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.. _~.,.~,,....-~ I HONORARY LIFE MEMBERS FRANK E. ADAIR, M,D. GUY AUD, M.D. GEN. WILLIAM J. DONOVAN ERIC A. JOHNSTON C. C. NESSELRODE, M.D. MRS. ANNA M. ROSENBERG ALFRED P. SLOAN, JR. JAMES V. STUART EDWIN B. WILSON, PH.D. BOARD OF DIRECTORS JAMES S. ADAMS .(N. Y.) LANE W. ADAMS (UTAH) GEORGE C. ADIE, M,D. (N. Y.) JOSEPH C. Aus, M.D. (MAas.) ELMER H. 8OBST (N. Y.) JOHN S. BOUSLOG, M.D. (COLO.) C. BERNARD BRACK, M.D. (MD.), G, V. BRINDLEY, M.D. {TEXAt) HARRY A. BRINKMAN (ILL.~ MRS. HAROLD S. BURDETT (N. Y.) L. T. COGGESHALL, M.D. (ILL.) WARREN H. COLE, M.D. (ILL.) 'WI'LLIAM C. CoPa:,, D'.C.S. (N. J.) RUTHERFORD L. EL4.IS (GA.) RALPH H. ERICHSEN (MO.) FRANK W. FOOTE, JR., M.D. (N. Y.) H.-Fl.IZM1NG FUIttER; F9:Dr (N'.'C) MRS. W. PARMER FULLER, JR. (CALIF.) WILLIAM U. GARDNER, PH.D. (CONN.) PAUL R. GERHARDT, M,D. (N. Y.) MRS. POWELL GLASS (VA.) JOHN R. HELLER, M.D. (MD.) MRS. MARGARETT. HELVENSTON (OHIO) CHARLES D. HILLES, JR. (N. Y.) LELAND E. HOLLY, M.D. (MICH.) CHARLES S. JOHNSON; PH.D. (TENN.) DONALD E. JOHNSON (MICH.) STUART H. KEAY (N. H.) • CALVIN T. KLOPP, M.D. (D. C.) GOV. WALTER J. KOHLER (WIS. ) L. W. LARSON, M.D. (N. D.) MRS. ALBERT D. LASKER (N. Y.) WILLIAM B. LEWIS (N. Y.) CHARLES C. LUND, M.D. (MASS.) IAN MACDONALD. M.D. (CALIF.) MA.0mr , an-aYu .1qL (Lx.) LcrLiwt A. F&-Ia.LJet ( WY*. ) H. FRED MorrITT, M.D. (PA.) MRS. R. E. MOSIMAN (WASH.) ARTHUR NEEF (MICH.) HARRY M. NELSON, M.D. (MICH.) ALTON OCHSNER, M.D. (LA.) MRS. E. LEE QZBIRN (OKLA.) WILLARD H, PARSONS, M.D. (MISS,) EUGENE P. PENDERGRAS$, M.D. (PA.) ALFRED M.'POPMA, M.D. (IDAryo) MRS. HAROLD PRINCE (NEBRASKA) J. ELLIOTT SCARBOROUGH, MrD. (GA.) S. F, SINGER, M.D. (IoWA) HOWARD E. SNYDER, M.D. (KAN.) F. C. SOWELL (TENN.) WENDELL M. STANLEY, PH.D. (CAF.IF.) FRANK STANTON, PH.D. (N. Y.) CHESTER A. STAYTON, M.D. (IND.) ERNEST L. STEBBINS, M.D. (MD.) FRANK L. TAYLOR (N. Y.) HOWARD C. TAYLOR, JR., M.D. (N. Y. ) MRS. 0. N. THOMAS (W. VA.) TRAVIS T. WALLACE (TE)LAS) CHARLES H. WALTERS (CONN.) OWEN H. WANGENSTEEN, M.D. (MINN.) GEORGE W. WATERMAN,.M.D. (R. I.) JUDGE HENRY G. WEN7,EL, JR. (N. Y.) GRANVILLE WHITTLESEY: JR. (N. Y.) ASHBEL C. WILLIAMS, M:D. (FLA.) NORBERT F. WINTER (MINN.) DAVID A. WOOD, M.D. (CALIF.) MRS. CHARLES L. WIRTH, JR. (W1S.) AMERICAN CANCER SOCIETY, NNCm 521 WEST 57th STREET, NEW YORK 19, N. Y. • PLAZA 7.2700 July 27, 1956 Edwin B. Wilson, Ph. D. 42 Brington Road Brookline* 46, Mass. Dear Dr. Wilson: . The, directors of the Roscoe.B. Jacksou laboratory could not have made a better choice than selecting Earl Green to succeed Dr. Little. _I only hope that he will find time to carry on his own research there. In 1943, when I waa head of the statistics depart«» ment of the School of Aviation Medicine at Randolph Field, Earl Green came there (as a officer-student as I recall) and we,a temors.Y'ily assigned to work with me. I quiek'ly came to the eonclusion that he was an exceptionally good man. When I vuas tran-sfi'ered to th.e, Pen-tagon a -s-hort time later, I re- commended that Green take my place at the school and this was done'. After the war, I offered himraa job with me here at the Cancer Society, but he had already made another commitment. Dr. Berkson loves to argue and I thoroughly enjoy arguing with him in private and purely as an intellectual amusement. He is certainly bright and stimulating. I do not enjoy arguing with him in public either on the same side or the eppa''uite, si(ie. On matters of some public concern, I find him to be most inconsistent. As you say, on the cigarette smoking question he takes the extreme and unrealistic position that until all of a complex phenomena can be explained, none of it can be. On the equally touchy question of the benefits of cancer therapy and the supposed benefits of early diagnosis, Berkson took precisely the opposite position and defended it with more emotion than sound logic. The occasion was the Second National Cancer Conference when Ernest Daland, Herbert yombard, Joseph Berkson, and I were commissioned to defend the position of the A•C.S. and most doctors against the attack of Lees and McKi.nnon who claimed that early diagnosis is nonsense and that treatment for canceT is of little or no benefit.

n , ~ ' 4uly 27~,x~95 Lees had very little evidence on his side. But he very quickly showed (as Lombard and I already knew), that there was also very little evidence on our side. To this day, it cannot be proved 'treyond possibility of do ubt that treatment for invasive cancer really saves many lives. There is far less evidence that early diagnosis is of any particular use. Lees and McKinnon took this position: patients should not be subjected to mutilating surgical or radiation therapy unless it can first be p roven beyond any doubt that it will greatly increase their chance of survival. Furthermore, they implied that the A.C.S. is guilty of almost criminal waste of public money in propogandizing for early diagnosis un»• less it can be proved that this will do some good. Berkson took this point of view: conclusive proof is almost impossible to obtain in medicine. If we demanded prior proof that our actions will be beneficial we could take no action at all. The fact that medicine bas progressed shows that acting on the basis -&f`professional judgement worka,wel1 in practice. There is an hypothetis which leads to the conclusiog that cancer therapy is beneficial and that early diagnosis is benefi#al. Most doctors are under the impression that the hypothesis is correct: Therefore, we should act on it without demanding any great amount of proof. To act in any other way would be foolish in the extreme. Herbert Lombard and I did not agree with Lees and McKinnon (i.e., one must have absolute proof before taking action), but neither did we go as far as Berkson in the other directi.om We took the position that Qa a practical matter it is necessary to act according to the best available information at the time; but on the question of early diagnosis there was a real dou'bt as to the validity of the hypothesis. Therefore, it was incumbent upon the A.C.S. (and the medical profession in general) to look at the problem without undue emotional bias and to support research to arrive at a more conclusive answer(granting that absolute proof could not be obtained). I always enjoy hearing from you and only wish that I could see you more often. With best regards, Sincerely, / sb