human prostate cancer cells under a microscope. Heiti Paves/shutterstock
human prostate cancer cells under a microscope. Heiti Paves/shutterstock

Last year, billionaire Robert F. Smith punctuated his Morehouse College commencement address with a surprise pledge to pay off student loans for the entire 2019 graduating class, worth tens of millions. Building upon that gesture, Smith’s Fund II Foundation recently launched the Student Freedom Initiative with a $50 million grant, offering Black juniors and seniors majoring in STEM fields at HBCUs a flexible, lower-risk alternative to private high-interest student loans. The initiative aims to support 5,000 new students annually at up to 11 HBCUs starting in the fall of 2021.

With $5.2 billion to his name, Smith, 57, has emerged as the richest Black American, and one of America’s top philanthropists. He’s also the first Black American to sign the Giving Pledge, committing the majority of his wealth to philanthropy. What’s particularly notable is how quickly this all happened, with Smith standing up the foundation in 2014 and ramping up giving right away. While the foundation’s public tax records are not yet available beyond 2016, a foundation board member told me that to date, the Fund II Foundation has made 76 grants awarded to 52 grantees worth $249.5 million. This is up from a cumulative figure given about a year ago of 68 grants to 42 grantees worth around $236.3 million.

Overall, just over 37% ($93 million) of grant funding has gone toward education, and 11.4%, or $28.5 million, has gone toward health. While Smith’s interest in education through Fund II and his personal donations has been quite apparent, that health figure might come as a surprise. It’s not explicitly listed as a focus area on the foundation’s website, which cites grantmaking priorities in human rights, music education and “preserving the African American experience.”

Still, in 2016, Fund II Foundation made a $27 million grant to Susan G. Komen to address the high breast cancer mortality rate among African American women, who are nearly 40% more likely to die of the disease than white women. And in 2018, Smith made a $2.5 million individual donation to the Prostate Cancer Foundation (PCF) to focus research on African American men and to aid veterans who are battling the disease. Black men are 76% more likely to develop prostate cancer than white men, and are more than twice as likely to die from the disease compared to men of other ethnicities.

At the time, per a press release, it was the largest donation ever dedicated to advancing prostate cancer research in African American men, and I remarked that given his active interest in supporting the Black community, Smith may be primed to step up with another related major health gift.

Indeed, Smith just announced a $1.9 million gift to the Prostate Cancer Foundation toward development of the Smith Polygenic Risk Test for Prostate Cancer, which will identify a man’s likelihood of developing prostate cancer over his lifetime. The low-cost test will use DNA found in a saliva or blood sample to identify genetic markers linked to prostate cancer.

“Robert’s most recent philanthropic gift is the largest single philanthropic commitment to ending, I think, the largest disparity in all of cancer,” says Jonathan Simons, president and CEO of the Prostate Cancer Foundation in Santa Monica, California.

Getting Involved

In a recent interview, Simons explained to me how Smith started digging into the issue, and his escalating philanthropy to tackle this disparity. The billionaire first connected with the Prostate Cancer Foundation through financier Michael Milken, a prostate cancer survivor and PCF founder, and decided to work with the charity around treatment and precision oncology in Chicago. Smith’s initial work created the Robert Frederick Smith Precision Oncology Center of Excellence at the Jesse Brown VA Medical Center, serving a predominantly Black populace.

Smith was particularly interested in socioeconomic factors, access to care, and health literacy at the VA. “This disease has touched his community, his friends, and he has regularly gotten tested himself,” Simons says. Over the course of just 18 months, though, Smith has become deeply committed not only to treating a cancer that disproportionately affects Black men, but being proactive about stopping prostate cancer in its tracks from the start.

“When you control for access to care and class, most all cancer disparities go away, except the prostate cancer disparity,” says Simons, a veteran oncologist who has made prostate cancer his life’s work. Simons himself found his way to this arena after his friend from college was struck down by the cancer in the days before the prostate-specific antigen (PSA) test. And Simons’ own father was one of the first thousand cancer patients to be cured of Hodgkins lymphoma. When Milken launched the Prostate Cancer Foundation in the early 1990s, they supported Simons’ research as a young scientist.

But why are Black men particularly vulnerable to prostate cancer? The answer, at least in part, lies in genes.

After two decades of work, Simons explains that researchers have started to better understand the human genome and now have critical buy-in from Black men to participate in clinical research. Some of this work took place at the Prostate Cancer Foundation with NIH funding. And recently, USC researchers led by Christopher Haiman discovered a genetic variant from West African ancestry that significantly increases the risk of prostate cancer.

“Same as sickle cell trait in Mediterranean populations. Or the gene for cystic fibrosis, which arose in Scotland. Genes don’t need to be your destiny, but they are an essential part of human disease,” Simons says.

This helps explain why, even when you eliminate socioeconomic factors and access to care, the prostate cancer disparity persists, he says. The USC research involved 10,000 Black male volunteers who facilitated this pioneering genome study.

Ending the Disparity

The Smith Polygenic Risk Test for Prostate Cancer will be the first polygenic test in all of cancer. Simons unpacks exactly what this means for the layman: “The test looks at a set of genes like a deck of cards, finding the bad combinations that put a man at high risk, and, on the other hand, the combinations that put a man at low risk. And the whole thing can be done for under 90 bucks.” Smith’s $1.9 million will allow PCF to go forward with developing the test, a two- to three-year research and development process to get everything off the ground.

“As African American men are at an increased risk for being diagnosed or dying from prostate cancer, understanding their risk profile and applying this knowledge earlier with strategic detection, care and decisions about cancer risk management is of utmost importance to address health inequity in the U.S.,” Smith said in the announcement. “This is why I made a personal commitment to help accelerate research, encourage African American men to participate in the study and subsequent testing, and develop new detection strategies that have the power to transform how we diagnose and treat this disease and help save lives.”

At the same time, Simons and Smith also recognize the work ahead, beyond backing simple (says the writer) R&D. For starters, while Smith is the first major donor to step forward in this area, there’s a need for more funding and more Black men to participate in testing. But Simons seems confident that Smith’s leadership here will move the needle on both fronts.

“The first olive out of the bottle is the hardest. But I think by bringing awareness that this is a solvable problem backed by robust research, we will be seeing plenty more support from other philanthropists, definitely from NIH, and definitely from the overall healthcare sector, too. We didn’t have a tool before. Now, we have a tool,” Simons tells me.

As to the second issue of getting more Black men engaged, Simons was open about the legacy of institutional racism in medicine and the understandable distrust Black Americans feel. He mentioned the Tuskegee Experiment, but there’s also the work of James Marion Sims, whose pioneering advances would have been impossible without enslaved Black women like Lucy, Anarcha and Betsey— who were used during his first female fistula experiments in the 1840s. And even this century in Nigeria, Pfizer paid the parents of Nigerian children who died of meningitis after a controversial drug trial.

“There’s a whole lot of distrust, cultural fatalism, but that’s the project for the decade, and Robert is committed, here,” Simons says. PCF aims to accelerate the reduction of prostate cancer disparities among African American men by 2030.

“A Leading Philanthropist like Carnegie”

Robert F. Smith, CEO and founder of Vista Equity Partners, an investment firm focused on financing and forwarding software, data and technology-enabled startup businesses, was relatively unknown outside of financial circles until recently. But on the heels of his Morehouse move, at least anecdotally, I’ve observed many more Black Americans taking an interest in the rise of this Cornell and Columbia-educated man who amassed wealth not as an entertainer or an athlete, but on Wall Street.

Simons also speaks to Smith’s enormous power and unique position, not just through writing checks, but as a trusted figure. What’s more, he’s convinced that Smith has the power to change the conversation about men’s health, offering no minor comparison.

“We want to work with Robert as the leading philanthropist here, as Carnegie was for liberties, and as Gates is for infectious disease. Robert is willing to use his name to leverage all the assets in our society to create a trusted conversation and get Black men the early detection that they need and deserve for prostate cancer.”

Hopeful about this reframing of men’s health, Simons believes the Smith Test could become as routine as a mammogram or a Pap smear. “You’ll get the Smith Test by the time you’re 40, so you’re not dying of advanced cancers in your 60s,” Simons explains, adding.

PCF has already formed partnerships with some HBCUs, and is focusing on highlighting leading Black PCF researchers, as well.

Early on in the pandemic, an unfortunate myth circulated that Black Americans were somehow immune to COVID-19. In reality, because of access to care issues, a higher rate of preexisting conditions, and a range of other challenges, Black Americans are proving more susceptible to bad outcomes. But while some came down hard on those propagating this dangerous myth, it’s easy to see why the most vulnerable sometimes weave such stories, skeptical of the medical establishment due to a legacy of mistreatment.

Ultimately, then, the health benefits of the Smith Test might prove secondary to the billionaire giver’s power to tap into a new narrative around medical research, providing a vulnerable population with trusted science and a true lifeline.

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