Why Curing Cancer Is Not a ‘Moonshot’

Here are some things that have been compared to moonshots: Google Books, nuclear fusion, Google Glass, artificial brains, drone delivery, getting from New York to London in one hour, a really big home run.

Here are some things that actually are moonshots: going to the moon.

Of all of the metaphors that have gotten shiny at the elbows, it’s the beleaguered “moonshot” that may be the worst. President Obama rolled it out again during his final State of the Union address when, expressing a desire to cure cancer once and for all, he called for a moonshot to get the job done.

The audience applauded as audiences always do at moonshots, and it’s hard not to. The term evokes one of America’s finest and boldest moments, when the Soviet Union beat us into space with Sputnik, the first artificial satellite, and we responded with men on the moon less than 12 years later. But the problem with using that real moonshot to call for metaphorical moonshots is that it misunderstands both the stakes and the difficulty of actually accomplishing what it is you’re trying to do—making hard things seem easier than they are.

Getting to the moon was undeniably an extraordinary thing. But we were further along when we began than most people realize. We knew how to build rockets—indeed we had already built plenty of them, though we called them missiles and put warheads instead of astronauts at the top. We similarly understood the physics of orbital and translunar flight; we just had to master them.

More important was the clarity and singularity of the stated goal, announced by President Kennedy in 1961: putting at least one man on the moon and bringing him home before 1970. Period. The commitment to that goal would have to be maintained over three presidencies and seven different congresses, which was perhaps the hardest thing of all. But knowing it would take just a single set of lunar footprints and the job would be done helped keep everyone focused.

Now consider cancer, or, more accurately, cancers—plural. Scientists have long known cancer isn’t one disease—it’s perhaps 100 or more, with the number growing as different types and sub-types are better understood. Making things worse, there will be perhaps 1.6 million Americans diagnosed with cancer in the U.S. alone this year, and each of those cases will be in some ways unique. That’s part of the reason two people with the same kind of cancer diagnosed at the same stage and receiving the same treatment can have radically different outcomes.

Actually “curing cancer”—in the larger global sense of simply wiping it out—would require personalized care, designed around every single patient with any single type of the disease. And in order to administer that kind of tailored care to every single person diagnosed with cancer, a whole lot more research is going to be needed. That may not be an unattainable goal—but it’s a devilishly complicated one.

With the “war on cancer,” declared by President Nixon in 1971, the imagery was different—if still seductive—but the idea was the same. It took us less than four years to go from the humiliation of Pearl Harbor to the utter defeat of the Axis powers, didn’t it? Why couldn’t the same commitment of manpower and treasure do something similar with cancer? But cancer—far too nimble, far too complex—didn’t play along then, and it won’t now.

It’s not as if all disease is impervious to a moonshot-type effort. The National Foundation for Infantile Paralysis was the NASA of the fight for a polio vaccine. That war was won, because polio is only one disease—albeit caused by three strains of virus—and on April 12, 1955 when the Foundation announced that the Salk vaccine was safe and effective, victory could be declared. The success has been even more complete against smallpox, which was officially eradicated in 1980 and exists today only in small viral samples in high-security labs.

Moonshots can work for other challenges too. Developing a clean-energy grid? Perfecting and mass-producing the driverless car? Pushing high school graduation rates above, say, 95 percent? Sure.

There is nothing wrong with calling for a national commitment to do something that’s very hard and, often, very expensive; indeed it’s a form of Presidential malpractice to see a grave problem and not do that. Obama—and Nixon before him—deserve credit for throwing down that challenge flag against cancer. But this moon is actually many moons. Expecting a single, final victory will only make us fail to notice the smaller, more incremental ones when they come.