Opinion: Spinning the Losing War on Cancer

By Samuel S. Epstein, and Quentin D. Young

CHICAGO, Illinois, November 4, 2003 (ENS) - Cancer has become the leading cause of disease and death in the United States. A much higher priority for prevention would reduce this carnage, and the need for treatment.

In 1971, Congress passed the National Cancer Act and Program. This was prompted by well orchestrated appeals from leading representatives of the "cancer establishment," the public National Cancer Institute (NCI) and the world's wealthiest nonprofit organization, the American Cancer Society (ACS). They promised that the cure for cancer was imminent, but only if given an increase in NCI's funding.

Spurred on by a major media campaign, aggressively promoted by ACS and NCI representatives, including a full page advertisement in "The New York Times,""Mr. Nixon, You Can Cure Cancer," President Richard Nixon enthusiastically embraced the Act. He launched the "War Against Cancer," increased NCI's 1971 budget from $150 to $220 million, and gave NCI unprecedented autonomy.

Unfortunately, the Act had unintended consequences. The Act authorized the President to appoint the director of the NCI, and authorize its budget, thus bypassing the director of all the other 26 National Institutes of Health. The Act thus effectively insulated and politicized the National Cancer Institute.

Over 30 years and some $55 billion later, we are further away from winning the cancer war than when it was first declared. But that is contrary to what we have been led to believe.

Since passage of the 1971 Act, the National Cancer Institute and the American Cancer Society have reassured the nation with a steady stream of misleading press releases, briefings, and media reports hailing major progress in the cancer war.

These include repeated claims for miracle "breakthroughs" in cancer treatment, and also the 1984 and 1986 NCI promises that cancer mortality would be halved by 2000.

Barb McCook (left) a radiation therapist at the Naval Medical Center Portsmouth's Radiation and Oncology Department, hugs Marcela Minzghor, a recovering cancer patient. (Photo courtesy Naval Medical Center Portsmouth)

Also misleading is the September 2003 claim, in the "Annual Report to the Nation on the Status of Cancer, 1975-2000," co-authored by the NCI, ACS, and the Centers for Disease Control and Prevention, that "considerable progress has been made in reducing the burden of cancer."

These claims don't even pass the laugh test. Cancer mortality rates have remained virtually unchanged (199/100,000) from 1975 to 2000. These rates are based on NCI's statistics, which are adjusted to compensate for the aging population.

Over the same period, overall cancer incidence rates have escalated by 18 percent, now striking about 1.3 million annually. Today, nearly one in two men and more than one in three women develop cancer in their lifetimes.

This translates into approximately 56 percent more cancer in men, and 22 percent more cancer in women over the course of a single generation. Cancer has become a disease of "mass destruction."

Contrary to what one might think, this increase is not due to smoking. Lung cancer rates have dropped sharply due to decreased smoking by men over recent decades.

Furthermore, the increased incidence rates from 1975 to 2000 involve many cancers unrelated to smoking. These include: non-Hodgkin's lymphoma (71 percent); testes (54 percent); thyroid (54 percent); breast (29 percent); and acute myeloid leukemia (15 percent). For African Americans, cancer rates are even higher, with excesses up to 120 percent.

Childhood cancers now strike about 9,000 young people each year and are killing about 1,500 annually. From 1975 to 2000, childhood cancer rates have increased dramatically. These include: acute lymphocytic leukemia (59 percent), brain cancer (48 percent), kidney cancer (43 percent), and bone cancer (20 percent).

The escalating incidence of childhood and non-smoking related adult cancers is paralleled by NCI's escalating budget from $220 million in 1971 to the current $4.6 billion, a 30-fold increase.

Paradoxically, it seems that the more we spend on cancer, the more cancer we get.

The reason why we are losing the winnable cancer war is because the cancer establishment's priorities remain fixated on damage control - screening, diagnosis, and treatment - and related basic research.

All these are unarguably important, and deserve substantial funding. However, much less funding would be needed if more cancer was prevented, with less cancer to treat.

The pro-industry agenda of the American Cancer Society is exemplified by its minuscule prevention research budget. In spite of bloated contrary claims, less than 0.1 percent of its $800 million budget has been allocated to research on the prevention of environmental carcinogenesis.

ACS' financial ties to the cancer drug and polluting industries remain extensive. Over 25 drug and biotech companies are Excalibur donors, who each have contributed in excess of $100,000 annually. These include: Bristol-Myers Squibb, Pfizer, AstraZeneca, Eli Lilly, Amgen, Genentech, and Johnson & Johnson.

Long term exposure to emissions of particulate matter from vehicles has been linked to deaths from heart and lung diseases, including lung cancer, says the U.S. Environmental Protection Agency's Draft Report on the Environment 2003. (Photo Warren Gretz courtesy NREL)

A total of some 300 other industries and companies make similar contributions to ACS's $800 million annual budget, a figure that excludes government grants, and income from about $1 billion in reserves. These figures hardly justify annual appeals, claiming the need for more funds to continue support of ongoing cancer programs.

As might be anticipated, the American Cancer Society returns its donors' favors with more than a wink and a nod. The society has supported the automobile industry in refusing to endorse the Clean Air Act. It has joined the Chlorine Institute in defending the continued manufacture of chlorinated carcinogenic pesticides. And it has supported the cosmetic industry in failing to warn women of risks of breast and other cancers from permanent black hair dyes, and of risks of ovarian cancer from sanitary dusting with talc.

Not surprisingly, "The Chronicle of Philanthropy," the nation's leading charity watchdog, charged in 1992 that, "The ACS is more interested in accumulating wealth than saving lives." The Chronicle also warned against the transfer of money from the public purse to private hands.

The most disturbing development in the cancer war has been its privatization by the American Cancer Society. In 1998, the ACS created and funded the National Dialogue on Cancer (NDC), co-chaired by former President George Bush, and Barbara Bush. Included were a wide range of cancer survivor groups, some 100 representatives of the cancer drug industry, and Shandwick International PR, whose major clients include R.J. Reynolds Tobacco Holdings.

The 1998 NDC initiative was strongly criticized by survivor coalitions, under the umbrella of the Cancer Leadership Council, and by Dr. John Durant, executive president of the American Society for Clinical Oncology.

In the "Cancer Letter," an insider cancer publication which has investigated the NDC from its onset, Dr. Durant charged the ACS with "protecting their own fund raising capacity … from competition by survivor groups. It has always seemed to me that this was an issue of control by the ACS over the cancer agenda."

Without informing NDC's participants, and behind closed doors, the American Cancer Society then spun off a small Legislative Committee. Its explicit objective was to advise Congress on the need to replace the 1971 National Cancer Act with a new National Cancer Control Act. The new Act is intended to shift major control of cancer policy from the public National Cancer Institute to the nonprofit American Cancer Society.

The proposed Act would also increase NCI funding from this year's $4.6 billion to $14 billion by 2007. The American Cancer Society was assisted by Shandwick in drafting the new Act and managing the National Dialogue on Cancer.

Smoking tobacco increases the risk of lung cancer. (Photo courtesy National Institute of Environmental Health Sciences)

But then, ACS hired another well known tobacco PR firm, Edelman Public Relations Worldwide, to conduct a voter cancer education campaign for the 2000 Presidential elections.

Edelman represents the Brown & Williamson Tobacco Company, and The Altria Group, the parent company of Philip Morris, the nation's biggest cigarette maker.

With the February 2002 appointment of American Cancer Society President-Elect von Eschenbach as National Cancer Institute director, the National Cancer Program was effectively privatized.

Commenting on the ACS relationship with the tobacco industry, prominent anti-smoking activist Dr. Stanton Glantz said, "It's like … Bush hiring Al Qaeda to do PR, because they have good connections to Al-Jazeera."

Playing the other side of the coin, on August 19 the American Cancer Society announced strong support for increasing the Food and Drug Administration's authority to regulate tobacco products.

Meanwhile, the good cop/bad cop relationship between the ACS and the tobacco industry and other polluting industries continues to escape public attention.

As disturbing is the growing secretive collaboration between the National Cancer Institute and the ACS-NDC complex, as revealed in the August 2003 Cancer Letter.

The latest example is the joint planning of a massive tumor tissue bank. This would cost between $500 million and $1.2 billion to operate, apart from construction costs in the billions.

This initiative would be privatized, rife with conflicts of interest, exempt from the provisions of the Federal Advisory Committee and Freedom of Information Acts, and free from federal technology transfer regulations.

These developments, coupled with the National Cancer Institute's track record on prevention, fully justify the recommendations of the July 2003 report by The National Academy of Sciences (NAS).

The report stressed the autonomous "special status" of the National Cancer Institute, resulting in "an unnecessary rift between (its) goals and leadership" and those of the National Institutes of Health.

More seriously, and unrecognized by the National Academy of Sciences, control of the nation's cancer agenda has been surreptitiously transferred from the public to the private sector's special interests.

A Congressional investigation of these critical concerns, and NCI's failure to implement the National Cancer Act's mandate is overdue.

{Samuel S. Epstein, M.D. is Chairman of the Cancer Prevention Coalition, and Professor emeritus of Environmental and Occupational Medicine at the University of Illinois at Chicago School of Public Health.

Quentin D. Young, M.D. is Chairman of the Health and Medicine Policy Research Group, Chicago, a Director of the Cancer Prevention Coalition, and past President of the American Public Health Association.}