Evaluation of the national cancer program and proposed reforms.
A statement by some 68 prominent national experts in industrial medicine, carcinogenesis, epidemiology, and public health, released at a February 4, 1992 press conference in Washington, D.C., charged that the National Cancer Institute (NCI) has confused the public by repeated claims of winning the war against cancer. In fact, age standardized incidence rates have increased sharply over recent decades, while ability to treat and cure most cancers has not materially improved. Furthermore, the NCI has minimized evidence for increasing cancer rates which are largely attributed to smoking and to diet. In so doing, NCI trivializes the importance of occupational carcinogens as non-smoking-attributable causes of lung and other cancers, and ignores the tenuous and inconsistent evidence for the causal role of diet per se and also the important role of carcinogenic dietary contaminants. Reflecting this near exclusionary blame-the-victim theory of cancer causation, with support from the American Cancer Society and industry, the NCI discounts the role of avoidable involuntary exposures to industrial carcinogens in air, water, food, the home, and the workplace. The NCI has also failed to provide scientific guidance to Congress and regulatory agencies on fundamental principles of carcinogenesis and epidemiology, and on the critical need to reduce avoidable exposures to environmental and occupational carcinogens. Contrary to NCI, analysis of their $2 billion budget reveals very limited allocations for research on primary cancer prevention, and for occupational cancer which receives only $19 million annually, 1% of NCI's total budget. Problems of professional mindsets in NCI leadership--fixation on diagnosis, treatment, and basic research (much of questionable relevance) and the neglect of cancer prevention--are exemplified by the composition of the Executive President's Cancer Panel and the National Cancer Advisory Board. Contrary to the explicit mandate of the National Cancer Act, the Board is virtually devoid of recognized authorities in occupational and environmental carcinogenesis. These problems are further compounded by institutionalized conflicts of interest reflected in the composition of past Cancer Panels, and of the current Board of Overseers of the Memorial Sloan Kettering Cancer Center, NCI's prototype comprehensive cancer center, with their closely interlocking financial interests with the cancer drug and other industries. Comprehensive reforms of NCI policies and priorities are overdue. Implementation of such reforms is, however, unlikely in the absence of further support from industrial medicine professionals, which is here solicited, besides action by Congress and concerned citizen groups.
Epstein
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SS
School of Public Health, University of Illinois Medical Center, Chicago.
D016265:Conflict of Interest; D006801:Humans; D009316:National Institutes of Health (U.S.) / Q000191:economics / Q000458:organization & administration*; D009369:Neoplasms / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D011050:Policy Making; D011634:Public Health; D012106:Research; D012307:Risk Factors; D015996:Survival Rate; D014342:Truth Disclosure; D014481:United States / Q000453:epidemiology