It seemed so simple in 1971.
President Richard Nixon declared war on cancer with the promise of new funding that politicians and physicians claimed would lead to a cure before the end of the decade.
But 18 years later, there's still no cure, no magic bullet for cancer. And the strategy of waging a short-term, one-front war on the disease has died as policy-makers, physicians and scientists have come to realize just how complex cancer really is.
For cancer is not just one disease; it's more than a hundred. Treatments that work on one variety will not necessarily work on another. But more important, researchers realize that they need to focus their work on a more fundamental level--how normal cells and cancer cells work. They know that the conventional treatments--surgery, drugs and radiation--simply kill or remove cancer cells and aren't effective enough. The goal now is to find treatments that will change cell behavior and then force cancer cells to stop acting like cancer cells.
Not that conventional treatments haven't helped. They have. According to the National Cancer Institute, the overall odds of surviving cancer have risen from 39% in 1950 to 50% in 1985, the latest year for which statistics are available. And for certain types of cancer, the chances of being alive five years after treatment and not showing new signs of disease are much higher. For instance, in 1960, a person found to have Hodgkin's disease had a 40% chance of surviving. By 1984, a person with Hodgkin's disease had a 74% chance.
Still, the number of deaths is discouraging. In 1988, the American Cancer Society estimates, about 1 million Americans were found to have some form of cancer and about 500,000 died--10 times the number of people who have died of AIDS in the past decade.
So, the question remains: Will there ever be a cure for cancer?
Last year, experts in Japan predicted that by 2002 their country's scientists will have developed a way to prevent the spread of cancer in the human body. By 2005, they said, they will be able to correct the abnormal proliferation of cancer cells and change them back into normal cells.
American scientists are not as optimistic.
In 1987, Louis Harris & Associates interviewed 227 prominent American researchers. The polling firm found that cancer scientists expect the cure rate to rise from about 50% today to 67% by the year 2000. The survey also showed that most cancer scientists believe that significant progress against cancer "will be made slowly, in a piecemeal fashion on a disease-by-disease basis, rather than as a result of one central insight that helps control a number of different cancers."
The common ground between the American researchers and the Japanese predictions seems to be that to achieve any major breakthrough, scientists must answer the fundamental question: What transforms a normal cell into a cancer cell?
In a large and growing complex at the north end of San Diego, scientists on the leading edge of biological research are trying to answer that question and others.
ON THE BRINK OF DISCOVERY
Nuclear scientists use the term critical mass to describe the amount of material it takes to create the chain reaction that causes a nuclear explosion. Biologists in La Jolla believe that something like a scientific critical mass has been reached in the research labs overlooking the Pacific Ocean, among the eucalyptus groves and Torrey pines on the northern edge of San Diego. La Jolla, once better known for its beaches than its brains, has evolved into a thriving generator of landmark biological discovery. Three major research organizations--the University of California at San Diego, the Salk Institute for Biological Studies and the Scripps Clinic and Research Foundation--came first and formed the nucleus of what was to follow. From the beginning, they have drawn world-class research scientists. But the intellectual explosion has occurred only within the past decade.
Today, La Jolla is often compared to the Boston area, where a collection of prestigious older academic institutions and new high-tech companies have created one of the country's most important biomedical research centers. Scientists occasionally even talk about a Boston-La Jolla axis. Some refer to the La Jolla scientific community as "Boston West." Ralph Reisfeld, a widely known cancer researcher who came to Scripps Clinic and Research Foundation from the National Institutes of Health in Washington in 1970, notes that he no longer has to spell La Jolla to colleagues when he attends out-of-town scientific meetings.
There are, of course, other important research sites in California. Caltech in Pasadena, City of Hope National Medical Center in Duarte and UCLA all have outstanding research reputations. But La Jolla is unusual in that it has, in just a few square miles, so many prestigious institutions that have come of age in the last 10 years.