The cancer field is poised to thrive under ARRA, but support for diagnostic firms that could further the goal of personalizing cancer therapeutics has been less forthcoming. According to the Office of the Director, the National Cancer Institute received $1.26 billion of the NIH's ARRA monies, including $731 million in grants, $494 million in R&D contracts for the academic community, $6 million for intramural funding and $25 million of support. Eighteen of the 37 challenge grants NCI sent to NIH are being funded to the tune of $17.7 million; plus NIH is putting up $38 million to cover 41 additional high-priority NCI grants. There's also $36 million going to fund 37 early-phase clinical trials of compounds that, according to NCI director John Niederhuber, “we hope will soon expand our ability to provide targeted, personalized medicine.”

Nonetheless, according to some observers, ARRA's impact on personalized medicine and cancer treatment, where the bulk of such research is focused, could be greater.

One reason is the holdup in the anticipated change to the Small Business Innovative Research (SBIR) program that would allow a flow of ARRA funds to venture capital–backed companies (see page 1065). Notes David Parkinson, CEO of Nodality in S. San Francisco, California, “Anticipating that the law would change, we applied for an SBIR grant, negotiated a budget, but then had to withdraw from what would have been an award because of the failure of Congress to reconcile the SBIR law.”

Even more importantly, diagnostics companies like Nodality, which is using flow cytometry to measure many signaling pathways concurrently to gain greater insight into why individuals respond or don't respond to particular therapeutic approaches, are not yet on the radar screen of policy makers. “Largely because the diagnostics companies have not been at the table, there's been little discussion of how to help the application of these new technologies to patient characterization,” Parkinson says. “Much of the allocation of stimulus money from NCI was for support of upstream biology, such as genomic sequencing. I thought there would be value to looking strategically at the application of this kind of funding to the downstream interface between all this new biology and information.”

That view is echoed by Stephen Friend, the founder of Sage, a not-for-profit initiative located in Seattle that is developing biological networks to model disease across tissues and organs. There's nothing in the NIH system or in pharma, he suggests, that advances the Obama administration's goal of ascertaining who's getting what care and whether that care is working. “I feel there is still a real opportunity for the government to increase transparency in the care of patients. Not just for us or for companies like Nodality. There's a real interest that hasn't been tapped and, more importantly, hasn't been funded.”