The Next Stage

Lance Armstrong will drive the pace car, a 505-hp Corvette Z06, at the Indianapolis 500 on May 28. Tip for Indy officials: Feed him before he gets behind the wheel.

Earlier this year Armstrong was piloting his black BMW M5 at roughly twice the speed limit down a rural highway while devouring a teriyaki beef wrap from the takeout window at Roscoe's, the culinary acme of Dripping Springs, Texas. The business of eating the wrap while dipping chips into a small container of salsa forced him to take both hands off the wheel periodically and steer with his left knee. When his passenger offered to take the wheel, the Texan fixed him with the Look.

"You do the interview," he directed. "I'll drive the car and eat my lunch."

You remember the Look: the glare that bored holes in the psyches of Armstrong's opponents while he won seven straight Tours de France, beginning in 1999. The Look made seasoned professionals quail, robbed them of hope, bade them ask themselves, Why do I even bother?

Armstrong may have walked away from competitive cycling last July, but the power of his glower is undiminished. Ten months after his final descent from the top step of the podium on the Champs-Elys�es, he is focusing his gaze, his attention, his displeasure--the Look--on an old foe, the one that came close to killing him a decade ago.

Having finished his wrap and arrived at his destination, Armstrong sat at the dining-room table at his home outside Austin, sifting through a pile of correspondence. He stopped at a card that said, From Our House to Yours: the Kunz family. It included a snapshot of a good-looking couple and their two young children. The woman had been dead for six months. She succumbed to cervical chordoma, a rare form of cancer that, Armstrong believes, has a 100% mortality rate. "I mean, what kind of odds are those?" There is the Look again as he answers his own question: "Unacceptable."

SPENCER SARTIN was diagnosed with acute lymphoblastic leukemia in October 2004. Suddenly, everyone he met wanted to stick a needle in him. There were needles to take his blood, a needle to knock him out so he wouldn't feel the even bigger needle that doctors would use to draw bone marrow from his hip. Spencer is now six years old, in remission and on the cover of this magazine. (He's the one in the yellow jersey.) But he will remain in treatment for another 20 months, and he needs so many shots--for chemo, for spinal taps, for the flu--that he has forbidden his parents to use the word around the house. When Spencer needs an injection, his father, Rob, lets him know by using American Sign Language. "You point your right index finger at your left biceps," says Rob, "and push down."

Before his son fell ill, Rob had raised more than $5,000 for the Lance Armstrong Foundation. In fact, Spencer first exhibited the symptoms of his illness--the stubborn fever that finally persuaded his pediatrician to order blood work--while his parents were at a dinner for Ride for the Roses, a cycling event that raises funds for the LAF. Little wonder, then, that the boy has gone on the offensive against his affliction. It's as if, in addition to the chemo, he has Armstrong's attitude pumped into his veins. Spencer signed up for martial arts despite being, on some days, too weak to walk from his bedroom to the kitchen. And last October he and his father completed the 40-miler at the Ride for the Roses. Spencer pedaled a Trail-a-Bike attached to Rob's hybrid. "He worked his butt off," his father says. He also raised $32,500 for the LAF.

Spencer is a foot soldier in what could be called Armstrong's Army, a generation of cancer patients who are the opposite of passive victims. They are, like him, warrior-survivors. If he walked away from the fight today, that would be his legacy. But he isn't walking away. He's just getting warmed up.

THESE ARE the best of times and the worst of times in the fight against cancer. In 2003, a year after becoming director of the National Cancer Institute, Dr. Andrew von Eschenbach stunned the medical community by setting the goal of "eliminating cancer as a cause of suffering and death by the year 2015." Praised by some for his bold optimism, the director was attacked by others who found his objective unrealistic and--in the likely event that the goal is not met--certain to undermine the credibility of the NCI, the government's main spigot for the approximately $5 billion a year that flows into cancer research and training.

Without the spur of a deadline, Von Eschenbach argued during an interview last February--a month before President Bush nominated him to head the Food and Drug Administration--big goals are "meaningless." He then held forth for half an hour on why his target is within reach. He spoke excitedly about the "molecular metamorphosis" that has taken place over the last decade and about recently developed "proteomic and genomic tools that can detect the presence of cancer long before somebody's got a big lump." He waxed optimistic about "advances in information technologies, opportunities to be able to use those tools, including the Internet, in a way that makes patients participants, rather than passive recipients, in their treatment." He asserted, "We've got the ball across midfield. If we just applied what we have in hand"--for example, persuading Americans to undergo preventive procedures such as colonoscopies--"we'd be getting pretty close to the red zone."

This "red zone" talk makes Hamilton Jordan red in the face. "Almost half the people alive today will have cancer in their lifetimes," thunders Jordan, a four-time cancer survivor who served as President Jimmy Carter's chief of staff. (As baby boomers age, decreases in mortality from other diseases will drive up cancer rates.) "That's a damn epidemic. And what are we doing about it? If you went back and added up all the budgets for the National Cancer Institute over the past three decades, we spent as much money on cancer as we spend in Iraq in nine months."

Von Eschenbach's gung-ho prognosis belies the kidney punch recently delivered to the very scientists on whom he must rely to meet his audacious goal. The day before Von Eschenbach gave his glowing assessment, the executive branch he serves proposed cutting the NCI's budget by $40 million, to $4.75 billion, for fiscal year 2007. The NCI is one of 27 centers and institutes run by the National Institutes of Health, whose budget was also decreased, for the first time in 36 years. In the current environment, says Doug Ulman, 28, a three-time cancer survivor who is the chief mission officer for the LAF, "people graduating from medical school fellowships and residencies are saying, 'I can't go into research. There's no money.'"

That may not change anytime soon, says Bush's more wonkish predecessor, an ardent FOL (Friend of Lance) who says he watched "almost every stage" of the 2005 Tour de France. "Regardless of which party takes the Congress next fall, or the White House in '08," says Bill Clinton, "we're stuck with this big deficit [projected to be $3.3 trillion over the next decade]. Even with a substantial change in policy, there will still be an enormous set of gaps between what the market will produce and what the government can provide. And the nongovernmental sector has to step into those gaps."