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Cancer, AIDS and Research


Washington. -- The suffering and fear induced by the two most dreaded diseases, AIDS and cancer, have provoked a pointless contention over whether one or the other is favored or neglected in the allocation of government money.

A moralistic element feeds into this dispute, with many of those who regard AIDS as a retribution for unsavory life styles hostile to lavish spending on a cure. For their purposes, the cancer comparison is a convenient weapon. What are the facts?

Statistical reality is fogged in at election season, but it is possible to nail down the essential numbers and examine the folly of these comparisons.

The often-made assertion of skimping on AIDS came up in the first presidential debate and drew a rebuttal from President Bush, who declared the government is spending "ten times as much per AIDS patient as per cancer patient." The annual AIDS figure he cited was $4.9 billion, followed by an exhortation for persons at risk to "change your behavior."

A sifting of the numbers reveals that of that amount, $2.1 billion is for research. The balance, with minor exceptions, is in Medicare and Medicaid funds for treatment of elderly and poor AIDS patients. But patients eligible for Medicare and Medicaid are cared for regardless of what ails them, including cancer. Research spending, however, is discretionary, and provides the only comparative measure of government spending on AIDS and cancer. As it turns out, the budgets this year for AIDS and cancer research are close, with $2 billion for cancer, and about $100 million more than that for AIDS.

But from this point on, the comparisons are complicated. The number of patients afflicted by the two diseases is enormously different. Since 1981, when AIDS was first detected, about 150,000 persons have died of the disease. In that same time, over 5 million have died of cancer. In terms of research expenditures per death, AIDS is better financed than cancer by an extremely wide margin.

However, a big difference, with massive lethal implications, must be noted. AIDS is a contagious disease, whereas cancer, as far as is known, is not. The AIDS epidemic has only just begun. With more infections occurring daily, an estimated 1 million to 1.5 million HIV-positive cases are currently incubating into full-scale AIDS.

The main onslaught of AIDS is yet to come. Inevitably it will, for there is deep pessimism in scientific ranks about near-term prospects for a vaccine or effective drugs. So the present imbalance in patient loads between AIDS and cancer is deceptive. Cancer is a calamity that's arrived; the full impact of AIDS is inexorably on the way.

Desperation has led to a good deal of nonsense in the arguments over AIDS funding. The AIDS camp points out that cancer tends to strike in the later years of life, while AIDS patients are relatively young. The difference shows up in the statistical category of "years of potential life lost," with AIDS patients ranking high by that measure. The measure may serve the needs of economists, but it surely conflicts with the humanitarian traditions of medicine and medical research.

The phony antagonism that's been raised between research on the two diseases disregards the naturally occurring overlap between cancer and AIDS research. AIDS exposes its victims to disease by destroying their immune systems. Cancer is frequently the killer of AIDS patients. Research on the immune system -- to protect or rebuild it -- is directly relevant to AIDS and cancer, and all other diseases.

The real financial problems of medical research are worsened by assuming that competition exists between diseases. It is impossible to specify the right amount for any field of research, but it is not at all difficult to recognize that the medical-research enterprise is under severe financial pressure.

Ironically, AIDS research has been one of the fastest-growing sectors, rising from a mere $6 million a decade ago to over $2 billion today. Other areas have grown, too, but not at that pace. Meanwhile, the future has been jeopardized as construction of new laboratories has been deferred to keep scientists at work, and training programs have been crimped.

The system survives and remains scientifically productive, but it will soon require large infusions of additional money.

Don't be misled. The problem isn't AIDS vs. cancer. It's science vs. stingy budgets.

Daniel S. Greenberg is a syndicated columnist specializing in the politics of science and health.

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