Medicine: The Politics of Cancer

Next to heart disease, cancer kills more Americans than any other ailment. Some 335,000 people, half of them under 55, will die of cancer this year in the U.S.; one out of every four Americans now living, some 52 million people, will contract the disease at some time during their lives. For many of those who do, the prognosis is poor. Doctors can often slow or even halt the progress of cancer by surgery, radiation and drugs; but, though researchers have uncovered many disparate clues (TIME, April 19), they do not yet understand the workings of most forms of the disease, let alone how to cure it.

The numbers afflicted and the deadly nature of cancer have made it a subject of national concern, and one that is increasingly catching the attention of politicians. Republicans and Democrats alike are convinced that cancer can be cured by massive infusions of money. Sensing the political benefits to be reaped from such a victory, both parties have been maneuvering since January to gain the advantage in a fight over the fight against cancer. Now their battle is about to end in a draw that will assure an equal division of the political credit, but may also produce more promise than prophylaxis for the victims of the disease.

Old Idea. The idea that the best prescription for cancer is financial is an old one. Mary Lasker, the longtime medical philanthropist, has strenuously urged the nation to commit more of its resources to the search for a cancer cure. She has argued that the National Cancer Institute, an arm of the National Institutes of Health, lacks the means to exploit many of its important findings. Last year Mrs. Lasker picked up some powerful support in Congress when a special commission put forth her favorite proposal: a $6 billion investment in cancer research during the coming decade and creation of a new, NASA-type National Cancer Authority outside the NIH to oversee the search for a cure. Senator Edward Kennedy, who succeeded Texas’ Ralph Yarborough as chairman of the Senate subcommittee on health, put his own imprimatur on the commission’s proposal and submitted the recommendations as legislation.

President Nixon, meanwhile, had moved quickly to regain the initiative. In his State of the Union speech last January, Nixon asked Congress to increase its cancer-research budget of $232 million by $100 million. But, contrary to the Senate subcommittee’s proposal, the Administration urged that any cancer-cure program be kept within the existing structure of the NIH.

The reasons were managerial, not medical. Administration officials feared that creation of the superagency would trigger demands for similar organiza tions to fight heart disease and other illnesses. That in turn might lead to the ultimate dismemberment of the NIH, which conducts a wide variety of medical and training programs. They also worried that the NASA-type agency proposed by Kennedy would rapidly develop its own constituency on Capitol Hill, where few Congressmen would publicly oppose rising expenditures aimed at curing cancer.

Many scientists shared the Administration’s reservations. James Shannon, a director of the NIH from 1955 to 1968, argued that biomedical research could no longer be judiciously balanced if the attack on one specific problem was assigned to a special authority. Philip Lee, chancellor of the University of California, San Francisco, warned that “a separate cancer agency would immediately create competition for funds and scientific talent.”

Backers of an independent agency, however, maintained that a concerted effort is needed to exploit recent progress toward understanding the causes of cancer and ultimately develop a cure.

The result of this conflict was a compromise. Kennedy agreed to the creation of a new, ambitiously named Conquest of Cancer Agency within NIH, yet administratively independent. The agency’s director would be appointed by the President and responsible to him. Its budget requests would bypass NIH and go directly to the White House’s Office of Management and Budget. Despite reservations, the Administration accepted Kennedy’s proposal. The compromise bill will be reported out of the Senate Labor and Welfare Committee this week.

Momentum of Discovery. Creation of the new agency will allow both parties to claim political credit for taking action against cancer. It will also make more money available for basic research, which, according to Dr. James Holland of Roswell Park Memorial Institute in Buffalo, will “increase the momentum of discovery.” But it is unlikely to produce real results with anything even remotely resembling the speed of the Manhattan and Apollo Projects, with which it has been compared.

The reasons are obvious to medical researchers. Scientists understood the principles of nuclear fission long before they undertook to build an atomic bomb, and grasped the physical principles of spaceflight before they attempted to send a rocket to the moon. They have no such unified store of fundamental knowledge about cancer. Says Columbia University Researcher Sol Spiegelman: “An effort to cure cancer at this time might be like trying to land a man on the moon without knowing Newton’s laws of motion.” A better-funded research effort could help science to understand more about the many diseases that are cancer. But until that groundwork is done, any talk of curing cancer may well raise false hopes—and lead to disappointment.