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This is America and this is a country that declared war on cancer more than 50 years ago and still hasn't won it. Billions of dollars spent in the world's richest biomedical machine has produced groundbreaking science, gene sequencing, targeted therapies, AI. The tools keep getting sharper, yet some of the deadliest cancers still endure. So what's standing in the way? Is it a drug industry built to manage illness rather than end it? Or is it a health system where the science outruns what patients can afford? On this show, we go looking for the real obstacles blocking America's search for a cure. First, though, let's go to our D.C. studio and Alex Marquardt. Thank you, Eva. It is a disease that has touched the life of nearly every American family. And for decades, the U.S. has tried to fight it, with hundreds of billions of dollars that have been poured into trying to cure cancer, president after president vowing to win that battle. But there's still no cure. Part of the answer is biological. Cancer is not just one disease exactly. It is hundreds. But another part of it is economic and political, a fragmented health care system and a drug industry that some say profits more from managing cancer than curing it. Our Richard Gaisford has more. By the start of the 1950s, post-war America had set its sights on a growing threat to a happy and healthy society. Trials of new drugs and treatments began in earnest. For more than a decade, there has been a national program to find and test anti-cancer drugs. By the late 1960s, scientists and doctors were beginning to see positive outcomes. We're still working on this. In the 1970s, President Nixon made the battle against cancer a key policy priority. We are here today for the purpose of signing the Cancer Act of 1971. And in the decades that followed, rapid progress was made. But as more cancers were discovered, new drugs and treatments were required. In 2016, Barack Obama launched a $1.6 billion fund called the Cancer Moonshot. It was led by the then Vice President Joe Biden, who lost his son Beau to cancer. For the families that we can still save, let's make America the country that cures cancer once and for all. What do you say, Joe? Six years later, the now President Biden attempted to reignite the moonshot. Let's end cancer as we know it. Since then, cancer deaths in the U.S. have fallen, but not by as much as Joe Biden had hoped for. The former president is now being treated for aggressive prostate cancer and has urged more to be done for early detection. In the 1950s, the National Cancer Institute started research on the outskirts of Washington at what's now become the world's largest clinical research hospital, known as the House of Hope. But over the last few years, this centre of excellence has been the focus of controversial cuts and staff layoffs. It was all prompted by the arrival of Elon Musk's now disbanded Department of Government efficiency. That led to protests amongst the scientific community, worried that reduced funding would impact advances in life-saving research. But U.S. firms continue their quest for new cancer treatments, with Moderna recently announcing promising results for trials for a new skin cancer vaccine. In 2018, Donald Trump passed the Rights to Try Act, allowing access to new unproven drugs. They didn't give me the right to try experimental treatments, Mr. President. You did. And without you, I'd have died waiting for them to be approved. His now assistant says she'd previously been blocked from trials for her bone cancer. But many experts have doubted the validity of that story, concerned that this administration has been less of a help and more of a hindrance in creating the conditions to beat all cancers. Richard Gaisford, Al Jazeera, Washington. And with us to discuss why this is such a historic challenge, we have Dr. Lewis Weiner. He is the director of the Lombardi Comprehensive Cancer Center at Georgetown University. And Ted Okon, he is the executive director of The Community Oncology Alliance. Thank you both for being with me for this extremely important conversation. We noted that the war on cancer, as it's become known, has endured for 50 years, and, obviously, some progress has been made. Dr. Wiener, you argued that this war on cancers has not failed, despite cures for some of the most important and deadly cancers. Can you explain that? It's a war that began at the beginning of human history. We are always at war with our with the cancers that develop in our bodies. It's the most important battle we face in this in this situation. In 1971, when it was officially declared that there was a war on cancer, the cancer survival rate was 50 percent in the United States. It is now approximately 70 percent, maybe a tiny bit more. And to put that in perspective, there are 2 million people who will be diagnosed with cancer in the United States this year. Had there been no advances since 1971, there would have been 500,000 deaths, roughly, and rather, a million deaths. And we'd have about 600,000. That's 400,000 lives saved on a yearly basis because of advances in research. And that's tremendous momentum. And nobody who does this work like I do thinks that's good enough. We all understand that it's a problem, because it's not just cancer, it's cancers. There's hundreds, thousands of different entities that we call cancer. And they're all different. They all come from a different place. And trying to decipher the many ways in which nature can go wrong is a really big task for all of us. And what I'm pleased about is that we're making that progress. It's slow, hard work. It's trench warfare. But there have been some remarkable advances. Childhood cancer is now routinely curable for many people. Breast cancer survivals have gone way up. There have been dramatic transformative responses with immunotherapy, with CAR T cells, with checkpoint antibodies with new treatments for dread diseases like pancreatic cancer, the KRAS inhibitors that have the promise to transform care. We're making progress, and the fuel for that progress is investment in scientific innovation. Ted, do you agree? How would you characterize the strides? And to what extent do you think impatience about not getting to that ultimate point of being able to cure all these cancers is justified? Well, the biggest problem is we talk about the cure of cancer, singular. Right. And as Dr. Wiener said, we're talking about multiple, multiple diseases. Even when you talk about breast cancer, you're talking About metastatic, adjuvant, all different types of cancer at the molecular level. The good news is that we understand more. The good news Is that we have more therapies and more approaches. The bad news is it holds us back because everybody says, well, we haven't cured cancer, singular. Should we be making more strides? Should webe making more investments? Absolutely, positively. But the bottom line is you can't look back and say we haven''t done something since the war on cancer was, you know, originally in 1971 declared. So it sounds like what you''re saying is a cure for cancer is essentially a branding slogan if you will. What we are looking for is many many many different kinds of cures for different kinds of cancers. It's true. You have to remember that in 1971 we knew so little about the fundamental biology of cancer. We didn't understand the diversity of the cancers. We don't understand molecular architecture. When I was in medical school not long after that. Remarkably, there was a debate about whether cancer was caused by abnormal genes in the body or whether it was caused via viruses or whether was caused by environment. Of course, the answer is all of those things. But the importance of the genetic architecture for creating cancers was totally unknown. So not surprisingly, we had a simplistic expectation for what we could accomplish. Let's look at some of the cancer rates that, Dr. Wiener, you were just mentioning a second ago to give the viewers a better sense of what it looks like here in this country. This graph reflects both new cases and the death rate going back some 50 years to 1975. That's a few years after President Nixon, as you mentioned, declared war on cancer. That top line that you see that's relatively flat, that refers to incidents per 100,000 people. The bottom line, which is sloping downwards, refers to the number of deaths, again, per 100,000 people. So essentially, the incidents, the detectable cases are relatively steady, while thankfully, the deaths are going down. Ted, when you look at the commercial landscape, do you feel that the incentives for the drug companies are aligned with the patient's goal, of course, of finding cures for themselves? Well, I think you have to realize that the reality of the world is that the drug companies report to their shareholders, okay? They're public companies. They don't report to the patient. But I have to say, in their defense, the number of new drugs, the numbers of understanding and literally attaching a biomarker, which is sort of this diagnostic test of understanding, and having a more precise treatment. Remember, cells, everybody thinks there's some outside invader. It's not, it's your body mechanism has gone crazy. And when you hit those cancer cells, you want to target those cells and not hit the healthy cells. That's why age old with chemotherapy, you would lose your hair, you would, you know, lose your eyebrows and everything else like that. So I think the problem is that, yes, I think industry has done its part. Can it do more? Absolutely. The government should be doing more, especially when you talk about pediatric cancers, rare cancers that may not have the, you know, the return on investment. And I think we've got to work more cooperatively. We have to do more. But on the other hand, it would be wrong to say that with these new therapies, these new bispecifics, CAR-T, these New Cellular Therapies using the cell mechanism of the body to basically fight cancer, you know we'd do a disservice there if we didn't realize that i do want to get into why cancer remains among one of the deadliest forms one of the deadliest causes of death rather in this country and why it's as prevalent as ever or even mccann explains why it's so hard to beat for more than 50 years america has declared war on cancer even as there is no single cancer to defeat cancer is actually hundreds of different diseases and sometimes hundreds of different diseases can exist inside the same tumor. Cancer happens when cells acquire genetic changes that allow them to grow uncontrollably and those cancer cells can keep changing. So a treatment might kill millions of cancer cells but leave behind a small population that is resistant. Those cells can survive, multiply and eventually cause the cancer to come back. That ability to evolve is one of the biggest obstacles to a universal cure. And some cancers are especially difficult because by the time doctors find them, they've already spread. Take pancreatic cancer. In 2026, about 53,000 Americans will die from pancreatIC cancer. Its symptoms often don't appear until the disease has advanced, and fewer than 20 percent of patients are candidates for surgery when they're diagnosed. The five-year relative survival rate is just 13 percent. Pancreatic cancer is one of the cancers with the fewest effective tools, but other cancers show what happens when research cracks the biology. The breast cancer death rate among American women has fallen 44 percent since 1989. America has in fact made progress when it comes to addressing cancer, but there is no one miracle cure. What we've gotten instead has been better screening, more effective surgeries, drugs, and immunotherapy. Eva McKend, Al Jazeera, Washington. And Dr. Wiener, you say that when it comes to the science, the challenge now is to understand the way that tumors evade or suppress the immune system and find ways to overcome the immune systems. Why is this the next step? Well, I want to take a step back. We're now finally figuring out how cancers are able to resist attack by the immune system, by drugs, by anything else. And they're very, very clever at it. And the problem is that it's not a technology problem. It's not an application problem. It's a discovery problem. We need to be able to do the hard work, the digging, the research in order to get the answers. So in the case of immunotherapy, which is what I do for a living, so I must tell you, I'm biased a little bit towards it. But I view the immune system as being the major threat faced by a developing cancer in the body. So cancers that succeed in growing in somebody's body have solved that problem. And if you can understand what tools they've used to solve it, you can attack those tools and you can disable them, right? And that's the whole concept of checkpoint antibodies that have revolutionized the care of melanoma, kidney cancer, and other diseases. And we are hoping that we're going to be learning more and more about that as time goes on. So cancers are capable of developing resistance. In many other diseases, the mechanisms and the processes don't lend themselves to developing resistance, they are what they are, they don't change, okay? In cancer, it's a constantly shape-shifting enemy. It's really like the terrorist inside our own bodies. And we have to figure out a way to anticipate that, cut it off at the pass, and try to degrade it before it can cause more damage. WILLIAM BRANGHAMS, The terrorist inside your own bodies, Ted, what about the health care system? How much are people suffering and dying because they either cannot afford the the right treatment and drugs, or simply don't have access to that in terms of distance to the right cancer centers, hospitals, et cetera? DAVID BROOKS JR.: You probably don't realize that, this morning, I testified to the Oversight Committee on exactly this issue. WILLIAM BRANGHAMS JR. Well, we're lucky to have you here. DAVID BROOKE JR.: And part of the problem is, is that you have middlemen, insurance companies, and their what are called pharmacy benefit managers, PBMs that are known, that basically have such control and leverage that when a physician like Dr. Wiener prescribes a drug, very often he has to go through what's called prior authorization. He has to get the prior authorization before the patient can get that drug. And often he may be talking to a pediatrician, not an oncologist. And there's something called fail first step therapy, which is that the patient, the insurer says, no, you have to try drug A before the drug that basically Dr. Wiener wants to give, and the patient has to fail on it before they get the drug that he wants to gives that feels optimal. Why is that? Because the insurance company and their PBMs, they want the drug to be used that is the most profitable drug for them, not the best and optimal drug for the patient. So you have delays, you have denials of care. Here you have a cancer patient that is literally, I talk about it, is fighting their bodies. You shouldn't have to fight to get treatment. And unfortunately, we have this convoluted, if you know the game of mousetrap or, you know, it's a Rube Goldberg model that doesn't exist anywhere else in the world except the United States. And as a result, that's why cancer patients face delays, denials in treatment, and it's a travesty. Dr. Wiener, we so often hear about patients who are participating in trials or are getting some experimental treatments. Why do you think it takes so long for the lab to turn a discovery into a treatment that is available on the open market? Boy, that is a tough question. There are so many steps. you have to think about it almost like a journey of a thousand steps you go from a great idea to testing it and proving it in cells in the laboratory you then have to prove it many times in animal models to prove that in animal models that are relevant to the possibility of human extrapolation that it might work and then once that happens you haveと do toxicology you have то make sure it will be safe to give in humans and do all kinds of tests for that. You also have to do pharmacology studies to see, does this molecule, will it actually circulate in the body? Will it cause damage to normal tissues? Will I get to the target? Will do what it's supposed to do? And then and only then do you get into the clinic. And once it gets into the clinic, then you have to go through a number of steps to establish safety, to show that it works, and then to show not only does it work, but does it matter? Is it actually better than what's available? So it takes upwards of a decade to go from a concept to a drug, and many times even longer. And one of our challenges is to come up with more effective strategies utilizing novel approaches, maybe AI-based or others, that might allow us to actually accelerate that timeline more effectively. I want to bring up some numbers to talk about how prevalent cancer is here in the United States. The lifetime risk of developing cancer in the U.S. is some 39.2%. That's both for men and women. That's based on data from 21 to 2023. These are the three deadliest forms of cancer for both men and for women. For women, it's first lung and bronchus, then breast, then colorectal. For men, it is lung, prostate, and then colo-rectal. Ted, if there were cures for all cancers tomorrow, back to the health care system question, could America's system even get those treatments to the people who need them? I think it would be very difficult. I think we basically have a, we're dealing with an antiquated system, and we're looking at novel therapies and approaches. So even if you had all the cures to those cancers, I think the system, which includes reimbursement from Medicare, remember, the older we get, the more likely we're going to have cancer, which means Medicare is the biggest single payer. And then if you look at commercial payers, it is a real problem because not only do you have consolidation working against you, but you basically have a system that is antiquated when you have new novel therapies to deliver. So I think it would be a problem. I think even if we had every cancer cured, you would not have every American basically cured. That's stunning. Dr. Wiener? So I want to double down on what I just said. Everybody, everybody is entitled to the best possible care they can get when they face a dreaded disease like cancer. No exceptions. We have a system in place that is literally designed to obstruct the delivery of that care for any one of a number of reasons, be they financial, cultural, societal, whatever it's going to be. And I think that in a just country, we should be figuring out ways to make sure that everybody gets the care they need to have the best possible outcome. And it's something we've really been striving for at our cancer center, and we're proud of the progress we've made. But we have, you know, Ted represents community oncology organizations around the country. I represent an academic medical center here in the nation's capital. But I think both he and I would agree that the need to get the care to the people who need it requires that we all work together, that we all are able to offer the best possible treatments to everybody, irrespective of where they live, how much money they make, and whether or not they're in a red state or a blue state or any of that stuff. People deserve that. How strong, Dr. Wiener, is the funding. Where are the shortfalls? Are government and private institutions doing enough to devote the resources that are needed to research these cures? Well, it's never enough. If you think about what might happen if this country were attacked, what would we do if many thousands of people were dying every day from hostile activities of some kind. We would spend whatever we needed to do to make it happen. About 2,500 people in the United States are dying every day of cancer, and we act as if it's just another thing. So no, we don't invest enough. We've never invested enough. It's been a particularly challenging time in the last couple of years, for reasons that I think we all understand. There's been a reduction in the amount of investment, particularly, I think, in the investment in our younger scientists, our earlier career people who are the future of our field, and also in the fundamental science that leads to the discoveries that we don't even know can occur yet, because that's where the future is. And if I can just add one thing that's really scary, if you look at the demand and the supply curve meaning basically the demand for cancer what's gonna happen we have an aging population we have a population that therefore we're gonna see more higher incidence of cancer if you look at that and you look at the supply of oncologists it's a divergence and it's very scary and you can't make that up so when you talk about investment in younger people when you talk investment in our physicians to treat those cancers who's gonna treat those cancers so the people who have who have the resources are going to get treated, the people who don't are not going to get treated. Where, Ted, is legislation failing or succeeding and how much of a political issue is this? Because of course cancer touches everybody. It's hugely political and it's a shame. I mean I spend too much time on Capitol Hill and right now, regardless of the way you look at this, there's a partisan divide, it's all politics and we can't get together even though there's a cancer caucus over in the Congress, can't get together to say, hey, let's literally put down the politics and let's find the cures that are needed. Let's make the investment that is needed. Look at this as a global national level, a national security level. And unfortunately, it's not. It's just the times we live in. Ted touched on this a moment ago, Dr. Wiener, comparing the U.S. to other countries. But where do you think the U S falls? How do you compare the U. S and its success in researching cancer to other counties? We are the gold standard of the world. We always have been. There are challenges now to that leadership. Spectacular research being done in China. Challenges in a good way. Yeah. Yeah, yeah. I mean, you know, the enemy is cancer. It's not the other country. It is not the other cancer center. But at the same time, the genius of this country has been to take this big sprawling mass of different ideas and competing strategies and the big mess of our health system and out of it emerges these magnificent discoveries and transformative changes. And we owe it to the future to be able to continue to do that and we can. It just requires an an agreement amongst the people who are making the laws and the people who are appropriating the dollars and the industry partners to come together and say, we owe it to the future of America. Because if you think about it, what we're saying is we're investing in our children, in our grandchildren. Thank you so much to you both for breaking down such an important and complicated issue. Ted Ocon and Dr. Louis Wiener, Georgetown University, thank you. That is all from the team here in Washington. I want to hand it back to Eva McKend and Al Jazeera's Global Headquarters in Doha. So after 50 years, four presidents and a mountain of research funding, the honest answer is that cancer was never one enemy to defeat. It's hundreds of diseases wearing one name. And the war on cancer isn't over. That's our show. Join us on Wednesday at 1830 GMT or 2.30 p.m. Eastern if you're here in the United States as Washington finally moves to build committees policing artificial intelligence. Thanks for watching This Is America. Goodbye for now. Thank you.