Maybe moonshot wasn't the most apt metaphor to describe the efforts of an entire country to (once again) cure cancer.
“I almost wish we hadn't called it the moonshot,” U.S. Vice President Joe Biden, the head of the White House Cancer Moonshot Task Force, said Sunday in Australia, where he was opening a cancer center in Melbourne. “It really is more like the Manhattan Project. It really is about collaboration in a way that hasn't happened before.”
In January, the White House launched the so-called Cancer Moonshot. President Barack Obama tasked Biden, whose son Beau died of brain cancer in 2015, with leading it.
The goal was to “double the rate of progress” toward finding a cure, Biden wrote in a blog post. “The science, data, and research results are trapped in silos, preventing faster progress and greater reach to patients,” he explained. The task force's plan was twofold: increase public and private resources devoted to fighting cancer and dramatically improve the coordination between every entity devoted to fighting cancer.
Six months later, doubts continue to surface about the plan and the overly simplistic terms in which it was couched, raising questions about whether it was a necessarily ambitious revitalization of efforts or an irresponsible metaphor that overreached in its promises to deliver.
The term moonshot dates back to May 1961, when President John F. Kennedy announced the new U.S. goal of landing a man on the moon by the end of the decade and bringing him back.
Kennedy later laid out precisely what it would take to achieve that goal: “a giant rocket more than 300 feet tall ... made of new metal alloys, some of which have not yet been invented, capable of standing heat and stresses several times more than have ever been experienced.”
“It harkens back to a time when America collectively set an audacious goal and then achieved it,” said Dorie Clark, a branding expert and the author of Stand Out. “By invoking the moonshot, it says something about the ambitions of the project,” she said of the cancer task force.
The problem, as many have pointed out, is that saving people from cancer is nothing like landing a man on the moon.
Even the singularity of the terminology—cancer, a cure—is misleading. “Cancer is not just one disease,” notes the American Cancer Society on its website. It can find a foothold anywhere in the body—the lungs, the colon, the blood—and it can grow and spread in a variety of ways and speeds. Symptoms, causes and treatment range wildly, too.
Critics of the moonshot concept still commend the effort to accelerate and pursue cures for cancers, from which an estimated nearly 600,000 people will die this year. But even Biden appears to be reconsidering the validity of the term in the context of what cancer actually is and what scientists and doctors understand about it.
The disconnect between how the effort is presented to the public and what it is primed to achieve is neither superficial nor inconsequential.
“The biggest problem is that if there is not reasonably rapid progress, the public might begin to feel discouraged about the process and become less supportive of aggressively funding it,” Clark said. “They may prefer to spend taxpayer dollars in other ways.”
Experts on cancer have also argued that an emphasis on “curing” cancer to save lives is misleading.
“While we believe these goals to have merit, we believe that they show a limited view of the overall problem of reducing cancer mortality and are shortsighted with respect to the lessons of history,” Alfred Neugut, of the Herbert Irving Comprehensive Cancer Center at Columbia University, and Cary P. Gross, of the Cancer Outcomes, Public Policy and Effectiveness Research Center at the Yale University School of Medicine, wrote in an editorial for JAMA Oncology in April.
Neugut and Gross argue that the real advances in reducing deaths from cancer have been in prevention—decreases in smoking, the shift refrigeration sparked in eating fresh instead of cured meat, the widespread use of Pap smears. And in the ongoing fight against cancer, the most fruitful advances would likely remain that way.
“Improvements in cancer mortality are much more likely to be brought about by lowering a state's smoking rate than by focusing exclusively on a search for cures,” they wrote.
In 2013, 14.1 million people lived with cancer of any type, the National Cancer Institute has estimated. This year, some 1.68 million people will be newly diagnosed with some form of the disease.
Given the heavy physical and emotional toll that cancer exacts on patients, caregivers, friends and families, major undertakings to beat the disease will inevitably raise hopes. The challenge is in not raising false ones.
In 1971, President Richard Nixon declared a war on cancer, calling for a “concentrated effort ... toward conquering this dread disease.” Although the initiative devoted billions of dollars to cancer research and elevated oncology as a field, it did not “conquer” the disease.
“Cancer is an area where the public has been disappointed before,” Clark said.