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Review of The Politics of Cancer Revisited

Journal of the American Medical Association, 284(4):442, July 26, 2000

While conceding that my Politics of Cancer Revisited, 1998 "offers much valuable information," Dr. Meyer's review1 is replete with serious misunderstandings.

First, Meyer incorrectly charges that the book "declares political war between a basic preventive approach and a general patient care approach to the cancer problem." However, the book's fundamental thesis is that the cancer establishment, the National Cancer Institute (NCI) and American Cancer Society (ACS), is fixated on damage control -- diagnosis and treatment -- and basic genetic research, with minimal interest in prevention, which for the ACS extends to frank hostility. 2 The NCI currently allocates under 3% of its $3 billion budget to primary prevention, while the ACS allocates less than 0.2% of its $700 million budget. More critically, the cancer establishment has never provided Congress, regulatory agencies and the public with scientific information on a wide range of avoidable and involuntary exposures to industrial and other carcinogens that have been incriminated in the escalating incidence of non-smoking cancers since the 1950s. These concerns have been endorsed by a group of 65 leading public health experts, 3 including past directors of federal agencies, who recommended drastic reforms of NCI policies, including parity of funding for research and outreach on prevention with all other programs combined.

Second, Meyer misattributes my criticism of cancer establishment policies as exclusively due to their conflicts of interest. However, the book emphasizes that the major determinant of cancer establishment policy is a professional mindset, compounded by conflicts of interest. The book documents a revolving door between NCI and the cancer drug industry. Dr. Samuel Broder, former NCI director, recently admitted "that the NCI has become what amounts to a government pharmaceutical company." 4 ACS conflicts are more pronounced. Their Foundation board is a veritable who's who of senior executives of pharmaceutical and other industries. Based on such information, The Chronicle of Philanthropy, the nation's leading charity watchdog, warned that the Society is "more interested in accumulating wealth than saving lives." 5

Third, Meyer incorrectly asserts that the book "knocks clinical trials, mammograms, and

chemotherapeutic agents." However, a recent Inspector General's report warned that patients entering these trials are "often exposed to unsafe and unethical practices because no one policed the research to protect their interests, . that doctors and drug companies often recruited people for their research with misleading advertisements in buses and subways (and that) review boards in hospitals and medical schools . were riddled with potential conflicts of interest . ." 6 Furthermore, studies have recently shown that only 1% of patients in clinical trials have a complete response to treatment, and only 5% have any response at all, as measured by temporary shrinkage of tumor size. 7 A recent article8 demands multinational review of all clinical trials, and warns that "failure to submit a trial for publication is tantamount to fraud because of the bias introduced to medical practice."

My criticisms of chemotherapy are directed to its routine use without evidence of efficacy, and also to questionable claims of success for the latest "miracle" cancer drug. However, the book emphasizes dramatic successes of chemotherapy, particularly for treating childhood and testicular cancer.

The book warns that the benefits of pre-menopausal mammography, aggressively promoted by the ACS, are at best arguable in view of the high incidence of false positives and false negatives. Other considerations include the high sensitivity of the premenopausal breast to the carcinogenic effects of radiation. Of related interest is the fact that no country other than the U.S. practices pre-menopausal screening.

 

References

  1. Meyer, R. L. "Review of Epstein, S. S. The Politics of Cancer Revisited, 1998." JAMA 2000; 283:3204.
  2. Epstein, S. S. "American Cancer Society: The World's Wealthiest Non-Profit Institution." International Journal of Health Services, 1999; 29:565-578.
  3. Epstein, S. S. "Evaluation of the National Cancer Program and Proposed Reforms." Am. J. Ind. Med., 1993; 24:109-133.
  4. Fellers, L. 'Taxol is One of the Best Cancer Drugs Ever Discovered by the Federal Government: Why is it Beyond Some Patients' Reach?" The Washington Post Magazine, May 31, 1998.
  5. Hall, H. & Williams, G. "Professor vs. Cancer Society." The Chronicle of Philanthropy, January 28, 1992, p. 26.
  6. Pear, R. "Report Says Clinical Trials Put Patients' Rights at Risk." The New York Times, May 30, 1998, p. A8.
  7. Epstein, S. S. The Politics of Cancer Revisited, 1998. East Ridge Press, Fremont Center, N.Y., p. 492.
  8. Reynolds, T. "Multinational Effort Aims to Record All Clinical Trials." J. Nat. Cancer. Inst. 2000; 92:681-683.

Samuel S. Epstein, M.D.

 


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