The Mid-Life Crisis of the National Cancer Act

I was born into an atmosphere of swelling national optimism about the future of cancer.

In fact, I can argue that I was conceived as the US Senate unanimously approved Senate Resolution 376 in late April 1970, the stem cell of what would first be known as the Conquest of Cancer Act. In January of 1971, just weeks before I was born, S. 34, the Conquest of Cancer Act, was introduced in the 92nd Congress. Over the next ten months, the National Cancer Act and I developed at a rapid pace. More money, more enthusiasm, more optimism, more and more and more.

We the people never felt more confident about the future of cancer than two days before Christmas, 1971, a stirring, swelling politico-optimism captured in black and white by photographer Linda Bartlett in the White House East Room as President Nixon officially signed all that optimism into a law known as the National Cancer Act of 1971.

A stroke of the pen launched the 'War on Cancer', adopting the combat rhetoric popular then—and now—to describe humanity's bitter, vitriolic relationship with this disease.

You can watch it unfold in a clip of the signing itself below. A couple things to note, beyond the usual awkwardness that accompanies official Presidential moments like these:

• 1) Nixon introduces the head of the American Cancer Society (ACS) as the head of the non-existent entity the National Cancer Society;
• 2) The ACS chief's unrestrained optimism culminates in his calling the National Cancer Act, "Probably the greatest thing that's ever been done by the United States";
• 3) Check out the youthful Senator from Massachusetts, Ted Kennedy, then-chair of Senate subcommittee on health care and among Nixon's primary political rivals, as he maneuvers himself into a spot directly behind the President for a high-scoring photo-op.

This year that optimism turns 38 years old and it's reaching middle age. The Act liberated the National Cancer Institute out from under the National Institutes of Health and made it the object of an enormous amount of funding to find a 'cure'. It also helped to establish the National Comprehensive Cancer Network (NCCN), which today includes the best cancer hospitals in the US, such as Fred Hutchinson, Memorial Sloan-Kettering and MD Anderson, to name a few.

Absent from the hoopla is Senator Gaylord Nelson, D-Wisconsin, the only US Congressman known to have voted against the National Cancer Act. Did Senator Nelson know something others didn't know?

Can't say for sure, but perhaps Nelson—a man widely credited for launching the first Earth Day in 1970—objected to the fact that the Act paid almost no attention to finding the causes of cancer, or to early detection, or to determining methods of cancer prevention. Rather, the optimistic—but widely misguided—mentality that fueled the National Cancer Act of 1971 was often framed in lunar terms: Apollo XI put men on the moon, if NASA could do that, then surely a similarly structured government organization can cure cancer. The NCI even brought in NASA engineers as consultants.

It doesn't take a genius to note how horribly flawed this logic is. What does one achievement have to do with the other? Fundamentally, nothing at all. In fact, in countering this mentality, then-director of Columbia University's Institute of Cancer Research, Sol Spiegelman, noted that "an all-out effort at this time [to find a cure for cancer] would be like trying to land a man on the moon without knowing Newton's laws of gravity."

Reminds me of a well-known line from Thoreau's Walden, "There are a thousand hacking at the branches of evil to one who is striking at the root, and it may be that he who bestows the largest amount of time and money on the needy is doing the most by his mode of life to produce that misery which he strives in vain to relieve."

In evaluating the issue of whether or not the National Cancer Act of 1971 has been successful or not, we probably have to borrow a line from Ronald Reagan, who during a debate with President Carter in 1980 famously suggested that voters ask themselves whether or not they were
better off now than they were four years ago, or in our case, 38 years ago.

In statistical terms, in percentages and mortality rates and in results of epidemiological studies, the answer is not really. Writing in late 2009, author and clinical professor of medicine Dr. Reynold Spector commented that in his own view, "the principal problem is that we just do not understand the causes of most cancers", a stark statement that could have been made—and probably was, and often—38 years ago, before any of the $100 billion had been spent on the quest for a cure to a multi-faceted disease that we just don't understand.

Yet for all its misdirection, publicly funded medical research—such as the research done at the NCI and at academic centers throughout the country thanks in large part to the National Cancer Act—has been the primary source of the overwhelming majority of innovation often mis-credited to the pharmaceutical industry.

The overt goal of the National Cancer Act was to defeat cancer, and in 2010, by its own measures, the Act has failed. But its own measures—the premise on which it was built—were flawed, something we understand better now.

So as the National Cancer Act reaches middle age, I think it's a mistake to count the wins and losses or point too many fingers. There are so many talented men and women at work right now trying to find solutions to treat the 200 or so types of cancer, and the bottom line is that it requires funding. The community is more aware than ever of just how difficult a problem this is. The rest of us must hope and be optimistic that another big breakthrough is right around the corner.

SOURCES AND ADDITIONAL READING:
- Profiles in Science at the National Library of Medicine: Mary Lasker's Cancer Wars
- Samuel S. Epstein, M.D.'s Cancer Prevention Coalition, a site highly critical of the 'War on Cancer'.
- Cure Cancer? Not Without A Course Correction, by Merrill Goozner.
- Devra Davis, PhD. The Secret History of the War on Cancer. New York: Basic Books, 2009.
- Marcia Angell, MD. The Truth About the Drug Companies: How They Deceive Us and What to do About it. New York: Random House, 2004.
- Reynold Spector, MD, "The War on Cancer: A Progress Report for Skeptics", Skeptical Inquirer, Volume 34 No 1, January/February 2010.