Cancer—and the quest to accelerate more effective treatments and potential cures for all life-threatening diseases—has perhaps shaped the life of financier Michael Milken more than his legendary career on Wall Street. In the early 1970s, Mr. Milken’s mother-in-law was diagnosed with metastatic breast cancer, and over the next decade with multiple myeloma, and his father was diagnosed with melanoma. They would both later die of their diseases. In 1993, at age 46, Mr. Milken received his own devastating diagnosis of metastatic prostate cancer and was told to get his “affairs in order.”
“The cost of cancer care will drop dramatically as advances in precision medicine increase, and we can more accurately sequence patients’ DNA and malignant tumors to more precisely prescribe treatments….”— MICHAEL MILKEN
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During a panel discussion, “Partnering With Patients—Making It Real,” at the 2023 ASCO Annual Meeting, Mr. Milken described his months-long global journey to find an effective treatment for the cancer. He adopted a multipronged approach combining traditional Western medical therapies with Ayurvedic medicine to help reduce his prostate-specific antigen (PSA) levels, altered his diet to include mainly uncooked fruits and vegetables, and received androgen-deprivation therapy (which lowered his PSA count to 0 ng/mL), followed by radiation therapy. The cancer has not recurred in more than 30 years.
Changing the Face of Medicine
Mr. Milken had already been supporting extensive medical research through the Milken Family Foundation for more than a decade before his cancer diagnosis. But in 1993, he launched CaP CURE, the Association for the Cure of Cancer of the Prostate, now known as the Prostate Cancer Foundation. It brought an entrepreneurial approach to cancer research by funding novel research for more effective treatments, with the goal of ultimately finding a cure for prostate cancer. In recognition of his efforts to reduce the death rate in prostate cancer, as well as in other cancer types, in 2004, he was named “The Man Who Changed Medicine,” by Fortune magazine.
In 2003, Mr. Milken founded FasterCures, a center of the Milken Institute, which aims to accelerate research progress against all life-threatening diseases. The Institute cohosts the annual Milken Institute Global Conference, which brings together experts in health, finance, business, technology, philanthropy, education, and civil society. He also helped found the Melanoma Research Alliance. In 2024, Mr. Milken will open the first phase of the Milken Center for Advancing the American Dream, which focuses on opportunities in education, public health and medical research, access to capital and financial empowerment, and entrepreneurship and innovation.
Earlier in 2023, Mr. Milken published Faster Cures: Accelerating the Future of Health with Geoffrey Evans Moore (HarperCollins, 2023). Part memoir and part a call to action, the book chronicles Mr. Milken’s mission to expedite cures and treatments for cancer, as well as for other life-threatening diseases.
In a wide-ranging interview with The ASCO Post, Mr. Milken discussed how he would rebuild the public’s trust in science; what it will take to rein in the cost of cancer care; his suggestions for speeding up the discovery of more effective treatments and cures for cancer; and what excites him about the future of cancer care. His answers have been edited for clarity and space.
Overcoming Mistrust in Science
In your book, Faster Cures, you describe an event you organized, in 2012, called The Celebration of Science, which you say “went a long way toward raising the profile of America’s bioscience achievements” and may have helped propel consistent increased funding for the National Institutes of Health (NIH). However, a recent survey by the University of Chicago found that, overall, only 39% of adults said they had “a great deal of confidence” in the scientific community, down from 48% in 2018 and 2021.1
Research shows that distrust in science and in public health agencies undermines public health efforts in cancer prevention strategies, including screenings for breast and cervical cancers, and use of the human papillomavirus (HPV) vaccination for HPV-related cancers remains lower than for other adolescent vaccines.
Please talk about how mistrust in science impedes scientific discovery in medicine and in prevention strategies, and how the scientific community, including the oncology community, can reverse this trend.
I have lived with this dilemma for most of my life. Between 1948 and 1955, polio was an epidemic in the United States, and many leading economists said the need to build iron lung “hotels” to house patients with the disease might bankrupt America. At the height of the epidemic, in 1952, nearly 60,000 children were diagnosed with the virus. About 3 years later, there was a solution to the problem: a polio vaccine. However, although polio was recognized as one of the most serious communicable diseases among children, less than 1% of teenagers were vaccinated, so distrust in science is not a new problem.
What changed the dynamic was that before a 1956 airing of one of the most popular variety programs on TV, TheEd Sullivan Show, Elvis Presley received the polio vaccine in front of press cameras. Within 6 months, the rate of teen vaccinations jumped from less than 1% to more than 80%. One event, one person changed the course of history. Unfortunately, we don’t have an Elvis Presley today for people to rally around.
It is disconcerting that although more than 90% of girls in Rwanda have been fully vaccinated against HPV,2 only 58.5% of adolescent girls in the United States have received two or three doses of the vaccine3 because the vaccine has become a political issue.
We are in a difficult period between the misinformation on social media and the political wars going on into an election year in 2024. To improve confidence in science today, we need to find the next Elvis Presley whom people can trust and create websites to accurately tell people what is real and what is not real.
We shouldn’t give up hope, and you can rest assured, there isn’t a day that goes by that my foundations and I aren’t doing everything possible to find the Elvis of 2023. When you tell me that only 39% of Americans have confidence in the scientific community, it doesn’t deter me one bit from finding solutions to reverse this trend. All it does is increase my resolve to find the right strategy to raise trust in science. It breaks my heart when a woman gets cervical cancer, because it could have been avoided if she had been vaccinated. Do women have to go to Rwanda to get the HPV vaccine?
Reining in the Cost of Cancer Care
A recent report from the American Cancer Society showed that the rate of people dying of cancer in the United States has declined by 33% over the past 3 decades, averting nearly four million deaths.4 Still, each year, approximately 610,000 people die of cancer.4 Although new innovations in cancer treatment and in better understanding of tumor molecular biology are resulting in growing numbers of cancer survivors—more than 18 million in the United States—the unsustainable escalation of the cost of cancer care in medical services and prescription drugs is expected to reach $246 billion by 2030.5 What can be done to reduce the cost of cancer care and make it equitably accessible to all patients with cancer?
When I was growing up, I did not know one person who made a long-distance phone call, because it cost $10 to $12 per minute and average salaries were just $100 per week. Today, on WhatsApp, you can call anywhere in the world for free.
The cost of cancer care will drop dramatically as advances in precision medicine increase, and we can more accurately sequence patients’ DNA and malignant tumors to more precisely prescribe treatments that we know will be effective against a specific cancer in an individual patient at first diagnosis.
The Human Genome Project launched in 1990 took 13 years to complete and cost $2.7 billion. Today, the genetic drivers of cancer can be sequenced for about $600,6 so technology is driving down the cost of genomic sequencing the way it drove down the cost of the telephone call. Let’s focus on giving patients what works for them at diagnosis with targeted therapy that is effective against the cancer, so the cancer doesn’t recur, and costs to the patient and society are limited.
“We should not age discriminate at the NIH and the National Cancer Institute. A high percentage of Nobel Prizes have been awarded for work done soon after recipients completed their early training.”— MICHAEL MILKEN
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Also, if we can reduce the time it takes to bring a cancer drug to market, the cost of care will be substantially less and treatments accessible to more patients. On March 11, 2020, the World Health Organization declared the outbreak of COVID-19 as a pandemic. On August 23, 2021, the U.S. Food and Drug Administration approved the first vaccine for the coronavirus. We should be able to take some of the general drug-development lessons learned during the COVID-19 crisis to bring drugs and treatments for cancer to market more quickly and less expensively.
This is a related question. You have said, “Today, I can see the end of cancer as a cause of death. The changes that have occurred in bioscience are so dramatic, particularly in oncology.” Still, only between 30% and 50% of cancers are cured. Cancer is being converted into a chronic disease that people live with for years and even decades but will have ongoing related out-of-pocket expenses. Research shows that cancer survivors who reported medical financial hardship (including problems affording health care or delaying or forgoing altogether any health care because of cost) had a higher mortality risk than cancer survivors without financial hardship.7
In a recent commentary in STAT, oncologist Ezekiel J. Emanuel, Vice Provost for Global Initiatives and Co-Director of the Health Transformation Institute at the University of Pennsylvania, argued that one remedy for cancer financial toxicity is for private insurance companies and Medicare to eliminate any deductibles, copayments, coinsurance, and other types of cost sharing for cancer treatment.8 Please talk more about your solutions to rein in the cost of cancer on society and especially on patients.
We know patients will have a better outcome if they follow the treatment protocol recommended by their oncologist. But as Dr. Emanuel contends in his commentary, if the out-of-pocket health insurance costs are too high, patients will not follow the treatment recommendations, and they will have a higher probability of recurrence; therefore, more money will need to be spent on their care.
In addition, as Dr. Emanuel pointed out, insurance companies often deny coverage for tests such as a prostate cancer magnetic resonance imaging (MRI) until the patient first has a biopsy; this is a shame because biopsies are more painful and can sometimes cause side effects, and they may be unnecessary if the patient had an MRI first. This is a fight we fight every day. How do we ensure that the tests and therapies prescribed today are not based on the past? This isn’t just an issue of reducing upfront insurance copayments. It is an issue that we are not even insuring the treatments that are the best treatments today.
Another factor in high medical costs is that a person’s lifestyle is accountable for a large part of their health-care costs. For example, being overweight or having obesity raises the risk of developing type 2 diabetes, heart disease and stroke, and cancer—all expensive diseases to treat.
Dr. Emanuel’s idea for reducing individual patient’s medical costs is interesting, but I think it should be a partnership. You have to help yourself, too. What role are you playing in your own health? Are you overweight, a smoker, physically inactive? Research shows that people who exercise appear to have a lower risk of developing cancer.
My point is that America wants the morning after pill for everything. An all-too-common attitude is, “I can do whatever I want, do as much damage to my body as possible, and not pay the consequences.”
I’m hoping the combination of advances in medical technology; earlier cancer detection; reducing or eliminating insurance copays such as suggested by Dr. Emanuel; and getting people to live long, healthier lives through personal responsibility will substantially reduce the cost of cancer care in this country.
Baseball icon Mickey Mantle, who died at the age of 64 of liver cancer, is quoted as saying: “If I knew I was going to live this long, I’d have taken better care of myself.” It is good advice for us all.
Speeding Up Cancer Cures
In 2016, you wrote a commentary in The Wall Street Journal that included three actions Congress and the White House could take to speed up the discovery of disease cures: sharing Department of Veterans Affairs (VA) data; passing the 21st Century Cures Act (which was signed into law on December 13, 2016); and setting a consistent funding goal for the NIH.9 What are your three suggestions today on how to speed up more effective treatments and cures for cancer?
First, I would implement nationwide the procedures we put in place at the Department of Veterans Affairs to expand the digitization of data on the more than 22 million current and former members of the U.S. military, so the information on patients’ DNA is not just housed in the VA. Wider access to these data will help researchers develop more effective therapies more quickly. For example, we found that among veterans who were enrolled in both the VA and in their local leading cancer center, the death rate for Black patients with prostate cancer could be reduced by 50% just by having the right precision treatment and supervision for that patient. Based on those results, the initiative has been extended to include other cancer types, not just prostate cancer. I see the development of these types of medical data and analysis of patients’ blood for targetable mutations will not only be used in cancer care but for other life-threatening diseases, such as Alzheimer’s disease as well.
Second, we have a medical workforce shortage that is estimated to be about 1 million. One contributing factor is that an estimated more than 4,500 physicians died during the early phase of the COVID-19 pandemic,10 and many nurses also died of COVID-19.
Another factor is our lack of a cohesive immigration policy. In Canada, for example, the immigration policy has increased Canada’s population by almost one-third. Recent data from Refugees and Citizenship Canada showed that Canada is taking in about four times as many immigrants proportionally as the United States does.11 Many of those immigrants being kept out are physicians, researchers, nurses, and other medical professionals. If we could ever get immigration right, we wouldn’t have a shortage of medical professionals.
Third, I would still say setting a consistent funding goal for the NIH is crucial to attracting researchers to cancer care. I don’t think students can apply for bioengineering classes in their freshman year at Johns Hopkins University, but they can during their sophomore year. I believe between 25% and 50% of the entire sophomore class applies to major in bioengineering, so there is a demand. We just have to let these students know there is funding for their careers after they graduate.
I’m concerned because we encourage students to go into research, we give them scholarships and fellowships, and then we say, “Sorry, there is no funding for your research.” I tell my fellow Giving Pledge members that our highest rate of return has come from supporting young people in their careers. I couldn’t have been more energized by going to the 2023 ASCO Annual Meeting, particularly seeing the number of young people in attendance, because we need to recruit the best and the brightest into this field.
Also, we should not age discriminate at the NIH and the National Cancer Institute. A high percentage of Nobel Prizes have been awarded for work done soon after recipients completed their early training. James Watson, at age 25, was the first to explain the structure of DNA; Albert Einstein was 26 when he published the theory of relativity; and Madame Curie developed the theory of radioactivity at age 28 and won the first of her two Nobel Prizes 8 years later.
Andy Grove, PhD, a cofounder of Intel Corporation and a teacher at the Stanford Graduate School of Business, used to tell me that young PhD graduates from Stanford knew more than he did about science and technology. Those countries that are the leaders in bioscience will be the leaders in this century because biological science is not just about the study of cancer, medical research, or health; it encompasses the study of energy, food, environment, and, unfortunately, bioterrorism.
Looking to the Future
What excites you most about the future of cancer care and treatment?
Everything we’ve talked about makes me optimistic about the future of cancer care, including the many research advances happening. For example, I am very excited about the development of focused ultrasound, which concentrates ultrasound energy on a target in the body without harming healthy surrounding tissue, and it may help patients avoid invasive surgery. I am on the board of the Focused Ultrasound Foundation, and there is promising research in the treatment of such diseases as Parkinson’s disease and prostate cancer.
The development of liquid biopsies in the early detection of cancer is also very exciting. And as more oral therapies are developed, patients will be able to be treated at home rather than in the clinic, which will reduce the cost of care.
Research in the role of the -microbiome and its relation to cancer and how it influences response to treatment is another area of -interest. Convincing people to take more responsibility in their health to reduce their cancer risk, advancing sequencing technology to continue to make it faster and less expensive, and providing consistent funding for the NIH are all solutions to the challenges we face. You can rest assured that I am doing everything possible to help solve these problems.
DISCLOSURE: Mr. Milken is a member of the Board of Directors of the Focused Ultrasound Foundation.
REFERENCES
1. Burakoff M: Confidence in science fell in 2022 while political divides persisted, poll shows. AP, June 15, 2023. Available at https://apnews.com/article/trust-science-medicine-social-survey-725ab3401f27900be6cc957eec52e45e. Accessed September 5, 2023.
2. Johnson S: How Rwanda could become one of the first countries to wipe out cervical cancer. The Guardian, August 18, 2022. Available at www.theguardian.com/global-development/2022/aug/18/how-rwanda-could-become-one-of-the-first-countries-to-wipe-out-cervical-cancer-acc. Accessed September 5, 2023.
3. National Cancer Institute: Cancer Trends Progress Report: HPV vaccination. Available at https://progressreport.cancer.gov/prevention/hpv_immunization#:~:text=In%202021%2C%2058.5%25%20of%20adolescents,(HPV)%20vaccine%20as%20recommended. Accessed September 5, 2023.
4. Siegel RL, Miller KD, Wagle NS, et al: Cancer statistics, 2023. CA Cancer J Clin 73:17-48, 2023.
5. Klinger E: Cancer costs and options for care in the United States. Association for Accessible Medicines. Available at https://accessiblemeds.org/resources/blog/cancer-costs-and-options-care-united-states#:~:text=Additionally%2C%20an%20estimated%20%24183%20billion,to%20more%20than%20%24246%20billion. Accessed September 5, 2023.
6. Mullin E: The era of fast, cheap genome sequencing is here. Wired, September 29, 2022. Available at https://www.wired.com/story/the-era-of-fast-cheap-genome-sequencing-is-here. Accessed September 5, 2023.
7. Yabroff KR, Han X, Song W, et al: Association of medical financial hardship and mortality among cancer survivors in the United States. J Natl Cancer Inst 114:863-870, 2022.
8. Emanuel EJ: Cancer patients shouldn’t be responsible for out-of-pocket costs. STAT, May 23, 2023. Available at https://www.statnews.com/2023/05/23/financial-toxicity-cancer-costs-cost-sharing/#:~:text=Patients%20diagnosed%20with%20cancer%20should,getting%20treatment%20for%20their%20cancer. Accessed September 5, 2023.
9. Milken M: Three ways to find more disease cures. The Wall Street Journal, November 29, 2016. Available at www.wsj.com/articles/three-ways-to-find-more-disease-cures-1480378446. Accessed September 5, 2023.
10. Berg S: New study tallies excess physician deaths during early pandemic. AMA, February 7, 2023. Available at www.ama-assn.org/practice-management/physician-health/new-study-tallies-excess-physician-deaths-during-early. Accessed September 5, 2023.
11. North D: Canada takes in—proportionately—four times as many (legal) immigrants as U.S. Center for Immigration Studies, February 22, 2023. Available at https://cis.org/North/Canada-Takes-Proportionately-Four-Times-Many--Legal-Immigrants-US. Accessed September 5, 2023.
