There is a paradox inherent in the nature of cutting-edge cancer research and the current, mostly corporate, funding structure. Drug development is an expensive undertaking, and the costs are compounded by cancer's new targeted therapies. Drugs tailored for specific genetic mutations reduce each drug's population of patients -- and thus the potential for profit. For example, non-small-cell lung cancer kills about 140,000 people in the United States each year, but the targeted drug Iressa benefits only about 10 percent of these patients. So even as the state-of-the-art in cancer cures improves, the chances to make money may be decreasing.

When Druker was developing the cancer drug Gleevec, he had to argue with the industry to push it through the FDA pipeline. Industry executives, worried about the drug's limited market, wanted to wait for other uses to be discovered before investing in expensive human testing, he recalls. "It was becoming a long, dragged-out affair," Druker says. "Meanwhile, I had patients in the clinic who were dying."

Washington offers incentives, such as patent extensions, to companies that develop drugs serving relatively small pools of patients. The FDA's "orphan" drug designation is meant to entice the industry to invest in cures for rare diseases that might offer little profit. But of the 395 cancer drugs in human trial today, only one, a drug tested on an uncommon type of brain cancer, was designated last year as an orphan. Industry isn't biting, says Dr. Genie Kleinerman, head of pediatric oncology at the M.D. Anderson Cancer Center.

Kleinerman is still frustrated by her attempts many years ago to test a novel therapy for osteosarcoma, a rare bone cancer that strikes about 900 U.S. children and young adults every year. Her idea was to combine two drugs licensed to rival companies, but she says competing lawyers could never agree to each other's terms. "It didn't get off the block. It's nowhere today," she says. "You are just never going to change the corporate culture."

Wall Street analyst Alex Zisson says it's not industry's responsibility to play the good guy. Stock investors everywhere are culpable; they expect their companies to compete headlong for profits. "We pay taxes so the NCI can fund humanitarian research," says Zisson, a New York analyst with Thomas, McNerney & Partners.

Pharmaceutical companies are the nation's most profitable industry, but drugs on average cost hundreds of millions of dollars to develop and market, and only one in every five that advance to human testing is eventually approved. The risks and expense make patent protection "essential to continued innovation and investment," says Jeff Trewhitt of the Pharmaceutical Research and Manufacturers Association, the industry trade group based in Washington.

The system works, Trewhitt insists: "Clearly progress is being made in the war when there are so many cancer drugs in clinical testing."

For example, pharmaceutical giant Pfizer, best known perhaps for Viagra, the erectile-dysfunction blockbuster, is spending 12 percent, or $192 million, of its research-and-development budget on 20 cancer medications. Eight of these compounds have progressed into advanced human trials, where a drug's efficacy is tested, says Dr. William J. Slichenmyer, the company's vice president of oncology drug development. Pfizer is drawn by the war's untapped potential, he says, and "huge unmet need."

"Despite the progress that has been made, some people still prefer to see the glass as half empty," Slichenmyer says. "But you could also see it as half full."

And yet, something appears wrong with the system. The treatment of cancer in the United States generated about $13 billion in revenue in 1980, $27 billion in 1990, and in excess of $60 billion today. In today's dollars, that's equal to a doubling in yearly revenue while the decrease in cancer mortality has been incremental.

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Some progress has been made. Several new cancer drugs in the past five years have been shown to extend lives by several months and have raised the hopes of cancer victims. But the rate of progress does not match the evolving potential, Druker says. The hallmark of science is selfless collaboration, but CEOs are required to put the interests of their stockholders first.

Between 1995 and 1997, there were 196 patents issued for cancer-fighting compounds, techniques and devices, according to records at the U.S. Patent and Trademark Office. In the past two years, there has been a piling on: 639 patents and counting.

"We seriously have to rethink what we have done with patenting in this country," says Druker, who testified before the Senate Cancer Coalition last year about the cancer war's conflicts and triumphs.

On his first day of work 11 years ago at the Oregon Health and Science University, Druker asked permission to test an obscure compound owned by the Swiss drug company Ciba-Geigy. Within hours an agreement was signed between the university and the company, now Novartis. Druker was soon experimenting with STI-571, the drug that became Gleevec, used today in the treatment of chronic myeloid leukemia and some rare stomach cancers.

"In today's climate if I could get something like that in my lab within six months I would be extremely pleased," he says from his Portland office.

In an effort to foster teamwork, the NCI began this spring requiring scientists, universities and industries that use its money to sign collaborative agreements. But the NCI is generally involved in less than 20 percent of the cancer drugs in human trials. Of the 395 cancer drugs in clinical trials this year, the NCI was sponsoring or co-sponsoring 69.

This is at a time when the cross-pollination of cancer science is more important than ever. In the war on cancer, doctors will increasingly rely on combinations of drugs aimed at specific molecular targets, says Dinah Singer, the NCI's director of cancer biology. "A single drug is unlikely to eliminate a tumor target," she says. "It takes multiple pathways with multiple drugs."

It takes a singularly minded army.

Which explains why Sonia Bawa wrote to Bush. If the war on cancer were funded like a real modern war, Druker and his cancer-fighting fraternity would not have to negotiate their every step with business -- and profits -- in mind. The pursuit of a killer might quicken.

Sonia and Bush exchanged polite letters. They are at an obvious impasse. Meanwhile, Congress this summer approved Bush's request for $25 billion in emergency funds for military operations abroad.

Former Washington insider Hamilton Jordan, 59 and a survivor of lymphoma, prostate and skin cancers, wants to know where Sonia's emergency funds are. "I'm baffled as to why this isn't a political issue," he says from his home in Atlanta. "It affects so many people that it's easy for me to imagine a presidential candidate saying, 'This is cancer week ... and it's the only issue we're going to talk about.'"

Sonia has battled leukemia, a cancer of the blood, for most of her life. She's endured chemotherapy, two bone-marrow transfusions and a transfusion of her older brother's healthy stem cells. She's very much at war.

When a letter dimpled with the presidential seal arrived one Friday this summer at her home in Fort Collins, Colo., she did what savvy teenagers do today. She scanned Bush's response onto her Web page.

She then stayed home for the weekend. She had hoped to go to the movies, but her mother didn't want her in a crowded theater. A girl in the trenches can't risk catching even a cold.

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