The Cancer Equation
The website is the only network in the country that actually matches patients with clinical trials. And the response from people seeking help has been strong since the site went active late last year. "The first month we had 1,000 hits," says Ray Carson of the Florida division of the American Cancer Society. The Cancer Society has banded together with a number of other groups in the state to form what they call the Florida Dialogue on Cancer, which secured the grant and started the website. Other members include cancer centers like Moffitt in Tampa and M.D. Anderson in Orlando; a group of local hospitals from across the state; the NAACP; and the AARP of Florida.
Like most Floridians, I believed that "clinical trials" occurred among small groups of patients in the cloistered settings of research hospitals and high-end cancer treatment centers -- a false notion that the Florida Dialogue is eager to correct. The group also wants to bridge a huge "participation gap" in clinical trials between children and adults. Virtually every child in the country who is found to have cancer ends up participating in the clinical trial of one treatment or another. But only about 4% of adults participate in such trials -- and more than 80% don't know that they're eligible to participate. Even doubling the percentage of adult cancer patients who participate in clinical trials to 8% would quickly advance progress toward more effective treatments and cures, says Carson.
In addition to getting more patients involved in clinical trials, the Florida Dialogue also is trying to push cutting-edge treatments out of cancer centers and into the offices of community physicians. Local physicians too frequently are unaware that clinical trials are available, or believe incorrectly that the treatments are too expensive. Often, Carson says, insurance or the sponsoring organization covers the cost of drugs in clinical trials.
All this is more than a little important in a state that will experience some 96,000 new cases of cancer this year and some 40,000 cancer deaths. It's particularly important as Florida's population edges toward the time, around 2020, when one in four Floridians will be over 65.
It's a statistical fact of life that many seniors -- active, infirm or in-between -- are going to get cancer, which now accounts for approximately 23% of all deaths and is the leading cause of death of Americans under age 85. It's also true, as the Florida Dialogue points out, that Florida lags many other states in cancer research and treatment facilities. California, for example, has about a third more new cases of cancer each year than Florida, but attracts more than $650 million in funding from the National Cancer Institute -- nearly 20 times the $38 million the NCI gives to Florida. Our state, the fourth-largest, ranks 20th in NCI funding, trailing other Southeastern states like Tennessee, Alabama and North Carolina. California has six NCI-designated comprehensive cancer centers; Florida has only one based in the state.
Money follows talent. And as is so often the case in so many areas of science, high-tech and business in the state, Florida has been slow to invest in the people and institutions that would make the state first-rate rather than cut-rate. Our legislators find $9 million a year for an unneeded and unwanted chiropractic school but get the anti-tax vapors when it comes to funding an adequate pre-kindergarten program or growth at the state's universities -- vital investments in human capital.
This session, the Florida Dialogue is asking the Legislature to increase funding for cancer research. One idea: Raise the tax on a pack of cigarettes by 5 cents. (That would raise the per-pack tax in Florida to 38 cents. California taxes cigarettes at 87 cents a pack; even Alabama taxes at 42 cents. In New York, smokes are about $5 a pack.) A nickel-per-pack more in Florida would raise $75 million, the Dialogue says, which could be bonded out to raise a total of $500 million over five to 10 years. The Dialogue participants believe that the state's investment would generate an additional $200 million in federal funding and would help it raise close to $300 million in private funding for cancer research.
Putting those sums into cancer research, the Dialogue members believe, would move Florida into the top five states in cancer research and treatment within a decade. The Florida Dialogue wants the money to be distributed by the Florida Cancer Council, a body the Legislature created last session. The Council would decide who gets research money based on peer-reviewed competition rather than which legislator's back to scratch.
As with all lobbying groups, the Florida Dialogue comes armed with an economic study touting billions in "total economic output" and thousands of high-wage jobs that additional research would create over time. Even discounting the "applause-for-hire" provided by the study, some additional investment in cancer research seems likely to pay off. Additional funding for research -- however much the Legislature may decide to provide -- will dovetail with what the Scripps Research Institute will be doing. And it will certainly contribute at least a few building blocks in the state's slowly growing biomedical infrastructure.
The context for the discussion about funding cancer research is, as always, the health of the state's economy. If Florida is looking for ways to market itself to affluent Baby Boomers looking for quality of life in their later years, the state has to do better than ad campaigns selling sunshine. A reputation for first-class cancer research and treatment wouldn't hurt. To say nothing of a reputation for acting boldly and decisively in the public interest.
Mark Howard can be reached by e-mail at firstname.lastname@example.org.