As other states prepare to spend their windfalls from tobacco companies to cut taxes or build roads, Maryland's plan stands out for its tight focus -- fighting cancer.
Nearly a year after 46 states settled their lawsuits against the tobacco industry, only Maryland has proposed such an aggressive effort to fight the disease -- through research, treatment, health education and anti-smoking programs.
Under the plan drafted by Gov. Parris N. Glendening, nearly half the $1.7 billion the state expects to collect from the settlement over the next 10 years would be spent in those areas. The spending requires General Assembly approval, but Glendening's priorities have generally been well received by legislative leaders.
The governor is wasting few opportunities to describe the plan in the most expansive terms. He insists that a midsized state can be a giant-killer in the fight against the disease.
"I would like Maryland to be the focal point when we for the first time find a cure for cancer," he said last week.
Such rhetoric has been met with skepticism from Glendening's political opponents. Del. Robert L. Flanagan, the House Republican whip, dismissed the governor's plan as "an effort at self-promotion" designed to bolster Glendening's national reputation.
Whatever is driving it, Maryland's anti-cancer emphasis is being noticed beyond its boundaries.
"It's perceived to be the biggest anti-cancer, anti-tobacco effort that's been undertaken by an individual state," said Eric Gally, who lobbies the General Assembly for the American Cancer Society and American Heart Association.
Matt Salo, a senior policy analyst at the National Governors' Association, tracks how the states are using their settlement funds. He said Maryland is "a leader in focusing its settlement on smoking and cancer-related programs."
Glendening is proposing to spend $300 million of the settlement money on anti-tobacco and smoking-cessation efforts. According to the Center for Tobacco-Free Kids, that makes Maryland one of just six states whose programs meet federal funding recommendations.
Maryland is by itself in its plan to invest $500 million in cancer research, prevention and treatment over the next 10 years. A few states, such as Michigan, plan to invest large sums in biomedical research, but not specifically on one of the diseases caused by smoking.
"Maryland's fairly unique in that at this point," Salo said.
Another $200 million would go toward drug treatment programs and crop conversion aid for tobacco farmers. The only spending that is not directly linked to tobacco addiction is the $700 million the governor wants to reserve for education.
The governor's single-minded attention to cancer could be broadened a bit by legislators. Del. Howard P. Rawlings, chairman of the House Appropriations Committee, says the plan will need some "tweaking" to take into account other smoking-related ills such as heart disease.
But Glendening -- who lost his mother to smoking-related lung cancer and his father at 50 to heart disease -- counters that "the more narrowly we focus, the more impact we will have."
He notes the state's strong role in cancer research at the National Institutes of Health, the Johns Hopkins University and the University of Maryland Medical Center.
"There's probably not a state in this country that has such an infrastructure for fighting cancer," Glendening said.
Health activists credit the administration with putting together a substantive program that could lower the state's cancer rate -- the fifth-highest in the country.
Dr. Martin D. Abeloff, director of the Johns Hopkins Oncology Center, said Glendening's plan shows "courage and vision."
Abeloff's employer and the UM Medical Center are the two largest beneficiaries of the plan. Both are to receive $150 million for a variety of anti-cancer projects.
The governor has appointed a panel -- boldly named the Task Force to Conquer Cancer in Maryland -- to recommend how to spend the remaining $200 million. The panel wound up a series of hearings around the state last week.
It is expected to submit its report to the governor by Nov. 1.
The proposal that the state directly fund cancer research is the most controversial item in the Glendening approach.
Supporters say it could help attract scientific talent to the state's research centers. That, in turn, would lure private companies involved in cancer research to Maryland, they say.
"This has positive economic impact on the state of Maryland," Abeloff said.
But detractors say the program could become a scientific gravy train with little specific benefit to Maryland citizens.
Delegate Flanagan said Maryland should not be in the business of funding cancer research.
"There's a reason that state governments don't take the lead in cancer research and the federal government does," he said. "For Maryland to bear the brunt of finding a cure while 49 other states spent their money on schools and roads would mean that we bear a disproportionate share of the expense."
But Stewart J. Greenebaum, former chairman of the University of Maryland Medical System and a member of Glendening's task force, said there are good reasons for conducting research at the state level.
"Will money be spent on research? You bet. But we're going to focus our research on those cancers that have a high rate of incidence in Maryland," he said.