- Accounting “Irregularities” uncovered in Congressional
- Funding for Cancer Prevention is Misstated
The U. S. National Cancer Institute (NCI) grossly exaggerates its alleged budgetary
allocations for research and advocacy on primary prevention, while trivializing
the role of industrial carcinogens as avoidable causes of cancer.
NCI claimed that $350 million (17%) of its approximately
$2 billion 1992 budget was allocated to primary prevention. However,
prevention expenditures, based
on published independent estimates, unchallenged by NCI, were under $50 million
(2.5%), of which $19 million (0.9%) was allocated to occupational cancer
(22). Only about $15 million (0.35%) of the $4.2 billion 2002 budget
to intramural occupational research. These trivial allocations strikingly
exemplify NCI's continuing neglect of cancer prevention.
The NCI leadership has used semantic tactics
to mislead and confuse Congress regarding claimed allocations for
primary prevention. NCI exaggerates such
allocations by including unrelated "secondary" prevention, screening,
diagnosis, and chemoprevention, by the use of dietary "nutraceuticals" or
drugs such as Tamoxifen, in futile efforts to reduce susceptibility to prior
carcinogenic exposures. Not surprising was the March 16, 1992 reaction by Congressman
David Obey (D-WI), at hearings before a House Subcommittee of the Committee
on Appropriations: "A number of scientists have suggested that cancer
prevention receives an even smaller percentage of the budget than what NCI
considers primary prevention." This skepticism is further detailed
in May 1998 exchanges between Congressman Obey and Dr. Klausner. Questions
Congressman Obey, and Klausner's responses are summarized below, followed
by comments on his responses (12):
Question: "Provide a breakdown
of NCI’s cancer prevention funding
by categories . . .where prevention is the primary purpose of the grant."
for primary prevention in 1997 was over $480 million, almost 50% (of
which) was directed towards environmental exposures, 19% was
directed towards nutrition research, 14% involved smoking, and 2% was
related to occupational exposures . . .Opportunities in cancer prevention
and we anticipate fully to take advantage of these opportunities."
Comment: The claimed $480 million primary prevention
expenditures, approximately 20% of the budget, is inconsistent
with NCI’s February 1997 budget, for "research
dollars by various cancers," listing an allocation of $249 million for "cancer
prevention and control." Furthermore, no information was provided on the
alleged 50% expenditure on "environmental exposures." The 19% for
nutrition research was allocated to chemoprevention, in attempts to protect
against avoidable exposures to environmental carcinogens, and to the "protective
effects" of low-fat, and high-fruit and vegetable diets, while
ignoring evidence on the role of their contamination with carcinogenic
disturbing was the less than 2% allocated to occupation, the single
most important cause of avoidable carcinogenic exposures. The balance
of 15% of the alleged
$480 million primary prevention expenditures was unaccounted. In response
to a later request for information from the House Committee on Government
and Oversight, Klausner responded by simply doubling this figure to
approximately $1 billion.
Question: "Other than tobacco and exposure to sunlight, do you think that
the general public has been adequately informed about avoidable causes of cancer?"
Answer: "The NCI and other organizations including the ACS . . .have worked
for years to inform the public about lifestyle choices that could increase
or decrease the risks of cancer . . . through NCI’s Cancer Information
Services . . . and through distribution of millions of publications. In addition,
when testing shows that chemicals cause cancer, NCI and other agencies including
the National Toxicology Program (NTP) and the International Agency for Research
on Cancer (IARC), publicize the test results."
Comment: This response illustrates NCI’s
fixation on personal responsibility for cancer prevention. NCI
still takes no responsibility for public dissemination
of scientific information on avoidable risks from involuntary and
unknowing exposures to a wide range of carcinogenic chemicals,
including those identified
and systematized by IARC and, on a more limited basis, by NTP.
Moreover, senior NCI scientists are on record as denigrating the
human relevance of carcinogenicity
test data. Furthermore, NCI has rarely, if ever, testified before
Congress on the validity of published evidence on avoidable carcinogenic
nor has it provided such information to Regulatory agencies.
Question: "Should the NCI develop a registry of avoidable carcinogens
and make this information widely available to the public?"
Answer: "Such information is already available from NCI’s Cancer
Information Service . . . and also from IARC and the NTP."
Comment: IARC and the NTP have not developed
such registries, nor is it their mission.
Question: "During the hearing, you stated that NCI could effectively spend
$5 billion by 2003. Provide a budget mechanism table that shows how you would
allocate this level of spending in 2003, compared to 1998."
Answer: "NCI envisions a three-pronged approach:
" 1. Sustain at full measure the proved research programs that have enabled
us to come this far.
" 2. Seize 'extraordinary opportunities' to further progress brought about
by our previous successes. Our goals in these areas are: Cancer genetics; pre-clinical
models of cancer; and imaging technologies, defining the signatures of cancer
" 3. Create and sustain mechanisms that will enable us to rapidly translate
our findings from the laboratory into practical applications that
will benefit everyone."
Comment: This response is as broad in
generalization as sparse in detail.
The most revealing evidence of NCI’s restricted policies on primary prevention
is detailed in its 2001 Cancer Progress Report. The report compared past "progress
with the cancer-related targets set forth in the Department of Health and Human
Services Objectives for the first decade of the 21st century." The Report
stated that "behavioral factors," detailed in 19 pages, are responsible
for as much as 75% of all cancer deaths in the U.S., while recognizing that "certain
chemicals in the environment are known to cause cancer." However,
these carcinogenic chemicals, summarily dealt with in three
pages, were restricted
to second-hand smoke, benzene in the air, particularly from
smoking and occupational exposures, and radon in the home.
More limited comprehension of primary prevention
is revealed in the Highlights of NCI’s May 2001 Cancer
Facts and Figures. The opening sentences state: “Cancer
prevention is a major component and current priority—to reduce suffering
and death from cancer. Research in the areas of diet and nutrition, tobacco
cessation, chemoprevention, and early detection and screening are the NCI’s
major cancer prevention programs.” Nevertheless, NCI claimed that 12%
of its $3.75 billion budget is allocated to “Cancer Prevention and Control,” without
any reference to primary prevention, and environmental and occupational carcinogens.
Cancer Before it Starts: How to Win the War on Cancer,
2003 by 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