Development of oncology policy

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Published: 22 Oct 2012
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Prof Jose Mariano Gago – ECCO Political Advisor

Prof Jose Mariano Gago explains that given the rapid expansion of the global oncological community, there is an ever growing need for a greater level of dialogue between oncology policy makers and stakeholders within Europe.


Prof Gago explains how ECCO can help the oncology community develop further the availability of personalised medicines.

Professor Jose Gago, a very warm welcome to the ECCO Oncopolicy Forum 2012, delighted to have you here. You’re of course a special political advisor to the European Cancer Organisation and very distinguished history in national Portuguese politics in science and technology, your own personal research programme and generally within science policy across Europe. We’re talking today about personalised cancer medicine, this is the topic of the Oncopolicy Forum. I wonder if I could begin by getting from you a sense of perspective, a history if you like, of where you see personalised cancer medicine sitting since, let’s say, the European Research Area and Philippe Busquin. How have you seen this evolving over the last few years?
As you know, I’m not at all an expert in that field, I’m a particle physicist myself. My reflection is the following: personalised cancer medicine in fact is an avenue of opportunity for molecular medicine and we have seen that in other areas. In fact, we have seen that in physics for the last decades, in physics and engineering. When quantum physics and physics at the quantum level were appropriated by engineering then a whole field of activity emerged - the development of nanotechnology, the development of quantum optics, the treatment of surfaces etc., all that, all the field of material science and so on and so forth were completely different after you understood the micro level. In fact in some cases you can even see the micro level and develop instruments to make visible the micro level.
So you’ve had this enormous ability to see these different fields evolve over time, as you made the point about the complexity of personalised medicine and the complexity of biology and then the fit within medicine as a social activity. Do you feel from a policy perspective when the activities that you’re involved in at the European level that Europe is ready to take on and understand the complexities inherent in these what are essentially paradigmatic changes in particular areas? Do you feel the policy makers understand the challenges of personalised cancer medicine and are prepared for that? What’s your perspective on that?
My first reaction is to say that the world has changed enormously over the last decade and it will change enormously in the field of knowledge for the next decade or so because of simply the enormous increase of the number of people doing research and being indicated all over the world. So  twenty years ago, even ten years ago, you could decently try to understand science looking at Europe or looking at the United States. That’s no longer the case. There was an increase of the number of students in higher education all over the world, increased almost 80% during the last decade from 100 million to 180 million. The number of scientists increased more or less in the same proportion. The number of published articles, the ideas, the numbers of people producing knowledge at world level is changing dramatically and will have to change even more because the very large countries are only starting, like China or India etc., are only starting. That’s an amazing period of humanity. For the first time large fractions of humanity are being able to produce new knowledge and share it at world level.
That’s a very important point you made is perhaps in the past we’ve been too inward looking and thinking about science in Fortress Europe.
We still are; we still are.
And you think we still are as well?
I think we still are. You look at any field of science in Europe, you really can’t discuss that without having the idea of a stronger collaboration with the best centres in the United States, you can’t, and vice versa. So it has been integrated in the life of individual scientists, that perspective of course, but it has to be integrated in science policy.
So how does your position as a political advisor to ECCO, for instance, European organisations, in terms of promoting this outward, more global feel and perspective? Is it about understanding other people’s systems and the way things work?
I’ll give you an example: in Europe you don’t have anything comparable with the National Institute of Health of the United States. The National Institute of Health of the United States has developed into a system not only of organising and delivering funding for research but also of pushing the research forward and of interconnecting research between the health sector and other sectors, including the physical sciences, mathematics and others, social sciences and others. When Harold Varmus publically distributed his provocative questions about cancer and said bluntly, ‘It was… I think and the reasons why I think... These questions can probably be now revised or discussed or analysed, please comment on that. Try to kill them or produce something else.’ what he was showing us is how scientific leadership can be combined with scientific organisation and how scientific leadership must be a crucial component of science policy. The instrument was there, the National Institute of Cancer, the NIH in the United States, provided the framework for this to happen. We are still in the very preliminary phases of this in Europe. We do that at national level and some countries have this type of internal discussion between the different stakeholders and the policy makers but certainly not at European level at sufficiently skilled.
You’ve made these extraordinarily insightful comments about the learnings that cancer policy and in the future personalised medicine can make from the successful initiatives like the European Space Agency and CERN. In a wrap-up what do you think are going to be the key steps for something like a European cancer organisation to engage and take for the community when it comes to personalised cancer medicine? Over the next five years what do you think are the one or two key things these organisations can actually do to achieve that next step forward in bringing together that European vision which is still outward looking?
My honest question is obviously I don’t know because, first, I am not an expert in the field and we don’t know exactly what is the shape of the future, we never know. What I feel, if it is a question of trying to identify, say, shaping factors or shaping actors here, is to say that first what organisations like ECCO are doing in trying to bring in policy and the science policy discussion into the community is the right way to do it. You need to have the biomedical community at large, not only in the cancer field but certainly in the cancer field it’s a very important and probably the most promising example now because of its organisation and because of the challenges that cancer itself provides. I feel that trying over and over again to attract to the debate of science policy the different stakeholders is absolutely crucial for the future of the field. That involves scientists and institutional leaders, it involves industry but also involves the medical profession in general, the oncologists and the patients. Educated patients, patient organisations were the first coming into life of politics essentially as lobbyists, as trying to address, to tell the members of parliament, of policy makers in general, of the importance of rare diseases, for instance of specific concerns of their groups of interest. But now, in the future it will become and is becoming much more interesting. Research in many fields would not be possible without them, without their participation, without their proximity with what is at stake. In my view, if I have to share from another area and from the relations between physics and engineering over the last decades, and if I have to translate this into possibilities for the biomedical field, I would say that the molecular biology and the combination of molecular biology with systematic medicine, with the identifications of other levels of understanding and action beyond the molecular level that have not been discovered yet but will be discovered, as they were discovered in other fields of science, is certainly on the cards. You don’t have, unfortunately, the whole 20th century has evolved without any visible success in the development of a proper theory of life. So all the advances you had in the physical sciences were extraordinary and they were critical to develop the first level and that’s the molecular understanding of many life processes. But certainly much is yet to come.
Wonderful, Professor Jose Gago, many thanks indeed for your time today. Superb.
Thank you. Thank you.