Cancer war should focus on prevention
Wednesday, April 27, 2005
By SAMUEL EPSTEIN
Today, there are generals waging a war that continues to take a massive toll of Americans' health and life. These generals are asking for billions of dollars -- on top of the more than $50 billion already spent -- to defeat the enemy's scourge. But increasingly, independent experts are reporting that the generals' intelligence and strategies are patently wrong, and that they consciously misrepresent critical facts in order to paint false, rosy scenarios.
In all likelihood, you must suspect that I am referring to the Iraq war. But there is actually another war being handled with startling ham-handedness and deception. It's a war that claims far more victims than the war against terror. It is the war against cancer.
In 1971, President Nixon declared the war against cancer and Congress passed the National Cancer Act. These actions ushered in the new battle, spurring a 30-fold increase in the budget of the government's National Cancer Institute -- to a tune of $5 billion this year. The new war also helped the nation's leading cancer charity, the American Cancer Society, raise tens of millions in public donations.
With the wind at their backs, and locked at the hip, leaders of the NCI and ACS became the generals in the new war, and have spent billions of tax and public dollars in waging it over ensuing years.
But after three decades of highly publicized and misleading promises of progress, the sad reality has finally dawned: We are in fact losing the cancer war, in what can only be described as a rout. The incidence of cancers -- notably breast, testes, thyroid, myeloma, lymphomas and childhood -- all unrelated to smoking -- has escalated to epidemic proportions, now striking nearly one in every two men, and more than one in every three women. Meanwhile, overall mortality rates -- the indicator of our ability to survive cancer once it strikes -- have remained unchanged for decades.
There is strong scientific evidence that this epidemic is due to avoidable exposures to industrial carcinogens in the totality of the environment -- air, water, soil, workplaces as well as consumer products, notably, food, toiletries and cosmetics and household products -- and even some common prescription drugs.
But our ongoing defeat in this war is attributable to two important factors.
First, NCI and ACS have focused their abundant resources and institutional mindsets not on preventing cancer, but on attempting to treat it once it strikes. NCI, for instance, allocates less than an estimated 3 percent of its budget to environmental causes of cancer, while the ACS allocates less than 0.1 percent toward this goal. As recently admitted by the president of one of NCI's leading cancer centers, most NCI resources are spent on "promoting ineffective drugs" for terminal disease.
By forsaking prevention -- the basic principle that medicine has taught us over the centuries, and the need for which science again underscores in the war against cancer -- our cancer generals have embraced a "damage-control" strategy, akin to treating wounded soldiers, rather than trying to halt further advance of the enemy.
The simple fact -- the more cancer is prevented, the less there is to treat -- continues to elude the generals' master plan.
Another reason why our cancer generals are so disserving is that they have become far too chummy with special interests who either oppose cancer prevention policies or who trivialize cancer prevention. The ACS heavily depends on their "Excalibur donors" -- a gallery of chemical industries opposed to regulating carcinogens, and pharmaceutical companies seeking approval of their highly touted miracle drugs -- drugs that have shown limited if any success over decades.
Similarly the NCI has also developed incestuous relationships with cancer drug companies. Indeed, a former NCI director candidly admitted that the NCI "has become what amounts to a governmental pharmaceutical company."
In order to change course, drastic reforms are needed in the cancer war high command and strategies. Both NCI and ACS must be required to devote at least equal priority and resources to prevent as to treat cancer. The NCI and ACS must also be required to inform the public, Congress and regulatory agencies of substantial scientific evidence on industrial, and other avoidable causes of cancer. Congress should also ensure that companies that pollute our environment and consumer products with industrial carcinogens are held to the highest standards of accountability and disclosure.
Nearly every American knows the pain to family and friends caused by cancer. The crime is that so much of it is avoidable.
Samuel S. Epstein, M.D., is professor emeritus of environmental and occupational medicine at the School of Public Health at the University of Illinois-Chicago and author of "Cancer-Gate, How to Win the Losing Cancer War."
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