Investing in the Future

By Josh Fischman

Investing in the Future

Despite funding concerns, a new generation of cancer researchers is rising up

By Josh Fischman

Being a cancer physician or researcher isn’t what it used to be. On the one hand, your patients don’t routinely die, as was common just a generation ago. Therapies are more effective, side effects are less intense, and people can be successfully treated. Not everyone, but many. And new drugs and new understanding of the disease seem just around the corner.

But on the other hand, resources to find those therapies, and to treat those patients, have rarely been so tight. Although the budget of the National Cancer Institute (NCI) and its parent, the National Institutes of Health (NIH), more than doubled between 1990 and 2000, funding for cancer has since flattened out. The NCI budget was $4.79 billion in 2007, and for 2008 the Bush administration has requested $4.78 billion; the money pays for even less if inflation is factored into the budget.

This worries Geoffrey Wahl, a molecular biologist at the Salk Institute in La Jolla, Calif., and past president of the American Association for Cancer Research. “We’ve trained all these physician-scientists, and now we’re not funding their research,” he says. “In the 1980s, I think about 30 percent of grants would get funded from NIH. These were elite people, and still two-thirds of them wouldn’t get anything. Now, last year, in my study section”—an NIH grant review panel to which he applies for research funding—“I think we could fund 10 percent of the grants.”

The result, Wahl believes, is that a lot of young researchers are getting turned off to cancer research. “Why should grad students go compete for non-existent money when they could go work for market analysts on Wall Street, evaluating drug company stocks, and make money there? We could be losing a whole generation of workers. And that means there won’t be anyone to carry forward the good work now being done.”

Members of that “lost generation,” speaking for themselves, agree that funding is tight. Many are still optimistic, however. Things are tough, says Keith Cengel, a new faculty member at the University of Pennsylvania in Philadelphia, but his career is a chance to put together a life as a healer and a scientist, which gives him satisfaction that he has found nowhere else. He and other young researchers talk about the challenges—finding research money, balancing work and family, getting a mentor to guide them through tough times—but they do not speak of one thing: backing down.

Joshua Brody

Tuesdays are hectic days for Joshua Brody. “That’s the day, in the morning, that I treat patients in a lymphoma vaccine human trial that we’re running,” says Brody, 33, a physician and clinical instructor in medical oncology at Stanford University Medical Center in California. Lymphomas, a group of blood cancers that start in the lymphatic system, are diagnosed in about 71,000 Americans each year. “Then I go to a bunch of meetings, which can be annoying. In the afternoon, in clinic, I see lots of different lymphoma patients with my rather famous colleague and mentor, [Stanford professor and cancer specialist] Ron Levy.”

That’s just Tuesdays. “On the other seven days—ha, ha—I work on developing vaccines for lymphoma in the lab,” Brody says. “So I run back and forth, between basic science and clinical research.”

Brody has always wanted to make that run, ever since he was 8 years old, growing up on New York’s Long Island as the child of a dermatologist-immunologist who did cancer research. He remembers, in 1982, a local newspaper reporter asking him what he wanted to do with his life. Brody’s answer: “I want to cure cancer, like my dad.”

But he never wanted just to practice medicine. It’s not only the hassles of maintaining a private practice, with mounting paperwork cutting into time that should be spent caring for people. “Even if today’s doctors were still part of this Norman Rockwell vision of doctoring, I wouldn’t want to do it,” he says. “The state of the art of treatment isn’t good enough. I want the job of making it better. I want to keep things moving forward, not be thrilled with what we can do now.”

What we can do now is what Brody characterizes as “brute force chemotherapy”: hitting the body with toxic chemicals that kill off cancer cells but a good number of normal cells too, leading to unpleasant and sometimes intolerable side effects. Vaccines that teach the immune system to recognize cancer and destroy it, in contrast, are more specific and less toxic. “The immune system has spent millions of years learning to tell one cell type from another,” Brody says, “and we should really harness that.”

But it isn’t easy. Not only is the science hard, but getting the resources to do the science, for a young researcher, can be difficult. Brody says he wrote a grant proposal to the NCI for an immunotherapy trial with lymphoma patients, a trial that involved a bone marrow transplant. “We got a great score on the grant,” he says, which means the NCI’s reviewers thought the project was promising. “But they didn’t give us any money. The next year they gave us partial funding. But you know, you can’t do a partial bone marrow transplant.”

That left Brody to find private money. After a long search, and pitches to many rich people, he found a philanthropist who agreed to donate $1 million. So the trial is ongoing.

Brody is also frustrated by arrangements with university suppliers. Basically, he says, the school has complicated legal agreements with companies that provide everything from lab equipment to molecules of RNA, and will allow researchers to use supplies from only a few approved companies. So researchers can’t always use the exact material or device they want for their research, if the company that makes it isn’t covered by one of the legal arrangements.

Nonetheless, Brody is optimistic about his goal of curing cancer. “Even with a frustrating system, good people will make things come together,” he says. “I think we’ll cure it before I die. But it’s an urgent disease, because we still don’t know much about avoiding it.” To reduce their risk of heart disease, he says, many people can take preventive steps, like avoiding fatty foods. “But if you don’t want lymphoma, there’s not a lot that you can do.”

Keith Cengel

In 1998, Keith Cengel was well on his way to becoming an endocrinologist. He was in his second year of medical school, and endocrinology—the effects of hormones—had grabbed his attention. But in med school, students have to study many things, and that year Cengel was deep in the part of the curriculum focused on the male genitourinary tract. “I guess it’s ironic that, right at that time, I was diagnosed with testicular cancer,” Cengel says.

The cancer changed his career and, he says, his life. Today Cengel, 37, is a radiation oncologist and an assistant professor at the University of Pennsylvania School of Medicine. He is just starting a lab to study the effects of photodynamic therapy, which uses light to activate anti-cancer drugs in particular areas of the body, sparing other areas from toxic side effects. “Why didn’t I die nearly a decade ago?” Cengel asks. “Because researchers and doctors developed some effective drugs, and I had a chance. Now it’s time to pay it forward.”

The experience of being a patient, he says, “brought home to me the suffering of patients. When I got back to school, I did a rotation in radiation oncology. I don’t know what it was, but I was there for two days and I knew it was what I was made to do. The feeling that somebody needed some care and you were able to give it—that’s a really good feeling. And I think that, because of my own experience, I happen to be very comfortable dealing with people who have cancer. Not everyone is.”

But he didn’t forget his goal of paying it forward: He wanted to develop new therapies like the ones that saved him. Normally, radiation oncologists do a five-year residency program, refining their skills as physicians. Cengel was accepted into a special program at the University of Illinois, in Urbana, that gave him nearly two years, during the residency period, to focus primarily on research. “I was able to do research and mix in clinical medicine at the same time, and I saw that the lifestyle really suited me,” he says. “I thought I could do it well.”

Along the way, Cengel also picked up a doctorate in molecular and cell biology. While pursuing the PhD, he says, he missed patients. And in medical school he missed doing science. “Now that I finally have a chance to put it together, I feel fulfilled,” he says.

Outside the lab, his big challenge is balancing work and family. Cengel has three small children—the youngest an 8-month-old girl—and “sometimes it’s tough keeping all the balls in the air.” He’s fortunate, he says, because his wife was a research scientist and knows the demands of the job. “She understands that when I have a grant application due, I disappear into my office from Friday through Sunday. She’s on board with that. It’s not the lifestyle she wanted for herself, which is why she didn’t go after a doctorate, but she understands me.”

That part of the balancing act in his life seems to be working. Funding for research, however, is another matter. As a new professor, he has some start-up money from the university to get his lab up and running, and a small grant from the American Cancer Society. But that money won’t last long, and “you see folks around you who don’t get grants, and their labs just stop.” His medical degree adds some comfort, Cengel says, because if the money completely dries up, he can still see patients, which he loves.

But it would be far from his ideal role, which is the physician-scientist, taking treatments from the lab to the bedside. “I hope to add something, to do some good, not just take up oxygen that someone else could be breathing,” he says.

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