know that this disease affects one in six American men or that a man is more likely to develop prostate cancer than a woman is to develop breast cancer?
It turned out that I was not alone. The public knew next to nothing about prostate cancer. Articles in the popular press, which so often chronicled the importance of pap smears, mammograms and smoking cessation, rarely mentioned that little walnut-sized organ surrounding men's urethras. As far as most men were concerned, this disease was something they didn't want to think about. Men seem to be more fatalistic than women and believe they're either living or dying so there's no point in getting tested.
Even more surprising was the lack of interest in the medical community. The National Cancer Institute didn't fund much research on prostate cancer because they received few grant applications. Physician-scientists weren't submitting the applications because there appeared to be little funding available. It was a vicious circle. The field was so moribund that one young investigator was told by his mentor to avoid the “career suicide” of prostate cancer research.
Meanwhile, the pharmaceutical and biotechnology industries weren't allocating enough research funds to cancer drug development because they didn't think the return on investment would justify the risk. And as I traveled around the country to major academic research centers, I felt a growing sense of frustration and even anger when I realized that each of these elite institutions considered the others to be competitors rather than collaborators in cancer research.
After extensive discussions with the heads of these centers and other advisors, I concluded that a new organization was needed to bring focus and a sense of urgency to the field of prostate cancer research. This organization, which would become the Prostate Cancer Foundation, would need to:
- Identify promising research not being funded by the NCI;
- Recruit the best and brightest investigators to energize the field;
- Reduce paperwork requirements and fund projects quickly;
- Require awardees to share the results of their work;
- Help build centers of excellence in prostate cancer and link them digitally;
- Encourage public-private partnerships;
- Pursue a venture-funding model;
- Act with urgency;
- Build public awareness.
The Milken Family Foundation jump-started the process with early funding. But since then, the majority of funds for more than 1,400 competitive research awards have been contributed by the public. Awardees gather each year at the PCF's Scientific Retreat to present their findings. Many of them are affiliated with member institutions of the PCF Therapy Consortium comprising eight leading cancer centers that now collaborate on prostate cancer programs.
Over the past 15 years, we've reached several important milestones. The Department of Defense Prostate Cancer Research Program exceeds three-quarters of a billion dollars in cumulative spending. Hundreds of bright young investigators are launching careers in prostate cancer research. Articles about prostate cancer in popular periodicals increased from 2,500 in 1993 to nearly 36,000 in 2006. Federal and state government funding of prostate cancer research is 20 times the 1993 level. Major states like New York and California allow taxpayers to check off a donation to prostate cancer research on their tax returns. Institutions in dozens of countries around the world now participate in PCF collaborations. Millions more men now know about PSA tests and digital rectal exams. Far more drugs targeting prostate cancer are available or in development than even a few years ago.
None of these achievements would mean much, however, if we weren't keeping more men alive. Fortunately, there's progress here too. Close to 40,000 prostate cancer patients were dying each year in the early 1990s. With the aging of the baby-boom cohort, that number was expected to increase to as many as 60,000 deaths today. Instead, the number has fallen to below 28,000. The reasons are complex and no one initiative should receive the credit. Nor can we be complacent because, without major breakthroughs, deaths could start rising again as the first baby boomers move through their seventh and eighth decades.
Building on the lessons of the Prostate Cancer Foundation, we've established a separate organization dedicated to removing the barriers to progress that so often frustrate the efforts of the best researchers in all fields of medicine. This new group, known as FasterCures and headquartered in Washington, D.C., does not fund medical research. Rather, it figures out how we can improve the process of research by creating more effective incentives and eliminating unnecessary bureaucracy. There is certainly cause for optimism. We move forward with hope and will continue our work until cancer is something our grandchildren will know only by reading history books.
Excerpted from the book, "Prostate Cancer: Signaling Networks, Genetics and New Treatment Strategies," Humana Press, 2008.