A phenomenal event occurred recently in the war on cancer, having nothing to do with a scientific discovery or a breakthrough in treatment.
Rather, the high command in this grisly conflict departed from normal practice and invited its severest critic to headquarters to state his case. And what a robust encounter that was, raising hopes for fresh strategic thinking in the face of two decades of scant progress against the disease.
The confrontation between the critic and the establishment took place recently at a meeting of the National Cancer Advisory Board, a 17-member assemblage of cancer scientists, physicians and other specialists who are the top advisers to the government's National Cancer Institute. Coming before them, at the suggestion of the chief of the $2-billion-a-year Cancer Institute, was a researcher and policy controversialist long at odds with the institute: Samuel Epstein, professor of occupational and environmental medicine in the University of Illinois School of Public Health.
For many years, he has been saying aloud, in speeches, newspaper articles and a book, "The Politics of Cancer," what many other cancer researchers concede only in private -- that, with a few exceptions, the war on cancer has failed to develop effective treatments.
Furthermore, Dr. Epstein argues, it's not likely to find additional cures any time soon, if ever, and therefore priorities should be shifted to research on prevention, plus removal of known carcinogenic substances from the environment.
Many in the cancer field regard Dr. Epstein as a tunnel-visioned fanatic who ignores the sums that are expended on preventive nTC activities. Others, including many with impressive credentials and professional accomplishments in cancer research and treatment, share his critical assessments of the cancer program and its priorities.
In February, some 65 scientists and physicians joined Dr. Epstein in a statement calling for a major reorientation toward cancer prevention. Among them were David Rall, retired director of the National Institute of Environmental Health Sciences, a sister agency of the National Cancer Institute; Eula Bingham, former head of the Occupational Safety and Health Administration, now a professor of public health at the University of Cincinnati Medical Center, and many professors of science and medicine involved in cancer research.
The strong pro-prevention statement they issued received wide press attention, soon followed by the Cancer Board's invitation. When Dr. Epstein got there, he let loose, noting that of the $2 billion a year spent by the institute, a mere $19 million is focused on risks of cancer from pollution in the workplace.
He ridiculed the institute's claim of an overall prevention budget of $335 million, describing it as a "shell game" and charging that the real figure is under $100 million.
Tobacco is indeed a major cause of lung cancer, he agreed, but the institute uses it as an excuse for neglecting industrial causes of lung cancer. The same applies to diet, he said, with fat elevated to the role of cancer-causing villain, while little attention is given pesticides and other contaminants that concentrate in fatty foodstuffs. Dr. Epstein attributed the strategic failings to industrial influence over cancer research, in government agencies and in private cancer organizations.
He concluded by charging that criticism of the cancer program has regularly been greeted by "vilification and misrepresentation" and "scientific McCarthyism." He added, "The first time we got your invitation is when you were, with due respect, hit over the head with a two-by-four."
Board members and Institute staff responded defensively, turning the "scientific McCarthyism" label against Dr. Epstein himself. But his appearance could signal a change of strategic mood in the war on cancer, which last year marked, in subdued fashion, its 20th anniversary.
After Dr. Epstein spoke, the director of the Cancer Institute, Samuel Broder, assured the board and the speaker that the agency is open to change. "Can we learn from this dialog?" Dr. Broder asked. And he replied, "I think the answer is yes."
Daniel S. Greenberg publishes the newsletter Science & Government Report.