Evaluation of the national cancer program and proposed reforms.
A statement by 68 prominent national experts in cancer prevention, 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 misled and confused the public by repeated claims of winning the war against cancer. In fact, age-standardized incidence rates have escalated to epidemic proportions over recent decades, while the 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, trivializing the importance of occupational carcinogens as non-smoking attributable causes of lung and other cancers, and to diet per se, in spite of tenuous and inconsistent evidence and ignoring the important role of carcinogenic dietary contaminants. Reflecting this near exclusionary blame-the-victim theory of cancer causation, with lockstep 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 any scientific guidance to Congress and regulatory agencies on fundament principles of carcinogenesis and epidemiology, and on the critical needs to reduce avoidable exposures to environmental and occupational carcinogens. Analysis of the +2 billion NCI budget, in spite of fiscal and semantic manipulation, reveals minimal allocations for research on primary cancer prevention, and for occupational cancer, which receives only +19 million annually, 1 percent of NCI's total budget. Problems of professional mindsets in the 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 National Cancer Advisory Board. Contrary to the explicit mandate of the National Cancer Act, the Board is devoid of members authoritative in occupational and environmental carcinogenesis. These problems are further compounded by institutionalized conflicts of interest reflected in the composition of past executive President's Cancer Panels, and of the current Board of Overseers of the Sloan-Kettering Memorial Cancer Center, the NCI's prototype comprehensive cancer center, with their closely interlocking financial interests with the cancer drug and other industries. Drastic reforms of NCI policies and priorities are long overdue. Implementation of such reforms is, however, unlikely in the absence of further support from industrial medicine professionals, besides action by Congress and concerned citizen groups.
Epstein
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SS
Health Resources Management (M/C 922), School of Public Health West, University of Illinois, Chicago 60680.
D000393:Air Pollutants / Q000009:adverse effects; D001291:Attitude of Health Personnel; D002017:Budgets; D016265:Conflict of Interest; D005260:Female; D006292:Health Priorities; D006801:Humans; D015994:Incidence; D007373:Interinstitutional Relations; D007857:Leadership; D008297:Male; D009313:National Health Programs / Q000458:organization & administration / Q000592:standards*; D009316:National Institutes of Health (U.S.) / Q000458:organization & administration* / Q000592:standards*; D009369:Neoplasms / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy; D016273:Occupational Exposure; D009937:Organizational Objectives; D011322:Primary Prevention / Q000379:methods / Q000592:standards*; D044469:Racial Groups; D012109:Research Support as Topic / Q000592:standards; D012307:Risk Factors; D015996:Survival Rate; D014481:United States / Q000453:epidemiology
D000393:Air Pollutants