Testimony to the U.S. Senate Subcommittee on Labor, Health & Human Services and Education Appropriations.
Senator Arlen Specter, Chair
June 16, 1999
Michael Milken Founder, President & Chairman, Prostate Cancer Foundation
Mr. Chairman and members of the Subcommittee on Labor, Health & Human Services and Education Appropriations, my name is Michael Milken. I am Founder, President and Chairman of the Prostate Cancer Foundation - the world's largest private funder of prostate cancer research. I am a six-year survivor of prostate cancer, and I have lost 10 close relatives to cancer.
The federal investment in finding cures for cancer - $3 billion annually - is less than ... zero ... point ... zero ...zero ... zero ... four ... percent of our gross domestic product, or about one-seventh of what Americans spend on beauty products. At the same time, we often hear that our nation is spending more than $100 billion annually - much of it by the federal government - for cancer care. With the graying of the baby-boom generation and its greater risk of cancer as members pass the age of 50, cancer-care dollars are likely to double within a decade. Is there any organization that would spend more than 35 times as much money to deal with the effects of a problem as it would to solve the problem? It makes no sense in the private sector, and, with current concerns about spending rates and budget caps, it should make no sense in government.
The federal government has, for example, made extraordinary investments - long-term - in components of the country's infrastructure; the interstate highway system is a case in point. It is now time to make a similar commitment in human capital. The suffering of cancer patients and the grief of their families and friends are beyond calculation. But some distinguished economists - such as Kevin Murphy at the University of Chicago - have calculated the economic value of the lives lost. These figures amplify cancer's already staggering annual morbidity and mortality costs. At Murphy's average valuation of $4 million per life, the 560,000 individuals who will die from cancer this year result in losses in trillions, not billions, of dollars.
Five hundred sixty thousand of our fathers, mothers, brothers, sisters, neighbors and friends - that's approximately the same number of men and women who served in Operation Desert Storm. Imagine the reaction if General Norman Schwarzkopf had announced that no Americans sent to the Gulf had survived. Then imagine that that happened every year! That's the impact that cancer should have on all of us.
The approximately $3 billion that we will invest in cancer research in 1999 only allows the NCI to fund about 28% of approved research grants; 72% go unfunded because of a lack of resources. In the 1970s, the National Cancer Institute could fund 60% of these grants. Mr. Chairman, it is clear that we are not advancing as quickly as we should toward victory in this nation's war on cancer.
When President Nixon announced that war in 1971, his intention then was to produce a cure within a decade - just as President Kennedy's earlier goal of putting a man on the Moon had been achieved in less than 10 years. We all thought it would work. After all, President Roosevelt had declared war on polio in 1938, and 17 years later, we produced the Salk vaccine. My family knows something about polio because my father had contracted it as a child and I was among the first of the baby boomers to receive the new vaccine. What a simple concept: get a shot and wipe out a disease. Surely we should do the same with cancer.
Then, two years after President Nixon's declaration, my mother-in-law was diagnosed with breast cancer. Four years after that, my father found out he had malignant melanoma. In the late 1970s, following my father's diagnosis, my family began a program of funding cancer research, later expanded and formalized by the Milken Family Foundation. In 1993, I founded the Prostate Cancer Foundation to help fight the most commonly diagnosed non-skin cancer in America.
In 1995, I told the National Cancer Summit that General Schwarzkopf, a fellow prostate-cancer patient, believed military lessons should be applied to the war on cancer. "There comes a time," he said, "when you must get on with the battle. You'll never have perfect intelligence on the enemy." The fact is that we have plenty of information for the offensive - we just lack sufficient firepower.
How much firepower do we need? Last fall, as part of THE MARCH ... COMING TOGETHER TO CONQUER CANCER, I suggested to Senators Connie Mack and Dianne Feinstein, at a hearing of the Senate Cancer Caucus, that the annual federal investment in cancer research be increased to $10 billion. While such a sweeping plan is beyond the immediate purview of this committee, I'd just like to say that a $10 billion investment is less than $40 per American. It is a fraction of the cost of failure - the cost of treating the more than 100 million Americans currently living who are expected to get cancer.
Consider what part of our national income we have spent on the military in wartime, and then consider the fact that an American soldier is more likely to die from cancer than from enemy action. Just as we don't fight guns-and-bullets wars with a 40-hour week, we must recognize that the war against the foreign invader we call cancer is a 24-hour-a-day, seven-day-a-week effort.
A single U.S. company, the Intel Corporation, spends more than twice the government's annual cancer research budget on R & D and capital expenditures: investing in laboratories and research procedures and then investing over and over again as new opportunities for discovery present themselves in subsequent years. Marketplace competition means that the investment is required - not just considered; it is an essential part of the company's success. We should learn from our country's technology leaders and make the same kind of investment in cancer research.
Perhaps it is cooperation and competition from the newly created Department of Defense cancer research projects that has propelled NIH's investments forward in this area. Perhaps it is cooperation and competition from the private sector that has generated rapid results in the National Human Genome Project. With competing companies claiming that they will unravel the human genome quickly, the government project may complete its work a half decade sooner than expected.
Technological advances could propel us further and faster on the road toward a series of cures. Improvements in imaging technology, for example, can help us visualize cancer cells. Adaptations of military technologies can be used to target radiation more effectively. These and thousands of investigations we haven't yet considered - including some that should be declassified from the military - will cost much less than the cost of failure.
An education leader once said, "If you think education is expensive, try ignorance." I would paraphrase that as, "If you think cancer research is expensive, try paying for continued treatment of 100 million Americans." The 76 million members of the baby-boom generation - 31% of our population - are turning fifty at the rate of one every seven seconds. As they pass that threshold, their risk of cancer - including prostate cancer - increases. Prostate cancer will affect about one man in six in this country, which means that more than six million boomers could become its victims during the next decades resulting in more than $600 billion in expenditures.
Consider the further economic and social impact of prostate cancer. Take, as an example, the potential impact of the disease on the eight million individuals - including men in uniform and retirees - who receive health care in the Defense Department's worldwide network. It's easy to see, but painful to recognize, that there are - and will continue to be - extraordinary losses in human capital to prostate cancer. It's easy to see, but painful to recognize, that the future liability of prostate cancer is, in fact, in the trillions of dollars. These losses are part of the cumulative skills and experience of men in the workforce - and they are great because prostate cancer most often strikes employees and managers with the longest tenure, men who are in the midst of making their most significant contributions to this country. And the pain will continue - for individuals, families and society - unless we decide to do something about the problem now.
In the six years since my diagnosis, the federal government has invested about $800 million dollars to find a cure for prostate cancer, only about $3,000 for each life lost to the disease. Compare that to the nearly $3 billion our government has wisely appropriated during that six-year period for breast cancer research - a disease that annually claims approximately the same number of lives. Or compare it to the more than $10 billion that the federal government has spent trying to find a cure for AIDS. It's not that breast cancer research or AIDS research gets too much research funding. As long as lives are lost to those diseases, or pain and suffering endured, no amount is "too much." It's just that prostate-cancer research has gotten too little.
Then, Mr. Chairman, in the FY99 appropriation, you and your colleagues required a sea change in the prostate cancer research strategy that will, this year, lead to NIH's investment of approximately $175 million. It is an important beginning. On behalf of the more than one-quarter of the families in this country who find or will find a member diagnosed with prostate cancer, we thank you, Mr. Chairman. We also thank the chairman of the full committee, Senator Ted Stevens, and your colleagues on the committee for your leadership.
Still, in the short time I'm speaking today, another American will have died from prostate cancer. That's five men every hour, more than a hundred men every day - almost 40,000 men this year alone. While prostate cancer kills men, its victims are also women - the wives, mothers, daughters, sisters, aunts and friends of those whose lives are cut short -- part of the human tragedy of this devastating disease.
That's why it's so encouraging to see that NIH is both increasing and diversifying its investments in prostate cancer research. But, given the aggressive impact of this disease, even this novel, assertive NIH investment strategy may not go far enough - in dollars or research development.
We believe that, as NIH and NCI "ramp up" their efforts to find a cure for prostate cancer, there will be a compelling need to visit with your committee, in the next four years, to ask for more funds for clinical prostate-cancer research. We think important clinical developments are taking place now and, with more funding, will only accelerate. For example, CaP CURE-supported research has already led to more than 70 new treatments that are currently in clinical trials. Among the most promising medical advances are:
- treatments using viruses programmed to replicate in prostate cancer cells and kill them;
- new chemotherapies that are successful in stopping the growth of previously untreatable tumors; and
- novel vaccines that cause patients to mount significant immune responses to their own tumors.
We know that an investment in clinical and translational research makes good business sense. As an example, in the 1980s, experts were predicting that, at the end of this century, American deaths from AIDS would exceed 500,000 annually. While AIDS is still a great human tragedy, this year, about 15,000 people - not half a million people - will die from the disease. We cannot yet celebrate a cure for AIDS and it is wrong to become complacent, but the impact of research breakthroughs through the creation of new treatments has been astounding.
Similarly, we need to accelerate research efforts for prostate cancer. We applaud NCI's creation of QuickTrials and RAID, new programs to hasten new treatments. And we applaud the creation of prevention trials, which could save lives in future generations.
We support NCI's Herculean commitment to collect more than one million men for prevention trials. But we would like to see their similar commitment directed to the collection of one million men - or more - for clinical trials. That fewer than 5 percent of eligible adults participate in cancer clinical trials - even less in prostate-cancer clinical trials - is staggering, and we'd like to encourage dedicating federal resources and ingenuity to solve that problem.
We would like to see more than 5 cents of every cancer research dollar dedicated to prostate-cancer research, because we think the value of the investment is already assured. According to the National Prostate Cancer Coalition, which the Prostate Cancer Foundation is proud to support and sponsor, at least $500 million could be invested in new and underfunded research areas in 1999. These include:
- chemotherapies that destroy cancer cells and halt the progression of disease;
- vaccines and other stimulators of the immune system;
- anti-angiogenesis therapies that destroy a tumor's nutrient blood supply;
- differentiation agents that normalize prostate cancer cells;
- treatments affecting the prostate cancer cell's androgen receptor;
- promoting apoptosis, or programmed cell death;
- radiobiology and radiology treatments;
- tumor molecular biology including the molecular "fingerprinting" of disease;
- genetics that may help stop the disease at its earliest stages; and
- nutritional and other alternative therapies that may impede or reverse the progression of disease.
We would like to encourage NIH to reduce barriers related to its grants procedures and encourage a streamlining of the process that would get funds into researchers' laboratories and clinics more rapidly. At the Prostate Cancer Foundation, we know it can be done without sacrificing the integrity of peer review. But there's even more that America can do. While it's beyond the scope of this Committee's work, I believe the Congress should consider tax incentives for research, such as enhanced investment tax credits, R&D credits, and sales of tax-loss carry-forwards. If we have a real war on cancer, then why not issue "cancer war bonds"? Why not extend patent lives, accelerate FDA approvals and authorize direct contracting with corporations for research and development? That kind of public-private partnership helped win World War II and it can win World War Cancer.
I believe in all of these proposals because it's clear to me that we can accelerate science. If we give cancer researchers the same kinds of tools that technology companies employ in accelerating scientific development, we can find a cure faster. That will relieve the suffering of more than 100 million Americans. We have talented people working on this inside and outside the government. Let's give them the tools and the incentives to finish this job. Let's send a message to our best and brightest young scientists that cancer research is an exciting profession and not - as one Prostate Cancer Foundation-supported scientist was told by his medical-school mentor - "career suicide." Finally, let's show all these dedicated people that we share their sense of urgency.
It is up to you, Mr. Chairman, and your colleagues, to provide and direct the necessary resources to pave the way. We owe this not to ourselves, but to our families and to future generations. We strive to leave our children a nation free from debt and a world free from war - a world that cherishes the sanctity of a single human life. That world must not allow the scourge of cancer to continue. Let us find a cure for cancer now. Let us choose life.