- Accounting “Irregularities” uncovered in Congressional Hearings
- Funding for Cancer Prevention is Misstated
The U. S. National Cancer Institute (NCI) grossly exaggerates its alleged budgetary allocations for research and advocacy on primary prevention, while trivializing the role of industrial carcinogens as avoidable causes of cancer.
NCI claimed that $350 million (17%) of its approximately $2 billion 1992 budget was allocated to primary prevention. However, prevention expenditures, based on published independent estimates, unchallenged by NCI, were under $50 million (2.5%), of which $19 million (0.9%) was allocated to occupational cancer (22). Only about $15 million (0.35%) of the $4.2 billion 2002 budget was allocated to intramural occupational research. These trivial allocations strikingly exemplify NCI's continuing neglect of cancer prevention.
The NCI leadership has used semantic tactics to mislead and confuse Congress regarding claimed allocations for primary prevention. NCI exaggerates such allocations by including unrelated "secondary" prevention, screening, diagnosis, and chemoprevention, by the use of dietary "nutraceuticals" or drugs such as Tamoxifen, in futile efforts to reduce susceptibility to prior carcinogenic exposures. Not surprising was the March 16, 1992 reaction by Congressman David Obey (D-WI), at hearings before a House Subcommittee of the Committee on Appropriations: "A number of scientists have suggested that cancer prevention receives an even smaller percentage of the budget than what NCI considers primary prevention." This skepticism is further detailed in May 1998 exchanges between Congressman Obey and Dr. Klausner. Questions by Congressman Obey, and Klausner's responses are summarized below, followed by comments on his responses (12):
Question: "Provide a breakdown of NCI’s cancer prevention funding by categories . . .where prevention is the primary purpose of the grant."
Answer: "Funding for primary prevention in 1997 was over $480 million, almost 50% (of which) was directed towards environmental exposures, 19% was directed towards nutrition research, 14% involved smoking, and 2% was related to occupational exposures . . .Opportunities in cancer prevention are emerging and we anticipate fully to take advantage of these opportunities."
Comment: The claimed $480 million primary prevention expenditures, approximately 20% of the budget, is inconsistent with NCI’s February 1997 budget, for "research dollars by various cancers," listing an allocation of $249 million for "cancer prevention and control." Furthermore, no information was provided on the alleged 50% expenditure on "environmental exposures." The 19% for nutrition research was allocated to chemoprevention, in attempts to protect against avoidable exposures to environmental carcinogens, and to the "protective effects" of low-fat, and high-fruit and vegetable diets, while ignoring evidence on the role of their contamination with carcinogenic pesticides. As disturbing was the less than 2% allocated to occupation, the single most important cause of avoidable carcinogenic exposures. The balance of 15% of the alleged $480 million primary prevention expenditures was unaccounted. In response to a later request for information from the House Committee on Government Reform and Oversight, Klausner responded by simply doubling this figure to approximately $1 billion.
Question: "Other than tobacco and exposure to sunlight, do you think that the general public has been adequately informed about avoidable causes of cancer?"
Answer: "The NCI and other organizations including the ACS . . .have worked for years to inform the public about lifestyle choices that could increase or decrease the risks of cancer . . . through NCI’s Cancer Information Services . . . and through distribution of millions of publications. In addition, when testing shows that chemicals cause cancer, NCI and other agencies including the National Toxicology Program (NTP) and the International Agency for Research on Cancer (IARC), publicize the test results."
Comment: This response illustrates NCI’s fixation on personal responsibility for cancer prevention. NCI still takes no responsibility for public dissemination of scientific information on avoidable risks from involuntary and unknowing exposures to a wide range of carcinogenic chemicals, including those identified and systematized by IARC and, on a more limited basis, by NTP. Moreover, senior NCI scientists are on record as denigrating the human relevance of carcinogenicity test data. Furthermore, NCI has rarely, if ever, testified before Congress on the validity of published evidence on avoidable carcinogenic exposures, nor has it provided such information to Regulatory agencies.
Question: "Should the NCI develop a registry of avoidable carcinogens and make this information widely available to the public?"
Answer: "Such information is already available from NCI’s Cancer Information Service . . . and also from IARC and the NTP."
Comment: IARC and the NTP have not developed such registries, nor is it their mission.
Question: "During the hearing, you stated that NCI could effectively spend $5 billion by 2003. Provide a budget mechanism table that shows how you would allocate this level of spending in 2003, compared to 1998."
Answer: "NCI envisions a three-pronged approach:
" 1. Sustain at full measure the proved research programs that have enabled us to come this far.
" 2. Seize 'extraordinary opportunities' to further progress brought about by our previous successes. Our goals in these areas are: Cancer genetics; pre-clinical models of cancer; and imaging technologies, defining the signatures of cancer cells.
" 3. Create and sustain mechanisms that will enable us to rapidly translate our findings from the laboratory into practical applications thatwill benefit everyone."
Comment: This response is as broad in generalization as sparse in detail.
The most revealing evidence of NCI’s restricted policies on primary prevention is detailed in its 2001 Cancer Progress Report. The report compared past "progress with the cancer-related targets set forth in the Department of Health and Human Services Objectives for the first decade of the 21st century." The Report stated that "behavioral factors," detailed in 19 pages, are responsible for as much as 75% of all cancer deaths in the U.S., while recognizing that "certain chemicals in the environment are known to cause cancer." However, these carcinogenic chemicals, summarily dealt with in three pages, were restricted to second-hand smoke, benzene in the air, particularly from smoking and occupational exposures, and radon in the home.
More limited comprehension of primary prevention is revealed in the Highlights of NCI’s May 2001 Cancer Facts and Figures. The opening sentences state: “Cancer prevention is a major component and current priority—to reduce suffering and death from cancer. Research in the areas of diet and nutrition, tobacco cessation, chemoprevention, and early detection and screening are the NCI’s major cancer prevention programs.” Nevertheless, NCI claimed that 12% of its $3.75 billion budget is allocated to “Cancer Prevention and Control,” without any reference to primary prevention, and environmental and occupational carcinogens.
Excerpted fromStop Cancer Before it Starts: How to Win the War on Cancer, 2003 by Samuel S. Epstein, M. D.
Cancer Prevention Coalition
University of Illinois at Chicago
School of Public Health
2121 W. Taylor St., MC 922
Chicago, IL 60612