Research:

Commission should be appointed to determine if any individuals tried to violate the public’s trust

Cancer institute can regain respect.

The citizens of Texaswere wise to contribute $ 3 billion to the fight against cancer.

Legislation and an amendment to the state Constitution created the Cancer Prevention andResearch Institute of Texas ( CPRIT), enabling a 10- year program in cancer research and community- based prevention activities. In three years, CPRIT has funded hundreds of excellent research programs at many Texas institutions, recruited roughly 50 outstanding scientists to Texas, established a statewide clinical trials network and helped companies developways to help patients.

Recent controversies at CPRIT caused us to resign as the institute’s chief scientific officer and chairman of its scientific review council. Leaving, we pause to reviewlessons from CPRIT’s past and offer advice for its future.

We have been guided by a fewsimple principles:

truthful about the complexity of cancer. To find cures, wemust ponder dynamic cellular systems containing huge numbers of partswhose behaviors are governed by rules that have evolved over millions of years. We don’t understand these systems in nearly enough detail to explainwhy and howthey become dysfunctional. Progress in treating cancer requires rare and penetrating insights into deep pools of ignorance and translation of these insights into new therapies. It’s pointless to push money at a problem— nomatter howimportant itmay be— if you lack insight for finding a solution.

entrusted to CPRIT financed the best ideas— period. Texans deserve the best cancer research, the best scientists, the best clinicians. Quotas based on geography, favoritism, type of cancer, or type of patient drain resources.

decisionswere based on the best possible advice from the finest experts, free of conflicts of interest. CPRIT’s research peer reviewcommittees have been chaired by some of the best cancer biologists and physicians in the country. All work and reside outside Texas. The chairs chose more than 100 committeemembers— again paying attention to expertise and lack of conflicts. These recruits to the Texaswar on cancer joined because they recognized a unique opportunity to make an impact. We used their time efficiently and treated them and their recommendations with respect.

selected the best efforts from the best peoplewho were willing to risk failure to makemajor strides. Peer review systems can be too conservative, searching for sure bets, where experiments are easy to execute but only buy minor increments in knowledge. Missed are the opportunities to take great leaps. Yet great leaps are exactlywhat’s required, andwe looked for them.

come first; commercialization is essential but comes second. Businesses hunger for great insights to turn into great products. We see this in the thriving biotech corridors of Boston and San Francisco.

The past eight months were difficult. Controversy flaredwhen several well- regarded, multiinvestigator, multiinstitutional collaborative research projects were put in the freezer for months— not brought to theOversight Committee for funding after strong recommendation by the ScientificReviewCouncil.

This delaywas at least partially based on the concern that several of these projects came from one institution. CPRIT’s executive director has offered different and conflicting explanations for this action.

Simultaneously, an expensive “commercialization” proposal, constructed and submitted in unorthodoxways that circumvented CPRIT’s rules, was rushed to theOversight Committee and approved for $ 20 million for its initial year of operations, despite the absence of description or scientific reviewof its drug development program. This was ultimately corrected, albeit with great effort. Writing in the Houston Chronicle, ToddAckerman and Eric Berger reported on various individual relationships that might have motivated these events.

Howcan CPRIT once again become a program respected by scientists across theU. S. and theworld?

should be appointed to determinewhether individuals tried to violate the public trust in the actions described above. If so, they should be removed from their positions.

governing board should have sufficient expertise to do its job. Only onemember of this 11- personOversight Committee has any direct knowledge of cancer, medical practice or research. TheOversight Committee should promote policy, provide broad oversight of personnel and operations, and ensure legal and ethical behavior. Memberswho meddle in day- to- day operations of the organization to further their own interests should be removed.

deserve to hear the truth about cancer. Theymust understand that miracles will not happen in a short time. Progress will not be made by thosewho simply proclaim without explanation that they can do better than hundreds of skillfully staffed andwellfinanced pharmaceutical and biotechnology companies. Real progress requires the concerted high- quality efforts of basic, translational and clinical investigators from the academic community collaborating with counterparts from the private sectorwhen appropriate. There is no single “cure” for cancer. Cancer is hundreds of diseases, and victories will come one or a fewat a time. CPRIT will have an enormously positive impact on society over time, both in terms of the health of its citizens and its economy. Texansmust understand this and demand that CPRIT continues to adhere to its core principles.

Academic institutions and for- profit companies have very different cultures, and these differencesmust be respected. Academics strive to develop new knowledge and, usually, disseminate it widely ( i. e., by teaching, broadly defined, and publishing). Companies operatemuch more competitively and in many cases in secret, with the goal of providing financial returns to investors by bringing useful products to society. There can and should be synergy between the two types of institutions, with academic knowledge being used to further the commercial activities of companies, and there can be links between the two. But the relationship shouldn’t be excessively intimate. Secretive behavior impedes education and research training and therefore doesn’t belong in academia. There are also questions of compensation, ownership, neglect of academic responsibilities, etc. CPRIT needs to understand this as it strives to facilitate commercialization of its research activities. Reliance on peer reviewto identify the best sciencemust continue to guide CPRIT in the future. Of course, there are otherways to distribute public funds, but they areworse. Their side effects include infamy and they end in irrelevance.