For many, the name Michael Milken is synonymous with avarice and conspicuous consumption that characterized Wall Street speculators of the 1980s. However, in the time since his release from federal prison after pleading guilty to securities fraud, serving a two-year sentence, and paying more than $1 billion in fines and settlements, the 48-year-old former junk bond king has been working toward being more closely associated with a cure for prostate cancer.
WHEELING AND DEALING: NCI's Marston Linehan praises Milken's "ability to get things done."
Perhaps as important, according to its grantees, supporters, and observers, are the novel studies the Santa, Monica, Calif.-based foundation finances and its streamlined application review and approval process. "Prostate cancer is hot," observes Kenneth Tew, chairman of pharmacology at the Fox Chase Cancer Center in Philadelphia, whose research focuses on hormone-refractory prostate cancer. "In the past three to five years, a tremendous number of investigators have flocked into the field, and what the CaP CURE people have managed to do is short-circuit bureaucracy. They've made it much quicker than NCI to get a grant proposal written and reviewed and to get the money to start research."
By his own admission, Milken's interest in eradicating the disease is more than purely philanthropic. He was diagnosed with inoperable prostate cancer the day after he got out of jail, and has received hormonal and chemotherapy treatment for the disease. "It is a war I cannot afford to lose," he acknowledged in a Washington Post interview last year (R. Fowler, Sept. 29, 1994, page D1). "For me, 10 seconds used to be a lifetime to make a decision. Now I'd like to see advancements in months, rather than years, in this field, for my future and for all the men who will be diagnosed." At press time, Milken was unavailable to be interviewed by The Scientist.
Tew--who is not a CaP CURE grantee--does not believe Milken's past should cause researchers uneasiness in accepting foundation money, although he acknowledges potential issues involved. "It's hard to speak of the ill in an ill way," he says of Milken. "There's certainly a lot to be said for him putting his money into this.
"I've asked myself if any money is dirty money, but the guy went through the legal system and came out smelling like a rose. I've struggled with this and I don't think I have an ethical problem with this; but I don't think it's black and white, either. If I worked out an idea and applied [for CaP CURE funds], I think I would go through with it."
STRATEGIC FUNDING: Fox Chase Cancer Center's Kenneth Tew wonders if CaP CURE's grant for Leroy Hood's "big science" project will pay off.
Grant proposals are scrutinized by an anonymous peer-review board of oncologists and other researchers, and are chosen and administered by a separate scientific advisory board. The advisory board includes University of Washington molecular biologist Leroy Hood; Howard Scher, chief of genitourinary oncology at Memorial Sloan-Kettering Cancer Center; and Christopher J. Logochetis, a professor of medicine and chairman of the department of genitourinary oncology at M.D. Anderson Cancer Center at the University of Texas. CaP CURE's board of directors includes Emil Frei III, physician in chief, emeritus, of the Dana Farber Cancer Institute in Boston; and Helene Brown, director of community applications of research in the division of cancer control at the Johnsson Comprehensive Cancer Care Center of the University of California, Los Angeles.
CaP CURE supporters and officials stress that the foundation's unique features are the ease of applying for funding and the types of research it supports. "Instead of four Manhattan telephone books of documentation and validation of principle [an extensive document required on most grants], we require only three to five pages for a proposal outlining a research idea, plus a C.V. to identify the qualifications of the investigator," says Stuart Holden, a urological oncologist and CaP CURE's medical director.
The foundation, he notes, has provided "bridge funding" for unusual and "off the wall" ideas: "A lot of creative ideas often get thrown away because there are no funds to try them out. We provide the funding to get these projects off the ground, letting scientists gather enough data to apply to other grant resources in the government."
In some cases, Holden claims, CaP CURE has approved a proposal and written checks of $100,000 or more to researchers in fewer than 30 days. "Even though our approvals process is nowhere as exhaustive as NCI, even NCI is now looking at its own process to find ways to become more efficient."
Holden boasts: "We've already seen significant progress [from research funded by CaP CURE] in certain types of drugs such as a phospholipid blocker and an anti-angiogenesis drug that cuts off the flow of blood to prostate tumors."
Speed, researchers emphasize, is of the essence. This year, prostate cancer will kill 40,000 men and afflict 240,000, making it, with lung cancer, the largest cancer killers among males in the U.S., roughly on par with breast cancer for women, according to NCI figures. Investigators maintain that prostate cancer has traditionally attracted less attention and funding than more visible illnesses--breast cancer, lung cancer, and AIDS, for example--with similar or lesser mortality rates but much louder advocacy groups, though attitudes are changing.
"For a long time, men didn't want to talk about prostate cancer," says Marston Linehan, head of urological oncology in the surgery branch of NCI. "But since the '80s, with early detection, it's being diagnosed in much younger men. There's renewed interest and concern about mortality and the prevalence of the disease."
Individual investigators from comparatively small labs say their CaP CURE grants have made their research possible where it hadn't been before. "This is the first time we've gotten money for prostate cancer," notes Takaaki Sato, a research associate at the La Jolla Cancer Research Foundation in California. Sato works on a genetic-prevention cancer strategy in the laboratory of John C. Reed, scientific director at the La Jolla center and director of its oncogene and tumor-suppression gene program, which received a $100,000 CaP CURE grant last year. "It's normally very competitive to get any kind of research grant from the government," Sato points out. "We're very excited and happy to have gotten this opportunity, because now we can apply a background in breast and ovarian cancer research to prostate disease."
At the other end of the spectrum, CaP CURE has committed $1.8 million to a three-part prostate research effort run by Hood. One part of the initiative will be a "superfamilies" project to identify genetic profiles in families with three or more members developing prostate cancer early in life. Similar to the Human Genome Project, the project aims to involve about 1,000 families. Some of the money will also go toward establishing a new national tissue bank centered in four U.S. cities--Seattle, Houston, St. Louis, and Boston--to provide fresh tumor samples to researchers. The rest of the grant will be dedicated to setting up a consortium of prostate researchers linked by a high-tech computer network. According to CaP CURE, the research network has already attracted leading geneticists, epidemiologists, and other specialists, among them epidemiologist Janet Stanford of the Fred Hutchinson Cancer Research Center in Seattle.
Hood, who could not be reached for comment, speculates the project could yield new means of diagnosing and treating the disease within as little as four years, according to a report in the Wall Street Journal (R.T. King, Jr., Feb. 17, 1995, B6). At least one biotech company, Cancer BioSciences Corp. of Lexington, Mass., which has received investment funds from CaP CURE and has a separate contract with Hood's lab, may also become involved in the consortium.
But some researchers wonder whether CaP CURE's "big science" investments will pay off as well as its more modest funding of individual investigator leads. "You never know where the really good ideas are going to come from," observes Fox Chase's Tew. "But some 35-year-old who has a great idea, employs one technician and a graduate student in a lab, may make a significant amount of progress. When you're chucking more than a few million at a senior investigator, on the other hand, it's sort of like big government. The chances of waste are a lot greater."
CaP CURE's emergence coincides with rising support in government for prostate cancer research, because of several leading congressional figures "who either have the disease or know somebody who does," suggests Tew, who is also an adjunct professor at the University of Pennsylvania. "The Army has gotten a lot of money for breast cancer research," and "powerful people on the Hill saw [prostate research] as a way to balance [support for] breast-cancer advocacy groups. NCI also felt it had to push prostate cancer research. So attitudes have changed."
Milken's presence--plus many friends he's retained in high places--is also being counted on to whip up public and congressional support to fight the disease. Milken and CaP CURE have hosted or cosponsored many parties, Capitol Hill receptions, and high-profile prostate cancer professional conferences this past year to raise money and bring together academic scientists, government officials, and privately owned biotech and drug companies.
The CaP CURE foundation board of directors has also played an influential role, Holden says. The board's roster, which contains prominent members of the business and science community, raises money and attracts other celebrities from the business and political world. In addition to the figures on the scientific advisory board, the board of directors now includes Merv Adelson, CEO of venture-capital firm East West Capital Associates in Los Angeles; former U.S. congressman Tony Coelho, a managing director of New York investment bank Wertheim, Schroeder and Co.; Vicki Hart, assistant to Senate Majority Leader Robert Dole (R-Kans.); and Rosey Grier, an ex-football star and health advocate. A highly publicized annual ceremony, in which CaP CURE grant recipients are presented with awards, is intended to bring major prostate cancer researchers in direct contact with leaders in industry and politics.
Linehan contends that Milken's efforts are galvanizing the research community: "He has an ability to get things done, bringing smart, thoughtful people together. He's doing for prostate cancer what Mrs. Betty Ford did in the '70s for breast cancer research. More and more scientists are being funded by Milken, and it's my impression that the research is of very high quality. He's inspirational, genuinely concerned about all these men dying; and he combines a real force of vision with phenomenal management expertise."
Tew sees in CaP CURE and other prostate research efforts springing up the prospect of dealing more effectively with late-stage disease. "There's no cure yet," he says, "but our incremental understandings of prostate cancer have really come a long way. We've seen tremendous improvement in drug combinations to treat hormone refractory disease [hormone-resistant prostate cancer]. I'm optimistic."
Arielle Emmett is a freelance medical writer based in Wallingford, Pa.