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On February 27, 2002, Senator Dianne Feinstein
(D-CA) introduced The National Cancer Act of 2002 (S.1976). Co-sponsored
by 30 bipartisan
Senators, including Majority Leader Tom Daschle (D-SD) and Hilary
Clinton (D-NY), the Bill is a radically different version of the
1971 Act that launched the National Cancer Program. The Bill adds
$1.4 billion to the $4.6 billion 2003 budget authorized by President
Bush, extra funds coming from the new Federal cigarette tax increase,
and a further 50% annual increase to 2007, reaching a grand total
of $14 billion. Feinstein said her goal is to "form our new
battle plan to fight cancer." The legislation was referred
to the Committee on Health, Education, Labor, and Pensions, then
chaired by Senator Judd Gregg (R-NH). In April 2002, a similar
bill, with 11 co-sponsors, was submitted to the House of Representatives.
These Bills establish a national network of
20 "translation" centers
to combine basic and clinical research, and to commercialize promising
findings. They also mandate insurance coverage for cancer screening,
smoking cessation, genetic testing, and quality care standards,
while making no reference to prevention.
Regrettably, this well-intentioned
Bill unwittingly surrenders the National Cancer Program to special
interests. The legislation
has been strongly criticized
by survivor coalitions, headed by the Cancer Leadership Council, and also the
American Society for Clinical Oncology (ASCO). Of major concern, the Bill displaces
control of cancer policy from the public to the private sector, the federal
NCI to the "nonprofit" ACS, and thus creates confusing duplication
and overlapping responsibility. American Cancer Society Seeks Control of U. S. Cancer Policy
As disturbing as the Bill is its background.
Meeting behind closed doors in September 1998, the ACS created,
funded and promoted the
National Dialogue on Cancer (NDC). This was co-chaired by former
President George Bush and Barbara Bush, with Senator Feinstein
as vice-chairman, and former Governors Tom Ridge of Pennsylvania
and Tommy Thompson of Wisconsin as "Collaborating Partners" (37).
Included also were some 100 representatives of survivor groups
and the cancer drug industry. The NDC leadership, including ACS
President-Elect Dr. Andrew Von Eschenbach, without informing its
NDC participants, then unilaterally spun off its own Legislative
Committee, co-chaired by Dr. John Seffrin, CEO of the ACS, and
Dr. Vincent DeVita, NCI director from 1980 to 1988, to advise Congress
on the proposed new Act. DeVita’s track record as NCI Director
was characterized by hostility to cancer prevention, and attempts
to mislead Congress to the contrary (12).
The ACS track record raises concerns on conflicts
of interest and special interests, in sharp contrast to the public
interest (Appendix
VI). Dr. John Durant, Executive
President of the American Society of Clinical Oncology (ASCO), awarded the
Society’s 2002 Presidential U.S. Cancer Fighter of the Year, charged: "It
has always seemed to me that this was an issue of control by the ACS over the
cancer agenda. They are protecting their own fundraising capacity . . ." from
competition by survivor groups (37). Not surprisingly, the authoritative U.S.
charity watchdog, The Chronicle of Philanthropy, warned against the transfer
of money from the public purse to private hands. “The ACS is
more interested in accumulating wealth than saving lives” (38).
These conflicts of interest extend to the personal.
The Legislative Committee co-chair, DeVita, is Board Chairman of
CancerSource.com, a website promoting
the ACS Consumers' Guide to Cancer Drugs; other Committee members also serve
on the Board. These members have thus developed their own special interests
in a publicly-funded forum. As disturbing, DeVita, and Dr. John Mendelsohn,
Director of the NCI's M.D. Anderson Comprehensive Cancer Center, were consultants
and board members of the publicly traded cancer drug company, ImClone Systems,
Inc. (39). Mendelsohn was also a board member of Enron, besides serving on
its Audit Committee; Enron was a generous and long-term supporter of the
M.D. Anderson. In May and June 2001, DeVita expressed enthusiastic
views on cancer
drugs that target “EGF” receptors in television and radio interviews
(40, 41). However, he failed to disclose his annual $100,000 consulting fees
from ImClone which was then actively seeking FDA approval of its targeted cancer
drug Erbitux. DeVita also insisted, contrary to NCI’s own data, that
the overall incidence of cancer had been decreasing at a steep rate every
year since 1990. In May 2002, Dr. Samuel Waksal resigned as president and
CEO of
ImClone. One month later, he was arrested on charges of criminal conspiracy,
securities fraud and perjury, and civil damages for insider trading, and
was subsequently indicted on charges of insider trading, bank fraud, forging
a
signature and obstructing a federal investigation.
In the September/October 2002 issue of The Cancer
Journal, an article by its co-editor DeVita, “A Perspective on the War on Cancer” was prefaced
by the following disclaimer: “No benefits in any form have been or will
be received from a commercial party related directly or indirectly to the subject
of this article.” However, as pointed out in a November 15, 2002 letter
(by the author) to the Journal’s other co-editors, Drs. Samuel Hellman
and Steven Rosenberg, this disclaimer is inconsistent with DeVita’s conflicts
of interest relating to the CancerSource.com web site, and his ImClone consulting
fees. The editors of the Journal responded that it “takes matters of
conflict of interest and disclosure very seriously,” but nevertheless
declined to publish the letter.
ACS has interlocking interests with the pharmaceutical,
cancer drug, mammography film and machine, and biotechnology industries
(38). This is reflected
by generous ACS allocations for research on highly profitable patented
cancer
drugs, and
aggressive promotion of premenopausal mammography. In striking contrast,
less than 0.1% of revenues in 1998 were allocated to environmental, occupational
and other avoidable causes of cancer. More seriously, ACS policies on
primary cancer prevention extend from a decades-long track record
of indifference,
or even hostility, compounded by pro-industry bias (Appendix VI), even
to the
tobacco industry. Shandwick International, representing R.J. Reynolds,
and Edelman Worldwide, representing Brown & Williamson Tobacco Company, have
been major PR firms for the ACS; Shandwick assisted the NDC in drafting the
new National Cancer Act (42), while Edelman conducted the ACS voter education
campaign for the 2000 Presidential elections. ACS promptly discontinued these
relations, protesting “front end due diligence,” once the
damaging information became public (42).
The highly politicized and non-transparent agenda
of the ACS is troubling. This is further exemplified by expenditures
on lobbying, including donations
to Democratic and Republican Governors' associations: "We wanted to look
like players and be players," an ACS representative admitted (38). Tax
experts have warned that these contributions may be illegal as charities are
not allowed to make political donations. Marcus Owen, Director of the IRS Exempt
Organization Division, also warned, "The bottom line is campaign contributions
will jeopardize a charity's exempt status."
It should be emphasized that the ACS has long
exercised dominant influence over NCI policy, and remains “the tail that wags the NCI dog.” This
influence has been further consolidated by the February 2002 appointment of
Dr. Andrew Von Eschenbach as NCI Director; prior to his appointment, Eschenbach
was Vice-President of the M.D. Anderson Cancer Center and President-elect of
the ACS. Furthermore, as a condition of his appointment, Eschenbach obtained
agreement that he continue as NDC’s leader. Thus, irrespective of the
fate of the Feinstein initiative, for all intents and purposes, the National
Cancer Program has become privatized.
Excerpted from
Stop
Cancer Before it Starts: How to Win the War on Cancer, 2003
by Samuel S. Epstein M. D.
CONTACT:
Cancer Prevention Coalition
University of Illinois at Chicago
School of Public Health
2121 W. Taylor St., MC 922
Chicago, IL 60612
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