Chapter 19: About the Moon Shots: Philosophy, Timelines, and Challenges
In this chapter, Dr. Mills sketches Dr. Ronald DePinho's Moon Shots program. He explains that he embraces the philosophy of identifying where the obstacle to improving an outcome lies and then devoting resources to address that specific problem point. He develops the analogy between John F. Kennedy's Moon Shot program and Ronald DePinho's. He explains program implementation challenges, such as the fact that when one builds a new facility, "nothing happens for four to five years." He explains how this natural timeline created some problems, since the technological platforms were not completely ready when the research teams needed them.
The Historical Resources Center, The Research Medical Library, The University of Texas MD Anderson Cancer Center
The Interview Subject's Story - Overview; Overview; On Research and Researchers; Understanding Cancer, the History of Science, Cancer Research; Discovery and Success; MD Anderson Impact; MD Anderson Impact; Technology and R&D; Working Environment; Institutional Processes; Devices, Drugs, Procedures
Tacey Ann Rosolowski, PhD:Do you want to turn to the Moon Shots?
Gordon B. Mills, MD, PhD :Sure. The Moon Shot, as I embrace it and understand it, at MD Anderson, was developed to ask and answer a very important question and one that I embrace completely. And that is, Have we acquired sufficient knowledge to, if applied and adequately supported, to transform outcomes for cancer patients, to go from the 1 to 2 percent improvement in outcomes a year. Note that's pretty good, to say can we make leaps of 5s and 10s and 15s. And to really ask the question of if we can't, is this because we are not implementing that knowledge that we have, or is it that our knowledge is inadequate? Answering that question definitively, yes or no, and it does not matter what the answer is, would drive the way in which research moves for the next ten or fifteen years. And we don't know. Is the problem of improving patient outcomes at a more rapid rate due to an implementation concern? Is it the lack of sharing of data, is it structural, is it the way in which we develop drugs? All of those pieces, versus is it a lack of understanding of the basic characteristics of cancer, the pathophysiology of cancer, would really set our research agenda for a long time. I think it's easy to state that we do not know the answer, and further, that until recently, we couldn't even ask the question without the knowledge leap that we've had over the last decade. This really was a moot question and the reason it relates to the concept of a moonshot, was the idea of Kennedy and others, was going to the moon now a scientific knowledge problem or was it an implementation/engineering problem, and the answer was clear. It was an engineering problem and that an adequately funded, driven project delivered. And so it is time to ask that question and ask it definitively. Now, that's not easy to do and I'm not going to say that I'm convinced that we are at a place where we can do that, or even that the way in which we are implementing the Moon Shots today, will give that definitive answer. But certainly, asking and answering that question is sufficiently important to say that the whole moonshot concept, if implemented correctly, would change the way in which we think about making progress. So for me, this is why this was an incredibly exciting opportunity. One of the questions that has come up and one that I would put on the table, although it's in retrospect. When you develop a new physics program, say the Hadron Collider and these massive facilities, nothing happens for four or five years, literally. You will say it is time for a new project, why don't five or six groups self-assemble and start to put together a plan by which you could do this. You then meet as groups and then super groups, and say okay, how could we now, as a community, come to a conclusion and say this is worthwhile? This is similar to things like the Hubble Telescope, where the amount of funding that is needed requires the community to come together and plan, and nothing happens functionally for several years. You build the concepts, you build the ideas, you build the way forward, and then the next step is you put in place, the infrastructure to make it happen, and still, you do nothing. You're putting in place, all of the pieces that are needed, that once you pull the trigger things happen quickly and efficiently. Unfortunately, I would say that while the goals and the concepts of the Moon Shots, in some ways fit that idea, with the concept of building platforms and infrastructure to make it happen, the process, because of the urgency, for many extrinsic reasons, started quickly. And I think that there has been a fair amount of struggle in figuring out how to move forward and truly answer those questions. So, I think that the idea is spectacular, I think that the concepts behind it are great, but that I think we need to really step back and say where are we in the implementation of this process.
Tacey Ann Rosolowski, PhD:Could you give me some examples, so I can visualize where some of these difficulties emerge.
Gordon B. Mills, MD, PhD :Well, I think we can do this in broad terms. I don't want to point fingers at anyone.
Tacey Ann Rosolowski, PhD:Sure, I understand.
Gordon B. Mills, MD, PhD :One of the ways in which this was planned to happen was to build a series of technological platforms, that all of the different disease oriented areas could avail themselves of, to make rapid progress. The idea that these platforms would be spectacular in their technology, their capability, their implementation, their ability to bring samples in and deliver high quality data out in a short period of time.
Tacey Ann Rosolowski, PhD:And what are some of these platforms?
Gordon B. Mills, MD, PhD :Oh, we have a cancer genomics laboratory, which is for sequencing of tumors, we have an immune monitoring platform, we have a proteomics platform. There are a number of them, and they keep changing as the needs of the program changes. In general, these platforms were not ready for the onslaught of requests that came, and failed to deliver in a timely manner, at least at the beginning. It's getting better. The other is, is that running a platform is very much the antithesis of running a research laboratory. So instead of me focusing on my research and what I want to do, I would turn around and say okay, I will set up this platform that other people are going to use, and I get no benefit from it. Again, this culture shift of saying right now, funding is so tight, that I have to focus on my own research, my own direction, so that I can get my funding in place, and saying I don't have the time, effort or drive, to run these platforms.
Tacey Ann Rosolowski, PhD:So, I guess I was assuming that someone would be hired to run a platform, but I guess that was a naïve assumption.
Gordon B. Mills, MD, PhD :Well, we did, and in many cases we hired a technical person to run the platform and that's great, but that's not enough. You need to be -- for these platforms to be cutting edge, innovative, delivering high quality work, you don't need -- sorry. You need the technical people who can do it, but you also need the people at the top or out on the edge, but they're out on the edge doing their own stuff that they have to get funded then it's pretty hard, in many cases, to put the time and dedication into making a platform deliver for others. It's just not part of the culture. And so yes, people were hired, and some spectacular people were hired, but again, even that says that if I want to hire those spectacular people, I shouldn't have been saying my platform was going to deliver until all of those pieces were in place, and so it was a timing issue. So it's very hard to build, from scratch, with a very tight and aggressive timeline, because you need to deliver and there's urgency, and you're promising your constituents, being philanthropy granting agencies and others, that you will deliver quickly, when in reality, time is a good way to do this. I'll give you an example of something I'm proposing, which we'll see what happens.
Mills, Gordon B. M.D., Ph.D. and Rosolowski, Tacey A. Ph.D., "Chapter 19: About the Moon Shots: Philosophy, Timelines, and Challenges" (2016). Interview Chapters. 78.