Nearly 45 years after President Richard Nixon signed the bill that would be called his War on Cancer, cancer is still right behind heart disease as the leading cause of death in the United States. Just a decade after the bill became law, critics were calling it a failure.
But Dr. Fred Appelbaum, deputy director and executive vice president of Fred Hutchinson Cancer Research Center, has an unconventional take on the old law, known as the National Cancer Act of 1971. “From my standpoint,” he said, “the ultimate impact has been extraordinary.”
Appelbaum was in medical school when Nixon signed the bill, and today he contends that the law has made all the difference for the cancer research center where he has worked since 1978. “Without that act, the Hutch would not exist,” he said.
In his opinion, the signing of the bill on Dec. 23, 1971 was a pivotal moment that helped make possible the recent spate of advances in cancer treatment.
Nixon presided over a different era in cancer research. “People had an idea that leukemia and other malignancies were caused by something that was wrong genetically, but we were so ignorant, back then, of so much,’’ Appelbaum said.
At the time, Dr. E. Donnall Thomas was conducting early work on bone marrow transplants in Seattle. Appelbaum was a med student then and, after having read a journal article about transplants in 1970, was on a course that eventually took him to work for Thomas at Fred Hutch.
The National Cancer Act passed Congress with bipartisan support and injected nearly $1.6 billion in federal funding to cancer research that was spread over three years. At the time, it was called a “moonshot” by a nation that was still actually sending men to the moon. It was an impressive appropriation for those times: $9 billion in today’s dollars. Now, in the waning months of the Obama administration, there is talk about another moonshot. Led by Vice President Joe Biden, the White House Cancer Moonshot Task Force last week issued a list of recommendations aimed at achieving a decade of progress in half the time. Drawn from feedback gathered on Biden’s nationwide “listening tour” of leading cancer research centers, including his visit to Fred Hutch on March 21, the recommendations were issued by a Blue Ribbon Panel of experts ― similar in concept to the Panel of Consultants on the Conquest of Cancer, led by famed Harvard researcher Dr. Sidney Farber in 1970. That panel drew up a blueprint of what became the National Cancer Act of 1971. Among the 26 members of that panel: Fred Hutch founder Dr. William "Bill" Hutchinson.
Appelbaum believes the most significant and lasting part of the National Cancer Act all those years ago was the formation of National Cancer Institute-designated cancer centers, 15 of them at first, across the U.S. Fred Hutch was among them.
Federal money began to flow into that network. In 1974 alone, a year before it opened its doors at its new facility on First Hill, Fred Hutch received $6.4 million in NCI grants and contracts covering research, training and construction.
The National Cancer Act required that designated cancer centers show expertise in clinical, basic and population sciences. Appelbaum said the first scientific divisions of Fred Hutch ― Clinical Research, Basic Sciences and Public Health Sciences ― were formed to fulfill that requirement. “Everything from the scientists who shaped the Hutch to its current structure arose from that Act,” he said. Obtaining NCI designation as a cancer center was key to securing federal grants to attract researchers and pay for their equipment, and these grants have been a consistent source of support. Today, Fred Hutch ranks first in National Institutes of Health funding among independent U.S. research institutions.
In countless ways, the infrastructure required of an NCI-designated Comprehensive Cancer Center has kept Fred Hutch competitive in lifesaving, leading-edge research, and has done so for decades. From his office chair, Appelbaum pointed his thumb to a fat blue binder high on a bookshelf behind him. “That is our application for renewal of the Adult Leukemia Center Grant, which Don originally had,” he said. He was referring to Thomas, who used that grant for transplant research at Fred Hutch; work that earned Thomas the Nobel Prize in 1990 and continues to evolve with advances in technology. The current grant provides $4.2 million annually. “The grant has been continually funded for 41 years.” Appelbaum added. “Don was the principal investigator for the first 15 years. I’ve been the PI for the last 26.”
Throughout the U.S., there are now 69 NCI-designated Cancer Centers, each one assigned a level. Fred Hutch earned the highest-level designation, “Comprehensive Cancer Center,” in 1976. There are now 47 institutions that have earned “Comprehensive” status.
Appelbaum said that meticulous research that flows from these centers is evidence that the war on cancer has never ended, and it is now fueling a renaissance of optimism. Fred Hutch President and Director Dr. Gary Gilliland believes that cancer research has reached a turning point, and last year he predicted: “It is actually plausible that in 10 years we’ll have curative therapies for most if not all human cancers.”
Former U.S. Rep. Norm Dicks of Seattle remembers well the effort to win passage of the National Cancer Act. In 1971 he was a legislative assistant to Washington Sen. Warren Magnuson, who as chairman of the Senate Committee on Commerce played a key role in shaping the bill and helping the Hutch get off the ground. How important was the National Cancer Act to Fred Hutch? “In my view,” said Dicks, “there was a direct link. … There were grants that Magnuson shepherded through that helped Fred Hutch get started.”
In fact, it was with Magnuson’s help that Bill Hutchinson became deeply involved in the legislative process that led to Nixon’s bill. Hutchinson had been working since 1965 to create a regional cancer research center for the Pacific Northwest in honor of his brother Fred, the legendary baseball player and manager who died of lung cancer at age 45. Magnuson was friends with both Hutchinson and Mary Lasker, the influential philanthropist and cancer research advocate who, along with Farber, is widely recognized as the driving force behind the legislation. It was Magnuson who arranged for Hutchinson to sit on the Farber’s Panel of Consultants.
The Lasker Awards, named after Mary’s late husband, Albert Lasker, today are recognized as the highest American honors in medical research and public service. Dicks recalled that in 1973, Magnuson received the Lasker Public Service Award, and at a black tie gala in Seattle he donated to Fred Hutch the $10,000 cash award that came with it.
Proponents of the National Cancer Act could be faulted for raising public expectations of a rapid cure but, in fact, most cancer scientists knew that was an unrealistic goal. “Perhaps ‘war’ was the wrong metaphor,” Appelbaum said. “Almost every scientist recognized that cancer was an extremely complex group of diseases and that success would come in small increments.”
Unlike NASA’s Apollo program, which was based on the scale-up of existing technology, cancer was still a little-understood disease. By 1980, the proof that many cancers are caused by oncogenes ― mutated genes that normally control cell growth ― was still fresh from the laboratory bench. Desktop computers, ubiquitous and essential in scientific laboratories today, were just entering the commercial marketplace. Successful mapping of the human genome was still two decades away.
However, those incremental gains kept coming from research institutes fortified by National Cancer Act funding. Chemotherapy drug combinations were inching up survival rates. Biotechnology was refining techniques to manufacture antibodies as cancer-fighting proteins. Fred Hutch scientists were making strides in bone marrow transplantation for the treatment of blood cancers, and as early as 1978, Hutch teams recognized that a transplanted immune system can sometimes recognize a patient’s latent cancer and eliminate it, setting the stage for today’s gains in cancer immunotherapy.
Dr. Robert Day, president and director emeritus of Fred Hutch who led the center from 1981 to 1997, credits Nixon’s War on Cancer with accelerating research, improving patient care and giving a boost to prevention.
“Things did happen that would not have happened without it,” he said. “It really started an institutional change in research and education in this country, and it continues to this day.”
Although funding from the NCI through the National Cancer Act helped establish Fred Hutch as the nation’s first freestanding cancer center ― not directly tied at the time to a university ― Day noted that Dr. Bill Hutchison was well on his way to creating Fred Hutch even without it.
Working with Sen. Magnuson, Hutchinson by 1971 was on the verge of winning approval to build a $5 million research and patient care facility in Seattle’s First Hill neighborhood through an existing federal channel, the NCI’s Regional Medical Program. That program was absorbed into the National Cancer Act funding scheme through the new legislation. Then, as now, private philanthropy was crucial to securing federal money. Hutchinson raised $1 million in local matching funds to help build the Hutch’s First Hill facility.
In Day’s opinion, more so than the temporary boost from Nixon’s moonshot, it was the successful research in bone marrow transplantation that assured Fred Hutch’s future. Once the Hutch opened its doors in 1975, it was not the money but the quality of the research inside that mattered.
“The thing that made the Hutch was Donnall Thomas,” he said. “He brought a lot of very good people to Fred Hutch. Don had the smarts, the perseverance and the capability to do it, and he did it.”
And as Appelbaum reflected on the impact of the War on Cancer, he said that history will be kind to Nixon’s moonshot. “It has already paid off in the cures of hundreds of thousands of patients,” he said, “and it paved the way for the exciting developments in immunotherapy and molecularly based treatments that are filling the headlines today.”
Sabin Russell is a staff writer at Fred Hutchinson Cancer Research Center. For two decades he covered medical science, global health and health care economics for the San Francisco Chronicle, and wrote extensively about infectious diseases, including HIV/AIDS. He was a Knight Science Journalism Fellow at MIT, and a freelance writer for the New York Times and Health Affairs. Reach him at firstname.lastname@example.org.