From the Desk of Dr. Louis M. Weiner

I have not lived through a more politically charged or event-filled period of time since the early 1970s, but must admit I breathed a bit of a sigh of relief when the legislation to repeal and replace the Affordable Care Act was tabled at the last minute. Politics aside, everybody recognizes the need for reform, but many, myself included, worried about the consequences of blowing everything up without appropriate safeguards in place. Perhaps cooler heads can now prevail and come up with meaningful improvements to the Act that improve our nation’s health and control health care costs. But for a few anxious days, we all were living on the edge, wondering what the proposed law would mean for all of us.

Speaking of the edge, I had a few awfully long days last week. I caught a 5 am train to New York on Monday to be on a grant review panel, and got back at around 8 pm or so. Then, on Friday I caught a 7 am plane to Charlotte NC for a site visit of the Levine Cancer Center’s clinical operations – we are trying to learn how other cancer centers optimize their clinical functions and adapt the lessons learned to our clinics. It was a very full day, and we came away with a bunch of great ideas. The Carolinas health care system is massive (25 hospitals scattered from the Virginia border all the way into South Carolina) and we can put these lessons to good use as we build out our clinical and clinical trials network. But it was a long day, with a very early wake up and a return home in the mid-evening.

At least the weekend has offered a bit of time for decompression. Our daughter-in-law Sarah and her kids were down here scouting out house rentals and school districts as they prepare for their move to the area; Ken had to work, and so could not come. After they left we had dinner out with our son David, his wife Kelly and some of her extended family, Sunday was “catch up” day, but the work week started early with a dinner meeting of the NIH Center for Scientific Advisory Council on Sunday evening. Monday will be devoted to the NCI Center for Scientific Research Advisory Council meeting in Shady Grove, and the rest of the week will be quite busy, as we continue our CCSG preparatory meetings and get ready for the annual AACR meeting, which starts at the end of the week. On Saturday morning, I will be speaking on a panel titled “Improving Cancer Patient Care: Latest Advances in Cancer Precision Medicine and Immunotherapy” at Progress and Promise Against Cancer, a free community event organized by AACR. Never a dull moment!

Have a great week.

This was a week notable for good and bad news. Bad news first – the Trump administration released its preliminary “skinny” budget, which, among other things eviscerates the NIH (and by extension the NCI) budget, with a proposed 18% reduction that would reduce funding to levels last seen about 17 years ago. If this actually gets enacted, life-saving biomedical research will be halted in its tracks, along with the careers of countless researchers and the robust commercial enterprises that support this research. Ultimately, the impact on human health and the general human condition will be devastating.

We all know that there is a lag time between breakthrough science and its transformation into life-saving therapies. Consider, for example, the successes of checkpoint antibody therapies for cancer. I have had the privilege of being engaged in fundamental research on the use of monoclonal antibodies since 1986, with federal funding despite widespread skepticism that antibodies could ever be used to treat human disease. Without federal support, the development of commercially viable antibodies would have been delayed or might never have happened.

What’s more, the federally-funded fundamental groundwork, such the discovery of CTLA-4 and of other immune checkpoints such as PD-1 and PD-L,1 all occurred before or at the dawn of the 21st century. Even though the development of drugs based on these discoveries proceeded quite rapidly, we are just now seeing their widespread application in this country. So, the gutting of federally sponsored cancer research will have immediate impacts on our ability to conduct science and to maintain the historic leadership of the United States in biomedical research. More importantly, the impact of this remarkably short-sighted plan will be felt by the generations that follow us – with fewer cures, more suffering and untimely deaths that would not have happened had we been permitted to continue our work without interruption.

As for the argument that the federal government should not be involved in supporting this research, I don’t have enough space in this blog to refute it. Suffice it to note that the genius of the private sector has never extended to basic, life-changing biomedical discovery. The return on investment is too low, because basic science is, by definition, risky.

The support of fundamental and applied biomedical research has been and remains one of the great accomplishments of our federal government. I hope, and we should urge, that Congress respect and support this historic commitment to betterment of the human condition. This is a bipartisan issue, and I believe that the legislative branch will protect this commitment. As a member of the AACR’s government affairs committee, I am doing what I can to advance this argument. I hope all of us can do this, each in our own way.

And, by the way, the CBO estimates that the American Health Care Act will leave millions of Americans without health insurance. They will turn to emergency rooms for their care, creating an unfunded mandate for health care providers. In addition to leaving so many people, especially vulnerable populations, without coverage and thus access to health care – a fundamental human right – the costs incurred will endanger precious surpluses that can be used to support research. This adds an additional layer of uncertainty that needs to be carefully considered. Congress has not yet been heard from on this issue, either, so perhaps reason will prevail. I am by nature an optimist, and believe that we will get past this challenge.

Well, isn’t this interesting? We are completing an ominously cold weekend, girding ourselves for a potentially brutal Nor’Easter bearing down (up?) on us. Whatever direction it comes from it sounds as if we are in for as much as 6 inches of snow in DC. As (bad) luck would have it, I was scheduled to be in Philadelphia on Tuesday evening and Wednesday to be a panelist on the AACR – Stand Up To Cancer review of Innovation Grant proposals. Since Philly is slated (or is it sleeted?) to get about a foot of snow on Tuesday we were asked to try and get in by Monday evening if possible. I have a full day of work on Monday, so I’ll be training up to Philly on Monday evening, just as the storm arrives there. It should be an interesting meeting, but I fear the science will be eclipsed by the elements this one time.

Last week was highlighted, as expected, by the all-day NCI Board of Scientific Counselors meeting on Monday, and then by a several hour webinar of the NCI Clinical Trials Advisory Committee on Wednesday. Needless to say there was a lot of work in between those meetings. As we rev up to submit the U54 on anti-estrogen resistance led by Bob Clarke, we had a fascinating call, modeling the interactions of host immunity with the acquisition of estrogen-independence and anti-estrogen resistance in ER+ breast cancer. That Tuesday call was interspersed with ongoing faculty performance reviews. Wednesdaywas notable for our first CCSG competitive renewal deep dive, in this case with Steve Byers, to start planning how we will organize and present our shared resources in the application. More deep dives will follow as we look at each of the critical application components. Wednesday ended with a special treat, as my brother trained down to DC for a few days of work, and stayed with us. We met for dinner at Brasserie Beck, in downtown DC. It is a very nice place, though in my view it is at least a notch below Et Voila on MacArthur Boulevard, which sadly is temporarily closed as the restaurant expands. We then showed him a bit of our neighborhood on Thursday evening, and ate at Casolare on Wisconsin Avenue.

Friday was highlighted by a very nice Grand Rounds presentation by Patricia Steeg. I had to leave a bit early (about 5 pm) to go home, dress up like a penguin and head over to the National Building Museum to attend the Prevent Cancer gala. Harriet and I had the privilege of sitting with Bo Aldige, the President and founder/driving force of the Foundation, which has given Lombardi scientists several million dollars of research support over the years. We didn’t get home until after 11 pm, but it was a very pleasant evening, and it was for a good cause that synergizes with our cancer center’s interests.

Now I am going to finish packing, and certainly plan to bring my cold weather gear up to Philadelphia tomorrow! Stay safe and warm, be careful and have a great week. Hopefully it will be a short winter – one that started in mid-March.

So, I took our oldest grandson Isaac to see Georgetown play Villanova on Saturday at the Verizon Center. Even though the Hoyas lost to a clearly better team, we had a simply great time. Isaac was in a winter basketball league and knows just enough about basketball to allow us to discuss a bit of strategy, while also working on his math skills (monitoring the point differential during the game). It’s great fun to have a front-row seat as a young mind blossoms and absorbs new information, turning it into an ever-richer understanding of how the world works.

That experience, which is reminiscent of how spores germinate and create new life, naturally morphed (for me) into the highlight of last week’s many meetings – an all-day Breast Cancer Program retreat, on the main campus, in the beautiful Healy Family Student Center on Monday. The retreat, led by Program co-leaders Bob Clarke and Claudine Isaacs, focused on how a new SPORE application might be structured. There were a number of really interesting presentations of possible projects, and I am sure that the eventual proposal will be compelling. The work week was bookended by a Friday afternoon meeting with visitors from Bristol-Myers Squibb to discuss opportunities to collaborate in the Immuno-Oncology area. This latter meeting was organized by Sandy Swain in her new role as Associate Dean for Research Development here at GUMC. We came away with some concrete ideas for collaboration and look forward to future interactions.

It was also very nice to have Naiyer Rizvi as our Grand Rounds speaker on Friday. Naiyer was a faculty member here a while back, and he has gone on to make very important contributions to the field of lung cancer immunotherapy. It is very impressive to look back at the list of really wonderful physicians and scientists who spent time here earlier in their careers. In addition to the wonderful group we now have at Lombardi, the cancer center has been an incubator of many leaders in our field.

The coming week for me will be dominated by two NCI meetings – first the Board of Scientific Counselors (BSC) on Monday, and then the Clinical Trials Advisory Committee (CTAC) on Wednesday. Fortunately the CTAC meeting is a 3-hour webinar this time, so I can tend to other business that day. Both meetings require a fair bit of preparation, but I still have had time to work on my annual faculty evaluations. I am caught up (I have reviewed about 25 so far), though I am still waiting for the rest of the self-evaluations assigned to me to trickle in for my action. I hope everyone has submitted their self-evaluations, so we have the time to review them and send the completed evaluations to GUMC. It’s important to do.

Have a great week.