By STEVE FINDLAY

The Obama Administration’s cancer “moonshot” initiative, announced in January and now being debated in Congress, comes at a time of significant advances in cancer treatment and a spurt of cultural attention to the disease.

A batch of new immunotherapy drugs approved in the last few years, such as Bristol-Myers Squibb’s Opdivo and Merck’s Keytruda, are being widely touted as breakthrough medicines—and aggressively advertised to both doctors and the public.  Jimmy Carter’s unexpected remission from melanoma that had spread to his liver and brain is attributed to Keytruda.

At the same time, a cancer memoir (When Breath Becomes Air by Dr. Paul Kalanithi) tops The New York Times nonfiction best-seller list.  The Death of Cancer by Dr. Vincent DeVita, a former director of the National Cancer Institute, has also garnered positive reviews and wide attention for its critical assessment of today’s cancer research establishment.

Before these two books, John Green’s 2012 novel The Fault in Our Stars—the touching story of two teens with cancer—was widely acclaimed and read, especially after it was made into a blockbuster movie in 2014.

The administration’s initiative comes at a significant time for me personally, too.  My brother, 70, was diagnosed with stage IV lung cancer 10 months ago.  Unlike Jimmy Carter, one of the new immunotherapy drugs (Opdivo) did not defeat his cancer.  He continues to fight for his life.  As with so many families, cancer has stalked ours.  My sister died of colon cancer in 2006, age 54.  My mother died of lung cancer in 1985, at 65.  Like anyone over age 60, I’ve seen friends suffer and succumb, their lives cut short.  And I’ve battled two cancers myself, melanoma (localized) and a salivary gland tumor.

Fight, battle, war…….moonshot.  We uniquely use these metaphors in the context of cancer and not other diseases.  While some patient advocacy groups think this risks leaving cancer patients and their families feeling as if they have failed if they “lose the battle,” the framing occurs for good reason.  Cancer is a fierce enemy, a vexing group of diseases that angers, scares, and humbles us, even as it earns our respect for it’s evil cleverness. Mutant cells that grow out of control and find innumerable ways to invade organs and flesh, and defy assault with chemotherapy.

Cancer remains by far the largest medical research challenge—scientifically and in the toll of lives it takes and cost it engenders.

In this context, the administration’s cancer moonshot deserves mostly praise.  It’s gotten that, but has also come in for a measure of criticism, and even cynicism.  That’s because this isn’t the first time a president has called for a surge against cancer.  Nixon launched a high profile “war on cancer” in 1971 and George W. Bush called for a “medical moonshot” to cure cancer in the 2000 presidential campaign.  (He didn’t really follow through.)

Critics see this latest effort as a PR ploy by the Obama administration in its last year in office, and they point to the proposed $1 billion in funding as inadequate to the task at hand.  By comparison, for example, the original “moonshot” – Jack Kennedy’s 1961 pledge to put men on the moon by 1970 (it happened in 1969)—cost $160 billion in today’s dollars.

Critics also note that it can cost $300 to $700 million to develop, test, and bring to market just one cancer drug.  nd, as quoted it newspaper articles—see this one in The New York Times, for example—cancer researchers worry that a call to “cure cancer once and for all” (Obama’s words in his 2016 State of the Union speech) is misleading, unrealistic, and based on an outdated view of the disease.

These criticisms have merit.  But I agree with this piece by David Grahamin Atlantic Monthly:  even though $1 billion a year is probably not enough to propel a transformation in cancer research, it’s not nothing and could be deployed meaningfully.   And, of course, any allegation that Obama or Joe Biden, whose son died of brain cancer last year and who is leading the effort, are launching the initiative for PR or political reasons is stupid, and itself politically motivated.

Moreover, the initiative is just getting off the ground, with the White House seeking broad input from scientists and others on priorities and how best to spend the money.  An initial detailed plan is due from the White House in June.   (Until then, read here.)

Meantime, the cancer moonshot is, in fact, wrapped up in politics.  That’s because funding for it is proposed in the administration’s FY 2017 budget, and because in the Senate, the moonshot has been attached to contentious health care legislation now being processed by the Senate Health, Education, Labor and Pensions (HELP) committee.

Namely, the cancer moonshot is now part of a package of related bills that form the Senate’s version of legislation passed (with bipartisan support) by the House last year, dubbed the 21^st Century Cures Act. This legislation funds NIH and makes substantial changes to FDA funding and drug approval policy. The Senate bills also incorporate a related initiative from the White House on advancing “precision medicine.” I wrote about these interrelated initiatives in THCB in February. I will follow-up soon on that blog and this one with a piece on 21^st Century Cures.

For now, what you need to know is that HELP committee Republicans and Democrats are fighting over how much all this is going to cost, and how the money will be earmarked.  Democrats this month proposed $5 billion in additional “mandatory” funding each year over the next 10 years, to be divided up between NIH, FDA, the moonshot, and precision medicine initiative—with about $1 billion per year dedicated to cancer, as the administration requested.  NIH would get the lion’s share.  It’s a substantial increase; NIH’s current annual budget is $32 billion, with the National Cancer Institute at $5.2 billion.

Republicans have signaled their support for additional funding but at an as-yet unspecified lower level.  And they have not yet supported mandatory funding—meaning Congress would have a tougher time clawing back the money in future years.

The House 21^st Century Cures bill would have increased NIH and FDA spending far less—NIH funding would have increased about $3 billion over three years, for example, according to this CBO score.  Thus, we can anticipate that if the Senate passes the package of bills over the next few months, a House-Senate conference committee will end up compromising somewhere in between.

Of course, the debate is about much more than just money. A third and final markup of the Senate package is scheduled for April 6.  More about that in future blogs.

Steven Findlay is an independent journalist and editor who covers medicine and healthcare policy and technology.