Billions are spent on finding cures, little on keeping cancer from occurring
By Samuel S. Epstein and Quentin D. Young
Dr. Samuel S. Epstein is chairman of the Cancer Prevention Coalition
and professor emeritus at the University of Illinois at Chicago School
of Public Health. Dr. Quentin D. Young is chairman of the He
August 31, 2003
CHICAGO — In 1971, after well-orchestrated appeals from representatives
of the National Cancer Institute and from the world's wealthiest
nonprofit, the American Cancer Society, Congress passed the National
Cancer Act, which authorized a national cancer program. President Nixon
quickly announced his "War Against Cancer," and the country was off and
running.
Since then, we've been repeatedly assured that breakthroughs are
imminent. In 1984, the NCI promised that cancer mortality would be
halved by 2000. In 1998, we were assured by both the NCI and the
American Cancer Society that the nation had "turned the corner" in the
war. Just this year, NCI Director Andrew von Eschenbach pledged to
"eliminate the suffering and death from cancer by 2015."
But
after spending 30 years and some $50 billion, we are further from
winning this war than when it was first declared. A recent government
analysis of leading causes of mortality in the U.S. from 1973 to 1999
revealed that, although the percentage of the population dying from
heart disease decreased by 21 percentage points during the period,
cancer deaths increased by 30 percentage points. Some 1.3 million
Americans are found to have cancer each year, and more than half a
million die from it.
Paradoxically, it seems that the more we
spend on cancer research, the more cancer we get. The steep rise in
disease comes alongside a far steeper rise in the NCI's budget, which
has shot up from $150 million in 1970 to its current $4.6 billion.
Today, more than 40% of men and more than 1 in 3 women develop cancer
during their lifetimes. Cancer has become a "disease of mass
destruction." Incidences of breast, testicular, thyroid and lymph gland
cancers have all risen sharply, as have cancer rates in African
Americans and in children.
So how can we be spending more and
still be losing ground? Because the cancer establishment's focus
remains fixated on damage control — screening, diagnosis, treatment and
related basic research — rather than on preventing cancer in the first
place. The things on which we're spending money are important and fully
deserve substantial funding. But much less spending on cures would be
needed if more cancers were prevented.
One of the few
successes in the cancer war has been a sharp decline in lung cancer
cases as people have either quit smoking or not taken up the habit.
This is a case where prevention has clearly worked. But still, only
minimal funding is provided for prevention research, and what there is
gets spent mostly on research into smoking and poor diet. U.S. Rep.
John Conyers Jr. (D-Mich.), ranking minority member of the House
Judiciary Committee, recently warned that, although much of cancer's
carnage is preventable, it would be prevented only "if the NCI gets off
the dime and does its job." In the meantime, far too little is being
spent on research into avoidable causes of cancer, including
environmental contaminants of air, water, soil, the workplace and food.
Not nearly enough research is being done into carcinogenic
ingredients in cosmetics, toiletries and household products,
particularly pesticides and prescription drugs. The failure of the
cancer establishment to aggressively investigate avoidable causes of
cancer has discouraged legislative and regulatory actions to protect
people from carcinogens and encouraged petrochemical and other
industries to continue manufacturing potentially carcinogenic products.
It wasn't supposed to be this way. The National Cancer Act called for
"an expanded and intensified research program for the prevention of
cancer caused by occupational or environmental exposure to
carcinogens." But the cancer establishment has not only failed to
embrace that mission; it has suppressed evidence of causation that it
had in its possession.
Take the NCI's belated release, in 1997,
of long-standing evidence predicting up to 210,000 thyroid cancers from
exposure to radioactive fallout following atomic bomb tests in Nevada
in the 1950s. These cancers could have been prevented by thyroid
medication had the NCI warned the public in time. The Senate Committee
on Governmental Affairs, in a 1999 hearing, charged that the NCI
investigation was "plagued by lack of public participation and
openness" and characterized the NCI's failure to release this
information to the public in a timely fashion as "a travesty."
The NCI's apparent lack of interest in prevention is institutionally
embedded. Benno C. Schmidt, the first chairman of President Nixon's
three-member NCI executive cancer panel, was an investment banker and
senior drug company executive with close ties to the oil, steel and
chemical industries. He was followed in the 1980s by Armand Hammer, the
late oil magnate and chairman of Occidental Petroleum, one of the
nation's largest makers of industrial chemicals. Not surprisingly,
Schmidt and Hammer showed little interest in cancer prevention and
instead focused almost exclusively on highly profitable drug
development and marketing.
The American Cancer Society's
financial ties to manufacturers of polluting chemicals and cancer drugs
are also extensive. More than 25 drug and biotech companies — including
Bristol-Myers Squibb, Pfizer, AstraZeneca, Eli Lilly, Amgen, Genentech
and Johnson & Johnson — contribute more than $100,000 apiece
annually to the group. It also receives substantial support from
British Petroleum, DuPont, Akzo Nobel, Pennzoil and Concho Oil.
The American Cancer Society's strong support from industry is reflected
in its research choices, which are overwhelmingly aimed at treatment.
As the Chronicle of Philanthropy, the nation's leading charity
watchdog, put it in a January 1992 article, "The ACS is more interested
in accumulating wealth than saving lives." The NCI's prevention budget
is, at first glance, less parsimonious. The agency's 2001 publication
"Cancer Facts" noted that "cancer prevention is a major component and
current priority — to reduce suffering and death from cancer." This was
followed by the claim that 12% of its budget is allocated to
prevention. But the only prevention efforts mentioned had to do with
tobacco and poor diet. No reference was made to environmental and
occupational carcinogens.
The war on cancer is certainly
winnable. But we've spent many years and billions of dollars focusing
on cures. Focusing on prevention instead would not only save lives: It
would save dollars.
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