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Eluslz'e QuPSt Cancer R.esearch Drive, Begun .'With Faniare, Hits Disillusioiiment Congress; Public, Ask Mnt Big Outlay Has Bought;, Is It a Fami:y of Diseaes? Ga.irls in Solne: Areas Noted ' . ByRrCH JAROsLovsKY~ .. $ttIJJ. R-p-l~ Of TH S.~R--L STRE E.T]O ORUA L ti{'.1SHINGTO*I - Donald Kennedy, the U.S. Food and DrugCom.missoner, calls the gpvernment's war on cancer "a medical Vietnam." Vast amounts of money and ef- fort are pumped into the battle, he says, yet victory seems no closer. Seven years and S5 billian ago. Reslt!enG Nixon,and Congress began an allbut drive to find a cure for the natioa's second-bigg-est Y.t;ler. Some le; slators spoke of solving the cancer riddlefn ti me . forr thee nation's 2COt}t bir thday in 19'6. The President called the ef. fort "our great crusadz " Today. ttioug5I a.cancer cure. Ls'still jtzst'ahopet Indeed, somerese:archers say the more thev learn about'cancer, the:less likely or imminent a single cure.seems: "We have been, simohstic, I'feek• In,outr notions about cancer," says Dr. Arthur Up- Thiss is lhv../irst oJ_nco crttdes.cn cancer researehk ton, directorr of the National Cv^tcer. Insa- ( tute..."I think were.wron, to.expect a.c:re to come soon, in tt:e toreseeaole h:ture." In- stead of a quick victory n t e cancer azs, he_ suggests, researchers may have to sett.'e ' for a series of smalle; battla'ce;d suecesses. I Such a conclusioniposes political as well as medical problems 'or scie :=-s. For the ' war on,cancer is sta.::.^gta cayt`.e pnce.forr theextras•agant c: aims cf.4.e past. Fuh- Gc disenchantment 'a,t1 ;::e slo-R s.-td ccsCy , effort is growing..And Congre-ss, long a'aas-:a bas- tion of supportI and dbl:ars;in-' creasihY signs of dCubt a.nd i.^.'utience. w 1' /I ~~ue1,~d1.fII 1 0~~C f t,l~Cr• a<< j i"I "The Honeymoon Is Over" Despite progress in some areas, "we haven't bought very much" tn,seven years I of researcD;. Sen. Geore: \icGo•rerncom- plains. The South Da,cota De.mccrat recently conducted hearings at whtcb the National Cancer Institute s band:i: g, of the cancer, campaign was cash -aed- "The car,cer-re- searcti establishment dog,~edly continues t(> ' seek an elusive cancer cure and concomi- tant'Nobel Prize" while slipts.g importantt areas sueh as cancer-preven_'on research, Sen. McGovern contends. - ' . Dr, Upton disnutes the Senator's charges. But he acknowledges that such complaints are symptoms of a growing nnease:about the cancer effort. "It's evidentto me that the attitude is chane.hg,"" he says. '"The honeymo n is.over." At the root of this disillusionment Is the huge buiid'up thanthe cancertighrreceived In the early 1910s: Bact then, pnLticiansand powerful interest groups like the American Cancer Society concluded that the time was right for tY'major campaign making use of researchers' increasing knowledge about the nature of the disease. A congressionaflyy sponsored adUisory; committee declared, "A national'program for the conquest'of cancer Is essential if we are to Iexp:.loit effectivelye the:great'opportunities which are presented as a result of recent advances." Backed by Presideat Nixon and key /egis- tators like Democratic Sen.. Edw'ard1 . Ken- nedyy of Massactiusetts• thee cancer war wass launched amid! much fantare in 1971i That year'Stiaconal Cancerlnstitutebude tµ•as increased toIS3.'v)million from Moim,illion;, the fiscal, 19;9 budget tops $910 rnrlDon,,The institute has spent t•:aice as:mu:ch money in the past seven years than in its entire pre-. vious 3i-year histary:, An Elusii.'e: Cure - Yet a cure-ttt'e "magic btdlet," some people calls it-has eluded researchers.. The cancer war "per pet :ally appears- on the verge:" of victory, t.ti FDA's Mr. Kennedy says• but victory is seemir:gly aiways jtist '' beyond' re..rh. The biggest reason for that frustration II, may lie inithe:very nature of cancer. ?dany ~ researchers have come to regard it nocas a I s6ng!e illness but as a oomplex family of di+- seasvs with many different'causes, including environmeatal ones:. While all cancers are characterized by, unchecked grewth of celis in the body, the disease can have very dif- ferent manifestations: Scientists wcnder whether the body processes leading to, say, leukemia (cancerof t.heblocd cells) are the same ones, leading to, for example, breast cancer., . I On the key question of whether cancer is a siagte disease, most governmert'o`SCalic and other sr.lentists seem to side with the FDA's Mr. Kennedy, who is a scientist!and former head of Stanford' University's hu- man-biology program He says there doesn't seem to be "a single formula" for ca.cer, and so there mightn't be a single cure, either. Same researchers and ot7iars, though, still believe in the singledsea_se concept as expressed'by essayist Susan Son- tag, who: likens current cancer theories to now-discarded views of' tuberculosis. Can- cer, she says, may yeb"ntm out, as TiB:did,, to have one principal causJ aIzer.t and be controllable by one program cf treat.men2" Ei gh t now, whar dfictors have are a cam+ ber of different treatments hat may be ootti,; effectiveand practical in scme cancer cLses ' but not in others. For ins[a;:ce: caqcecs iike ; those of the breast or co!on may resvlt Ln Ib-~ cahzed turnors that can ,x's<r-gtca1 r re- i moved if detected early e r~u_-i C'~zr cart- ~ - cers l ike leukemia or lymphanccmcery ina Illy be treated with drugs or rada;on Snme marked . advances have, been ~ achieved' against certain tyTes of car.cer. i For example, the Cancer L.s~;ute's Ih. Up- ton notes that "belatedly, we've begun to Plertae Turn fo Pagt G0, Column t j

d l~ ~~~' ~l.usi~r~ Qucst~:~ .Caricer Research Despite Gains, Hits Disillusionment Continued'From First Page treabbreast cancer with drugs" that help,in- crease the chances of survival among women who have had breast removals. Sim- ilarly, research into the body't immune sys-' tem, may help doctors combat some skin and other cancers:.lnd some uroleguts re- port good results by implanting rad:oactlve Isotopes In men suffering from prostate can- ter. Research is also continuing on some sub- stances that may prove usefuliin the future. bfedltal fnstitunons soon willibegin tests Ln I cancer patients of Lnterferon, a naturN'b'ody 'substance that seems to protect celis from . viruses. And a Brown Unlversity researcher recently reported that In a laboratory test a chemical called WfF seemed to convert hu, man cancer, cells Into noncanceromsrellfi. It probably will be years before sclenhsts can f.tlly gauge the uselit:ness o6 such sub- stances for people, however. Parttcularly dramatic gains already have been made against leukerrtia. Because of' chemotherapy successes„ the Cancer Insti' tute says, about half of all childhood leuke- mla victims now live for at least five:years ttYer developir.g the di5ease.,0ften, disea_se- free survival'that long,means the patient is curedi Just a decade ago, the institute says;, only about 676 oG children with the disease llved'fSve years:. . Yet survlval'rates among all'cancer vic- tltns have risen more slowly. In the 1930s„ lt's estimated, about 25% obalUU.S. cancer victims lived at least five years after the diseue develbped, Despite all the reseanch since then, the figure has risen only to about' 35 ,7', Health oftlcfalss blame that frustrating y pace largely on an upsuree In the Incidence ' of lung cancer, whlch still is often'fatal! _•'`They say that because of clgaret smoking and other factors, the incidence of ]ung:can- cer-more thaa doubled between 19t7 and' 1971 and !s st:11'lircreasimg. The of5dals say; that.rapid rsels mascingthe progress on ot.her fronts., _ Changes at Institute But the prosgect of only llmitedadvances !n :-several key areas Is ea sing: some c.`'.acges at the Cancer Institute. For exam- pVe, the ihstl:,tte la lesseniitg somewhat its emphasis on cont: a,R r esearrh, In which sc1- entistl receive money to condct stud:es in areas set by t!•e government. Crinrs of the cancer war say such a planned efiorttends ta restrtct ::'e rsttge of scie-ntir.c u:quiry: Instead, t.`;e ihst:tute plans to give more ., weL3ht.to ~g-rantresea.th;,1h wh;ic'i scientLtsreeceivelnstitute financing to pursue promis- .tagareas of basie reseaich. The cancer .. war,..Dr.'Upton,says, L;n't "an engineertngg problem llke put :iig men on themoon." The goal can't.be aUaiaEd justb•y assigning tasksand h:andi.ngcut mcney, he says,.add- ing; "1i"ee still dn.n'tur.derstand enough" to _ take thaCapproach. - •%-- 1.j' Health officials.concede..t.tiatmanypeo- 1 pT.ebelleve- t:iatt the cancer effo:rG' shouldi have arlvancedscientttic.kr.awledge enough to be pays.g:more d:v!der.dsbynow. Cancer research "now faces a crt;ss.ofcredib'6'lty," Dr.,Theodore Cooper, former Ass[stant Sec- retary of Health, Education and Welfare, toVd Sen. bicCovern's nutrition-research panell "People are asking why after seven years . . . haven't we conquered those fear- ftil diseases:"'' But Dr. Cooper suggests that "ths Is a crisis of understar.ding, of overexpecta- tlons" thatdoesn't impugn the basic conduct ot'th'e cancer effort. Criticism "Fashionable" Rep. Paul Rogers„who heads the House's major health panel, agrees. The Florida Democrat, who helped shape the cancer-war legislation, recently told a group of scien- tists that it has become "fasttiionable" to criticise the effort "and to rationaliie that the early years were a nalve search for.,. a single cure for a single disease, and thatt only recently have:we recogni:,ed that it is more complex. But I suggest that we've k.^to•wtt from the onset that itwould be a long fight." Yet even the people now running the can- cer war say it has been oversold to the pub- lic. Dr. Upton, who joined the institute last year, blames the initial "false optunism." Without naming names, he says, "7here were statements by knowlldp ahle people that. Implied more than should have been promised." Richard Rettig. a Rand:Corp, social s¢i- entlSt and author of a book calied "Cancer. Crusade," says not only polltictans misled the public. Scientists mustshare the blame, he add9. Despite the Inflated rhetoric that, surrounded the cancer war, he says, manyy researchers "felt theycou,d benefit from all the drumbeating without feeling the ohlPga- • tion to issue even a muted deniall' of over• entltusiastic claims. Cooling In Congress . F .,ri'. As results haven't matched earlier expec- tations, the polltictans whovote thee cancer- war financingg seem tobe cooling on it a bit'. The: Carter admintstrat:on this year pro- posed a budget less than 1% above 12st year's. Congress added tr.ore money, but.the total!increase stlaitratls the inflation rate. "Something has happened-I'm not sure what-to people's attitudes up~he,re,^saysan aide to one of the congressional panels that decide the Cancer Institute budget. "The thing grew so fast" that legislators now want to see some firm results, he says. "But instead of coming in and talJdng re- sults," he says, cancer researchers fzom botli,withln andl.outside the Cancer.Institute "have tieen talking still more dbllars,',' The upshot,, the aide says„is:M that leg'•.siatcrs will be.lncreasingly reluctant to commit s<a moch of thegovernment'se biomcrileat-res>.arch money to the cancer ef'ort. _- 1 At the Cancer tnvtitute. It.seems, there's al.readysome nostalgia lor.the he.adyearly Idays of the cancer war. "People who've been here along:time.telllme; 'Gee, it's a''Idaterent cllmate now,' - Dr.. Up±on says.'. ~""P.eused to goo up (ta Con~ress) acd- ~Itiardly. have toaskbrforeo t.^:cy'd give us,w1ate:verr we:wantM.' " i ,