Tobacco Documents Online

June 17, 1977 MEIyIO RANDUM TO: Horace R. Kornegay FROM: Charles L. Waite- RE:- Hearings on.the National Cancer Frogram, NCI and the ACS -- 14-16 June 1977: Overview and comments concerning. : ; .,; I. Overview The Chairman, Congressman Fountain, initiated the hearings by-saying that the current hearings were only the first'of a series of hearings°to be held in-the coming- months to-give Congress the-necessary__facts to-make deci-- -sions concerning the National Cancer-Program, its goals, successes, shortcomings and its-future direction. Because of_the size of the program ($800 million-plus annual budget) and the great public fear of cancer-, _ it deserves the closest Congressional surveillance, As you will remember, the National Cancer Act has- been extended_by one year- ohly, pending this investigation and Mr.- Fountain's hearings- and recommendations to Congress. In general, the three days of this first effort -heard-the critics and proponents of the program as it now exists. Additionally, the relationships and interactions between the NCI, the President's Cancer Advisors and the P-_CS-were explored in moderate depth. ~ Considerable discussion was heard on how NCP money ~ is spent with regard to emphasis on the environment, basic research, prevention, clinical care, chemotherapy, mammography-(diagnosis), laetrile, nutrition, etc.--past ff ~ , present and future. .i~ m

CLW to BRR June 17, 1977 Page-two Printed testimony was obtained when avai-lable-and is in the Institute. II. Specific comments on Cigarette Smoking - Mr. Fountain wisely kept on a low profile re- garding the smokina and-health issues, since the overall intent of the hearings is to_investigate the NCP, NCI and the role of the ACS. The witnesses who went out of their way to impli- cate smoking as a leading preventable cause of lung cancer were: Dr. Temin, Mrs. Birch Bayh, Mr. Benno Schmidt and Dr. Newell. Dr. Temin:- "the incidence-of lung cancer due to cigarettes will increase again in the near future"..."we need to do more to stop cigarette-smoking--it is the only method now available -to us to prevent lung cancer." - Mrs. Bayh: "we must do everything possible to educate the public against-cigarette-smoking and the many diseases it causes." Mr. Schmidt: "the results are-in on cigarette smoking... since we have-had no success-in reducing the-number of- smokera, we must do everything in our power to educate people and prevent iung cancer." Dr. Newell: "-further studies are in progress to develop- tests (AHH) to identify cigarette smokers who have a high ability to induce AHH and-are at high risk for lung cancer, and encourage them to stop smoking." "We are supporting the development of a- less hazardous cigarette, although we recommend that the best course is not to smoke...Nevertheless, we believe- smoking less hazardous cigarettes will substantially - reduce the risk of lung- and other types of cancer in those who continue to smoke...There is general agreement that cigarette smoking, an environmental factor, and presumably a voluntary one, contributes to about 40% of - cancers in men in the United States."

CLW to HRR June 17, 1977 Page three -"As long as cigarette smoking continues; research on detection-and treatment of lung and other types of cancer involved is-vitally-necessary." - -"Cancers caused by-known-chemical carcinogens- account for no more than-10- percent. These include 5% related to tobacco-pius alcohol use..." "NCI-has a broad-involvement in-enviromental -carcinogens, consisting of four major areas of activity: 1. The-study of known environmental-carcino-- gens, including radiation,-tobacco, che_mica?s- (including drugs ) -ar_d hormones-." III-. Highlights and specifics- Nir. Fountain and Mr. Wydler in opening remarks: Despite the huge expenditure of money, the incidence of cancer is increasing.- The cure rate has not-_ been substantially improved in the past 30 years;-_ it_ remains at-one in three. Are we spending-Federal money on a losing program? Is prevention a legitimate goal for money targeted for research? Some say there is not enough basic research-in-the program and that the--quality of research is poor. We now have some -cancer "cures" that are worse than the disease. "There seems to-be a.conflict of interest between the grantors and some of the researchers." Dr. Dorothy Rice, NCI biostatistician, presented a series of charts on cancer incidence (we have) and stated that even accounting for population growth and longevity, the residual increase in cancer was still 19%. - Mr. Wydler: "It appears we are doing worse since the cancer-progr-am was started." Dr. Ftice:- "Smoking does-not account for the - difference in mortality between whites and others in lung cancer, it is probably a socio-economic factor and related to non-whites living in an industrial environment. Non- whites have lef~ the farm and now work in an occupational environment which has a higher risk."

CLW to HRK - June 17, 1977 Page four Mr. Fountain: (Q) "If there were no cigarette smoking would lung cancer disagpear?" Dr. Rice: (A) "No, but it would be reduced. Also there is a 20-year lag-before it would be noted." Dr._Sidney Wolfe: critizing the NCP and the Federal government: - - - Arsen'rc,-a-known cause of lung_cancer, is not- regulated by OSHA. Neither is benzene, chloroform, chromium or di--ethyl stilbesterol. "Cigarette smoking-is over-blamed to the exclu- sion of other carcinogens." "...but cigarette-smoking and occupational exposure needs- to -be studied:" Industry should-pay for carcinogen testing. Get politics-out of the NCI/NIH and HEW. Get rid of the Presidential-Cancer Panel and revise the N.C.A.B. - Dr. Bross: (Roswell Park) Preventive aspects is where the money should be spent. National Cancer Institute is badly managed, a- characteristic of all Federa,l management of health and science. There is no direct accountability to the people for results. If it is not going to be accountable, it should be phased out. Additionally, the NCI -sponsors researchers who are deliberately evasive. - Technologists should not make public health decisions, the-public should. ' O ACS as a beneficiary of NCI gr-ants should be barred- ~ from getting any money. - ~ C1 Grant review as practiced at NCI should be scrapped-- ci it's nothing-mor-e than people g-iving out money to themselves. ~y

C CLW to HRR June 17, 1977 Page five- The control and deployment of cancer technology must not be left to the technologists, who generally meet in secret groups. Dr. Temin:= Generally defended the present NCP plus his comments on cigarette smoking. Dr. Garb=- You can't run the NCP iike a space project, because the basic science to utilize is just not there. NCI is-like a patient with a wart, a stye-and dandruff--that is nothing seriously wrong, but definitely correctable. FDA must be left out of the cancer drug approval business. Dr. Holland: In general, he defended the NCP and made a plaa for the importance of chemotherapy. He cited the breakthroughs in leukemia and chemotherapy and evidence of improved survival in lung cancer (as recently reported in JAMA) -End of first day

CLW to HRK June 17, 1977 Page six-- Day two - III. Specifies-- Senator H.-He-Hurr~phrey: -made an impassioned plea as a victim to expand the NCP, stressing nutrition and saying "we are eati ng our -way into- =^an-cer. "-- Mr. Wydler:- remarked after the Senator's departure: "Enthusi asm has its limits-, how- much is- too much?" R. Lee C1ark,-M.D.: (President, ACS) defending the -role of ACS,-cited-the establishment of 15 new regional comprehensive Cancer Control Centers (C-.C.C.C.) through- out the United States and characterized-them as reapers - of the harvest-of cancer reeearch, makinq new advances=- in treatment-available to the-g_ublie. He $poke of the new Internatibnal nomenclature=for cancer and the - ACS-sponsored blood program (in competition with the ARC)= Dr. A. I. Holleb , M.D.: (Senior Vice President, ACS) defended the ACS mammography program on a risk/benefit basis and felt that the improved-technology warranted continuation of-the program for women age 30-74. Congressman Fountain, Mr. Wydler and Waxman: - then opened up the subject of Dr.-and Mrs. Rauscher's travel-expenses to Montego Bay, double-dipping, and horioraria. (see attacY:ed newscopy).- Mr. Wax:nan took Dr. Holleb over the hurdles of the NCI/ACS split over mammography -and its use. - - - Mr. Fountain: we are trying to determine how ACS related to NCI-since it represents the largest non-Federal effort in the fight against cancer. -There are people who rightly or wrongly believe that the ACS runs NCI. He then asked for a list of persons who are "dual hatted" between ACS- and the NCI's advisory boards. - At first, Dr. Clark said-there were only a£ew,-t..hen- obtained a list which_included the following names: Heller,

CLW to HRK June 17, 1977 Page seven Endicott, Sloane, Morrison, Lundford, Miller, Gori, Van Nehel,°Edwards, Newell, Arje, Martell, Varona, James and several others. It was a3.so noted that various NCI members had later been given positions in the ACS. - Day three Mr. Benno Schmidt defended the NCP, the President's Panel and made his previously noted anti-smoking remarks. - Drs. Brederickson (NIH)-and Newell (NCI) defended their institutions and programs-(we-have-written submission copies).