[MUSIC]

Brian Lehrer: It's The Brian Lehrer Show on WNYC. Good morning again, everyone. Now we continue with a special edition of our series 100 Years of 100 Things. It's 100 years of cancer research. Before the news, we did the straight 100 years treatment on the century of development in identifying, preventing, and treating different cancers. Now we will land squarely in the present to convene a discussion of what should happen this year and beyond, at a time when cancer research funding is being cut as a policy of the Trump administration. The American Cancer Society says cut by 37%.

Again, the context for this is that each year, WNYC's Local News Division hosts a health convening with support from the Alfred P. Sloan Foundation. The convening has typically been an opportunity for healthcare experts and practitioners to inform WNYC's health reporting in an off-air briefing and interaction, but again this year, as we did last year on the show, we're bringing it onto the air as we think it'll be a service for you to hear the briefing, too.

With us now on the current state of cancer research in the United States, scientifically and politically, are Sudip Parikh, PhD, CEO of the American Association for the Advancement of Science, the AAAS, an executive publisher of the journal Science and other journals for AAAS publishers. Otis Brawley, professor of oncology at the Kimmel Cancer Center at the Johns Hopkins University School of Medicine and co-editor of the Cancer History Project that our guest before the news was also associated with, and Julie Rovner, chief Washington correspondent at KFF Health News and host of their podcast, What the Health. Julie, as some of you know, previously covered health news for NPR. Julie, welcome back. Dr. Brawley, Dr. Parikh, welcome to WNYC.

Julie Rovner: Thanks for having me.

Otis Brawley: Thanks for having us.

Sudip Parikh: Thank you.

Brian Lehrer: Dr. Brawley, since you're with the Cancer History Project, let me just make the segue from the previous segment to this one, because coming into this year, there was a Biden approach known as the Cancer Moonshot. I wonder if you can put that into words, if it was any different from whatever there was in Trump's first term or under Obama, going back a few years, or even George W. Bush. What was the Cancer Moonshot, and what was its status heading into 2025?

Otis Brawley: The Cancer Moonshot was additional money being put into cancer research. Some of it went to DARPA, or ARPA-H, I should say, which is a new entity that was founded to fund some innovative research. Some of it went to the National Cancer Institute. I generally think of the Cancer Moonshot as additional money going into research that tried to get us back to 1999 funding. If you look at the cost of money and inflation over the last 25 years, National Cancer Institute right now is funded less than 1999 levels. The Moonshot was an attempt to get some additional money for a few years during the Biden administration to the National Cancer Institute to get it back to about 1999.

Brian Lehrer: Professor or Dr. Parikh, for you, as publisher of the journal Science, what would you say, if it's possible to say, what kinds of cancer research were most prevalent going into this year in diagnosing or preventing, or treating cancer based on that infusion of funds in the Moonshot?

Sudip Parikh: That infusion of funds, together with the sustained investment over the last really almost 50 years, has led to things like new uses of immunotherapy, which is where we harness the body's own immune system to fight the cancers. It's also led to some really incredible research on cancer vaccines. These are potentially personalized vaccines that are trained to recognize tumor cells.

We've seen some really impressive preliminary results on cancer vaccines. Then there's a whole set of new technologies being used in early detection, new technologies like next-generation sequencing and nanotechnology. These are all areas that have been built up over the last 50 years, but really, the rate increased thanks to that additional investment that Dr. Brawley talked about.

Brian Lehrer: Julie Rovner, anything to add from your posted KFF Health News to either of those first answers about where we were scientifically or government involvement-wise coming into 2025?

Julie Rovner: The NIH in general can-- The National Cancer Institute in specific has been such a broadly bipartisan effort. It surprises me what's going on now because my entire career, it was the Republicans who doubled NIH funding in the late 1990s. It's so visible. A lot of medical research you don't really see the advances of, but in cancer, we all know people who've died of cancer, and now we all know people who've survived cancer. It is just so common in our society. It's one of those amazing medical advances that everybody can see.

Brian Lehrer: Let's talk about the cuts. I mentioned the American Cancer Society release from just last week that refers to a cut of 37% this year. Julie, let me stay with you. As a journalist, have you reported on that American Cancer Society release at KFF Health News, or do you understand what that number refers to, 37% of what?

Julie Rovner: Yes, I have. We've been talking about this. The administration came out with the details of its fiscal 2026 budget plan just late last week, and they're proposing basically a 40% cut to the entirety of NIH, including almost a 40% cut to the National Cancer Institute. Actually, the National Cancer Institute would be down to the same level that it was at in 2003, although, as Dr. Brawley points out, that money is not worth what it was worth in 2003. It would be a really dramatic cut.

The administration would also like to condense NIH's 27 institutes into just 8. All of this requires congressional approval. Congress has always been very hands-on with the NIH in general, with cancer research in particular. I've been surprised at the hands-offness that Congress has shown this year because, as we've already seen, this is not just about next year's budget. They've frozen in money and canceled grants that have already gone out the door. We've seen this really work stoppage across the country.

Brian Lehrer: Dr. Brawley, for you at Johns Hopkins, much of the coverage of Trump science research cuts has focused on their relationship to anything considered DEI. For example, the New York City health commissioner was on recently describing cuts to their program that collects data to measure health disparities by race or other demographics. That kind of thing is in their crosshairs. Also, things related to LGBTQ health, anything they flag as DEI. Does it appear to you that cancer research is being implemented by that standard or that war on DEI?

Otis Brawley: Oh, absolutely. Some of it is just ridiculous. Not long ago, a grant that involved transgenic mice got a cease and desist order from the federal government. It was no longer going to fund this transgenic mice research because the people who were doing the cuts thought transgenic is transgender. Totally different. Mice have very small gonads. It's very hard to do trans operations on them. Transgenic involves changing genes and looking at gene research.

By the way, what I should say since I have the floor, is the research that's been done through the National Cancer Act in the 1970s, 1980s, 1990s, developed laboratory techniques, helped us understand what's going on in the cancer cell. That helped us understand more about prevention, more about treatment, but many of those techniques and much of that molecular biology knowledge has spilled over into other diseases. All of these advertisements we see about drugs on TV now are based on research that came out of the National Cancer Act.

In answer to your question, we are falling behind in terms of our ability to learn about cancer, and the DEI emphasis or anti-DEI emphasis is hurting us in our ability to learn how to spread out and apply what we've already learned. By the way, the largest group of people who suffer from disparities in cancer health, and we can't use that word, disparities, too much, the largest number of people who suffer from cancer disparities are actually white Americans. By us not being allowed to do these things, we're hurting not just Blacks, not just Hispanics, but whites.

Brian Lehrer: What do you mean whites suffer the most from health disparities? Give us an example of that.

Otis Brawley: In a study that was done about six years ago, we were able to figure out who dies from cancer, how many people die from cancer needlessly. That is, if they got adequate prevention, adequate screening, and adequate treatment, they would not die. We figured out that of 600,000 who die every year from cancer, about 132,000, 22% of those deaths, were avoidable if everybody got the care that people ought to be getting from prevention all the way through treatment. Of the 132,000 avoidable deaths, over 80,000 are white Americans.

Brian Lehrer: Are you suggesting that that's a greater proportion of those deaths than their proportion in the population?

Otis Brawley: No, I don't think it's a greater proportion. I'm not sure about that, but I think the fact that the largest group of people from cancer health disparities are white, and now we're not able to study cancer health disparities, is an interesting conundrum.

Brian Lehrer: All right. Let's hear for a few minutes from one researcher who's going to join this conversation, whose grant was recently canceled. She is Delivette Castor, PhD. Assistant Professor in Medicine in the division of Infectious Diseases at the Columbia University Medical Center. Her biopage says she is an epidemiologist who studies how to deliver public health innovations at scale by examining the unique and joint effects of biomedical, behavioral, and structural factors that affect infectious diseases in priority populations in low and middle-income country settings and in marginalized populations in the US. I know that's a lot of words, but she'll explain. Dr. Castor, thank you for coming on. Welcome to WNYC.

Delivette Castor: Good day. Brian and everyone else. It's really delighted to be here, and I'd really like to thank you for the invitation to participate in this discussion. It's really important.

Brian Lehrer: It's an honor to have you. Would you tell us what you were studying-

Delivette Castor: Thank you.

Brian Lehrer: -with the grant that got cancelled?

Delivette Castor: Yes, sure. It was actually an NCI-funded grant. Our program was called the Impelliswane [crosstalk]

Brian Lehrer: NCI, National Cancer Institute, just so our listeners know, right? National Cancer Institute.

Delivette Castor: That is correct.

Brian Lehrer: Go ahead.

Delivette Castor: The US National Cancer Institute. The Impelliswane Initiative, which means a place in Isixhosa, which is one of the 11 national languages in South Africa, where this work was being implemented. Cervical cancer, as some people may know, is an entirely preventable cancer. In fact, there's a global [inaudible 00:13:00] to eliminate cervical cancer right now.

Almost 95% of cervical cancer could be attributed to about 14 and really 8 types of human papillomavirus types. In the US and in most high-income countries, since 1940s, we've had the Pap smear as an acceptable screening tool that many women would know from their routine practices. Then we've had advancements with new molecular tests to detect high-risk HPV types, and that, in addition to the introduction and scale-up of HPV vaccination, has really made cervical cancer very low in the US and almost declining.

In the US, we have about 13,000 women who are new cases of cervical cancer and that makes up only about 0.1% of all cancers among women in the US. Yet in low and middle-income countries, we see about 600,000 new cases each year, and about half of those, about 340,000 deaths, occur. The question is, why is that? Why are we seeing such an exacerbation of cervical cancer deaths in low and middle-income countries when we are seeing low and declining rates in the US?

I will also add that in the US, we do see disproportionate rates of cervical cancer among women who identify as Black, American Indian, or Native American, and they are often diagnosed late, which highlights an access issue that we also have in the US. When we look at it on a global stage, the disparity is really a number of issues relating to implementation. Because effective cervical cancer screening is really a multi-step screening process in order to be effective, and it requires specialty care, most women will know that they go to their obstetrician-gynecologist, the gynecologist for screening.

In most low and middle-income countries, we do not have enough gynecologists, cytologists, and pathologists that's needed to deliver screening using the Pap smear. With the advancements that we've had in molecular testing, we now have had models where we've tested being able to screen a woman and if she screens positive through this molecular test, be able to actually treat her on site on the same time, day, or in the very near future. That alleviates a lot of the logistical issues that have been the major impasse in being able to bring the benefits that we've had in the advancement of cervical cancer prevention in high-income countries to most of the women in the world.

That's where our collaboration comes in. It's really-- We had partnered with academic partners at the University of Cape Town in South Africa, and our public health partner was the Western Cape Department of Health, which is the equivalent of a state-level health department here in the US. This initiative aimed to develop an approach to integrating cervical cancer screening into primary care. Rather than having it be a specialty care, that we would train primary care providers to be able to deliver this intervention and then to evaluate whether it was effective. We were comparing two different approaches to screening with this molecular approach.

One was using a point-of-care test. That means it was done on site in the primary care facility, the clinic where women would go for care and that they would then be treated at that site, versus another approach that allowed the health system in South Africa to use platforms that they have to use another molecular test that's more high volume. That would mean that the results would have to go out, and then women would potentially have to come back. We understand that these were some of the logistical challenges in terms of retaining care. [crosstalk]

Brian Lehrer: Let me jump in for a second because I just want to say and reflect that it sounds like you're describing a scenario where there's a cancer that is so preventable in terms of deaths and really serious cases through early detection and early treatment. That detection is not taking place equally among different populations of people, so you're studying the best ways to make sure that that does happen because it's such an achievable thing. Were you told why they were canceling your grant?

Delivette Castor: We were not. We received a notice. Like many investigators at the university, I received a notice of termination of my grant from the university's perspective. That's where the work stopped.

Brian Lehrer: Do you want to say, or do you not want to say why you think it was? Was it just because it was focused largely on South Africa, and their feeling is why should US taxpayers be paying for a public health study in another country? Do you have speculation, or do you not want to go there?

Delivette Castor: I won't speculate too much, but what I will say is, I think with everything that we're going through with the cuts to science and research, this research was emblematic of, I would say, death by strangulation, which is that we initially were part of the first suite of cuts relating to Columbia's universities antisemitism executive order. Subsequent to that were issues around implementation in low and middle-income countries, where the idea being that the research should be repatriated to the US. There are multiple different barriers that we are confronting in terms of how to proceed with this research in light of numerous guidance from the government.

Brian Lehrer: What will you do now, and then I'll let you go, to try to continue doing the kinds of research that study and other things that you do in epidemiology, the study of diseases at the population level? What will you do now?

Delivette Castor: Many of us who come into this field are mission-driven, and so our orientation is to continue the mission and to find alternative ways to fund the work where we can. That is our commitment. That is the partnership that we built with our colleagues in South Africa, and our hope and intent is to continue to do that work. Ours is one of numerous grants that I call the grants purgatory, that seems to be neither dead or alive. That will be a process that will continue as we understand where the US government makes its determination.

Brian Lehrer: Delivette Castor, PhD, Columbia University epidemiologist. Thank you very much for coming on with us and giving us a few minutes.

Delivette Castor: Thank you so much, Brian.

Brian Lehrer: Dr. Parikh, do you want to reflect on any of that, maybe that research purgatory that she just mentioned at the end, studies that are not stopped but not ongoing, or anything else from your purchase, executive editor of the journal Science?

Sudip Parikh: Absolutely. Brian, hearing that, it's heartbreaking for several reasons. One is the direct impact of the work that Dr. Castor is doing in South Africa. The second is there's a reason why we do this and why the United States government funds it, in addition to the impact it has in South Africa, which is that we can learn things. We have uninsured and underinsured people in this country. We have to figure out ways to deliver healthcare that is efficient, that gets the most value and the most impact on people's lives for the least dollars. We can learn from this research that Dr. Castor is doing in South Africa.

Second, this purgatory of research proposals, this is really worrisome for two reasons. One is the impact that could be had from the research that has been put into paralysis. These things move quickly. We have seen in the past few years that the time to get from discovery, such as gene editing, to a treatment in the clinic has been reduced from what seemed to be 17 or 20 years, really down. That happened in less than 10 years, which is extraordinary and is a real cure for a disease called sickle cell anemia.

We could see opportunities like that being lost because of this paralysis, but then the second reason, and this one really is troubling, is that we have a whole generation of scientists and clinicians. These really incredibly smart and creative individuals who have dedicated their lives to curing disease, to treating disease, and they are in this limbo where they don't see a future. In a span of four months, we've created a situation where folks are questioning their life choices on being in science, being in research, and being in a place where they're trying to cure disease.

Now, they're mission-driven and they're resilient, but there is a breaking point, and 40% of the National Cancer Institute is not waste, fraud, and abuse or DEI. That is a cut into cures and treatments for Americans.

Brian Lehrer: We have to take a break, but when we come back, I'm going to ask you based on what you just said, Dr. Parikh, I'll come right back to you if there's anything in terms of a Trump or RFK specific focus or motivation here, because they wouldn't say they're against cancer research as a thing, I'm sure. RFK emphasizes chronic diseases as opposed to infectious diseases, meaning he emphasizes the category that most includes cancer. When we come back, I'm going to ask you and the others, other than say, punishing Columbia University for other things, which came up with the last guest, what's going on here.

Listeners, we can take a few phone calls and texts from you, too, if you want to participate in this health convening, ask our guests a question or tell us your own story of doing cancer research as a scientist or applying for grants and what you would like to see us or other journalists cover more in reporting on cancer in any way. 212-433-WNYC, 212-433-9692, call or text. We'll get right to that Trump and RFK motivation for cutting cancer research, if there is one, right after this.

[MUSIC]

Brian Lehrer: Brian Lehrer on WNYC as we continue with our health convening on Cancer research with Sudip Parikh, CEO of the American Association for the Advancement of Science and executive publisher of the journal Science, Otis Brawley, professor of oncology at the Kimmel Cancer Center at Johns Hopkins and co-editor of the Cancer History Project, and Julie Rovner, chief Washington correspondent at KFF Health News and host of their podcast, What the Health. Dr. Parikh, why is RFK cutting cancer research if his interest is in chronic diseases, of which cancer is certainly a leading, if not the leading one?

Sudip Parikh: I'm fairly convinced. Look, I'm going to be generous about this. I think that RFK Jr. and the president want to cure cancer. I believe that. I believe that they want to ensure that Americans have good health care, but I also think that they are misinformed about the damage that's being done. One part of this is DOGE, the grant that Dr. Brawley mentioned about transgenic mice, that's collateral damage. This is a lack of understanding about what things are. You could put that in the category of waste, fraud, and abuse until you realize that transgenic mice are one of the greatest discoveries that have enabled us to learn more about disease that we've ever had.

Transgenic mice are not waste, fraud, and abuse. In fact, they are one of the amazing things that science has produced in this country. Then there's targeted damage, which is there are leaders in the scientific establishment and at HHS who are saying that science is broken, that we have a reproducibility problem. We have all these problems related to science not being done well, and they'll even equate it to some things in the pandemic. The challenge is their solution to fixing and optimizing that amazing biomedical research infrastructure we have is to dismantle it. A 40% cut is not fixing, it's not optimizing, it's not making things better. It's just breaking it.

I think that's the challenge, is that they're doing collateral damage because they think they're cutting waste, fraud, and abuse, and they're doing targeted damage because they think they're trying to fix the enterprise, but they're really breaking it.

Brian Lehrer: Julie Rovner, anything to add-

Julie Rovner: Brian, can I--

Brian Lehrer: -since you're a chief Washington correspondent? Go ahead.

Julie Rovner: Something I think that hasn't been said is it's also a tremendous waste of money, cutting off grants that are partway done. We're cutting off clinical trials in the middle, leaving patients without treatment, basically throwing away the money that's already been spent, which is just not something-- I've been doing this for 40 years. It's not something that NIH does. Grants are only supposed to be canceled for malfeasance. They are canceling grants because, in the words of the administration, this is research that doesn't comport with this administration's priorities. That's not how the NIH has worked throughout the NIH's history.

Brian Lehrer: Here's a question for you, as an oncologist, Dr. Brawley, from a listener who writes, "It's great to highlight the advances in treatment. However, can the guests comment on the increasing rates of cancer incidence and potential correlating environmental and dietary risk factors with that increase?" It's not all a straight line up, right?

Otis Brawley: That's exactly right. Dr. Parikh was being very charitable when he said that the administration wants to cure cancer. I would point out that the administration has gotten rid of all smoking and tobacco control efforts in the FDA, CDC, and NIH. Last time I looked, the leading cause of cancer was tobacco use, and all tobacco control efforts, all tobacco control research has been stopped. People who are concerned about increasing incidence of cancer really need to be concerned about tobacco control.

Brian Lehrer: Maria in Rye has a personal story. Maria, you're on WNYC. Hello.

Maria: Hi. Thank you for taking my call. I'm calling on behalf of all the survivors. Curing cancer is one of the most important things that we can do, of course, but it's only part of the picture. The group of childhood and young adult cancer survivors has just been neglected, and some of the organizations or support groups that I'm involved in, we're just trying behind the scenes to give each other as much information as we can from our own experiences. There are some survivorship clinics. A lot of them are cutting back, but in many, many parts of the country, even in New York City, it's very difficult to find doctors, providers who know anything about cancer survivorship.

You go to the doctor with a problem, and you know it's because of the radiation treatment that you received 40 years ago, but they don't make the connection. They don't know how to screen, and patients don't know. You're told, "You're cured, go on, have a happy life."

Brian Lehrer: Dr. Brawley, for you, as an oncologist, is she raising an issue you're familiar with?

Otis Brawley: Oh, very much familiar with. We've gotten to the point through research that 70% to 80% of kids with cancer actually go into sustained, complete remissions, we call that cure, but a large proportion of them end up having side effects from the treatment. Some of them die in their 30s and 40s of heart disease caused by radiation or other diseases caused by the treatment. Among people of all ages, not just children and young adults with cancer, there are numerous side effects.

Now, the National Cancer Institute has been studying side effects of treatment and survivorship. They opened an office of survivorship to do survivorship grants about 30 years ago. There's been some progress there. Not enough, but there's been some progress. With the recent cuts, that office and the research is being scaled down dramatically, unfortunately.

Brian Lehrer: There's something that the caller brings up, and Marie, thank you for sharing your painful personal story, I'm sure it wasn't easy, that doesn't get a lot of press coverage that maybe deserves more. I want to go around the room in our last few minutes in the spirit of the original conception of these convenings as a briefing for WNYC journalists. I think we've heard a number of things here during this hour, plus with you and the previous guest that imply areas of coverage of cancer research maybe looking at which cuts are actually stamping out any kind of waste or fraud or abuse, as opposed to ones that may ironically be a source of waste themselves.

As one of you was saying, stopping research in midstream, that could lead to useful results, and that money was therefore flushed down the toilet. Let's just go around the room, and I wonder if each of you would identify one or two things that might be an area of coverage for cancer research that you think are ripe for more reporting. Dr. Parikh, would you start?

Sudip Parikh: Yes. I'll start with the funding aspect, which is that we've seen the president's budget with that 40% reduction. It's time to see what Congress is going to do, and Congress is going to be writing these appropriations bills in the month of July. It'll be really important to see, does that bipartisan consensus still remain for support of biomedical research and cancer research. It'll be a signpost because then it'll take six months before that process ends, but I'm very curious. I want to see are Republican senators, are Republican House members, and bipartisan consensus, does it remain?

Brian Lehrer: Julie Rovner, how about you? You're already in the journalism space, but what haven't you been able to report on or assign that you think is ripe for more reporting?

Julie Rovner: One of the things that I really would like to look at more deeply is what this is doing to the future workforce, the healthcare workforce, public health workforce, the research workforce. I think one of the panelists mentioned that we've seen universities canceling acceptances for PhD students. We've seen research institutions in other countries trying to draw away our researchers.

This is a huge source of economic growth in this country, the whole biomedical research establishment. I don't think this administration quite appreciates how much they could be just kissing it goodbye.

Brian Lehrer: Dr. Brawley?

Otis Brawley: Research that started 50 years ago was a huge, huge investment. Much of that investment has paid off in new drugs, greater understanding of how to prevent disease. I'm really worried that as we start cutting that investment, we're going to hurt our future. The COVID vaccine came about very quickly because Richard Nixon signed the National Cancer Act of 1970, and a bunch of research that done over the next 50 years made creating a COVID vaccine an engineering project, instead of doing basic science. They took the basic science and turned it into the COVID vaccine.

I'm worried about what the challenges are going to be in the future. Maybe it's cancer in young people, maybe it's something we haven't envisioned that we're not going to be able to tackle because we're not making these investments in scientific research.

Brian Lehrer: You all did that so efficiently that I have an extra 30 seconds to ask you, Dr. Brawley, this question from a listener, "Are there any attempts at replacing lost government funds with private funding for this vital research?" Real quick.

Otis Brawley: The American Cancer Society was heavily behind the National Cancer Act of 1971. It was Mary Lasker who did it. She first wanted to fund cancer research through the American Cancer Society and realized that no private entity could come up with as much money as was needed to fund cancer research. The other thing is corporations, drug companies, so forth, they're always interested in what profit can they make in three to five years, whereas the National Institutes of Health funds research so that we can grow knowledge, not necessarily research, so we can make a profit.

Brian Lehrer: Isn't the incentive to do a lot of the research that needs to be done?

Otis Brawley: That's right.

Brian Lehrer: Dr. Parikh, Dr. Brawley, Julie Rovner, thank you all so much for participating in this health convening. We really appreciate it.

Julie Rovner: Thank you.

Otis Brawley: Thank you.

Sudip Parikh: Thank you, Brian.

Brian Lehrer: That's the special two-part edition of 100 Years of 100 Things Health convening for today, thing number 98, 100 Years of Cancer Research. Special thanks to Brian Lehrer Show producer Amina Srna, who organized this convening. Listeners, thanks for your input on the phones and on texts. Stay tuned for Alison.

 

Copyright © 2025 New York Public Radio. All rights reserved. Visit our website terms of use at www.wnyc.org for further information.

New York Public Radio transcripts are created on a rush deadline, often by contractors. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of New York Public Radio’s programming is the audio record.