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problem~ much. earlier)can undetermined number of womem in the program, duz- enscountedalready, have: had their breastss removed without there having been any trace of cancer. It was typical of the slapdash man- nerim whioh; the joint ACS/NCI program wasininiated tMatt early questionss about thee fatal potential of repeated mammog- raphy were totallyignored, as were re- search fihdings published well!before the program began, which,, yearsJater., were to resultt inn complete' revision of the screening guidelines for younger wom- en.. "We just didn't doo ourr homework the way we shouldl have," said NC[ As- sistant Director Dr. B'ayardMbrrison, thee only administrator who concedes negligence. Those directly responsible for NCFs part in the program-De. Diane Fink, Directorr of the NCI. Division of Cancer Control and'. RehabJ;itation (also on the ACS board of directors until re- cently): Dr. Frank Rauscher: then NCI Director andlDr. Guy Newell, NCI Act. ing Director in the program's later stages-insist they hadl no reason to sus- pect', there was any seriouss question of radiation: risk until 1975. AtACS the official amnesia runs on till'. 1976:. But NCI's own files clearly expose these fee:- ble.lies.. Among many early memos and letters sent to Dr..Frank Rauscher(now ACSSenior Vice President for R'e« search) was one by Dr. Newell himself', dated October 1973, only a few months after thescreening, project'hadt begun, Responding to ACS:'s suggestion.that the number of screening centers be in- creased from,20 to27, Newell wrote::."I cannot inalln good' consciousness[sic] agree to, this unless some specific con- cerns and'.questionsare addressed and answeredi asto thee safety of repeated mamm ography by an e xpert group." But.am ever-obedient NCI adminisn tration agreed to shell out more taxpay- er's.money forthe extra. centers..while giviugnot.a thoughtt to.the appoihtment of even one radiation biology expert- especially irresponsible considering that: the studyoni whiehthe screening pro- gram was based. conducted! by the. Health Insurance Plan of Greater NewYork,. showed absolutely no, benefit too women under 50, who made up 50 per- cennof the program participants, and for whom anyadded riskk would have:a long- ertime to play.itself out.. In.adlfiiionto the radliation problem:, somescientists, after carefW analysis:, 0 '. questionedl the validity oflthe.program it-~ self:. "The projectis ill-conceived and is not likely to resulnin significant patien0.~benefit," wrote Dr,. Marvin Zelen, then ~ Professor of Statistics at Uhiversity of ~; Buffalo. And Dr. lohn. Bailar. III,, then ~NCI.Deputy Associate Director for Can- cer Control, expressed doubt whether anything;at alllcould: be learned about re- ducing breast cancermonalit5t'consider- img the projecds lack of proper research design. Responding to~ all these criticisms:, in a..confidential in-housee memto,, breast surgeon and ACS Senior Vice President for Medical Affairs, Dr. Arthur Holleb,, conceded: "I d'o nott feell qualified to an, swer with statisticall expertise." Yet he went on to.denigratethe critics with pa- thetic ad hominem argumentssuch, as: "I am always suspicious of' the man who comments on a:breast cancerpro'ject and refers to the anatomic site ass the 'bresn."' referring to:a typo in one.of thecritic:'s letters. The idea for thescreening program originated:witb ACSI It was first on a lisn of suggestionssents to NCI by Dr.. Hol- leb, shortly after the National Cancer Act was passed, as to how the newCanrcer Control Program, money (whichACS'. had lobbied for) should bee spent. Though NCI agreedftom, thebegin- ning,to fund abouo 85 ' percent of thef54.6, milfion project, ACShascom-manded every detail, backed bythe AmericanCollege ofi Radiologists. As Dr. Kenneth Olson,, formerly Chiefof Diagnosis of NCI's; Diviaion of Cancer Biology, explained in a1973. memo: . "This project. has limited . objec- tivesand theyy havebeen pretty much. dictated byACS. In summarytheyarer. Can ACS volunteers mobilize a.largea number (100,000 per year) of women for thermography., mammography. and a physical examihation?. . . This rather endsthe objectives. .. While not bothering to establish adequate research protocoll (though afollow-upstud!y was planned) or to re- view previous researchfindings.. ACS'S took great.careto seee that the 27 centerss weree distributed! evenly over itsfund'.raisingzones and that the centers them- selves refrained from fund-raising,so as, not tocut into ACS profits.. BENh1 nhl NO At each challenge to the program,. ACS and other mammography propo- nentsresponded nott witK scientific rea- soning butt withh professional arrogance. NCI Chiefof CancerDiagnosis„Dri. NdilliamPomerance,. tried'd to persuadee screening center: directors, many oBwhom aree affiliated: with ACS or theA;merican College of Radiolbgists,, to, raise the minimum age for x-ray scneen-ingfrom 355 to 45. "They all fell on me," he reported., "and even went so far'as to d'ecideih their protocol they wouldlstarl: with age 30., 1 know thatatt this moment their reaction ishysteria„ butt thereyoue have it. .... . It does.give you an idea as tothetenor ofthemedical profes-sion. . . ." As thecontlroversye became moreheated, women participating inthen pro- gram were not even informed that tliterewos a,.controversy-the word "risk:" did 4

not: appear on the informed consent sheets until May 1976,and was not.clear- ly described to them until May 1977. Meanwhile, not even the simplest precautions were takenn to keep x-ray ex- posure toa minimum. A.report byRalph Nader's,Health Research Group showed that 33-or 55.pereent-of the x-ray ma- chines surveyed in 1975 emitted more than the:acceptabfe:limit.of 2.5Roentgens per film;; in 1976. I I centers weree stil I ex- posing women: to.dangerousdoses.of x- rays.. This meant that.,, evenn for thou- sand's of women ouer 50,, mammography could result in greaterrisk.than.benefit, as one of three expert groups.,., finally appointedby. NCII. suggested in a March '77 report. Belate& as itt was,, the expert groups' appointment was not. even ini- tiated, by NCII directors,: but: wasthe re- sultt of effortsby Dr. John Bailar who. after a fruitless 3-year barrage of ACS and NCII directors' oftices,, brought the question.of rad'iation risk to the public.in a paper presented before the.American Assoc. for Cancer Research.. Thecon- clusions of the expert groups,, basedchiefly on. the same November 1972 Na. tionaf Academyy of Sciences reporb. ("Bi'-ological Effects: of Ionizing. Radiationi') than Bailar and othershad reffered to, eonfirmed'that asymptomatic women unt der 50, shouldlnot neceive:repeated x-ray screening unless they had a personal or family history of breast canc er.. While publicity generated by the ex:- perts:" reports forced the NCI to shift sluggishly from~ passive negligence to sincere effortstos modify screening procedures. ACS. along with the Ameri- can College of Radiologists;, attempted to sabotage thesee effontss and tokeep~ women ignorantt of the experts' eonclb- sions: Alugust 1976: A letter from NCI based on the panel'spreliminaryreporrs was sent to.all screening center diiectors.s advising them to, . restrictt x-ray screening of womenunder 50~ Severallrefused tocomply., publicly referring too thee newguiidelinesw as "so much more govern- ment gobbledygook" and "Potomac Fe:-ver" One source reportedl that center di~ rectors calling ACS'.for advice were toldd to"Go ahead and screen: 'emn" and too justify. their dbingso by certainn loop- holes in the guidelines, loopholeswhicb ACSwasreponedly responsible for in- serting. In the fallowingsix months.75~. percent of'f women under 500 were stil I' being x-rayed. Septemher 1976:. The New YorkCity division of ACS circulated over 15.000 copies of'ani "Urgent Message to. Women," whichadvisedl women under 5ortoundergo mammographyifi they fell into one or more of several risk catego-ries. By ACS's:own account„these risk categories.include 80.percent of alllwom- en.under 50. While ACS'officials denied that their national office had anything to do. with itt it was just a rambunctious act byy one of their madcap local branches-Dr. Hollebhimself told me that hehad personally approved the Message and, he adtiedI proudly, "I'd still stand behind it."Cn fact he:'0 wriaten an, editoriall for the Nov. / Dec. issue ofACS's Ca:. A Cancer Journatfor C7tni- cians, the medical journal withthe:larg-h estt circulation in the worfd, that made. just about.the same points~as were madee in the U'rgentM'essage. March 1977: NCIVs OfficeoNCancer Communications, under Paul Van Nevel',, prepared.a press release to announce thee conclusions of the expertt groups. Rather thamrtelease it.on thedate.expect- edl,. Drs. Fink and'~ Newelli and Mr. Van: Nevellwent.to New York City to consult with ACS, Theresultinge press release consisted of' wishy-washy doublbtalkk bearing little resembiance: to~ anything. the.expertshad written. ThoughDr: Ne+well d'eniedi before a~congressionalisub- committee. this summer that any change had been made.in the originall release other than the date. Idr. Fink Ikter adtnit- ted to me that "certain parts of the re- pon'ss summaryhad,tobeleft.out"after "vigorous discussion" with,ACS. Curuurm to orusadurs Mention. "National Cancer Insti: tute" tomost people, even in Bethesda,. Maryland (NCI headquarters), and'd youi B probably be "corrected": "Youu mean,.the American Cancer Society." ACS power and'd atHuencedependse on.its being recognized as the sole dis-pensen of eancerinformation and hope,., and as the sime qua non of any eventuall cancer cure. Their firstt big publicityblitz'y was launched in 1945 by ad4ertising, magnate Albert Lasker, his wife Mary, now honorary chairmann of the ACS board of directors, and Emerson Foote, co.founder of the. Foote, Cone and Beld- ing advertising agency. They hired apro-fessional fund-raiser and persuaded'd prime-time broadtasters to~ speak aboutt the: horrorss ofcancer and our only hopes-a checkk and a checkup. 'p'he: April fund-raising crusade was immedi- ately effective. Im its: second year, $10 million was gleaned from a newly can- cer-aware American public. Since then,. ACS has becomethee wealthiest of thee health charity groups,, itsofficialss thehighest.paid, and'. with, its image as.thecaneer-fighting organization in the coun-try,. is not aboutt to sitt back andl watch things change~ A formen employee of'NCIrs Office of Cancer Communications, specifically charged.by Congress "to disseminate in- formation to:the practiicing:physician and to the general public," toldime of'.the dis- integration of theentite Program L.iai- son. Branch, basically because of ACS interference. "WHen NCI getss recognition for some piece of public information, ACS doesn't.like in. Sometimes we'd be at.the eleventh hour with the budget and every- thingg approved byy our superiors, and suddenly. there'd be a meetling scheduled with.ACS in. NewYork.. Their Public. In- formation and Education people would have objections toit,o and that~ was the end- Or they'd have us.dobusy work, like run tests.on messages or think again whether we shoultb say 'Us Against Can- cer'or'We AgainsCCancer.'" Eventually ir was nothing, against cancer, and after 4 or 5' frustrating years, thee branch's four staff, members left: for other jobs:and have not been replaced. Why would an NCI Division Direc- tor, i~n this case Mr. Paul V an Nevel, in- sisn that his staff consultfirst with ACS? An:NCllsource.from another.departtment explains: "Ifl' you make waves, someone will get in touch with someone else and before you know it Mary Lasker saysto .,

Life Memibers. who act.as consultantsto the board'.f of directors. At. NCII, several members ofl the advisory board ac6 as consultants to industrial firms. The most notable, Phillipe. Shubik„ was private consultant and scientific adMisorto Gen- eral Foods, Proctor & Gamble, Abbott Lab~, MilesLab., Royal Crown Cola Co.. Colgate-Palmolive. Co:., the . Exaract ManufaeturersAssociation,. andrthe Cal- orie Control Council, during the time he served as chairman of the NCI.subcom- mittee on Environmental Carcinogene- sis..Iu a: dispute over the.carcinogenicity of a particular chemical manufactured by Proctor and Gamble, Shubik was asked byanotheri NCI scientist.no state whom he wasspeaking:for. "Proctorand Gamble." Shubikreplied, without Poesi- tation. No wonder, them,t that. smoking, al- cohol and excessive sunlight are the main environmental targets forthe . selec- tive: cancer-fighterss at ACS: and'. NCII- reduetion in exposure depends safely on a change in specific personal habits„not in the habits of industcy,, chief producer of chemical carcinogens,. Maligning the tobacco industry or citing a few workplace.carcinogens like asbestos an& vinyl chloride still doesnwt place imquestionthe practice of'f pouring thousands of newchemicals, untested, unmonitored,, intothe environment ev- whether apregnanta woman, should att ery year: Among, thosee already pro- least avoid eating}hemostcontaminated~ duced,, nearly 2',p0o.are on a government species of fish: list oflsuspected carcinogens. "Thati fishh is very good for your NCI's bioassay (chemical. test) wife ., .. It might be one op thee best branch was to have.tested and reported thingsshecouldieatin.hercondition..Thes on severalhundtedl of these by now; in- fish you buy inn a. regular fish. storee or a steadl it has becomea testimony to the: regular supermarket will noti bee con- adminiistration's.lackof support for this taminated. I assure you-shopp in aregu- linea of attackk on cancer. So, fewstaff, . larfish storeand'you'II have noproblem membersweres assigned toahe branchatall." thatt testing, reportsCongressman.Obey,. You'd like to think that this was an was "turned over too a complex web ofi isolated case-a single irresponsible ex.outside research firms who are, for thee ecutive who hassomething against ir- mostt part.. privatee businesses that are: regular fish stores. But fierce protective-also, contracting.with the industriesthati ness toward.dangerous chemicals istypi: manufacture these chemicals, and incal' of the top administrators at ACS and' some cases are onvned' outright by theNCI. chemical manufacturingcosnpanies."' For instance, while an FIDA agent Thecareinogenesis program's originall told me they regularly find residues o8director resigned IIg8 monthsago.,s fol-several different pesticiHes~ includingg lowed by his. assistant, chiefly because: DDT„ in food,. Dr.. Frank Rauscher as- they could' not tackle unassisted the ev- sured me, "Wedon't havee any pestir er-increasing backlog of unevaluatedl cidesshowing up ini the food' chain any- R chemical tests.. Now that backlogg has more.. DDT was thought.to bee a reasonr reached over 200,. and in the: pastt twoo ably potent carcinogen in mart, but wee years,reports on: only 14chemicals.have. Just don't have that anymore." Poof. been issued.(A review of'f theInstitute:'s. Among food color additives alone'.,, approach to environmentafl causes of there are 4suspected and 2 known:car-cancer hass been initiated by recently cinogens, as a Health Research Groupp appointedNCI Director Dr. Arthur C:. reportt based on FDA files revealedL.Yet Upton.) Dr. Rauscher and Dr. Lee Clark recently wrote:in the WashingtonBost.: "There is. ACS, with; its provenn influence: oveunor evidencee totmplicate food'd preserva:-Congress:..iis in a uniqueposition toinflu, tives or additives now onthemarket in, ence national policy om eancer-causinghumamcancer .. .. chemicals:.. Yett they have eonsistentlyM~eanwhile,. ACS has been sniping, refused to give effecnive.support tocru-away'at the-0elaneyClause, the public'ss cial biflssuchas the Toxic Substancesmaindefense, weak as itist against car.Control Act, the Cleani Air~ Acn and a.a cinogens in: food. Despite public state:-proposall toban DES, a.known carcino- ments to the contrary. I was told by Lar.gen, ftomcatult:feed: ry Garfinkel, Dr. Hammond'sassistant„ "ACSS will send a IetteraS supportt that ACS would.liketo see the Delaneyafter a bill hasalready beem passed by Clausemodifiedlso that it.would be.more. Congress,"an employee: of the Housedfilhculte totakeo legislative actionn on, subcotmmicteee on Healthandl Environ-efiemicals- based on animal test results. mentt nold me. "Butt they'vee neverr been, "There should be some human epidemi-of any real help,, except on smoking leg- ological evidence presentt before a sub.islation." stance is bannedl," Garfinkel said. Perhaps worsethan legislative in-BLt asDr:. Robert Hoover., NCII ertia is ACS' betrayal ofYhe trust of in-HCeadlof the Environmental Studies. See- dividuals,, whoo call their public informa, tion of Environmental Epidemiology„ nion service.expecting to.be given the lat- explains, "Youhave.to use animalstud-est available information.. ies and sound biological reasoning. Consider the question ofthe. "saBe-That'sall we have. short:of placingahrge. ty" ofi polychlorinated biphenyls segments of the.population att risk." Be-(PCBs)-a potent carcinogeniand terano-cause of cancer's 20-to-30-year latency gen (causing birth defects) that accumu-period~ "epidemiological evidence"' latesmainliy in fish. Even after lowering, wouldd consist of aseries ofdisastersf acceptablee limits of PCB,, the FDA haseontinuing Ibng.g afterr a substancewasadmittedlthateatingcontamibatedlfirshis. Q banned. M'anyscien¢ists8eelwe'reinfor still not safe f'orchildrenand "women of ~ a lot of such evidence soon,, due to thee childlbearing age". And„ based on re-~A unthinking, uncontrolled outpour of' centt studies wPoich.havefound PCB in 0) chemicals since the 1960s, both the human embryonic fluid and pla-rQ Says Dr. Bruce Ames,.Universiay of' centa at levelss many times higher than 0) Californiabiochemist, expert' in the field what's considered safe, a Unirversity of~ of.carcinogenesis: "'Most.ofusare:walk-Wisconsin: parhologist, Dr. J'.R.. Allen, ~+ ing around.withlittletimebombs tickingg has said that "women who plan too have away insideof us... children had best discontinue eating Relax.. As ACS1s Dr. Hammondd fish." (Italics added.) says,."IOfl:percent of the people will die Here's what ACS's Irving Rimer anyway, and there's no way in the.fore-saidin response too a question abourt seeable:futuretoprevenrthat." • Reprinted Courtesy New Times Magazine

/ ~ly ` ay Ruth Rosenbaum ,ed Courtesy. New Times R4agazine ~ With the billion-dollar support of' government,, industry and' a cancer-crazed public, the cancer establish- ment has set up a very privatee practice - specializing in benigm benefits and malig- nant negllect t was another war to end all wars . . "A national~ crusade," Congresshad resolved, "tobe accomplished by 1976 in com- memoration of the. 200th anniver- sary of our country.. . . Richard Nixon launched the. "all- outt assault on cancer" with the National Cancer Act on December23:, 1971„in- tending to trigger "the.samekind of con- centrated effort that split the atom and took mam too the moon." With the gov- ernmentt division-the. Nationall Cancer Institute(NCI}-at the front:line„receiv- ingan immediate doubl ing of funds and'a revamped administration directly re- sponsiblee to-the president. Nixon called for participation by priivate:industry and research, Ilabs,, and for the enlistmentt of the American,Cancer Society. (the largest pri~vatefy funded health agency). We wereat a point in cancer research, Niixon said, "when problems begin to break openand results begintopourin.. .. . , "A. bunch of' skitl" was. Nobel Laureate James Watson's private. opim- ionn of the National Cancer Program; more restrained before. Congress,, he callbd the meetingg than drew up the 3- volume National Cancer Plan "a soporific orgy;" producing,no "promis- ing.feads" asirclaimed,s but:"onl17. delay- ingactions"-withtheg main research thrust toward "just much more of what has.already shown itself unlikelyy to cure a majorcancer." Creating a super-administration to dole outt millions to afewpopular re- search areas and forr frantic construction of facilities, with so little basicc knowl- edge of cancer, wasAike trying "to put a man, on the.moon ih 11920,.before missiiles were invented . . . [by givingl) com- tractss to cannon manufacturers, ladder builders, andl many, manyy administra- tors..,, buu [Iwithf no support for mis- sile research.,"said Dr. Ruth~ Sager, Chief of'the Cancer Genetics IDivisionat an NCI-afBiliated cancer centere ffive years and $4 billion:later,.noth:- ing has changed-neitherin research em,- phasisnon in cancer s grip on American lives.. Yett thee cancer generals' yearlly proclJimations of'.. "great strides" are louder than ever. The NationallCancer. Institute;, with hundreds of millions oftaxpayers' doll- lars,, and the. American Cancer Society, with; millionss contributed in good faith by a hopeful public, serve moree to bolF steu the status of cancdr's current ruling class through.earefu7ly distorted facts- "careful public relations," as Dr... Waln son~ put it-than tooptimize.the chances for real progress agaihsnthe disease. The U..S. stilll holdEtthe record for cancer incidence-SO percentt moree than the world average-while the chance f'or an American to survivee a cancerr inva= sion has not increased more than II per- cent since the latee forties. And this, de- spite improvements inn earlydiagnosis and'd refinements in surgery, chemothera- py an& radiation therapy-the only hopes that the American Cancer Society and'the National Cancer Institute dangle before thepublice flc d'allar DumD SinceNCI wasfoundedl iit 1937' (largely thirough: ACS lobbying) as thee first of the Nationall Institutesof Health(NIH);. itspoliciess and narrowliy definedl researchh priorities havere8lected thee opinionsand ambitionss of the medicall professionals-gynecologists, surgeons„ radiologistsand.pathologists-whos dome inatethe. scientific half of. the ACS gov.erning~g board (many of whom serve oni ihflluence and placement onn the Insti- tute'ss twoo major decision.making bod- ies: the three-member President's. Can- cer Panel and the 23-member National Cancer AdwisoryB'oard. And'' thee new budget-approvall proeess,, bypassingg the. National Institute of Health's. complexx revieww system, has broughat funding from $230 million in197D up to, $g19mil- lion for next year-an unprecedented amountfor a single health institute, near- ly one-third of thetotal'. Nl H budget. "They've [ACS]turned NCI into a dollarr pump. ..." says a: member of the: House Appropriations Committee, which okays funds for NCL "They run the whole program,, the moneygoesy where they want it togo-"IMeanwhile',o many concernedl top- notchernployees.have lefu NCI. in frus- tration because. "nothing ever getsdone";:officials.with corporate and insti:- tutionalloyalties betray public interest,. Who's doing what research is so far beyond NCI monitoring capacity that some researchers do unrelated work with government money and millions of dollars are consumed by research tha[goest virtuallyunre viewed. Some of thee programs.are reported- lyy so ill-conceived and irresponsiblyex- ecuted-cl'oser to publicity maneuvers, than real strikess againstt cancer-thatt they've.ledto coverups among the self- monitored, ACS-controlled clique that7 dominates NCU policy and funding:deci- sions. "Thelittle. Watergate that broke before.the big one," is the way one high- ly respectede empl'oyee: at. NCI d'escribest he . nation'scanc er program. N-ralad mammo9rap" NC] committees). The most ambitious folly to date and Foundedi in. 19113 by' aa handful of the first joint ACS-NCl:undertaking is physicians and Ihymen dedicated too theBreastCancerDetection Demonstra- "educatingthe.publie . . . gettingthem~ tion Project."ThegreatestPRthing:the to seek medical adviceeardy,"' ACS'. NCI and ACS have everdone,;' former evolved in, the1940sinto. a coalition of'. ACS President. Dr. Hamblin. Letton medical professionalk and powerfud lay- . called'd itt in July 1976, even after it had al:- men from~ the top~ strata of industry.,, O, ready become clear tu many scientific busihessand the Republiican.partyn who. ~. expertsthatthe:mammoth.screeningpro- tailored public education programs to~A gram., involving 270;00& women aged suit the needs of fund-raising crusades. ~, 35-70..hadlbecome the "scorched earth" It wass a small groupof ACS mem- tp phase of the cancer war.. Because: ofbersand'.associates.who hand'crafted the. ~ abuse of one off three screenimg tech- National Cancer Aet, insuring,thatg gov- %J niques-mammographry (breastt x-ray)- ernment funds : forr the National Cancer C!1 there is a significant:risk that more wom:- Ihstitute would boost their self-serving strategies. Withtop. NCII appoinrments no longer subject toreview by Congress or byy the Department of: Health, Educa- tion, andl Welfare„ ACS was guaranteed en under 50' will die from cancer becauseof'the.program.than, will be saved by io.. And then theree iss thedarke horse horror which materialized tbisfall (thoughsome. ~ scientists had warned about apossible R

it71' tetl you . s°' goung' wrong* ~ •~sore that d~oeseno~ 618dderfra6its. 9: Thicksun endngor 1Ag or d'si:harge. S,Inbr~atorel'µ~e e,. insw floonordifh~f~, .6-©hvibus: kan ~ alVaggi~ng eougfgor j ofe, auea ar enes s~You ~h »reming:sighaf fslseaferd~tor.Ifit'sa ' ~~rfan't Yolu~,gtell iveh,m, rt'6. whatefp; Deon'f he afraid', th . Youdontk at n can$~~~ -ow ACS's power and affluence dependd on ~ its being, recognized as'the sole dispenser of cancer information and hope lion from,whau most scienistss agreeis.an urgent need to pursue innovati.+e,.radi- cally new ideas in cancer research..Criti- cizing NCI's research program, 1975 No- bel Ptizee winner Dr. Howard. Teminclaimed there is tooo much emphasis "on directed research that assumeswes know how cancer is caused andcan bee cured! .,, and thart puts large sums of money ina feww places to pursue only a few ideas." But the people who carefullyengi- neened the National Cancer. Act and NCI`s increasingly largesums: have too much at stake.personally and profession, ally t'oo allow competition withtheir few ideasand'.assumption s. Take chemotherapy-am ACS fa- vorite. Nott onliy does ACS'co-own thepatent for oneof'e the most frequently used cancer drugs-5-fiuoroucaril-but Mary Lasker.. a f:iend'd of Dr. Sidney Farben, who pioneered the first chemo- therapeutic drugs in thelateforties.e has pushed NCI for years tofund amassive., impractical "Chemotherapy Screening, Program." designed totest at random some 50.000 chemicalsa year for their effectiveness againstt cancer:.. Though anindependent commission described theprotect as. "utterlrywithouC scientific mertt!`asearly as 1965, NCI's firsrbudk- etunder the National Cancer Act'(1972)~ tripled funds for the.screening.project. I m. response to an ACS/NCI "educa- tionalf' claim that "about one-third of alll cancers are responding,to chemothera, py," Dr. Marvin Zelen of the Eastern Cooperative Oncology Group,. aa groupp which, specializes in clinical trials of dtugsand: othertherapies, often funded by NCI, laughed: "Itdepends on whar you meanby 'responding."You have too distinguish between cure and a werytem- pomryresponse-I would.hesitate to say anything I ike that:" For some raree cancers, such aschfldhood leukemia, Hodgkim's.disease,. Wilm:'s~s tumor, chemotherapy can in- creasesurvival tiime, but most ofltenonlyar the.risk.of devastatiing side effects,. in+cluding an inereasedd chance of develop- ing a secondcancer after adecade. Important questions about the value . of conventional treatmen0 for certaim cancerss havee bee n raised by recentt stud'- ies. One, reported in Lancet, the Btitish~ medical journal..in December 1975, 'comcludesthan "moo immediate treatmenn proved a significantlyy better policy for patients' survival and forthequaGOy ofremaining ,life•'for inoperable carcinomaa of the bronchus: ; and another, which, Dr:. E., Cuyler Hammondl ACS Vice President for Epidemiology and Statis- tics, described to me, involved "a re-markable number of patients diagnosed. with Breastt cancer in whom no evidence of breast cancer could be found later, even though theyreceived.absolutely no, treatment." Opeo soasos oo quacks B oa s t i ng' t h e"l arge s n. repo s i t or y f o r unproven methods information in thewordd,"ACS's Committee on Uhproven. Methods off Cancer Management workshand-in-hand with local and state medi- call soc.ieties• and with the American: M'edicalAssocietion's(A~MA). Commit-~ of' ~' tee on Quaekery,, forming a networkk ~ vigilantes prepared t;o.pounee on anyone who promotes acancer.therapy thactuns~ against.their substantial prejudices and ~ profits.T Indiscriminate inn its"quack. at- 0 tacks,°" the ACS committee-whose members, half laymen, half professionr a15,, includee representatives ftomi the Food and Drug Administration (FDA). NCI andl AMA-has ruined promising careers and keptt potentially valuable ideas f rom being seriously tested.. (Their rationafeis that these ideaswould Ibre patients's from "known cures" and "provenmetfiod§. ") Protesting ACS's "negativerole" in thiss area, one establishedd cancer re- searcher said'., "Theree have been any number.of peoplewho:have been unable to, obtai~n grantss and/or have been scornedl by theircollkagues over the years for concepts that have now be- come accepted in the cancer fieldi" An exaruple:. Dr.. Bradford Coley'ss bacterial toxins treatment, whose two basic principles, immunotherapy andhy- perthermia„ are now being actively in- vestigated by the medical establishment, has just.been removed from th e1 hdex.of ACS File Material. on. Unproven Mleth-od5of Cancer Management. As Dr..Sid- ney Arje, ACS Vice Presidenrfor Pno- fessionalEducation and staff member of the Unproven Methods Committee, told me, "With all the current ihterest in~ im- munotherapy an&work: with such things as. BCG1 Bacil le . Calmette-Guerin, a~ tu- berculosis vaccine thoughtt to stimulate the.bodr's immune system to fight can- cer],.it'sall sosimilar to what Colegwas doing that it wouldn't be fait.to keep him on the lisn." How reasonable... Actually.,, it was only at the request of Dr. William Regel- son.. foumerly Chairman of the Division of Medical Oncology at Vitginia Com- monwealth Uhiversily. that action was finally takenL . Hadl Coley's work been se- riously investigated att the time„even if it were nott i tself. a'`sol ution," 40 ~years. of immunotherapy research would have been gainedl_ and many lives, perhaps, saved. Such thoughts off wasted potential don't phase ACS. When I askedi Dr.. Arjee about am.in- R

While grant applications must pass through the NIH peer review system, for contracts "there is practically no re-view," said a, scientist whose institute receiveslarge sumsof money from NCI for contract research. "And there are manyy areas where.a researcher canapply. Bor either a grant or a contract to: do the same thing." Apparently those with weak.propos'- als go for thecontracts.. In the casee of the virus's program„ the Zinder report claimed that "lessthans half of the.con- tract proposals would have been ap- proved if reviewed by areal grantt peer review." •No one yet knows exactly what.is going on.at Fort Detrick.. the former bio- Not ewen the most simple precautions were taken t'o keep x-ray exposure to al minimum logical warfare researeh, center in 'Fred:- erick. Maryland. part of which was transformed into a cancer research cen- ter after Nixon's emotional "swords into plowshares" speech. Speciali¢ing in vii- ral oncology, and in.researchandltesting of possiblecarcinogens,e the:eenter,e manr agedd by a.divisioniof LittoniIndustries., has received a total of $119~ million since 1972'-thc largest amounTfor a single con- tract'. in the: entire program:. "We've wasted a. fortune on that system; absolittely nothing has come out of im." said Dr. Garb. "t was one of the mosu enthusiastic supporterss of the Cen, ter,, and I haveto say Itm sorry now. We canftt even tell whyit's.not working-but say you haveae handfull of quarters and put them in a popmachine. If you don't get any sodaafter the fifth quarter, you are entitled to say thee maehinee is no damned good- even if you don'tt know what's wrong with it." Next year's budget deposits another $24 million quarter in,Fort.Detrick-. • "If whatt the General Accounting OtTice. (GAO/: has apparently'foundlinre- viewing the Eppley. contract is an indica- tiomof how other contracts and research efforts att the Cancer Institute have' been administened„ I think Congress has no choice but toeonsider'a.complete.over-haul of the Institute." reported Con- gressman David Obey. Eppley Institute'.ofOmaha. Nebras- ka, which has received.$20 millionfrom NCf in the past eightt years has been charged with using. NCII contract moneyy for non-related projects, and for charg- ing the government for supplies used inn industrial projects-includ:ing 53.00t1(t laboratory test animalss which Eppley. elaims were destroyed.. Bun the stickiest question raised by the GAO'findings iss one of conflict of interest:: EpplegDirec-tor PhiJippe. Shubikk has been, an influen- tial memiber of the National Cancer Advisory Board.since its inception, andl. an the' timeof the alleged contract io- regularitiess wass chairman ofthe: NCI subeommittee on Environmental Carv cinogenesie. Ass such:, he was themem- ber mostresponsiblet for overseeing thee division that awardedl Eppleyy contracts. Ironicallg, inn defense ofl Shubik,. the. Cancer Letter,, an NCI-affiliated weeklly,., states:: "Why Obey has singled out. Shu- bik ass a.target for conflict of interest charges is~ a mystery.. Nearly every scientific member of:the Boardl,..the Pres- ident'sCancer Panel, and the various adNisory committees could be subject tosuch'charges . . .. Slatihlicall ahsIraOous' It took. Irv.ing. Rimer, ACS Vice President of Public Information, aloneamong,the top ~ACS executives, to crackk the cheekyy new statistics riddle in ACS's1975 annual report: "Cancer incidence," it' teased. contradictingg every other sourceon thee subject. "has declinedd slightlyinthe last 25years," "You have too understand some- thing," Rimer explained~.. "Somewhere around 197?or'73, westopped.inoluding: in our calculationsail skin cancers ex- cept melanoma..the only one that-sfatal. and al so irrsitm cervical cancerar, because many experts don'tt consider these to be cancers.at.all. Sineee together they ac-count f'ora.large number of cases..that couldd be whyy the incidence has gone down."' No wond'er cancer is "one of thee mosn curable ofthemajor di,seases in this country," as The FlopefufSide of Catmer.. ACS's basicc public educati on primer. st;ues.. Those skin and[ cervicah cancers. unfit for the incidence figures,.. are greatt for thegrand'e tall!y of "7.5p(t,tA)0: Americans alive today who have had cancer." towhom ACS points as.proof of the success of their "eancer, awareness"campaigns and themethod5e o ftreat ment't they promotle.. 77houghtheir own chief statistician reportedly suggested thact the.figure be droppcd because of its unreliabledata~ base„ACSbrazenly upped it to = million. in 1976. Ift is this type of outright dishonesty and statistical legerdemain thar.supports the country's system of orthodox cancer treatmennand leadsahe public to befievee that thee medicall establishmentt is well om the way to controlling cancer. -'Today'. one: outt of three cancer pa- tients.isbeing saved', And it could be oneine two, if the disease.were.detected early and treated'.promptly," This, the central: hope-myth conjured upby ACS/NC[,C has been retold since.1956:. Adding~a final flourish, this summer, Dr. Lee Clark (ACS Presidenn and NCI"s: senior scientific member of. thePiesident'sCancer Panel) predicted the advancee to'. "one in two" wouldl come "within the next five years." But we have yet to see.even aone-in-three survival rate that has been based~ on, a fair representation of the American' popularion. Non-whites, for example,, whose cancer death rate is higher- a nd. much higher for males-thann thatt ofl' whites„were virtuallyi'eft'out ofltheone- in-threee calkulations, while those pa- tients included (,only 3 percent. of thee country's total ) weree treated at largee pri-vate andluniversity hospitals wherepre-sumably they were receiving, thebest' possiblecare and treatment_ It iss rarely mentioned'd in ACS/NCC educational material that "saved" refers. only to being alive five yearss afterr thee time cancerwasr diagnosedl... not to long-term survival as most people would in- fer. Even without alfl these qualifnca-tions. the fact that "one inn three"sur-vives today is noo triumph... People diag-nosed as having cancer in 1948-52'al-ready had a32 percent.chance of.surviv-ing:.f and. "the commone st cancers,"' ac-cording to Dr. Donaldl Gould, NewScientist. editor, "are asresistanc to, treatment as they were 40 or 50 yearsagu." Still- orthodox treatment methodsare peddled to the public and to Con-gress as "known cures," diverting atten- You muau"V 11111 cuall harc hpcast caaccc? There. had been, . early warnings. Severadl scientists, including one of the world"s'.leading pathologists, had writ- ten that mammography as a screening technique might detect breastt lesions tooo small or too uncommon for most pathologiststos correctlyy identify as malignant or benign.. This September, ann expert pa- thologist review committee reported that out. of the. 506 "minimal cancer" cases they studied, at.least.ti6, possibly 88„ were entirely benign'. Seventy'-one off the women involved have had com- plete mastectomies, mosrof them radi- cat Though there is data to:suggest that even morewomen have undergoneun- necessary breast surgeryy as a result of the ACS/NCI breastt cancer screening program. officialis have been, scram- bling alioutt madly, trying to prove that "there may nott have been any un- necessary masttctomies att all."'-RIR, R

the NCI.Director: ' Wedon'tJike your di-rector of such and such, somybe: you.u should!think about.gettinga newone.' " "AA red herring of Yidiculouss propor-tions!" Benno Schmidr.. a WaI1:Street. in-vestment banker.r who has been chairman. of' the: President's Cancer Panel, the apex of NCI's power structure, since 1971, spokee in an angryvoice of the nasty suggestions of an, "ACS-NCIlink" brought upat the House prelimi- nary oversight hearings on NCI!this sum-mer. "I never even heard firomthe. American Cancer Society-in five years noo one from theree has even calfed' me." Hasn't Mr. Schmidt been aware of ACS President and former Vice Presi- dent:Dr: LeeClark, who has been serv- ing.g with hi m ion. the President's Cancer Panel for five years; or of ACS past offic- er director and Pennwalt Corpbrationdi- rector Dr. Jonathan Rhoads, who has sat nexat to: himm at NCI'ss monthly National Cancer. Advisory B'oardd meetings (Rhoads is the Advisory Board's.chair- man)t or of several other ACS members who serve, or have recently.servedlon the. Advisory Board or on important NCI committees-includingMary Lasker, Emerson. Foote.. Frank Dixon (consult- °Thelittle Watergate that broke before the big, one;" is how one NCI employee describesthe nation's':cancer program ano for Eli Lilly andl Co.)) and Elmer Bobst (chairman of the Warner-Lambert pharmaceutical company and old Nixon friend and'd campaign.contributor).. No one: controls Benno Schmidt, butt he would'd not have been singled out for such an imponantt position if his views did nott coincide with ACS intar- ests.. When Senator Ralph. Yarborough (the original sponsor of the National Cancer Act legislationi appointed a panel of consultants to make recommend'a- tions for.the act, names were: "suggest- ed too him" by Mary Lasker and an ACS Iobbyist in Washington, including the name of'~ Benno Schmidt, who became chairman. Considering the act's provision that officials be appointed by the President withoun amy outside review, andlthe fact thatt both~ Mary Lasker and. Benno Schmidtt were frequenn visitors to Nix- on's andlFord's White House,.it was mat- urali thatt memberss of the panellof con- sultants and other. ACS.favoriteswoul!d fall:intoposition on NCE's National Can- cerAdvisory. Board, which has final say as to.where research funds go, Also: monitoring of: NCI activities under the actwasleftt to the 3-member President's Cancer Panel, whichh is to say, to Benno:Schmidt.. "Heruns.the whole Advisory Board and President's Cancer Panel," said an AdMisory Board member. Asked.at the oversightt hearingss howthePresident"s Paneldoes: itss monitoring, Benno Schmidt replied, "If instances comee to my attention,. I raise thosee questions, discuss them and satisfy myself that whau wass done was: done for good rea- son.." arly 118010311: No fala ~We emphasizethat'.a.majmrpercentageed.example:of the rewardsof.early di- :of cancers cambe curedthroughd earlyagnosiis, supposedly"'largely nesponsi- diag>tnsis:. ble for a 65:percent.d6cline in mortality I -Walter]ones,.ACSWice ratef'rom.uterine.cancee." Buttheun- , Presid'ent for Public Education, distorted statistics dori t support that. ACS'sIDr. Hammond explained in aJ1970. Go beyond ACS and NCI publicc paper before the British Association relations divisions and you find that the for Cancer Researchrthat "the decline. 'frailtyof currentmetPoods.of earlydiag-in uterinee cancerr began before the in- ,nosisas a hope against.cancer is com- troduction of cytology [Pap test]"an& limonn knowledge. "There isn't onee thatthePaptest"didnot.playthelead- t shred' of evidence that early diagnosis ing role during the years when the larg-. I doesany good',: except:perhaps in.theest.declinetook:place," Icase: of breast„cerviaw. andlbladder ean-"There.is a great deal of overstate- cers," said' Dr. James Peters, former ment about: thee vallueof earlydiagmo- NCIiDirector of the Divisionof:Cancer sis," says. Hammond., "I'i m stull trying. . ~ Causeand.Preventione after25yearstotindsome.deHiniteevi- Dr. Frank. Rauscher believestlhats demce. ... "evenwithcervicalandbreasncancer, Actuallly, earlly diagnosis may therei~snogoodevidbncethatlbngevi- serve to artificially boost survivall ty is improved by early detecrmtes. A 11956'6 study byHammond. tion... .." showedd than it. may extend only past. The Pap tlest-which: ACS takes surviMall time, timee when thee patient credit for popularizing-iis themost.cit- would have.beeni alive anywa .-R:R. Apparently„ he is easily satisfied. The "NASA-style management,"'as hestill dares to refer to the new. NCI ad, ministration, spawnsterrible:inefhcieney and waste-partlyy becausefavoritism~ takes.precedence over fitnessin fillingg top positions. When, 253of the professionals on the NCI staff weree asked in, a: 19744 sur- vey to indicate probl'ems adversely affecting their job performanceauthe Iln.stitute,. half cited "widespread lack of confidencee in the scientific acumen of the decision-makingg hierarchy" and'' a.a third complained of the. "shortage of' qualified scientific and technical'personnel. A, ncw, ive o!. Mcllaro With so few in-Bousescientists, the new millions were dished out.to private institutes and industries,.commercial re- search labs and largeuniirersities. There, who's doing whatt research is so far R beyond NCI monitoring capacity that some researchers do unrelated work withgovernmenrt moneywhile others re- ceivemoney only by the grace of the. "excellent writing and prepanation" of professional grantsmen., which~ commer:- cial organieations can well afford, and! which has. "little or no relevance to the kind of laboratory research they db>" ac- cording toDr. Solomon Garb, Scientific Director of the American Cancer Re- search Center and Hospitallin Denver„ Colorado. Itn effect. the influx. of funds.initiat- ed byy the National Cancer Actt created anew typeof welfare system-as Dr. Watson described it, one "moree palat- able to this administration because the recipientscannot solely sop up beer andd watch, TV-. but instead'l will wear eleamr white lab coats and look into cancer cells. Nofu being trainedd for' thee task, however, they are most'.unlikelry to fath- om the.inner workings of the.cancer'cell, and in a ghoulish way will be forever as- suring the. contlnuatiom of their job de-scriptions." The mainstay ofNC1's welfare:sys:-tem is contracu research.,, which afisorbs. 40.6 percent of all its.research.funds, and invitesabuse and poor quality work. For example: •The Special. Virus Cancer Pro- gram, which depends mostly on contract research, has been glutted witivmis-used funds-nearlyhalf a billion dollars to date-since its inception in 1964. "A self-perpetluating bureaucracy. full of conflictss of ibterest:, its existence justiflyingits further existence . was the way a 1974 reviewby outside scientists (the Zinder report) character- ized the Special Virus Cancer ProgramL Those running, it, the reportt charged., come "from a. narroww section of thee scientific community, and receive IargCamounts of the money theydisr pense. . ..

stance where a reporter had prove&that promising elementsandl supportivee quotes..abouts a particular "unpnoven"' cancer therapy had been omitted in.the. "quack file" write-up.. hee said, "I don'tt remember the details exactly-but basi-cally. C mean evem if we were that nega-tive, that.initselfis valid. Our purpose is:. too keepp these unproven~ approachesaway from the public., especially as they' become popular-that's whem they'remost dangerous. " Most dangerous to whom7It seemsthat thee restrictivee authority ofthef lIn-proven Methods Committeee is designedd more toelimimateanythreat to ACS'9to-tal dominance off cancer management and cancer publicity than.to protect the public.. For instance, I was astonished tofind.among some documents on unpnov-en method sa l ength ymem:by AlanDa- vi9~ . ACS Vice. President for Governmen- tal Relbtions,, warning division execu- tives ofian individual fnom, a small pri- vatecancer instimtee whoo was: asking mayorss and governors toproclaimi a "National Cancer Day"-notrthe kindlof thing you'd imagine could killl a lot of people. In fact, all he: was advocating were medical check-ups and' early diag- nosis. "If a city or state.in your division is involvedl," Davis wrote.,."see if itis pos- siblee toFiavethe Mayor or Governor 'de- proclaim'. ... Being fori moree aware- ness of cancer is a good wayto get.favor- ableattention,.and.the cause is exploited byy many for various reasons, often with considerablee success." Apparently. ACS'.has,had the most success. icrmiaal oplimiDm "There's something I don't think people understand," Dr. E. Cuyler Hammond sighed. "Say something, in- creasess yourr risk of dying of bladder cancer (we'd just been talking about sac- charin whichhas,beem shown in human studies mo cause a BO percent increasein bladdercancer, inmen) . . . "Look; says Dr. Hammond,"if you die of one thing, you can't later die of somiething else" "Well- ifl it imcreasesyour'risk of dying of bladder cancer, it decreases your risk:of dyingof cancerof the.pros- tate: cancer of the.lung, cancer of the stomach, or any other f'orm off can- cenL. .. Look, if, you die off one thing you canPtlater die of something.eise, do you follow me?" Sure. While monopolizing and bung glingthe areas of research and trea4 ment., the cancer establishmentt mini- mizess the importance off cancer preven- tion to avoid steppingg on industrialized toes. A major source of support for ACS D9qlrkaaE bcsC? WhileACS:'s self-proclalmed'. pur-pose is "tado everything possi- ble ... .. . tohastem the elimination of cancer as a threatt to human life, and' well''.-being," theiv larger commitment isto.the supremacy and absolute.freedom, of'f theindividual physician, including the freedom to.administer dangerous or, carcinogenic drugswitfiout thee pa- tient's knowledge. Consider the use of'f estrogenss too treaut symptoms.of inenopause:. Studiess linkingg estrogens withr a greatly in- creased risk of d'evelbpingg endometrial cancer (a form.of uterine cancer) have led some experts to cite the drugsass the chief responsiblee agents in a 50'per- cenn ri~sein uterinecancer between11469'and 1973. The.FDA,recently ruled, that a: warningg about tkecancen riskk must.be includedlon package inserasfor the womenusingn the drug as well as for pharmacists and physicians.. Before, this ruling. (Oetober 17),. 1 asked Dr. Sidney Arje, ACS Vice. President.for Phofessional Education,, if ACSbe-lieved that women should be told aboutt the potential riskorif inention~of it wasincluded in any of ACS.'ss educational material on uterine cancer. "No," says Dr. Arje. "Thatt would beinterfering, with the physi-cian-patientt relationship." Interestingly, thesee exactt words wereused byttie American Medical!, Association (AMA).,., and recorded in the 1Federall Register; as an argumentt against aproposal that thee risks in-volvedd in taking birth control pillss belistedlon the patient package insert. When I asked Dr. Ar~jeif'ACS:pol- iciesever' differed fromm those. offtheAMA,. 1 wass immediately assured,. "Not in any instance II can think of. . The ACS,. AMA, and American Collegee of'Radiologists all use the same technical staff."' llCaving, called several of the58ACS~ lbcal'otHces, aswells as the nation- al office, askingthe.public information representative about various subjects, including estrogens and'd other con-trorversial I drugs,. I was never given . any iioformntion., butt was told "Ask your physician:° or°If~. your doctor haspre- scribed it.,, you shoultln't worry:" Thee factss i ndicate you should worry:. 0 In 19755 moretham:500,000 pre- scriptionswere gjlvento pregnant wom- en for progesteronee drugs, known to cause.birth defects. when it began fund-raising activity in: 1945 came from industrialists.enlisted by George Stringfellow, then Senior Vice Presidentt of Thomas A. Edison,fndus- tries, Since then, manyhave become • fn one necenrt year, between 40',(q0 and 60,000 . women received pre- scriptions for DES too prevent.t miscar- riages-a drug which:caused~ an.unusu- al number of cases of vaginal cancer iin the.daughters of women who took itiin the:fifties. • Depo: Promera,. a drug approved by. FDA.A onlyy for treatment of a rare kind of uterine cancer, is being pre- scribed by d'octorsasa contraceptive. Amongg other dangerous side effects, there isa possibility that it`may cause breast and cervical cancers;,85percent off women soo far contacted by a con- sumer groupin California had not been infortmed of'the side effects nor thau it was being sold to them fbr ann unap- proveduse. While sending cancer patients and the general public to theirl'ocal physi: cians foranswersto~ most questions, ACS public information reps actuaBy discourage them.from,seeking out can, cer specialists (oncologists),. andfrom going to: NC1-fundedd comprehensive cancer centers, wPoichACSlobbied for, andd where their chances for survival are best- What does ACSdo,S then, to educate the primary physician with whom most of uscome in contact? °Our doctor education is not so much a matter of transference of knowledge, but ratherof motivation," Dr. Arjeexplainedl. "Ws not directed toward'.teaching the doctor what he has to know but toward getting him.to use what he already knows." The education program d'ependk chiefly on theCaJournal': A Cancer Journal'for CRinieians„ which reaches 400;0p0:physicians,0 and'whose primary goal, according toArje, is "to keep the doctorhopefullaboutcancer." "14+e've:found a wonderful educa- tion opportunity with cancer." he con, tinues. "You don't really havee to do anythingg butt use the name 'cancer'- there's a subliminal effect-Evemif the physician doesnit goo to our confer- ences, it's enough that the Ca Journal crossess h is desk „or that . it's in the hos- pital at his station~ whenhen walks by- something will sink in." For thismagical osmosis„ com- bined with the public.information and educatiom programs, ACS spends about $30 millionannually-then same amounrtheyt spend on cancer research. -S.R. R