6. Transparent Decision Making on Cancer, other Public Health and Environmental Effects
Key governmental decisions and policies are generally determined by recommendations of governmental scientific institutions, designated expert committees and regulatory bodies. Their independence, integrity, expertise and accountability are thus matters of critical concern.
All institutions such as the cancer establishment receiving government or tax-exempt funds should be required to provide clear and audited budgetary statements defining their sources of funding, and expenditures on basic molecular research, diagnosis and treatment, and primary prevention.
For instance, budgetary information on prevention should specify allocations for the following: research primarily directed to investigating avoidable causes of cancer; research on all possible risk factors for each type of cancer whose incidence has increased substantially over recent decades; research on cancer risks from carcinogens identified in well designed animal tests and/or listed by the International Agency for Research on Cancer; activities with regard to the development of a comprehensive registry for all carcinogens to which general populations and populations at high risk may be exposed; and, outreach activities providing Congress or Parliaments, governmental agencies and the public with available information on all avoidable carcinogenic exposures and actions that may be taken to reduce or avoid such exposures.
Legislation to ensure full accountability and transparency of all cancer institutions involved in cancer research and related activities is long overdue. Legislation is also needed to ensure that cancer institutions direct the highest priorities, with minimally half their budgets specifically allocated to research and outreach on primary cancer prevention. Examination of the track record of the US and UK cancer establishments makes it clear that only drastic reforms of their policies, priorities and leadership will achieve such objectives, and belatedly restore an overdue sense of mission and balance to winning the losing war against cancer.
The US 1972 Federal Advisory Committee Act requires that the composition of regulatory agency advisory committees reflects balanced and qualified representation of all concerned interests, and that meetings must be publicised in advance and open to the public (Gage and Epstein, 1977). However, in practice, these requirements are more often honoured in the breach than the observance.
In a 1997 US and Canadian challenge against the EU ban on hormonal meat before the World Trade Organisation (WTO), the 134 nation trade regulatory authority, I served together with other international scientists as the public health consultant to the EU in defence of its ban. Apart from documenting the scientific evidence on the cancer and other risks from high residues of unmonitored sex hormones in meat, I analysed the reports and composition of the relevant FAO/WHO committees, particularly the 1988 'Joint Expert Committee on Food Additives' (JECFA) on whose authority the US and Canadian legal action was largely based, who had claimed that hormonal meat was safe. On the basis of this analysis, I concluded (Epstein, 1998, Appendix XI):
'The membership of these committees reflects disproportionate representation of US senior regulatory officials and of veterinary and food scientists, with minimal if any involvement of independent experts in preventive medicine, public health and carcinogenesis. The European Commission Scientific Conference of November 29 - December 1, 1995 also reflects such imbalanced representation. While Conference participation of "scientists directly employed" by industry was "generally refused" no apparent attempt was made to identify or exclude industry consultants, contractees or grantees. Furthermore, the Conference based its findings and conclusions largely on unpublished industry data.'
FAO/WHO advisory committees thus clearly represent a sanitised front for powerful industry interests and pre-determined regulatory decisions, rather than sound science and consumer safety (Verall, 1999). Similar concerns relate to the February 1998 JECFA committee report and that of the September 1998 Codex Committee on 'Veterinary Drugs in Foods' report, both of which concluded that genetically engineered (rBGH/rBST) milk is safe in spite of strong published evidence to the contrary (Epstein, 1998, Appendix XII; Epstein, 2001).
Clearly, legislation is needed to require that expert scientific committees, such as JECFA, and regulatory agencies, such as the Codex Alimentarius, International Office of Epizootics/FAO, and WHO/ILO, dealing with health and environmental concerns conform to basic requirements to ensure unbiased and sound scientific findings and appropriate subsequent regulatory decisions (Verall, 1999; Castleman and Lemen, 1998). Examination of the structure of the WHO/ILO committee on asbestos over recent years is illustrative of extreme pro-industry representation, bias and reckless indifference to occupational safety and health (Castleman and Lemen, 1998). Past experience clearly confirms that scientists appointed to expert committees exclusively by administrative or regulatory agencies are rarely, if ever, impartial and objective, apart from serious questions on their competence, qualifications and standing in the independent scientific community. These considerations apply particularly to the WTO, the current global regulatory authority.
A surprising, but most timely, recent development is the March 12, 2001 unique ruling (WT/DS135/AB/R) by the WTO's Appellate body that France has the right to enforce a total ban on the import of all products containing chrysotile or white asbestos. In their ruling, the judges unanimously rejected a Canadian effort, based on a plea for a 'controlled use' exemption, to overturn an earlier finding by a WTO dispute panel. This ruling is precedential as it is the first time that a trade ban has been justified under a clause in WTO rules allowing well-based health concerns of any nation to take precedence over free trade principles.
Absolute rights should be given by law to grant consumer, environmental, occupational, cancer prevention and other concerned NGO's full membership on scientific and advisory committees. They should also be given full right to participate in the evaluation and selection of scientists performing risk assessment, and also financial support to appoint their own experts to work with scientific and regulatory committees charged with safety evaluation of industrial products and processes, medicinal drugs, consumer products, and emerging technologies, notably genetically-engineered foods.
Similar and equally rigorous legislation is needed for executive, advisory and scientific committees of all cancer institutions, governmental, charitable and academic, to ensure full accountability and transparency of their deliberations, and to ensure that maximal priority be directed to cancer prevention, rather than virtually exclusively to damage control - diagnosis and treatment - and basic molecular research.
Transparency of all scientific and regulatory proceedings should further be ensured by providing advanced public information on scheduled committee meetings which should be open without restriction to the public.
The European Commission (EC) has recently implemented a new policy of openness by publicising declarations of interest by members of their influential and supposedly independent scientific committees (Watson, 2000). This move followed a lengthy campaign by the British advocacy group Baby Milk Action, the UK partner of the International Baby Food Action Network, with support from UK Labour members of the European Parliament. The EC has always claimed that the members of its various scientific committees act independently, make annual declarations of interest, and declare conflicts of interest at each meeting. However, even if that were the case which is certainly not so, this information has never before been made public.
Now, details of the 19 members of the Scientific Committee for Food, established in 1974 to advise on consumer health and food safety, are the first to be made widely available. According to Baby Milk Action, four members of the Committee - Professor Albert Flyn (Ireland), Professor Ronald Walker (United Kingdom), Wim H.M. Saris (the Netherlands), and Professor Anna Ferro Luzzi (Italy) - have declared 'economic or ethical interests which might be considered prejudicial' to their independence. Seven other scientific committees, and their overall steering committees, are now likely to follow suit. The EC insists, however, that contacts between the committees' members and commercial organisations are 'part of normal and professional life' and should not be treated as 'undesirable' (Watson, 2000).
An ominous recent development has been the creation of a secret World Science Court or Global Science Advisory Board proposed by and under the leadership of Dr. Bruce Alberts, President of the US National Academy of Sciences (Epstein, 2000). Alberts has fought tooth and nail against complying with the Federal Advisory Committee Act's requirements for transparency of operations and balanced representation; these concerns are heightened by the long-term record of pro-industry bias and serious conflicts of interest of National Academy of Sciences Committees. The World Science Court, now known as the InterAcademy Council based in Amsterdam, is organising expert panels to provide scientific advice to the United Nations World Bank and other international organisations on issues ranging from food safety to emerging diseases.