Introduction

7
The Failed Crusade
If the government’s role in reducing AIDS mortality represents a great
victory for the idea that directed research campaigns can substantially
affect the history of an epidemic, the war on cancer is an entirely different
matter. For more than half a century, all the weapons of directed
medical research—extramural grants to academic researchers, intramural
programs of research and drug development, public-private partnerships,
and outright support of industry—have been deployed against
cancer with far less satisfactory results.
It has been more than three decades since President Nixon signed
the National Cancer Act. The government over those years spent more
than $50 billion combating what one social historian called “the dread
disease.” The National Cancer Institute (NCI), the largest arm of the
National Institutes of Health (NIH), created and financed a nationwide
academic research establishment dedicated to understanding the biochemistry
of cancer. It also devoted a sizable fraction of its resources to a
wide-ranging hunt for drugs.
Those efforts transformed the commercial landscape. At the campaign’s
outset, the pharmaceutical industry for the most part ignored
cancer. But by the early twenty-first century there were dozens of firms
pursuing more than four hundred potential cancer drug candidates.
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