The Washington PostDemocracy Dies in Darkness

The ‘War on Cancer’ continues, 50 years on. Who sets the terms of victory?

What we’ve learned since the National Cancer Act was enacted in 1971

A scientist works at Laminar Pharma in Spain on Nov. 25. (Cati Cladera/EPA-EFE/REX/Shutterstock)

This month marked the 50th anniversary of the National Cancer Act, colloquially known as the “War on Cancer.” But how is victory in this conflict judged?

President Biden has touted his administration’s new initiative, Advanced Research Projects Agency for Health, patterned on the Defense Advanced Research Projects Agency, to speed biomedical “breakthroughs” against cancer, such as immunotherapy. Others have emphasized the growth of biomedical studies and public knowledge about cancer.

This focus on biomedical breakthroughs has a history that dates back to the passage of the act in 1971. And this understanding of victory has shaped the cancer fight, producing breakthroughs in some areas but drawing attention away from other promising advances. It reminds us that moving forward, who has the power to set these terms of what constitutes success will determine the course of future research — not just into cancer but into other dreaded diseases.

Lawmakers planned the act not as an investment in cancer care but in cancer research. This aim stemmed from the vision of Democratic activists such as Mary Lasker, who had galvanized Congress to write the law. They thought the federal government could use its power to solve the challenges of cancer and other diseases at a fundamental biological level. President Richard Nixon, seeking to position himself for the 1972 elections, found it easy to embrace this scientific mission as well — even overseeing the conversion of a government biological warfare facility into laboratories for cancer research.

The act’s approach was different from the type of biomedical research usually supported by the government. It sought to make scientists accountable to their government sponsors and the public that they represented. To do this, the act empowered the National Cancer Institute to issue contracts that would dictate the scope and direction of biomedical research through management methods drawn from the Defense Department and NASA.

These methods framed cancer as a time-sensitive research-and-development project and empowered government administrators to, in the admiring words of one Life reporter, to “do more than hand out money and wait for results.” Instead, “they would plan research and make results.”

Yet, this structure alarmed the very scientists from the new field of molecular biology that the act envisioned finding a cure for cancer. They were alienated by the heavy hand of government in managing nuclear physics during the early Cold War period and they worried that the act’s staff of planners drew heavily on the civilian manifestation of this style of management — the Atomic Energy Commission. Fundamentally, research accountable to the government was incompatible with how they defined good science: as curiosity-driven research aimed at answering questions about the “physics of life” rather than helping patients in the clinic.

James Watson, the co-discoverer of DNA and a leading representative of molecular biology, warned that without an overarching understanding of how cells worked, clinical cancer research was an “intellectual graveyard.” The biochemist Arthur Kornberg envisioned a dystopian future in which the availability of money for cancer research “seduced” scientists into “second rate” contract work with no hope of the “serendipitous discovery” that was the true engine of scientific progress.

Yet molecular biologists also knew that this money was essential to supporting the growth of the next generation of their field.

Without the political power to challenge the act’s approach head-on, the biologists embarked on a public battle to redefine the appropriate aims and methods of the War on Cancer. They presented cancer research as a complex biological puzzle rather than an activity that should provide immediate therapeutic advances. Watson ally and bacteriologist Norton Zinder wrote a bombshell report critiquing the NCI’s Virus Cancer Program — an effort to develop a cancer vaccine. Zinder asserted that the government should be content to let “the scientists decide” the direction and pace of “fundamental research” against cancer rather than seeking a rushed, inefficient moonshot. Other molecular biologists and sympathetic reporters amplified this message.

These tensions between scientists and the federal government festered until the late 1970s when a confluence of factors forged a truce.

The NCI had failed to deliver progress against cancer: The rate of cancer incidence had continued to rise and improvements in treatment were still few. Environmental, labor and civil rights groups demanded a reorientation of the institute’s mission. They wanted to cut its research budget and redirect funds toward public health and prevention-oriented approaches to cancer. To them, critiques of the cancer vaccine program like Zinder’s weren’t evidence of poor management techniques stifling scientists. Instead, they revealed that any effort to address cancer through biological research was misguided.

As these activists repurposed the molecular biologists’ critique of the NCI, however, the scientists who had been the institute’s fiercest critics came to need its funding even more than they already had. Virus Cancer Program-supported research into virally caused cancer had revealed something surprising. Scientists J. Michael Bishop and Harold Varmus announced in 1976 that they had proof of cellular “oncogenes” — a molecular mechanism for the genetic basis of cancer. Cancer was not something triggered from outside, but rather a cellular event.

With this discovery, molecular biologists argued for the need to focus less on the external causes of cancer — like viruses or chemical exposures — and more on the cellular origins of cancer. Such research could eventually produce new therapies targeting the products of oncogenes. These future therapies would be a precise “rifle” compared to the “shotgun” of chemotherapy and surgery, in the words of the president of the American Cancer Society.

But there was a catch — one that pushed the molecular biologists back in league with the NCI. It might take a generation to grasp these mechanisms, during which molecular biologists would be vulnerable to disruptions in their funding and public disillusionment. Defending the legitimacy of the NCI and its research mission became essential.

In 1982, Watson invited new NCI director Vincent DeVita to speak at the dedication of a building for mammalian genetics. At the ceremony, Watson praised the Virus Cancer Program’s unplanned discovery of oncogenes as evidence of how well “the public purse” had been spent in the War on Cancer. Likewise, DeVita embraced the therapeutic promise of oncogene research, calling it exciting research “that brings molecular biology to the crowded bedside of the cancer patient.”

In this exchange both sides gained something. Watson’s supportive remarks helped thwart activists who sought to steer the NCI away from research, while DeVita’s comments promised that the NCI would grant more support and autonomy to molecular biology’s exploration of cancer as a complex scientific puzzle.

The future promise of oncogenes — even with new therapies decades in the distance under the best-case scenario — meant that it was too soon to judge the success or failure of research in the War on Cancer. This consensus forestalled questions about whether other approaches focused on public health or prevention might prove equally effective, quicker or more efficient.

Stifling these questions came with a cost, however — one reckoned not in monetary terms but in the attention paid to other ways of addressing cancer.

Even as the NCI turned away from vaccine development, the first vaccine against a virus tied to cancer, hepatitis B, debuted, while other interventions, such as restricting tobacco use, eventually played a decisive role in curbing cancer deaths. Realizing the promise of these approaches fell to other groups outside the NCI and the federal government, often with far fewer resources at their disposal. This is to say nothing of concerns for the affordability and accessibly to the therapies for cancer that do exist.

The way that a small number of scientists and administrators narrowed what it meant to succeed against cancer stands as a cautionary tale for our present moment. Whether future research explores the challenges of diseases on all levels “from molecular to social” — what President Biden promises to do with the Advanced Research Projects Agency today — will shape the future of medical research and public health. And this broad definition of victory is exactly what the war on cancer has lacked over 50 years with untold ramifications.