That seminal success of putting a man on the moon is often invoked when thinking about other great challenges, such as curing cancer. As a cancer physician — and having cared for my late wife, Carolyn Kaelin, who survived breast cancer only to die of glioblastoma in 2015 — I understand the temptation to treat cancer as though it were an engineering problem. But while we will greatly benefit from the kinds of collaborations and resources envisioned by “cancer moonshot” programs, they must not come at the cost of robust support for curiosity-driven science. And all should be careful not to suggest unrealistic timetables for success.
There is a fundamental difference between science and engineering. Science generates new knowledge (“learning the rules”), whereas engineering applies that knowledge (“using the rules”). President John F. Kennedy knew approximately how much time and money it would take to put a man on the moon because the basic scientific principles required to do so were known by 1960. The lunar landing was a brilliant engineering feat enabled by prior scientific advances extending back to Galileo and Newton.
Engineering projects — or applied science projects — start with an agreed-upon goal and timeline. They are often carried out by teams of individuals who are centrally managed to ensure that their efforts are harmonized, resources are distributed appropriately and timelines are met.
Treating early-stage science like engineering, however, is shortsighted and counterproductive. Early-stage science is often dominated by creative individuals who are allowed to follow their curiosity and to go where their scientific discoveries take them. Prematurely forcing scientists into teams with predetermined deliverables risks creating a herd mentality and tunnel vision. Better to have 10 scientists going in different directions in hopes that one of them actually discovers something.
Scientific progress comes in fits and starts, and it is often difficult to predict where the next breakthrough will come from. As a result, the timelines and deliverables in science are far less predictable than those in engineering. The only thing for certain is the greater the investment, the faster new knowledge will emerge. It is both exciting and frustrating that the utility of this knowledge can seldom be anticipated. For example, the work recognized by my Nobel Prize led to a new treatment for anemia, even though I study cancer. The CRISPR gene-editing technology that will revolutionize medicine and agriculture emerged from studies of bacteria and their resistance to viruses.
Although basic science is fundamental to applied science, it is the most vulnerable part of the entire scientific enterprise because most investors and philanthropists will not tolerate its uncertain timelines and deliverables. For most of my scientific career, however, I benefited from the wise decision to have the federal government support basic science and to have the private sector decide when the knowledge it generated was ready for application and commercialization.
Today, federal research funding is increasingly linked to potential impact, or deliverables, and basic scientists are increasingly asked to certify what they would be doing with their third, fourth and fifth years of funding, as though the outcomes of their experiments were already knowable. But the most important scientific discoveries often began with an unexpected experimental result that a scientist then pursued. Holding scientists to written work plans risks placing blinders on them.
It does all stakeholders — including patients, their families and researchers — a disservice when policymakers and fundraisers overpromise and oversimplify with respect to cancer. I understand too well the frustration that progress is not coming faster, but it is coming. Progress has accelerated dramatically because of two engineering feats: the sequencing of the human genome in the year 2000 and new technologies for rapidly determining which genes are altered in specific cancers.
Understanding how these genetic alterations cause cancer and how to tackle them, however, still requires investments in science. The next breakthrough in pancreatic cancer, for example, might come from a scientist studying pancreatic cancer, but it could also come from a scientist working on another form of cancer or a non-cancer scientist studying some arcane piece of biology in a model organism. Now is not the time to abandon basic science in the false hope that we already know enough to eliminate the pain and suffering caused by complex diseases such as cancer.