Excerpt from "American Cancer Society: More Interested In Accumulating Wealth Than Saving Lives"
by Samuel S. Epstein, M.D.
Emeritus professor Environmental and Occupational Medicine University of Illinois School of Public Health and Chairman, The Cancer Prevention Coalition
FRANK CONFLICTS OF INTEREST
Of the members of the ACS board, about half are clinicians, oncologists, surgeons, radiologists, and basic molecular scientists, mostly with close ties to the NCI. Many board members and their institutional colleagues apply for and obtain funding from both the ACS and the NCI. Substantial NCI funds also go to ACS directors who sit on key NCI committees. Although the ACS asks board members to leave the room when the rest of the board discusses their funding proposals, this is just a token formality. In this private club, easy access to funding is one of the "perks," and the board routinely rubber-stamps approvals. A significant amount of ACS research funding goes to this extended membership. Frank conflicts of interest are evident in many ACS priorities. These include their policies on mammography, the National Breast Cancer Awareness campaign, and the pesticide and cancer drug industries. These conflicts even extend to the privatization of national cancer policy.
The ACS has close connections to the mammography industry. As detailed in the author's 1998 The Politics of Cancer Revisited, five radiologists have served as ACS presidents, and in its every move, the ACS reflects the interests of the major manufacturers of mammogram machines and films. These include Siemens, DuPont, General Electric, Eastman Kodak, and Piker. In fact, if every woman followed ACS and NCI mammography guidelines, the annual revenue to health care facilities would be a staggering $5 billion.
ACS promotion continues to lure women of all ages into mammography centers, leading them to believe that mammography is their best hope against breast cancer. A leading Massachusetts newspaper featured a photograph of two women in their twenties in an ACS advertisement that promised early detection results in a cure "nearly 100 percent of the time." An ACS communications director, questioned by journalist Kate Dempsey, responded in an article published by the Massachusetts Women's Community's journal Cancer: "The ad isn't based on a study. When you make an advertisement, you just say what you can to get women in the door. You exaggerate a point. Mammography today is a lucrative [and] highly competitive business."
In addition, the mammography industry conducts research for the ACS and its grantees, serves on advisory boards, and donates considerable funs. DuPont is a substantial backer of the ACS Breast Health Awareness Program; sponsors television shows and other media productions touting mammography; produces advertising, promotional, and educational literature and films for hospitals, clinics, medical organizations, and doctors; and lobbies Congress for legislation promoting availability of mammography services. In virtually all of these important actions, the ACS remains strongly linked with the mammography industry, while ignoring the development of viable alternatives to mammography, particularly breast self-examination.
The ACS exposes premenopausal women to radiation hazards from mammography with little or no evidence of benefits. The ACS also fails to tell them that their breasts will change so much over time that the "baseline" images have little or no future relevance. This is truly an American Cancer Society crusade. But against whom, or rather, for whom?
2. National Breast Cancer Awareness Month
The highly publicized National Breast Cancer Awareness Month campaign further illustrates these institutionalized conflicts of interest. Every October, ACS and NCI representatives help sponsor promotional events, hold interviews, and stress the need for mammography. The flagship of this month-long series of events is the October 15 National Mammography Day.
Conspicuously absent from the widely promoted National Breast Cancer Awareness Month is any information on environmental and other avoidable causes of breast cancer. This is no accident. Zeneca Pharmaceuticals -- a spin-off of Imperial Chemical Industries is one of the world's largest manufacturers of chlorinated and other industrial chemicals, including those incriminated as causes of breast cancer. Zeneca has also been the sole multimillion-dollar funder of the National Breast Cancer Awareness Month since its inception in 1984, besides the sole manufacturer of Tamoxifen, the world's top-selling anticancer and breast cancer "prevention" drug, with $400 million in annual sales. Furthermore, Zeneca recently assumed direct management of 11 cancer centers in U.S. hospitals. Zeneca owns a 50 percent stake in these centers known collectively as Salick Health Care.
The link between the ACS, NCI and Zeneca is especially strong when it comes to Tamoxifen. The ACS and NCI continue to aggressively promote the Tamoxifen, which is the cornerstone of its minimal prevention program. On March 7, 1997, the NCI Press Office released a four-page statement "For Response to Inquiries on Breast Cancer." The brief section on prevention reads:
Researchers are looking for a way to prevent breast cancer in women at high risk...A large study [is underway] to see if the drug Tamoxifen will reduce cancer risk in women age 60 or older and in women 35 to 59 who have a pattern of risk factors for breast cancer. This study is also a model for future studies of cancer prevention. Studies of diet and nutrition could also lead to preventive strategies.
Since Zeneca influences every leaflet, poster, publication, and commercial of the National Breast Cancer Awareness Month, it is no wonder that such information and publications, made no mention of carcinogenic industrial chemicals and their relation to breast cancer. Imperial Chemical Industries, Zeneca's parent company, profits by manufacturing breast cancer-causing chemicals. Zeneca profits from treatment of breast cancer, and hopes to profit still more from the prospects of large-scale national use of Tamoxifen for breast cancer prevention. National Breast Cancer Awareness Month is a masterful public relations coup for Zeneca, providing the company with valuable goodwill, besides money from millions of American women.
3. The Pesticide Industry
Just how inbred is the relation between the ACS and the chemical industry became clear in the Spring of 1993 to Marty Koughan, a public TV producer. Koughan was then about to broadcast a documentary on the dangers of pesticides to children for the Public Broadcasting Service's hour-long show, Frontline. Koughan's investigation relied heavily on the June 1993 National Academy of Sciences ground-breaking report, entitled "Pesticides in the Diet of Children." This report declared the nation's food supply "inadequately protected" from cancer-causing pesticides and a significant threat to the health of children.
An earlier report, "Intolerable Risk: Pesticides In Our Children's Food," by the Natural Resources Defense Council in 1989, had also given pesticide manufacturers failing marks. The report was released in high profile testimony to Congress by movie actress Meryl Streep. A mother of young children, Streep explained to a packed House chamber the report's findings, namely, that children were most at risk from cancer-causing pesticides in food as they consume a disproportionate amount of fruits, fruit juices, and vegetables relative to their size. However, shortly before Koughan's program was due to air, a draft of the script was mysteriously leaked to Porter-Novelli, a powerful public relations firm for produce growers and the agrichemical industry. In true Washington fashion, Porter-Novelli played both sides of the fence, representing both government agencies and the industries they regulated. Its 1993 client list included Ciba-Geigy, DuPont, Monsanto, Burroughs Wellcome, American Petroleum Institute, Bristol-Myers-Squibb, Hoffman-LaRoche, Hoechst Celanese, Hoechst Roussel Pharmaceutical, Janssen Pharmaceutical, Johnson & Johnson, the Center for Produce Quality, as well as the U.S. Department of Agriculture, and the NCI, besides other National Institutes of Health.
Porter-Novelli first crafted a rebuttal to help quell public fears about pesticide-contaminated food. Next, Porter-Novelli called up another client, the American Cancer Society, for whom Porter-Novelli had done pro bono work for years. The rebuttal that Porter-Novelli had just sent off to its industry clients was faxed to ACS Atlanta headquarters. It was then circulated by e-mail on March 22, 1993, virtually verbatim from the memo Porter-Novelli had crafted as a backgrounder for 3,000 regional ACS offices to help field calls from the public after the show aired.
"The program makes unfounded suggestions...that pesticide residue in food may be at hazardous levels," the ACS memo read. "Its use of 'cancer cluster' leukemia case reports and non-specific community illnesses as alleged evidence of pesticide effects in people is unfortunate. We know of no community cancer cases and none in which pesticide use was confirmed as the cause."
This bold, unabashed defense of the pesticide industry, crafted by Porter-Novelli, was then rehashed a third time, this time by the right-wing group, Accuracy in Media (AIM). AIM's newsletter gleefully published quotes from the ACS memo in an article with the banner headline: "Junk Science on PBS." The article opened with "Can we afford the Public Broadcasting Service?", and then went on to disparage Koughan's documentary on pesticides and children. "In Our Children's Food...exemplified what the media have done to produce these 'popular panics' and the enormously costly waste [at PBS] cited by the New York Times."
When Koughan saw the AIM article he was initially outraged that the ACS was being used to defend the pesticide industry. "At first, I assumed complete ignorance on the part of the ACS," said Koughan. But after repeatedly trying, without success, to get the national office to rebut the AIM article, Koughan began to see what was really going on. "When I realized that Porter-Novelli represented five agrichemical companies, and that the ACS had been its client for years, it became obvious that the ACS had not been fooled at all," said Koughan. "They were willing partners in the deception, and were in fact doing a favor for a friend -- by flaking for the agrichemical industry."
Charles Benbrook, former director of the National Academy of Sciences Board of Agriculture, charged that the role of the ACS as a source of information for the media was "unconscionable." Investigative reporter Sheila Kaplan, in a 1993 Legal Times article, went further: "What they did was clearly and unequivocally over the line, and constitutes a major conflict of interest."
4. Cancer Drug Industry
The intimate association between the ACS and the cancer drug industry, with annual sales of over $12 billion, is further illustrated by the unbridled aggression which the ACS has directed at its critics.
Just as Senator Joseph McCarthy had his "black list" of suspected communists and Richard Nixon his environmental activist "enemies list," so too the ACS maintains a "Committee on Unproven Methods of Cancer Management" which periodically "reviews" unorthodox or alternative therapies. This Committee is comprised of "volunteer health care professionals," carefully selected proponents of orthodox, expensive, and usually toxic drugs patented by major pharmaceutical companies, and opponents of alternative or "unproven" therapies which are generally cheap, nonpatentable, and minimally toxic.
Periodically, the Committee updates its statements on "unproven methods," which are then widely disseminated to clinicians, cheerleader science writers, and the public. Once a clinician or oncologist becomes associated with "unproven methods," he or she is blackballed by the cancer establishment. Funding for the accused "quack" becomes inaccessible, followed by systematic harassment.
The highly biased ACS witch-hunts against alternative practitioners is in striking contrast to its extravagant and uncritical endorsement of conventional toxic chemotherapy. This in spite of the absence of any objective evidence of improved survival rates or reduced mortality following chemotherapy for all but some relatively rare cancers.
In response to pressure from People Against Cancer, a grassroots group of cancer patients disillusioned with conventional cancer therapy, in 1986 some 40 members of Congress requested the Office of Technology Assessment (OTA), a Congressional think tank, to evaluate available information on alternative innovative therapies. While initially resistant, OTA eventually published a September 1990 report that identified some 200 promising studies on alternative therapies. OTA concluded that the NCI had "mandated responsibility to pursue this information and facilitate examination of widely used 'unconventional cancer treatments' for therapeutic potential."
Yet the ACS and NCI remained resistant, if not frankly hostile, to OTA's recommendations. In the January 1991 issue of its Cancer Journal for Clinicians, the ACS referred to the Hoxsey therapy, a nontoxic combination of herb extracts developed in the 1940s by populist Harry Hoxsey, as a "worthless tonic for cancer." However, a detailed critique of Hoxsey's treatment by Dr. Patricia Spain Ward, a leading contributor to the OTA report, concluded just the opposite: "More recent literature leaves no doubt that Hoxsey's formula does indeed contain many plant substances of marked therapeutic activity."
Nor is this the first time that the Society's charges of quackery have been called into question or discredited. A growing number of other innovative therapies originally attacked by the ACS have recently found less disfavor and even acceptance. These include hyperthermia, tumor necrosis factor (originally called Coley's toxin), hydrazine sulfate, and Burzynski's antineoplastons. Well over 100 promising alternative nonpatented and nontoxic therapies have been identified. Clearly, such treatments merit clinical testing and evaluation by the NCI using similar statistical techniques and criteria as established for conventional chemotherapy. However, while the FDA has approved approximately 40 patented drugs for cancer treatment, it has still not approved a single nonpatented alternative drug.
Subsequent events have further isolated the ACS in its fixation on "orthodox treatments." Bypassing the ACS and NCI, in June 1992 the National Institutes of Health opened a new Office of Alternative Medicine for the investigation of unconventional treatment of cancer and other diseases. Leading proponents of conventional therapy were invited to participate. The ACS refused. The NCI grudgingly and nominally participated while actively attacking alternative therapy with its widely circulated Cancer Information Services. Meanwhile, the NCI's police partner, the FDA, used its enforcement authority against distributors and practitioners of innovative and nontoxic therapies.
In an interesting development, the Washington, D.C. Center for Mind-Body Medicine, held a two-day conference on Comprehensive Cancer Care" Integrating Complementary and Alternative Medicine. According to Dr. James Gordon, president of the Center and chair of the Program Advisory Council of the NIH Office of Alternative Medicine, the object of the conference was to bring together practitioners of mainstream and alternative medicine, together with cancer patients and high-ranking officials of the ACS and NCI. Dr. Gordon warned alternative practitioners that "they're going to need to get more rigorous with their work -- to be accepted by the mainstream community." However, no such warning was directed at the highly questionable claims of the NCI and ACS for the efficacy of conventional cancer chemotherapy. As significantly, criticism of the establishment's minimalistic priority for cancer prevention was effectively discouraged.