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“ Why prevent cancer if we’re making money on it?”
As the American Cancer Society's wealth grows, its spending on prevention research remains at lowest priority Responding to a 1999 article in Sierra, the magazine of the Sierra Club, which charged the ACS with indifference to prevention, Dr. Harmon Eyre, executive vice president for research and medical affairs for the Society, released details of its allocations for research on environmental carcinogenesis. Yet while Eyre claims cancer cause and prevention are a high priority and receive generous funding from the ACS, his documentation says the contrary. Eyre's figures indicate the Society spent $2.6 million in 1998 on nineteen large research grants on environmental carcinogenesis, but only three grants could reasonably qualify as environmental cancer research. And although the Society claims it allocated $100 million of its $677 million budget to support cancer research in 1998, analysis reveals that actual expenditures on environmental carcinogenesis totaled less than $500,000, well under one-hundredth of one percent of the Society's total annual budget.
Marching in lockstep with the National Cancer Institute (NCI) in its "war" on cancer is its "ministry of information," the ACS (6). With powerful media control and public relations resources, the ACS is the tail that wags the dog of the policies and priorities of the NCI (7, 8). In addition, the approach of the American Cancer Society (ACS) to cancer prevention reflects a virtually exclusive "blame-the-victim" philosophy. It emphasizes faulty lifestyles rather than unknowing and avoidable exposure to workplace or environmental carcinogens. Giant corporations, which profit handsomely while they pollute the air, water, and food with a wide range of carcinogens, are greatly comforted by the silence of the ACS. This silence reflects a complex of mindsets fixated on diagnosis, treatment, and basic genetic research together with ignorance, indifference, and even hostility to prevention, coupled with conflicts of interest.
Indeed, despite promises to the public to do everything to "wipe out cancer in your lifetime," the ACS fails to make its voice heard in Congress and the regulatory arena. Instead, the ACS repeatedly rejects or ignores opportunities and requests from Congressional committees, regulatory agencies, unions, and environmental organizations to provide scientific testimony critical to efforts to legislate and regulate a wide range of occupational and environmental carcinogens.
This history of ACS unresponsiveness is a long and damning one, as shown by the following examples (6):
1. In 1971, when studies unequivocally proved that diethylstilbestrol (DES) caused vaginal cancers in teenaged daughters of women administered the drug during pregnancy, the ACS refused an invitation to testify at Congressional hearings to require the FDA (U. S. Food and Drug Administration) to ban its use as an animal feed additive. It gave no reason for its refusal.
2. In 1977 and 1978, the ACS opposed regulations proposed for hair coloring products that contained dyes known to cause breast and liver cancer in rodents. In so doing, the ACS ignored virtually every tenet of responsible public health as these chemicals were clear-cut liver and breast carcinogens.
3. In 1977, the ACS called for a Congressional moratorium on the FDA's proposed ban on saccharin and even advocated its use by nursing mothers and babies in "moderation" despite clear-cut evidence of its carcinogenicity in rodents. This reflects the consistent rejection by the ACS of the importance of animal evidence as predictive of human cancer risk.
4. In 1978, Tony Mazzocchi, then senior representative of the Oil, Chemical, and Atomic Workers International Union, stated at a Washington, D. C., round-table between public interest groups and high-ranking ACS officials: "Occupational
safety standards have received no support from the ACS."
5. In 1978, Congressman Paul Rogers censured the ACS for doing "too little, too late" in failing to support the Clean Air Act.
6. In 1982, the ACS adopted a highly restrictive cancer policy that insisted on unequivocal human evidence of carcinogenicity before taking any position on public health hazards. Accordingly, the ACS still trivializes or rejects evidence of carcinogenicity in experimental animals, and has actively campaigned against laws (the 1958 Delaney Law, for instance) that ban deliberate addition to food of any amount of any additive shown to cause cancer in either animals or humans. The ACS still persists in an anti-Delaney policy, in spite of the overwhelming support for the Delaney Law by the independent scientific community.
7. In 1983, the ACS refused to join a coalition of the March of Dimes, American Heart Association, and the American Lung Association to support the Clean Air Act.
8. In 1992, the ACS issued a joint statement with the Chlorine Institute in support of the continued global use of organochlorine pesticides— despite clear evidence that some were known to cause breast cancer. In this statement, Society vice president Clark Heath, M. D., dismissed evidence of this risk as "preliminary and mostly based on weak and indirect association." Heath then went on to explain away the blame for increasing breast cancer rates as due to better detection:
" Speculation that such exposures account for observed geographic differences in breast cancer incidence or for recent rises in breast cancer occurrence should be received with caution; more likely, much of the recent rise in incidence in the United States . . . reflects increased utilization of mammography over the past decade."
9. In 1992, in conjunction with the NCI, the ACS aggressively launched a " chemoprevention" program aimed at recruiting 16,000 healthy women at supposedly " high risk" of breast cancer into a 5-year clinical trial with a highly profitable drug called tamoxifen. This drug is manufactured by one of the world's most powerful cancer drug industries, Zeneca, an offshoot of the Imperial Chemical Industries. The women were told that the drug was essentially harmless, and that it could reduce their risk of breast cancer. What the women were not told was that tamoxifen had already been shown to be a highly potent liver carcinogen in rodent tests, and also that it was well-known to induce human uterine cancer (6, pp. 145– 151).
10. In 1993, just before PBS Frontline aired the special entitled "In Our Children's Food," the ACS came out in support of the pesticide industry. In a damage-control memorandum sent to some 48 regional divisions, the ACS trivialized pesticides as a cause of childhood cancer, and reassured the public that carcinogenic pesticide residues in food are safe, even for babies. When the media and concerned citizens called local ACS chapters, they received reassurances from an ACS memorandum by its vice president for Public Relations (9): “ The primary health hazards of pesticides are from direct contact with the chemicals at potentially high doses, for example, farm workers who apply the chemicals and work in the fields after the pesticides have been applied, and people living near aerially sprayed fields. . . . The American Cancer Society believes that the benefits of a balanced diet rich in fruits and vegetables far outweigh the largely theoretical risks posed by occasional, very low pesticide residue levels in foods.“
11. In September 1996, the ACS together with a diverse group of patient and physician organizations filed a "citizen's petition" to pressure the FDA to ease restrictions on access to silicone gel breast implants. What the ACS did not disclose was that the gel in these implants had clearly been shown to induce cancer in several industry rodent studies, and that these implants were also contaminated with other potent carcinogens such as ethylene oxide and crystalline silica. This abysmal track record on prevention has been the subject of periodic protests by both independent scientists and public interest groups. A well-publicized example was a New York City, January 23, 1994, press conference, sponsored by the author and the Center for Science in the Public Interest. The press release stated: "A group of 24 scientists charged that the ACS was doing little to protect the public from cancer-causing chemicals in the environment and workplace. The scientists urged ACS to revamp its policies and to emphasize prevention in its lobbying and educational campaigns." The scientists— who included Matthew Meselson and Nobel laureate George Wald, both of Harvard University; former OSHA director Eula Bingham; Samuel Epstein, author of The Politics of Cancer; and Anthony Robbins, past president of the American Public Health Association— criticized the ACS for insisting on unequivocal human proof that a substance is carcinogenic before it will recommend its regulation.
This public criticism by a broad representation of highly credible scientists reflects the growing conviction that a substantial proportion of cancer deaths are caused by exposure to chemical carcinogens in the air, water, food supply, and workplace, and thus can be prevented by legislative and regulatory action. Calling the ACS guidelines an "unrealistically high-action threshold," a letter to ACS executive vice president Lane Adams states that "we would like to express our hope that ACS will take strong public positions and become a more active force to protect the public and the work force from exposure to carcinogens." ACS's policy is retrogressive and contrary to authoritative and scientific tenets established by international and national scientific committees, and is in conflict with long-established policies of federal regulatory agencies. Speakers at the conference warned that unless the ACS became more supportive of cancer prevention, it would face the risk of an economic boycott. Reacting promptly, the ACS issued a statement claiming that cancer prevention would become a major priority. However, ACS policies have remained unchanged. More recently, the author has issued this warning again, a warning echoed by activist women's breast cancer groups.
In Cancer Facts & Figures— 1998, the latest annual ACS publication designed to provide the public and medical profession with "Basic Facts" on cancer— other than information on incidence, mortality, signs and symptoms, and treatment— there is little or no mention of prevention (10). Examples include: no mention of dusting the genital area with talc as a known cause of ovarian cancer; no mention of parental exposure to occupational carcinogens as a major cause of childhood cancer; and no mention of prolonged use of oral contraceptives and hormone replacement therapy as major causes of breast cancer. For breast cancer, ACS states: "Since women may not be able to alter their personal risk factors, the best opportunity for reducing morality is through early detection." In other words, breast cancer is not preventable in spite of clear evidence that its incidence has escalated over recent decades, and in spite of an overwhelming literature on avoidable causes of this cancer (6, Chapt. 6). In the section on "Nutrition and Diet," no mention at all is made of the heavy contamination of animal and dairy fats and produce with a wide range of carcinogenic pesticide residues, and on the need to switch to safer organic foods.
1. Bennett, J. T. Health research charities: Doing little in research but emphasizing politics. Union Leader, Manchester, N. H., September 20, 1990.
2. Bennett, J. T., and DiLorenzo, T. J. Unhealthy Charities: Hazardous to Your Health and Wealth. Basic Books, New York, 1994.
3. Hall, H., and Williams, G. Professor vs. Cancer Society. The Chronicle of Philanthropy, January 28, 1992, p. 26.
4. DiLorenzo, T. J. One charity's uneconomic war on cancer. Wall Street Journal, March 15, 1992, p. A10.
5. Salant, J. D. Cancer Society gives to governors. Associated Press Release, March 30, 1998.
6. Epstein, S. S., Steinman, D., and LeVert, S. The Breast Cancer Prevention Program. Macmillan, New York, 1997.
7. Epstein, S. S. Losing the war against cancer: Who's to blame and what to do about it. Int. J. Health Serv. 20: 53– 71, 1990.
8. Epstein, S. S. Evaluation of the National Cancer Program and proposed reforms. Int. J. Health Serv. 23( 1): 15– 44, 1993.
9. American Cancer Society. Upcoming television special on pesticides in food. Memorandum from S. Dickinson, Vice-President, Public Relations and Health, to C. W. Heath, Jr., M. D., Vice-President. Epidemiology and Statistics, March 22, 1993.
10. American Cancer Society. Cancer Facts & Figures - 1998, pp. 1– 32, Atlanta, 1998.
Excerpted from “The High Stakes of Cancer Prevention” by Samuel Epstein and Liza Gross, Tikkun Magazine, Nov/Dec 2000www.tikkun.org
and “American Cancer Society: The World’s Wealthiest Nonprofit Institution” by Samuel S. Epstein, International Journal of Health Services Volume 29, Number 3, 1999
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