In 2003, then-NCI Director Andrew von Eschenbach, MD, made the provocative and highly controversial statement that his goal was to "eliminate suffering and death" from cancer by 2015.
One year after that deadline, von Eschenbach told ľֱ in an exclusive interview why the statement was the biggest mistake of his life and what he really meant to say.
The urologic oncologist explained that he still thinks he had the right idea, but didn't execute it effectively in its rollout.
"Did I make a mistake? Yes. Do I sit back today and say did I have the wrong idea? Did I decide to do the wrong surgery? And the answer is, no, I did not have the wrong idea, but then I ask myself, 'Did you do the operation correctly?' And the answer is, no, I screwed it up."
Von Eschenbach said that he didn't appreciate then how he had mislaunched the 2015 goal and how much people would misunderstand it. He says it was a mistake because he didn't realize at the time that no one understood what he was talking about.
"I didn't realize that people would not see [what I meant] as clearly as I did and what I wanted them to appreciate, because, if they did, we might be in a very different place today," he said.
He blamed himself for not having made himself clear at the time and said he hadn't received the best guidance from NCI communications.
Von Eschenbach said that he had come to NCI in 2002 after more than a quarter century treating patients at and had originally gone into medicine because he wanted to make a difference in people's lives. He had been the president-elect of the at the time of his appointment and could not serve as the society's next president.
He said that he found the culture on the NIH campus to be different from his past experience and quoted former Speaker of the House as once having said that it was the , not Research.
Von Eschenbach, who as NCI director also served as FDA commissioner concurrently for 6 months before going to the FDA full-time, said that he never used the word cure -- that he had really meant to say "control," and he was talking about stopping cancer strategically. He hoped his statement might start a national dialogue, he recounted.
He then shared an anecdote about being taken to task by Nobel laureate , PhD, regarding the 2015 proclamation.
"He and others had excoriated me in an article as probably being the dumbest NCI director in the history of the institution. How could I be so stupid as not to appreciate how complex cancer was and to say we were going to eliminate the suffering and death from the disease?"
So, according to von Eschenbach, he invited Baltimore and a few other Nobel laureates, including and , as well as other prominent researchers to a daylong retreat at NCI.
"I brought them all together, and David was giving me a pretty hard time, saying what I did was dangerous and irresponsible, and raising people's expectations, and sounding like Nixon about our going to cure cancer," he recalled. Von Eschenbach said he just sat and listened for a while before saying to the group: "I have tremendous respect for each of you as basic scientists, and I couldn't even begin to consider eliminating suffering and death from cancer if it weren't for your discoveries and contributions."
But then he told his guests that they were looking at cancer as basic scientists and he was looking at the problem as a clinician and he wanted to explain the difference.
He said that the group -- with all their Nobel prizes and other honors -- were among the most brilliant people on the planet but that they had been living on an island and the only thing that they had seen fly was a bird.
He noted that if he had come to that island and taken the scientists to Dulles Airport he would have shown them a 747 and said, "See that's a bird but look at what it can do. It can fly nonstop across the Atlantic Ocean and find Paris, France, and land on a dime there every time, and then fly back to Dulles and do it again."
He then told them that if he had asked them to explain how that [747] bird had done that, they would have said, "That's the most complicated bird we ever saw. It will take us forever to find out how that bird did that."
Then von Eschenbach said he told the basic scientists that they were right, it would take them forever to figure it out.
"But that's not what I asked you. As a clinician I didn't ask you to tell me how that airplane landed on a dime in Paris, I asked you to tell me how to stop it from landing. I didn't ask you to explain everything there is to know about cancer, I asked you how to stop it."
He continued that cancer is a process and takes off here and ends up there on a dime, and all he wanted to ask them was how to stop it, adding that he had a 5-year-old grandson, who given a few tools and 48 hours, could guarantee that the plane wouldn't land in Paris.
"I repeated that I didn't care how they did it or what they focused on, I just wanted it stopped, and Baltimore to his credit, and I still respect him for this, looked at the others and said, 'You know when we think about it that way, maybe he's right. Maybe we spend too much time thinking about what we don't know about cancer, and we don't spend enough time thinking about what we do know about cancer, and we do know a lot.'"
Von Eschenbach then related how he was fascinated by what happened for the next hour when he listened to the basic scientists argue among themselves about who had the best ideas about how to stop the process.
He said that Watson admitted that he had a bias but said that no one dies of localized disease and it's all about metastasis and growth, and if you gave him a billion dollars he'd focus on angiogenesis and stop the blood supply so the tumors wouldn't grow. (This was 5 years after Watson had that angiogenesis inhibitors would be curing cancer in 2 years.)
According to von Eschenbach, Hartwell said that rather than letting the disease get too far down the line, there was a need for early detection and developing biomarkers.
"So, they started discussing how they could strategically intervene to stop the process. But I had [already] put a goal out there that no one really understood and that was my fault for how I rolled it out. But the idea was that cancer could be attacked strategically, and I wasn't telling anyone what to focus on -- metastasis, modulation, or anything -- I just wanted them to show how to make a bad cancer a good cancer."
He reiterated the need to begin thinking about cancer strategically as a process, but then said that in the midst of his efforts, in December 2005, he received a call from the White House and the next day he was acting FDA commissioner in addition to serving as NCI director.
He said that it was difficult to finally leave NCI but that the FDA was "in shambles, free-fall, and crisis," and, following a contentious Senate confirmation in 2006, he stayed on until the end of President George W. Bush's second term in 2009.
He has since moved back to the Houston area, which was home for nearly 30 years when he was at MD Anderson Cancer Center, and where he now holds an adjunct faculty position, interacting mostly with the urology department. The Philadelphia native also has a summer home on the New Jersey shore.
Von Eschenbach had also been involved in 's since its inception in 1993, and was a board member and scientific director to , a foundation comprised of leaders of key national cancer organizations.
His current business card reads, president, , which he explained is his healthcare consulting business. He serves as a consultant to the , originally founded by Newt Gingrich; sits on the board of directors of ; and serves a director of . He said he was advised by a mentor of the value of seeing things from a business perspective in addition to his academic and governmental viewpoints.
"It's really been an eye-opening experience to sit around the table with managers and investors and to understand the pressures of taking a project to market and to learn how it all fits together," he said.
And although he is not involved in Vice President Joe Biden's current , he proffered some advice: "It shouldn't be cancer-centric, but cancer-led."