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Guest Editorial: Nobel Laureates Offer Simple Formula To Save CPRIT From "Infamy and Irrelevance"
The citizens of Texas were wise to contribute $3 billion to the fight
Legislation and an amendment to the state Constitution created
the Cancer Prevention and Research Institute of Texas (CPRIT), enabling
a 10-year program in cancer research and community-based prevention
In three years, CPRIT has funded hundreds of excellent research
programs at many Texas institutions, recruited roughly 50 outstanding
scientists to Texas, established a statewide clinical trials network and
helped companies develop ways to help patients.
Recent controversies at CPRIT caused us to resign as the institute’s
chief scientific officer and chairman of its scientific review council. Leaving,
we pause to review lessons from CPRIT’s past and offer advice for its future.
We have been guided by a few simple principles:
We were truthful about the complexity of cancer. To find cures, we must
ponder dynamic cellular systems containing huge numbers of parts whose
behaviors are governed by rules that have evolved over millions of years.
We don’t understand these systems in nearly enough detail to explain why and
how they become dysfunctional. Progress in treating cancer requires rare and
penetrating insights into deep pools of ignorance and translation of these insights
into new therapies. It’s pointless to push money at a problem—no matter how
important it may be—if you lack insight for finding a solution.
Money entrusted to CPRIT financed the best ideas—period. Texans deserve
the best cancer research, the best scientists, the best clinicians. Quotas based
on geography, favoritism, type of cancer, or type of patient drain resources.
Funding decisions were based on the best possible advice from the finest
experts, free of conflicts of interest. CPRIT’s research peer review committees
have been chaired by some of the best cancer biologists and physicians in the
country. All work and reside outside Texas. The chairs chose more than 100 committee
members—again paying attention to expertise and lack of conflicts. These recruits to
the Texas war on cancer joined because they recognized a unique opportunity to
make an impact. We used their time efficiently and treated them and their
recommendations with respect.
CPRIT selected the best efforts from the best people who were willing to risk
failure to make major strides. Peer review systems can be too conservative, searching
for sure bets, where experiments are easy to execute but only buy minor increments
in knowledge. Missed are the opportunities to take great leaps. Yet great leaps are
exactly what’s required, and we looked for them.
Science must come first; commercialization is essential but comes second.
Businesses hunger for great insights to turn into great products. We see this in the
thriving biotech corridors of Boston and San Francisco.
The past eight months were difficult. Controversy flared when several well-regarded,
multi-investigator, multi-institutional collaborative research projects were put in the freezer
for months—not brought to the Oversight Committee for funding after strong recommendation
by the Scientific Review Council.
This delay was at least partially based on the concern that several of these projects
came from one institution. CPRIT’s executive director has offered different and conflicting
explanations for this action.
Simultaneously, an expensive “commercialization” proposal, constructed and submitted
in unorthodox ways that circumvented CPRIT’s rules, was rushed to the Oversight Committee
and approved for $20 million for its initial year of operations, despite the absence of description
or scientific review of its drug development program. This was ultimately corrected, albeit
with great effort. Writing in the Chronicle, Todd Ackerman and Eric Berger reported on various
individual relationships that might have motivated these events.
How can CPRIT once again become a program respected by scientists across the U.S.
and the world?
A commission should be appointed to determine whether individuals tried to violate the
public trust in the actions described above. If so, they should be removed from their positions.
CPRIT’s governing board should have sufficient expertise to do its job. Only one member
of this 11-person Oversight Committee has any direct knowledge of cancer, medical practice or
research. The Oversight Committee should promote policy, provide broad oversight of personnel
and operations, and ensure legal and ethical behavior. Members who meddle in day-to-day
operations of the organization to further their own interests should be removed.
Texans deserve to hear the truth about cancer. They must understand that miracles
will not happen in a short time. Progress will not be made by those who simply proclaim
without explanation that they can do better than hundreds of skillfully staffed and well-
financed pharmaceutical and biotechnology companies. Real progress requires the concerted
high-quality efforts of basic, translational and clinical investigators from the academic
community collaborating with counterparts from the private sector when appropriate.
There is no single “cure” for cancer. Cancer is hundreds of diseases, and victories will come
one or a few at a time. CPRIT will have an enormously positive impact on society over time,
both in terms of the health of its citizens and its economy. Texans must understand this and
demand that CPRIT continues to adhere to its core principles.
Academic institutions and for-profit companies have very different cultures, and these
differences must be respected. Academics strive to develop new knowledge and, usually,
disseminate it widely (i.e., by teaching, broadly defined, and publishing). Companies operate
much more competitively and in many cases in secret, with the goal of providing financial
returns to investors by bringing useful products to society. There can and should be synergy
between the two types of institutions, with academic knowledge being used to further the
commercial activities of companies, and there can be links between the two. But the relationship
shouldn’t be excessively intimate. Secretive behavior impedes education and research training
and therefore doesn’t belong in academia. There are also questions of compensation, ownership,
neglect of academic responsibilities, etc. CPRIT needs to understand this as it strives to facilitate
commercialization of its research activities.
Reliance on peer review to identify the best science must continue to guide CPRIT in the
future. Of course, there are other ways to distribute public funds, but they are worse. Their side
effects include infamy and they end in irrelevance.
Gilman is professor emeritus of pharmacology at the University of Texas Southwestern
Medical Center. Sharp is an institute professor at the Koch Institute for Integrative Cancer
Research at the Massachusetts Institute of Technology. Sharp won a Nobel Prize in Physiology
or Medicine in 1993, while Gilman won the same Nobel Prize in 1994. This editorial
was originally published in The Houston Chronicle and is reprinted with permission.