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The Cancer Journal - Volume 10, Number 2 (March-April 1997)

editorial


A speech by a Chairperson (speciality: cancer)




"We are all convinced, myself included, that cancer research has reached a critical point. Today, the possibilities of applying the results of basic research for the benefit of patients are higher than ever before and, after a long effort, we are now on the brink of some of the most exciting discoveries in human biology. You also know as well as I do that at this very moment, our government has so inopportunely decided to make drastic cuts in research funding. Therefore, as clinicians, scientists and, above all, as citizens, it is our duty to ....."
"Furthermore, we all know that to assure the health of the men and women of this country is the best way of reducing spending on medical care and thus contributing to economic growth".

The author of this editorial does not chair any group or lobby, but has this speech ringing in his ears and offers it to anyone who wishes to use it. However, we must agree that these statements, which have been heard in all industrialised countries, are beginning to show their age. They may touch the more naive among us, but they do not cut any ice with leading politicians and administrators.

Let us return to a tone more appropriate to our way of thinking about the difficulties associated with cancer research. Of course, we realise that medical research, not only in the field of cancer, requires funding and that continuous cutback in laboratories and hospital departments create problems for the clinicians and researchers concerned. We also admit that when financial support is limited, choices have to be made between different lines of research. It is perhaps time to agree on a procedure which will allow a variety of hypotheses and projects to be explored, leading to results which will finally allow us to emerge from the present clinical and therapeutic stagnation. There is no shortage of new and original ideas. However, these are not appreciated by the decision-making committees, who prefer fashionable ones, which are not the same. For this reason, many scientists are concentrating on a restricted number of subjects, although these may appear less promising than when they first took them up. How much research, locked in a deterministic framework of out-dated mechanisms, has been simply looking at cause and effect? For ten years (1979-1989), all hopes were invested first in oncogenes, then in anti-oncogenes and the balance between the two. From the beginning, loud announcements were made about a rapid transfer from the laboratory to the clinic, which impressed and stupefied the credulous and those with vested interests. This period has now passed. We could return incessantly to the same theme of insufficient resources and the near-certainty of obtaining more cures and longer survival times if these resources were to be increased.

We have an alternative suggestion:

Without interrupting existing work, we should support those who are brave enough to move in new directions. To encourage this, we should not demand short-term publication as the only criterion for obtaining grants.

We should earmark a substantial part of the available resources for scientists who have already proved their worth and stop the practice of peer review. We should trust imaginative scientists, who are seldom understood by this system of evaluation, rather than standardised projects. This approach is unlikely to carry many risks. A generalised, and nowadays legitimate, fear that an innovative project will be rejected for funding adds to the voluntary unimaginativeness of our working hypotheses and to the mediocrity of the results obtained. We certainly need increased resources, but not in order to constantly reformulate the same old questions.

The concepts of health and disease should be seen less as normative states than as processes designed to allow the organism to adopt a structure and organisation appropriate to its needs and outside constraints. The natural history of a cancer can perhaps be resumed as survival obtained at the price of extensive and sometimes dangerous changes, illustrating the astonishing capacity for adaptation of living organisms.

New concepts, giving rise to new hypotheses, are needed more urgently than money. Many scientists and clinicians are capable of conceptual innovation, but this lies dormant because of institutional conformity. Political decision-makers, the general public and journalists should seek other sources of scientific inspiration. New ideas are fostered by both individuals and a favourable institutional environment. We must pay more than lip-service to the freedom to innovate; otherwise, ideas outside the mainstream, which give rise to the best projects, will remain clandestine. This is not to say that all unconventional projects are good ones, but it is among them that true scientific creativity is to be found.

The necessary progress will not come from an inventory of observable phenomena, however much modern technology lends itself to this, nor from serendipity or lucky mistakes. Some accidental discoveries have been made like this, and they should be recognised and exploited, but not used to justify dogmatism, lazy thinking or a lack of courage.

We are not the first, nor will we be the last, to write in this way and we are not naive enough to believe that these propositions will be accepted easily. No matter, this sort of message must follow the slow path of those which shake conventions. The vocation of the Cancer Journal is to give space to such ideas.

Jean-Claude Salomon
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