Community Practices Say Moonshot May Sputter

Tony Hagen
Published: Friday, Mar 04, 2016
John Powderly, MD

John Powderly, MD

There’s a place for Vice President Joe Biden to stay in North Carolina if he would like to come and witness some of the problems the National Cancer Moonshot is going to encounter before its lofty goal of doubling the pace of clinical discovery is achieved. John Powderly, MD, of the Carolina BioOncology Institute, would welcome Biden to stay in his second floor guest bedroom, if only for the chance to show him how tough it is to get coverage for clinical trial patients.

“Joe Biden can come see how, on a daily basis, insurance companies deny patients routine care, how much the federal regulations have made it impossible to do day-to-day routine patient care, and how much money I have lost and the debt I have incurred in fighting insurance companies to just do the right thing,” Powderly said.

Powderly’s clinic specializes in early phase trials for immunotherapy and personalized medicine. He says a number of well-intentioned government actions designed to guarantee coverage of routine costs of care associated with trial participation have been compromised by concessions to the payer industry, Powderly said.

Physicians who have been active in clinical trials programs were divided in their opinions of how well the Moonshot initiative would succeed, and whether it would benefit independent oncology practices. Powderly and Luke Nordquist, MD, of the Urology Cancer Center and GU Research Network in Omaha, said that private industry-sponsored research is likely to be the more successful source of innovation in cancer research and treatment. Industry payments amply cover trial costs—to the point of supporting other practice activities—and process efficiency is far greater than can be achieved through government supported research efforts, such as are carried out through the Cooperative Group System, they said.

On the other hand, Stephen Grubbs, MD, a longtime practicing oncologist and clinical trials researcher who participated in talks with Biden and his White House staff on developing the Moonshot, said that curing cancer is a major bipartisan goal and Biden’s involvement could unlock government-led discovery and result in many exciting advances. “This family tragedy of losing his son has really motivated him to do the right thing and advance where we are with cancer,” said Grubbs, who also serves as vice president of Clinical Affairs for ASCO.

“I think he’s sincere about this. As an oncologist, what I heard from him that I found encouraging, was that he wants to move research and advances at a faster pace and get more done quickly. He’s also looking at how we can improve cancer care delivery—how do we get the discoveries into the hands of physicians who are taking care of patients all over the US, even in remote areas. Those are the two take-home messages from him that I thought were very important.” He added that the Moonshot could be a turning point signifying increasing government funding for research.

Under the Moonshot, public and private partnerships will be developed to streamline research and the government’s vast computing and medical resources could be tapped to give a solid boost to compiling and understanding the large volumes of medical data already collected and still accumulating, much of which may contain clues to meaningful advances in cancer treatment, such as ASCO hopes to achieve through its CancerLinQ initiative, Grubbs said. “We think there are abilities to partner with the Departments of Defense and Veteran’s Affairs. We’re hoping there’s more help with electronic health records and interoperability,” he said.

Powderly contends that the $755 million in funds promised for the Moonshot in the FY2017 budget will not achieve much. He expects very little of this money, if any, to trickle down to the independent oncology practice level. Government compensation for trial participation was scant to begin with, he said.

Nordquist also is doubtful about the impact the money will have. He expressed the view that government spending is often diluted by the siloed character of research institutions and the tendency for grant money to serve institutional goals, rather than pure research interests. “These grants usually provide academic careers for people, because they’ll apply for a grant, and that funding solidifies their job at the university, and then they have to support their staff and their lab techs, etc. That’s a very necessary form of investigation, but it’s a very slow process for doing cancer research because everybody’s working in their siloes. Very rarely do they work in some sort of network where people are learning from what the others are doing. It’s more, how do we keep funding these people’s careers through that money?” he said.


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