Houston, we’ve had a problem here.

Moon shot. Noun. A high-velocity home run in which the ball reaches an extraordinary height. Wally Moon, who was a major league outfielder in the 1950s and 1960s, was a left-handed hitter. His shots would pull to the right, and when he was playing for the Los Angeles Dodgers wouldn’t clear the stadium’s deep 440-foot outfield. By perfecting an inside-out swing, he figured out how to send the ball sky high, up-and-over the closer left field bleachers. His “Moon shot” helped the Dodgers advance to the 1959 World Series.  He remembered that day for the rest of his long life: After playing for 11 years, he retired in 1965, went on to coach, and died in 2018 at the age of 87.

Moonshot. Noun. A very challenging and innovative project or undertaking. In 1962, President John F. Kennedy, who had already floated landing a man on the Moon to Congress, delivered a speech to drum up public support at Rice University in Houston, Texas. Kennedy flatters Houston, a “city noted for progress,” and Texas, “a state noted for strength,” but not the zeitgeist: “an age of both knowledge and ignorance” that lacks the will to take advantage of all that science and technology have to offer. Sceptics ask, “Why go to the Moon?” Kennedy answers: Why attempt any great conquest of land, sea or sky? Because we are Americans, and we do things “not because they are easy, but because they are hard.” Otherwise, he joked, “Why does Rice play Texas?” Why go to the Moon? Because we choose to.

What could go wrong?

The Moonshot. Noun. The act or procedure of launching a rocket or spacecraft to the Moon. “Houston.” That was the first word spoken by Neil Armstrong when the lunar module touched down on the moon in 1969. Buzz Aldrin had already mumbled a few words about turning the engine off, and Armstrong wouldn’t take his famous walk and make his famous “one small step” speech until about 4 hours later. “Houston” was really just a “Hey” to Mission Control, a shout out to the small blue marble down below to see if someone was listening. Everyone was.

Kennedy did not live to hear the part of the conversation between Armstrong and Houston— “Tranquility Base Here. The Eagle has landed.”—that confirmed his goal was realized.  He was assassinated in 1963, in Dallas, Texas, a city noted for a grassy knoll and conspiracy theories.

The Apollo 11 mission was followed by Apollo 12, whose communications with Houston lack the gravitas of Armstrong’s. Instead, the three astronauts sound like star-struck teenagers: Alan Bean calls everyone “Babe,” and Charles Conrad, trying to stick the landing, gleefully confesses, “Hey, we flew right by the crater, Houston.…”  When we think of the Apollo 13 mission, we think of Tom Hanks telling Houston that something has gone amiss. “Houston, we have a problem,” is an understatement for the near catastrophe that followed. Mission Control fixed possible carbon monoxide poisoning by rigging a cleaning system of cardboard and tape. We call that American ingenuity.  

Moonshot. Noun. A very challenging and innovative project or undertaking. Vice President Joe Biden returned to Rice University in September 2016, 54 years after Kennedy, to promote the Cancer Moonshot. Houston’s MD Anderson Cancer Center is at the forefront of oncology research. Biden’s son Beau was treated there for brain cancer before succumbing to the disease in 2015, and the Moonshot is named for him. Biden talks about Beau often, at perhaps inopportune times, but remembering his family’s tragedy—the time spent by his son’s side talking to doctors and learning as much as he could about the disease and the research, and the realization that his son’s diagnosis was a death sentence—helps him process his loss. It also fuels a rare eloquence. Speaking about the possibilities of the future, Biden linked Kennedy’s challenge of flying to the moon to the challenge of finding a cure, a challenge we are “unwilling to postpone and one we intend to win.” But Beau’s death has also made him impatient with both the past and the pace of progress. Nixon’s “War on Cancer,” the National Cancer Act of 1971, was well-intentioned, said Biden, but it is now 45 years later—and 1 year too late—and its goal of a cure has not been realized.

Moonshot. Noun. A long shot. The clinical practice guidelines for colon cancer includes a flow chart that plots cancer stages and treatments. This chart is the “if/then,” “this-or-that,” “either/or” road map of a patient’s future: Surgery or radiation; this chemo drug or that one; if the cancer progresses, then a clinical trial…or hospice. Nixon mandated that cancer research make its way more quickly from the test tube to the patient, and by 2014 most patients had access to a clinical trial in their community. The success rate of clinical trials, however, is quite small.  

In Atul Gawande’s Being Mortal, he warns against the long shot: The endless parade of treatments that have little chance of extending life, offered because doctors as well as patients engage in wishful thinking. The failure of the long shot can prolong suffering with little to show for it and leave families and loved ones feeling guilty that they somehow missed a miracle.

Moonshot. Noun. A very challenging and innovative project or undertaking. Cancer Moonshot, Part Two. In February 2022, without much fanfare, President Biden re-booted the Beau Biden Cancer Moonshot Initiative with a new goal of reducing cancer deaths by 50% in the next 25 years. The Moonshot of 2016 had lofty ambitions: Investing in immunotherapy and precision medicine research, collecting and mapping tumor data, and minimizing inequities in cancer screenings and care. It has had notable successes: 3,500 potential treatments are in the pipeline, a 75% increase since 2015; 240 research projects are ongoing; and, there is a clunky but searchable database of clinical trials. In his remarks, Biden rambled off script to talk about Beau. Seven years after Beau’s death, his dad like many of those left behind, still wonders why he didn’t know what to do and why there wasn’t anything to do. The Biden’s had unlimited resources and access, yet like many of us they were stymied by bureaucracy. His aside about not being able to get a scan sent from one hospital to another struck me in its familiar head-exploding idiocy.

Moon-shot, adj. Obsolete rare; illuminated by moonlight. I stand in my yard looking up at the Moon. That men once walked across it seems impossible. But Houston, we have a problem. And the solution is a long shot.

I choose to go to the moon.