Journal of the American Medical Association, 284(4):442, July
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
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
- Meyer, R. L. "Review of Epstein,
S. S. The Politics of
Cancer Revisited, 1998." JAMA 2000; 283:3204.
- Epstein, S. S. "American Cancer Society: The World's
Wealthiest Non-Profit Institution." International Journal of Health
Services, 1999; 29:565-578.
- Epstein, S. S. "Evaluation of the National Cancer Program
and Proposed Reforms." Am. J. Ind. Med., 1993; 24:109-133.
- 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.
- Hall, H. & Williams, G. "Professor
vs. Cancer Society." The
Chronicle of Philanthropy, January 28, 1992, p. 26.
- Pear, R. "Report Says Clinical Trials Put Patients' Rights
at Risk." The New York Times, May 30, 1998, p. A8.
- Epstein, S. S. The Politics of Cancer Revisited, 1998.
East Ridge Press, Fremont Center, N.Y., p. 492.
- Reynolds, T. "Multinational Effort Aims to Record All Clinical
Trials." J. Nat. Cancer. Inst. 2000; 92:681-683.
Samuel S. Epstein, M.D.