‘Ambition is good’ but…

August 16, 2006

Maryland has a crowded Democratic Senate primary, in which the candidates largely agree with one another on all the major issues of the day. Distinguishing oneself is a challenge, but Rep. Ben Cardin (D), a leading congressional proponent of cancer research and screening, thinks he’s found a niche (via Minipundit).

With a month to go before primary voters head to the polls to choose Senate nominees, Rep. Benjamin L. Cardin kicked off yesterday a weeklong effort to highlight his congressional record and vision on health care by making the mother of all campaign promises – to cure cancer.

Cardin, a Democrat from Baltimore County, gathered with cancer survivors and doctors in Lutherville to detail his efforts to expand cancer screening and his plans to fight the disease.

“We are going to lick cancer by 2015,” Cardin told a group of 15 people at the HopeWell Cancer Support Center on Falls Road.

Cardin isn’t kidding. He wants to lead the fight in the Senate to eliminate cancer over the next decade. It’s not entirely clear how, but Cardin does know a thing or two using the power of the federal government to tackle cancer.

In 1997, Cardin spearheaded bipartisan efforts that resulted in a new law that expanded Medicare coverage for screening several types of cancer. Two years later, he pushed for Medicare coverage of patients undergoing clinical cancer trials, a measure enacted by a 2000 executive order issued by President Bill Clinton.

Dr. Marvin Schuster, a retired Johns Hopkins gastroenterologist, said Cardin has been a leader on health care since he was first elected in 1987. “Hillary Clinton once told me that Ben knows more about health care than any member of Congress, and she’s right,” said Schuster, who attended yesterday’s event.

All of this starts to sound a bit like a West Wing episode. Oh wait, it was a West Wing episode.

From Season Three’s “100,000 Airplanes“:

BARTLET: Good evening. Thanks for being here so late.

ALL: Good evening, Mr. President.

BARTLET: A President stood up. He said we will land a man on the moon before the end of the decade. You know what we knew when he said that? Nothing. We didn’t know anything. We didn’t know about the lunar surface. We didn’t know how to land one of these things. All we’d ever done is crash it into the ocean. And God knows we could figure out how to land soft. We didn’t know how to blast off again, but a President said we’re gonna do it, and we did it. So I ask you, why shouldn’t I stand up and say we are going to cure cancer in ten years?

Silence in the room. No one responds.

BARTLET [CONT.]: I’m really asking.

JOSH: Well, how close are we to really being able to do this?

BARTLET: Nobody knows.

JOSH: Then…

BARTLET: Toby.

TOBY: It’ll be seen as a political ploy.

BARTLET: Why?

C.J.: It can be seen… [to Toby] Excuse me. [to Bartlet] It can be seen as self-serving.

BARTLET: How?

C.J.: Using cancer to deflect attention from MS.

BARTLET: You think people with cancer care what my motives are? You think their families do?

C.J.: I’m saying…

BARTLET: Joey?

JOEY [KENNY]: I agree with everything that’s been said, except, I don’t think they’ll see it as deflecting the MS. I think they’ll see it as deflecting the censure.

BARTLET: Once again, why would somebody…?

JOEY: Everybody cares about motive, Mr. President.

BARTLET: I didn’t…

KENNY: She said, “Everybody cares about motive,” sir.

BARTLET: Sam.

SAM: Yes sir?

BARTLET: Why shouldn’t I do it?

SAM: I think you should. I think ambition is good. I think overreaching is good. I think
giving people a vision of government that’s more than Social Security checks and debt
reduction is good. I think government should be optimistic.

Great episode. It turned out Bartlett’s idea was quickly shelved — they didn’t know how to pay for it and lacked time to work it into the State of the Union — but it was hard not to like the motivated approach to government.

Of course, it was fiction. With [tag]Cardin[/tag], there’s certainly nothing wrong with being the “I want to [tag]cure[/tag] [tag]cancer[/tag]” candidate. As niches go, it’s a good one. That said, is this even remotely realistic?

Depending on what you mean by “remotely realistic,” it’s certainly within the realm of possibility. Who knows where science will be in a few years, let alone 10? Would I let such a promise steer my vote? Not entirely, but I’d consider it at least a commitment to fund medical research, which we pretty much all benefit from.

  • something being realistic is irrelevant to political discourse now. if it drums up voters desperate for hope in bush’s shit for all america, then it’ll work. if anything, cardin can then say his opponnent is pro-cancer or a cancer himself for opposing the disease’s cure.

  • If he wanted to roll that into a broader health-care or research strategy, OK with me. It could be used to point out the potential benefits of stem-cell research, and how we do have the ability to do these things if we didn’t spend all our money on Iraq wars.

  • It’s a cinch we won’t find the cure(s) for cancer(s) if we don’t continue massive research. The problem is one of priorities. Is spending billions to make thelast year of one’s (usually old) life more bearable? Wouldn’t it be better to invest in pre-natal and post-natal care and early childhood diet and health?

    This isn’t one of those puzzles that can be solved with a slogan — “greatest health of the greatest number” (there is no unique way to maximize two variables simultaneously). Or even “we put a man on the moon, why not a cure for cancer?” We have to make judgements about how to spend our limited amount of research funds.

    Of course, if we hadn’t already given away trillions to the obscenely rich…. Or if there were a way to pry a few trillion out of the pentagon over the next ten years…. But then, I’m being delusional.

  • 10 years is such a long time when it comes to scientific and medical advancement. Pick any major medical advancement and then think about how likely it seemed 10 years before it happened. You’ll find that how likely it seems has very little to do with whether it will happen. OF course many forms of cancer are already treatable, so maybe we’re closer than it seems? I wouldn’t want to bet on it unless there was a high payoff, but I’m not sure that I’d want to bet against it either.

  • In all seriousness, I think Nixon may have declared war on cancer back in the early ’70s. The idea pretty much faded away, but it was there.

  • As Ed S. points out, there are multiple cancers with mulitple cures needed. Consider cervical cancer. Solving that just took a vacine to prevent infection by a family of related viruses (HPV?).

    But basically, this is a little stupid. Human Beings, mammals, vertibrates in general are not designed to live forever. If you want to live forever go back to being a one-celled organism. We gave up immortality for sex (gene recombination to find more effective mechanisms to win the challenge of the survival of the fitest) and I’m actually glad we did. But since we are not designed to live forever we start to break down. Some, but not all, cancers are a result of that breakdown.

    Now, if we wanted to prevent and cure childhood cancers. If we wanted to develop treatments that don’t make the last six months of life a bed-ridden nightmare of tubes and paliative care. If we wanted to work on avoiding and detecting cancers. That would all be great.

    But if the idea is to allow Americans to smoke like chimneys, eat like pigs and drink like lushes and not pay the piper, I don’t see the point.

  • cancer is not one disease, it is many. therefore, there will be no one “cure”. that having been said, there are worse platform planks than increased support for health care, preventative medicine and medical research. it works for me. it is pro-reality based and pro science; very anti Bush

  • Ed,

    I don’t know what the age distribution is on cancer, so while “usually old” may apply, I’m curious as to what age is considered “old” and what percentage of cancer patients are younger than that cutoff? Secondly, I’m not positive but I think the concept of “a cure for cancer” is to add many productive and enjoyable years to the life of the patient, not making the last year of life bearable. Euthanasia and hospice can go a long way towards making the last year of life bearable, but do nothing to cure cancer.

    If we want to take a cost/benefit look at cancer research versus prenatal care, I suspect that adding many productive years on to the life of all cancer patients will increase national productivity, and depending on the cost of the cures once they are found, there may be reduced health care costs compared to the current treatment and care options for terminally ill patients.

    I agree there are many medical issues that all need research. Since we don’t know where the next major advancement will come, we need to balance how much effort is put into each area of study. I just don’t feel that cancer research should be disregarded as making the last year of life for old people more bearable.

  • Lance,

    I agree that death is inevitable. Nobody ever “saves a life” or “prevents death”. All they do is postpone death for a while.

    On the other hand, I and many others feel that learning to postpone death is a worthy pursuit. Otherwise why spend any money at all on medical care?

    Your comment “But if the idea is to allow Americans to smoke like chimneys, eat like pigs and drink like lushes and not pay the piper, I don’t see the point” sounds frighteningly similar to “If the idea is to allow Americans to engage in homosexual relationships, and inject illegal drugs and not pay the piper, I don’t see the point.” in reference to AIDS.

    Keep in mind that many people who smoke like chimneys, eat like pigs, and drink like lushes never get cancer, and many people who never smoke, eat healthy and never touch a drop of alcohol do get cancer.

  • Silly me – I’d much rather hear him talk about how he’s going to help get our nation’s finances in order. What good is pro-longing life by eradicating cancer if we’re going to end up living on the street in cardboard boxes?

  • It’s great for a number of reasons. First, full disclosure, my dad is only 63 and never smoked, yet he has stage 4 lung cancer. In the months since the diagnosis I have gotten involved in research and discussion about the disease in a way I never thought I would.

    This is a great promise because it does put our shared resources to use for the greater good. The wealthy GOP-voting tax-cut-getting assholes get cancer just like everyone else. We saw with Ken Lay that wealth does not make you bullet proof.

    Another thing it does is draw attention to the fact that as we fight ill-advised wars of choice with no end and let that take up all our national attention, it also takes away from the good that government can do.

    And finally it forces a discussion about cancer that isn’t taking place right now. We hear a lot about research and fund raising, but I hear nothing about a concerted and centralized effort to support all the different projects underway. All I ever hear about in terms of the government is that NIH has repeatedly refused to fund testing certain types of promising therapies because they are not profitable enough for drug companies.

    In a country with such a high percentage of uninsured, and where there are about 10 million new cancer diagnoses each year, trying to cure cancer is the least we can do. Of course then we need to talk about making sure that people can afford the treatment, but that’s for another post another day.

  • Danny,

    Sorry to frighten you. Of course, AIDS is a communicable desease, like the virus that causes cervical cancer. -I- think it deserves research.

    As for postponing death, remember that a huge percentage of our health care spending in this country is spent on keeping people ‘alive’ for the last six months of their lifes. Life extension on feeding tubes and respirators and paliative drugs (or not) when the final outcome is still death does nothing for anybody except the selfish, either the patient or the family, who fear to let go. I fear it too. Come the time to make the decision, will I be brave enough to let go. For myself, I think so. But for my wife, or heaven forbid, my daughter, I might not be strong enough. Cures of cancers I approve of. New and fascinating ways to extend life that is little better than tortures? Not so much.

    Remember Terry Shivo!

    “Otherwise why spend any money at all on medical care?”

    Because the cured person becomes again a productive member of society with a positive life prospect. Our rise to humanity from ape-hood included the ability to see that helping a member of the tribe with a broken leg recover meant a total benefit to the group, an investment that paid dividends. That is what health care is meant to be.

    But for Americans, health care has become a repayment of what they think they have already given. The patient has no prospect of repaying from future earnings. He just thinks the extrodinary efforts are his due.

    But if you were asked at 30 to sock away $100,000 to extend your life from 79 to 80, would you do that? Are we saving enough to just add to the end of our lives?

    There are better investments after all. I don’t smoke (though I lived with smoking parents for years). I drink very rarely, and usually only wine. But I do eat too much and am overweight, much caused by the stress of my job (certainly the last ten pounds). I suppose I could do more, but I am doing more than some Americans not to become a health burden as a senior.

  • Nixon announced the “War Against Cancer” in 1971, increasing the NCI budget from $150 to $220 million, and we are still fighting it. (No exit strategy, apparently.) In 1984 and 1986, the NCI promised that cancer mortality would be halved by 2000, and on 11 February 2003 NCI director Dr. Andrew von Eschenbach pledged to “eliminate the suffering and death from cancer by 2015.”

    This report ( http://www.preventcancer.com/publications/pdf/nov04,03.htm ) is very skeptical on the War on Cancer, most notably griping about it becoming a boondoggle for pharmaceutical firms and other private concerned interests, and the lack of attention to environmental carcinogens.

    That report complains about steady and even increasing death rates from cancer, but this is wrong, because preventing deaths from other causes will necessarily increase deaths from cancer – if nothing else goes wrong, cancer will eventually happen. (Increasing rates of cancer in juveniles, presumably from environmental causes, is a huge concern, however.)

    As worriedaboutthis said, there are many different causes for cancers, but it’s still a great campaign platform. As others already noted, everyone’s self-interest comes into play, and why not fight for medical research and preventive medicine? Opening a second front on the war on cancer could justify additional attention to environmental issues. And what could be sweeter than slamming Republican opponents as being pro-cancer?

  • Looking for a cancer cure doesn’t sound to me like just prolonging life for 6 months…To me it means research and even if the research is pointed toward cancer other things may pop up. Drugs that do or cure other problems sometimes serendipidisly ( spelling?) appear. I can’t name any instance but I have a feeling this has happened…just as getting a man on the moon created propducts that are now being used commercially, teflon I think.

    And then for full disclosure…I am old and I have a living will and it states no feeding tubes if the problem ( stroke or whatever) cannot be solved and I be returned to a functional life in a month. My children know how I feel and they had better not change anything!

    And finally, running ( as someone else said) on a cure for cancer ticket sounds like a winner…

  • Lance,

    On the point of CB’s original post, I think you and I are mostly in agreement. It’s the way you keep wandering away from that topic to the topic of end of life medical care that seems to bring about any disagreement on my part. And then it’s not to disagree with your views on end of life medical care, but rather to point out that end of life medical care and a cure for cancer are not the same thing.

    We are discussing the likelyhood of curing cancer, and whether Ben Cardin’s promise to cure cancer is a good or bad idea. As an extension to that discussion we are discussing why a promise by a polotician to cure cancer would be a good or bad idea.

    I’ve assumed that most people don’t consider a cure for cancer to consist of life extension on feeding tubes and respirators and paliative drugs for six months or a year. The idea of a cure for cancer is to extend productive and enjoyable years of life, and to get patients off of feeding tubes, respirators, and paliative drugs.

    Terry Shivo didn’t have cancer and Ben Cardin isn’t promising to extend everyones life for as long as possible by any means possible, nor is he promising to try to force life extension on people who don’t want it. He’s promising to cure cancer.

    “Because the cured person becomes again a productive member of society with a positive life prospect” – And this can also be the point you weren’t seeing when you said “But if the idea is to allow Americans to smoke like chimneys, eat like pigs and drink like lushes and not pay the piper, I don’t see the point”. Obviously they’ll die (pay the piper) eventually, we all will, but if cancer or other fatal diseases can be cured, then the cured person becomes again a productive member of society with a positive life prospect.

    “The patient has no prospect of repaying from future earnings. He just thinks the extrodinary efforts are his due” – I’m sure many people feel this way, but keep in mind that while a cured person may no longer be a member of the workforce and therefore not “repay from future earnings”, that doesn’t mean they won’t still have a positive impact on society. There are many ways they can affect society, including but not limited to participating in the political process, and being a positive influence on the lives of their family and friends.

    Like I said, I think you and I are in agreement that finding a cure for cancer is a good idea, and that forcing life extention with feeding tubes and respirators and paliative drugs on someone who doesn’t want it is a bad idea. As for allowing someone to choose life extention with feeding tubes and respirators and paliative drugs; that’s a different topic of discussion that I’m not going to jump into right now. I have mixed feelings on the freedom to choose versus the cost to society.

  • Politically, the specific goal of Cardin’s declaration (cure for cancer) is less important than the Dems having a Big Idea. For a long time, I’ve believed an ambitious and worthy national goal has been something this country has needed to reduce our polarization and to actually accomplish something on a scale of Kennedy’s “Man on the Moon” Energy independence or a revolutionary improvement in a several areas are worthy targets. Winning the war in Iraq “should” be a major goal right now, but the American people have, for good reason, never had much interest. Sacrifice is satisfied by being a ribbon magnet Samurai.

    An ambitious national goal, I think, is much more advantageous than negative campaigning. Bush’s faults are many and obvious, and better highlighted by a positive, message. Good salesmen know that people are far more likely to respond to a positive message about a product than a sales pitch based on slamming the competition. It’s easy to slam, but John Edwards, for example, got a lot of mileage from a positive message that was relevant to most Americans.

  • Nixon announced the “War Against Cancer” in 1971 -N.Wells

    Can’t Republicans try to make progress without declaring war on something? WTF is it with these guys?

  • Hi Danny,

    As N. Wells points out, people who don’t die of something else usually end up dying of cancer. Trying to avoid that outcome so that we can live to 120 when our biological processes just give out may be worth a lot of research (if we raise the retirement age to 90) but just coming up with extrodinary life extensions and calling it ‘curing cancers’ doesn’t seem worth it to me.

    Cancer is tied to end-of-life issues. I don’t believe in seperating them.

    Glad we agree on other things though.

  • There are some really amazing comments on this thread. Some ruminations on a few:

    AYM #2 – The line “if anything, cardin can then say his opponnent is pro-cancer or a cancer himself for opposing the disease’s cure,” is brilliant. How many times have the Dems questioned a so-called solution put forth by Repubs only to be be painted into a corner by then being labeled as for the problem if he reject the Republican idea. This would be a bit of et tu Brute.

    Otto Man #7 and Doubtful #20 pointed out truthfully that this sounds like another one of the government’s “wars” on problem that never seem to find a solution. Say, have we won the war on drugs yet? I think the nation may be a bit war weary to launch yet another one.

    My final point is that what good is a cure if people can’t afford it? I we can find a cure to the high cost of health care, think of all the suffering that could be eliminated from so many diseases, not just cancer. If a cure for cancer was found, would it be so expensive that, like the moon landings, only a few would get to enjoy the experience?

  • Danny, this may be my favorite point ever in an argument: “Lance, I agree that death is inevitable.”

    Petorado, thanks.

  • Lance,

    “people who don’t die of something else usually end up dying of cancer” – (Actually people who don’t die of something else ALWAYS end up dying of cancer. think about it) Of course if cancer were cured you could just as easily say people who don’t die of cancer just end up dying of something else, as a matter of fact heart disease is a more common cause of death than cancer, so it’s probably more accurate to say “people who don’t die of something else usually end up dying of heart disease not cancer.” And once cancer is cured, stroke is ready to fill the number 2 spot.

    I suppose what we need is for someone to ask Ben Cardin what he means by “curing cancer”. If he means extraordinary life extensions that involve feeding tubes, respirators, and paliative care for the rest of the extended life, then I’ll join you on the “There are better investments after all” side of the debate. On the other hand, if he means returning patients to a productive enjoyable life, then perhaps you’ll feel that his promise holds more weight for you.

    Cancer is only tied to end of life issues because people die from it. If Ben Cardin is successfull in curing cancer (meaning returning patients to productive enjoyable life), then there will be no more reason to tie cancer to end of life issues than other curable diseases.

  • AYM,

    Thanks, it is a bit obvious, I mean most rational people are aware that death is inevitable, but since Lance was using the inevitablity of death as an argument against working on a cure for cancer – “But basically, this is a little stupid. Human Beings, mammals, vertibrates in general are not designed to live forever. If you want to live forever go back to being a one-celled organism. We gave up immortality for sex (gene recombination to find more effective mechanisms to win the challenge of the survival of the fitest) and I’m actually glad we did. But since we are not designed to live forever we start to break down. Some, but not all, cancers are a result of that breakdown. . . . . if the idea is to allow Americans to smoke like chimneys, eat like pigs and drink like lushes and not pay the piper, I don’t see the point”, I wanted to make sure that it was clear that I wasn’t arguing that curing cancer would prevent death, just that it was a worthy cause inspite of the inevitability of death.

    Yes, I know I left out the part of the quote where Lance talks about the worthiness of some “cures”. But this seems to be the sticking point in our debate. I agree with lance that returning patients to productive lives can make researching a cure a worthwhile effort, but Lance keeps coming back to the idea that a cure might involve “extraordinary life extention”, which I take to refer to his comment on “feeding tubes, respirators, and paliative care”

  • There are very good points being raised from many angles here, and this just shows how complex and interconnected all these areas are. And I think it’s great that everyone is discussing them intelligently and without rancor, even if we don’t agree on every point. Talking together like this is how real solutions get found.

    Personally I support Cardin’s idea for several reasons:

    1) It’s pro-science. You can’t find a cure for cancer without the best possible minds working on it, so the anti-science agenda of the ID movement and others will be ignored.

    2) It presents a positive message of hope instead of demonizing real and imagined human enemies. And isn’t that a refreshing change?

    3) It promotes the innate human desire to solve problems instead of just rolling over in despair. We can debate the cost effectiveness of life extension, etc etc etc until the cows come home. But humans love challenges, and this is a really big one.

    As others have pointed out, Kennedy challenged us to go to the moon, and we did it. If the human race ever stops creating positive challenges for ourselves to overcome, then as far as I’m concerned we’re already dead.

    And to prevent that from happening is worth the price of admission.

  • “Lance was using the inevitablity of death as an argument against working on a cure for cancer…” – Danny

    Not quite.

    First, there is no ‘cure for cancer’ because there is not one ‘cancer’.

    Second, I’m all for curing every cancer we can. But I’ve got to say, not all ‘cures’ are going to achieve anything but a painful extension of life. I see no point in that. There are practical limits.

    As for Cardin making this a campaign theme, that’s fine, but he had better be ready for a lot of ridicule, because we’ve fought wars on cancer before. As Goldilocks says, keeping our environment unpoisoned would do far more for prevention of childhood and young adult cancers than all the research Cardin would fund. Sloganeering often distorts the best solutions and I suspect that Cancer has been the victum of this effect for far too long already.

  • Is it remotely realistic? Surely the possibility of curing cancer is at least as realistic as the possibility of keeping North American safe from a nuclear attack by planning to shoot *every single* ICBM headed this way our of the sky with interceptor missles. Just because something seems (nearly) impossible doesn’t mean the government can’t be convinved to spend a bunch of money on it.

  • “First, there is no ‘cure for cancer’ because there is not one ‘cancer’.” – True, there are cures for some cancers and there are other cancers that don’t have cures yet (and may never have, but I’ll continue to hope). I’ve entered this debate on the assumption that Ben Cardin is indicating that we’ll lick all forms of cancer by 2015. If that is true, then there will be a ‘cure for cancer’ or rather we’ll be able to use the general statement that ‘cancer is curable’.

    “But I’ve got to say, not all ‘cures’ are going to achieve anything but a painful extension of life.” – I think this is the one point where you and I completely disagree. I don’t consider a painful extension of life to be a cure for cancer. At best I might call it a treatment for cancer, but really I’d consider it more of a personal decision on how to deal with a terminal illness.

    By definition a “cure” restores health. So by definition all “cures” are going to achieve more than painful extension of life (I hope we can agree that painful extension of life should not be considered restoration of health).

    Of course the point I’ve been ignoring here is that Ben Cardin’s quote in CB’s post doesn’t say we are going to “cure” cancer by 2015, it said we are going to “lick” cancer by 2015. I’ve taken “lick” to mean “cure” but that may be the biggest flaw in my side of the debate. You seem to have taken “lick” to mean that we’ll find ways to drag out the dying process in some cases.

    The fact that we’ve each chosen different meanings for the word “lick” is what I think is keeping us from coming to full agreement.

  • The goal of cancer research is to figure out ways to target specific genetic abnormalities in the cancer cells to make the cells selectively die (or at least not grow). The goal is not to put old people on ventilators and delay death; we can do that already. At a minimum, the goal is to make some forms of cancer more of a “chronic disease”, like diabetes or heart disease. Something the person can “live with” and have a meaningful life. Most cancer patients are not all that “old” (although that depends on your point of view).
    I can’t see this as a bad thing in any way. The only way such new treatments would be too expensive for anyone to have would be if big Pharma is allowed to (continue to) drive the agenda.
    Again, it’s a good Dem argument about the benefits of government and something the private sector can’t/won’t do. This is a winner, but not a stand alone one. I love the ‘publicants as the pro-cancer party.

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