Michael Milken
Founder and Chairman, Prostate Cancer Foundation, Milken Institute and
FasterCures / The Center for Accelerating Medical Solutions
In recent years, a new breed of philanthropy has emerged. Infused with the
energy, passion, breakthrough thinking, and sense of urgency that often
characterizes entrepreneurship, many philanthropic efforts are making progress
at rates thought impossible before now. One such organization is the Prostate
Cancer Foundation. Its founder, Michael Milken, provides an overview of the
Foundation's work, showing us that it is possible to jump-start innovation in
medical research.
The minute I walked in the door, I knew something was wrong. My wife waited
until I took off my coat and sat down at the kitchen table. "I got some bad news
today," Lori began. "Mom has cancer." We talked for hours about what it meant
and what we could do to help. It was 1972, only a year after President Nixon had
declared "war on cancer," and many of us thought that a concerted national
effort could lead to a cure in the same way that President Roosevelt's targeting
of polio and President Kennedy's quest to put men on the moon had succeeded.
Over the next twenty years, I acquired an extensive layman's knowledge of
cancer in the process of supporting research and seeking effective treatments
for my mother-in-law's breast cancer and, later, my father's malignant melanoma,
and the cancers of several other close relatives. By 1982, my brother and I had
assembled a professional staff to formalize our philanthropy through our family
charity, the Milken Family Foundation. Working closely with the Foundation's
medical and scientific advisers, we became very familiar with the leading-edge
work of our grant recipients. We were inspired by the progress of such pioneers
as Dennis Slamon in breast cancer, Bert Vogelstein in cancer genetics, Owen
Witte in leukemia, Lawrence Einhorn in testicular cancer, and many other
recipients of the Foundation's Cancer Research Awards.
By the time I was diagnosed with advanced prostate cancer in 1993, I thought
I knew a lot about cancer. So the shock of my diagnosis was compounded by the
realization that I knew almost nothing about prostate cancer. How could I have
spent two decades working with cancer researchers and possess so little
knowledge of this disease that had already spread from my prostate to my
abdominal lymph nodes? How could I not know that this disease affects one in six
American men or that a man is more likely to develop prostate cancer than a
woman is to develop breast cancer?
A Vicious Circle
It turned out that I was not alone. The public knew next to nothing about
prostate cancer. Articles in the popular press, which so often chronicled the
importance of Pap smears, mammograms, and smoking cessation, rarely mentioned
that little walnut-sized organ surrounding men's urethras. As far as most men
were concerned, this disease was something they didn't want to think about. Men
seem to be more fatalistic than women and believe they're either living or
dying, so there's no point in getting tested.
Even more surprising was the lack of interest in the medical community. The
National Cancer Institute (NCI) didn't fund much research on prostate cancer
because they received few grant applications. Physician-scientists weren't
submitting the applications because there appeared to be little funding
available. It was a vicious circle. The field was so moribund that one young
investigator was told by his mentor to avoid the "career suicide" of prostate
cancer research.
Meanwhile, the pharmaceutical and biotechnology industries weren't allocating
enough research funds to cancer drug development because they didn't think the
return on investment would justify the risk. And as I traveled around the
country to major academic research centers, I felt a growing sense of
frustration and even anger when I realized that each of these elite institutions
considered the others to be competitors rather than collaborators in cancer
research.
Bringing Focus to Research
After extensive discussions with the heads of these centers and other
advisers, I concluded that a new organization was needed to bring focus and a
sense of urgency to the field of prostate cancer research. This organization,
which would become the Prostate Cancer Foundation (PCF), would need to:
- Identify promising research not being funded by the NCI;
- Recruit the best and brightest investigators to energize the field;
- Reduce paperwork requirements and fund projects quickly;
- Require awardees to share the results of their work;
- Help build centers of excellence in prostate cancer and link them
digitally;
- Encourage public-private partnerships;
- Pursue a venture-funding model;
- Act with urgency; and
- Build public awareness.
The Milken Family Foundation jump-started the process with early funding. But
since then, the majority of funds for more than 1,300 competitive research
awards has been contributed by the public. Awardees gather each year at the
PCF's Scientific Retreat to present their findings. Many of them are affiliated
with member institutions of the PCF Therapy Consortium, comprising eight leading
cancer centers that now collaborate on prostate cancer programs.
Cause for Optimism
Over the past thirteen years, we've reached several important milestones. The
Department of Defense Prostate Cancer Research Program is approaching
three-quarters of a billion dollars in cumulative spending. Hundreds of bright
young investigators are launching careers in prostate cancer research. Prostate
cancer Specialized Programs of Research Excellence (SPORE) grants have increased
fivefold. Articles about prostate cancer in popular periodicals increased from
2,500 in 1993 to nearly 35,000 in 2005. Federal and state government funding of
prostate cancer research is twenty times the 1993 level. Major states, like New
York and California, allow taxpayers to check off a donation to prostate cancer
research on their tax returns. Institutions in dozens of countries around the
world now participate in PCF collaborations. Millions more men now know about
prostate-specific antigen (PSA) tests and digital rectal examinations (DREs).
Far more drugs targeting prostate cancer are available or in development than
even a few years ago.
None of these achievements would mean much, however, if we weren't keeping
more men alive. Fortunately, there's progress here too. Close to 40,000 prostate
cancer patients were dying each year in the early 1990s. With the aging of the
baby-boom cohort, that number was expected to increase to as many as 60,000
deaths today. Instead, the number has fallen to below 30,000. The reasons are
complex, and no one initiative should receive the credit. Nor can we be
complacent, because without major breakthroughs, deaths could start rising again
as the first baby boomers move through their seventh and eighth decades.
The work described here is certainly cause for optimism. We move forward with
hope and will continue our work until cancer is something our grandchildren will
know only by reading history books.
Excerpted from the book, Prostate Cancer: Signaling Networks, Genetics, and
New Treatment Strategies, to be published by Thomas Jefferson University in
2007.
This essay is an excerpt from the
Kauffman Thoughtbook 2007. To view a table of contents for the 2009 edition, or to order a printed copy of the publication,
please visit our 2009 Thoughtbook page 
