Today the Vice President’s Office announced that it will host a Cancer Moonshot Summit on June 29th. The national meeting will take place at Howard University in Washington, D.C. and in a break with the typical cancer meeting, the focus is on cancer, not a specific type of cancer. This is consistent with the focus of the Moonshot – reducing barriers to communications across fields and specific cancers, as well as encouraging data sharing.
The meeting in Washington is not the only Summit planned for June 29th. The Department of Health and Human Services is looking to coordinate a series of summits across the country. If you are interested in participating in such a meeting, you can let them know here.
The events are intended for a wide variety of stakeholders, including researchers, clinicians, cancer patients, caregivers, and others involved in fighting cancer and trying to understand it better.
On Tuesday the Senate is scheduled to vote on various proposals for committing over $1 billion to fight the spread of the Zika virus in the United States and in other countries. The White House released a spending proposal back in February, while whatever Senate proposal emerges still has to be approved by the House of Representatives (or a House proposal, reportedly coming this week, would need to be approved by both houses of Congress).
Meanwhile, the Centers for Disease Control and Prevention (CDC) have obtained money redirected from other federal programs in order to help state and territorial governments the ability to boost their own Zika preparedness programs. Proposals are due by June 13 and the money will be available through July 2017. The Obama Administration has identified several hundred million dollars that will be redirected (not just through the CDC).
While some coverage of the emergence of the Zika virus in the United States has been described as sensational, to me it doesn’t appear to rise to the level of the concerns over Ebola in the United States back in 2014. The consequences of the disease may not be as severe as the lethal potential of Ebola, but the nature of this virus, and how it spreads, suggests there will be many more cases than the handful of people infected by Ebola that were discovered in the U.S.
About those consequences…Zika is very rarely lethal. But it can contribute to birth defects (most notably microcephaly) in the fetuses of pregnant women that contract the disease. Perhaps the fact that the most serious consequences of Zika are to fetuses makes it easier to push off acting against the virus. If the consequences aren’t seen for months, the urgency to act may be hard to stoke.
As of May 11, the locally generated cases of Zika – those not linked to people traveling from affected areas – have been limited to the territories of Puerto Rico, American Samoa and the U.S. Virgin Islands. There have been a total of 1204 cases reported in the U.S. and its territories, with cases of Zika reported in 44 of the 50 states.
Increasingly it appears that many elected leaders are inclined to treat disease prevention like they do funding elections – as cheaply as possible and after ‘more important’ things receive funding. Maybe we can put both actions in the maintenance camp – things that need to be done, but lack the interest or the rewards to motivate sufficient action.
Earlier today the pharmaceutical company Pfizer announced restrictions to the sale of seven of its drugs to better control the uses of said drugs (H/T The New York Times). Each of the covered drugs has specific medical applications (and all are approved by the Food and Drug Administration – FDA – for those medical applications) but they can be used in executions by lethal injection. The relevant drugs are:
- Propofol (anesthetic)
- Pancuronium bromide (muscle relaxant)
- Midazolam (anesthetic)
- Hydromorphone (opiod analgesic, lethal in sufficient dosage)
- Rocuronium bromide (muscle relaxant)
- Vecuronium bromide (muscle relaxant)
- Potassium chloride (helps the body replenish potassium, but can stop the heart in sufficient dosage)
While drug shortages have prompted some changes in execution drug protocols, typically the procedure is to administer an anesthetic, followed by a muscle relaxant and then potassium chloride to stop the heart. Alternatives to the three-drug protocol have tried lethal doses of an anesthetic, or combine the anesthetic with a lethal dose of an opiod.
Pfizer’s action marks the closing of the last open market source of these drugs for use in executions. If you compare the new Pfizer policy with the one it replaced, (H/T Joanne Stocker) while the company was not in favor of having its drugs used in executions, it acknowledged that Pfizer drugs could still be acquired through third party channels. The new policy suggests that Pfizer will take steps to foreclose such workarounds, and will insist that government purchasers of its drugs affirm to the company that they will use the drugs only for patient care and will not resell or otherwise provide to other parties.
This is unlikely to eliminate the death penalty, but will certainly contribute to the trend of fewer executions by lethal injection. States will probably continue to seek the appropriate drugs through channels like compounding pharmacies (which are not subject to FDA regulations). However, there is now no FDA-approved U.S. manufacturer of these drugs willing to provide them for execution (or to allow such provision through the gray market and/or alternate providers), so what has been a tough task will become much tougher.
I would also expect states to ensure that they have alternate methods of executions available in situations where drugs are not available at the time of execution. While some states have alternate methods of execution as an option, lethal injection has been the primary method of execution for all states and the federal government for a few years. The ongoing drug restrictions have prompted a few states to amend their laws to accommodate the possibility of lethal injection not being available.
Additionally, the Supreme Court has resisted efforts to have lethal injection declared unconstitutional, and in the last death penalty case it heard (Glossip v. Gross), several of the Justices were frustrated by what was perceived as an end run around the Supreme Court by restricting the ability to procure the necessary drugs. In other words, the state’s ability to execute should not be infringed by drug companies seeking to restrict the use of their products to only medically approved uses.
It will take time for the implementation of Pfizer’s new policy to have an effect. But the short shelf life of many drugs means that whatever amount from Pfizer of those seven compounds is in the hands of prisons will become unusable in the next several months.
This week the Vice President announced the opening of a White House website for people to share their ideas and stories concerning cancer. As part of the Cancer Moonshot effort, this public outreach would help put faces to various forms of cancer and try and connect public ideas with researchers and their work.
The White House site joins two other main sites connected to the effort. If people have cancer research ideas, they can go to Cancer Research Ideas (the White House website will send them there as well). There is also a Cancer Moonshot page on Medium, a platform that the Administration has used for other projects as well. This collection of stories and articles functions as a high-level archive for the Moonshot project. If you’re looking for more research-focused coverage, consult the National Cancer Institute’s page for this project.
Besides research ideas, the Vice President is interested in hearing general suggestions for the Moonshot, as well as the kinds of things people are doing to accelerate developments in cancer research. No deadlines are stated, but since the Vice President is leaving office in January, there’s not reason to dawdle.
Oprah Winfrey has been involved in trying to get a film adaptation of The Immortal Life of Henrietta Lacks made since the book was published in 2010. The film, an HBO Productions film, will start shooting this summer, and this week it was announced that Oprah will star.
Oprah will play Lacks’ daughter Deborah and the story is told from her perspective, as Deborah learns about her mother and how the harvesting of Henrietta’s cells led to many medical breakthroughs. Rebecca Skloot, author of the book, is co-executive producer, and three members of Lacks’ family are serving as consultants to the film. George C. Wolfe will direct. No release date is available, though sometime in 2017 would make sense for what will likely be a television release (it’s an HBO film, after all).
This week the Science Channel has had President Obama host its 9 pm (Eastern and Pacific) DNews segments. On the Thursday edition the President used the time to promote the Precision Medicine Initiative and specifically, the Sync4Science program.
The Sync for Science (S4S) program is being administered by the Office of the National Health Coordinator for Health Information Technology. That office joined the National Institutes of Health in launching a pilot of Sync4Science last month, so we are still some time away from being able to push the button the President speaks about in the video.
The initial phases of the pilot will start with small amounts of patient data and expand from there. At this point the work is limited to electronic health record providers and health systems, with no set deadline for full implementation. So you’re not alone if you think the President teased us last night.
Yesterday the National Institutes of Health (NIH) announced the names of a blue ribbon panel that advise the federal officials that comprise the Cancer Moonshot Task Force. The Panel will be part of the National Cancer Advisory Board, which is one of the entities that the Task Force is encouraged to consult in its work (per Section 2).
There are 28 members of the Panel, which is co-chaired by Dr. Tyler Jacks, Dr. Elizabeth Jaffee, and Dr. Dinah Singer. Jacks co-chairs the National Cancer Advisory Board and directs the Koch Integrative Cancer Research Center at MIT. Jaffee is a Professor at Johns Hopkins and is Deputy Director for Translational Research at the Sidney Kimmel Comprehensive Cancer Center. Singer is Acting Deputy Director of the National Cancer Institute (NCI). While most of the members have academic appointments in relevant research disciplines, other members come from private companies, a cancer advocacy organization and non-profit research institutes.
Of potential insight to the Panel’s work is a recent article published in The New England Journal of Medicine written by NIH Director Francis Collins and the Director of the NCI Douglas Lowy. In it they describe the Moonshot initiative, identify some promising areas for future advancements in attacking cancer (such as genomically-informed targets, tumor microenvironments, and immunotherapies) and various policy tools to address current constraints in making progress (a dedicated research fund for novel research proposals in oncology, data infrastructure support for cancer research).
The Panel will develop its recommendations for the Task Force over the summer and deliver them through the director of the National Cancer Institute. A report is expected to be developed and delivered to the President by December 31st. As the President leaves office not three weeks later, that deadline can’t slip.