Skip Navigation LinksHome > September 25, 2012 - Volume 34 - Issue 18 > MUSINGS OF A CANCER DOCTOR: On Vail
Oncology Times:
doi: 10.1097/01.COT.0000421362.72893.c7
Opinion

MUSINGS OF A CANCER DOCTOR: On Vail

Sledge, George W. Jr., MD

Free Access

A few weeks ago I was at the AACR/ASCO “Workshop on Methods in Clinical Cancer Research.” This is one of my favorite meetings, not least because it is held in beautiful Vail, Colorado. As a flatlander from the Midwest, I'm always somewhat in awe of the Rocky Mountains—at least once I get over my mountain sickness.

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I'm also impressed, as always, by the meeting. Every year ASCO and AACR bring together 100 students, and roughly half that many faculty members, for what might be thought of as “clinical trials boot camp.” The students, a mixture of oncology fellows and junior faculty, come to the meeting with a trial concept, and by the end of the week leave with a finished, IRB-ready protocol.

The beating heart of the meeting is the Protocol Development Group. My group was fairly typical: two senior oncologists, a biostatistician, and a patient advocate serve as faculty for eight students. The students were quite wonderful: six women and two men, three of the eight born outside the United States (India, Portugal, and Italy), representing seven different academic institutions. We were a pure breast cancer group, as the Vail course tries to lump by disease, but the protocols were a diverse mix of Phase I, Phase II, and biomarker trials.

The Protocol Development Groups spend considerable time interrogating the students about their concepts, their informed consent statements, the stats for the trials, and the fully written protocols. The process prepares students for what they will encounter when they submit protocols to their local IRB, to pharmaceutical companies, and to the cooperative groups. The interplay is intense and productive.

If the Protocol Development Groups are the heart of the meeting, the lecture sessions are its brain. The faculty is great, a who's who of clinical trialists and biostatisticians. Learned (and often hilarious) lectures cover the gamut of the clinical trials process.

I'm envious of my students: nothing like the Vail course existed when I started out, and I spent years acquiring the knowledge presented to them (in compressed form) during a week.

I'm envious for other reasons. Older oncologist envy younger oncologists—not just their youth, but also the exploding opportunities in cancer research. Loads of new drugs, backed by logarithmic increases in data informing our growing understanding of cancer biology, and they will get to play with all these new toys for years after my generation leaves the scene.

At the same time I worry about their future. Colorado differs from my home state of Indiana, not just in height, but also in politics. Indiana is a comfortably red state, Obama's 2008 electoral victory there notwithstanding, and as such neither party bothers to spend too much money touting their presidential candidate.

Not so Colorado. You cannot watch television there without being bombarded by political advertisements, with their relentless negativity, and generally poor production values, endlessly repeated. Living in a swing state apparently condemns you to months of bile, worse even than the usual cable TV talking head drivel.

What impresses, in watching these advertisements, is the unwillingness of either party to wrestle with reality. Elect me, and I'll reduce the debt and restore prosperity. The other guys are—take your pick—unfeeling plutocrats or socialist spendthrifts.

Neither party's outpourings give you the same sense of hope one gets at Vail, and neither addresses the real basis of our prosperity over the last two generations—namely the application of modern science, and the technology derived from that science, to the human condition.

I grew up in a world without personal computers, iPhones, trastuzumab, PET scans, the Internet, or hundreds of other technologic wonders we all could name. For that matter (I date myself) my family didn't have color TV, air conditioning, or cars with seat belts when I was a child. The world is an almost unimaginably different place than it was a few decades ago.

Politicians, and certain political zealots, like to pretend that all of these things just happened. But they didn't. They required huge investments, investments by government, by industry, and by countless individuals, in the development of both an infrastructure and a philosophy capable of creating ongoing prosperity.

We seem, as a society, to have lost, or at least misplaced, the beliefs that generated our current prosperity. All over the United States we see declining investment in public education, at both the early and advanced stages of schooling. We see, at the national level, flat-line spending—and the promise of decreased spending—for scientific research.

One speaker at the Vail course, a representative from the NCI, spoke of the real anguish he and others had when trying to decide which investigators would receive research grants in a resource-constrained environment. I envy my juniors the scientific opportunities offered by modern technology, but I wonder how many of them will remain working on research in lab and clinic when the NIH payline drops lower and lower into the single digits.

When your chance of getting a grant is 1 in 20, you might be better off betting at the track than betting your career on the promise of an R01: and so a nation gambles away its future.

The students at the Vail course are not naive about all this, of course: they can read the tealeaves just like I can. But they bring immense optimism and faith in the future to Vail, and (when they go home) to the national cancer research enterprise. And more power to them.

I can't close this missive without mentioning those who make Vail possible: the federal government, through an educational grant to the course, many private sponsors from Pharma (though we need more!), and the steadfast support of two of the world's greatest societies, AACR and ASCO, and the wonderful staff that work for them.

In a way, the Vail course is a microcosmic view of how we have succeeded in the past, and how we must proceed in the future: a joint effort of government, private enterprise, non-profits and individual virtue, all working towards the common goal of improving the human condition. Let's hope the spirit of the Vail Course informs our future, rather than being some remnant of a better past.

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