Losing The War on Cancer:
The ‘Awful Numbers’ Revisited
May 20, 1976
David M. Rorvik
Inveighing ever more stridently against the cancer “quacks,” whose menace in reality is no more than that of mere sitting ducks, the American Cancer Society cautions us to keep our sights firmly on “progress” and “proven cures” in the billion-dollar-a-year “War on Cancer.” In its publication, “Unproven Methods of Cancer Management,” the ACS states: “When one realizes that 1,500,000 Americans are alive today because they went to their doctor in time, and that the proven treatments of radiation and surgery are responsible for these cures, he is less likely to take a chance with a questionable practitioner or an unproven treatment.” While health statisticians seek in vain to discover any substantive data that might even remotely authenticate this broad claim, other ACS spokesmen are not reluctant to make even more preposterous assertions. Helene Brown, president of ACS in California (front line in the guerrilla war with the cancer “quacks”), takes mighty strides against the most-feared disease of our generation each time she makes a public pronouncement, stating on one recent occasion that “there are now ten kinds of cancer which can be cured or controlled by chemotherapy” and, on another, astounding even the optimists with her conviction that “present medical knowledge makes it possible to cure 70 percent of all cancers, if they are detected early.”
Hope apparently springs eternal in Ms. Brown’s unmastectomized bosom ”” and so does it at ACS headquarters where, if as one cancer researcher put it, “Brown is the Martha Mitchell of the cancer establishment,” she is at least its unrepentant, pro-Watergate Martha Mitchell whose pronouncements still find favor in the inner sanctum of the cancer court. For Ms. Brown’s optimism, however at variance it may be with the facts, is reflected in numerous ACS publications. In the ACS’s “Hopeful Side of Cancer,” for example, the first sentence boasts that “Cancer is one of the most curable of the major diseases in this country.” Over at the National Cancer Institute, meanwhile, the situation has not been much different. NCI director Frank J. Rauscher Jr. has been fond of claiming that “the five-year-survival rate for cancer patients in the 1930s was about one in five. Tcday the figure is one in three.” Both NCI and ACS persistently seek to convey the idea that progress, steady and sure, is being made, that there’s light at the end of the tunnel if only Congress and the public will keep the funds flowing.
James Watson, the Nobel Prize winner whose discoveries in biology are fundamental to our further understanding of living matter, whether malignant or benign, asserts from a perch as nearly objective as one can attain in this imperfect society that our now vastly inflated national cancer program, the result of ex-President Nixon’s declared “War on Cancer,” the National Cancer Act of 1971 and the ensuing billions of tax dollars, is a complete “sham.”1 A medical moonshot that misfired at its inception ”” except that the television cameras weren’t there to make the disaster immediately evident, with the result that most Americans believe the “rocket” is still moving steadily toward its target.
Just a billion dollars a year for ten years, and we’ll cure 90 percent of all cancer, Dr. R. Lee Clark, president of the M.D. Anderson Hospital and Tumor Institute in Houston, promised in the 1960s. And Ralph Yarborough, then a Democratic Senator from Texas, bit. When it became evident that the Democrats might cop the next post-Apollo “spectacular,” so did Nixon. The National Cancer Act of 1971 zoomed through Congress with only Gaylord Nelson, Democrat of Wisconsin, dissenting in the Senate, objecting to the Act as “a mischievious political compromise of a very important scientific matter.” Today, the nearly autonomous National Cancer Institute has an annual budget of about $800 million, with which, its critics claim, it is merely perpetuating, albeit in greater comfort, the same vested medical interests which failed us with equal aplomb when they were funded at the still-generous, pre-1971 $200 million level.
By 1975, with funding at the half-billion-dollar level, Dr. Watson said that from his inside view, serving on the National Cancer Advisory Board, it was clear to him that the National Cancer Plan was having no impact and that the more than doubling of funds had merely doubled pre-existing programs. As for those claims of steady progress, Dr. Watson charges that “the American public is being sold a nasty bill of goods. While they are being told about cancer cures, the cure rates have improved [since the 1950s] only about one percent.”
ACS/NCI propaganda to the contrary went largely unchallenged by the press until science writer Daniel S. Greenberg, author of The Politics of Pure Science, wrote an article for Columbia Journalism Review (January/February 1975) deploring both the misrepresentations of the cancer establishment and the press’ unquestioning acceptance of its claims. The article loosed a storm of controversy and, finally, a flurry of “rebuttals” which were patently unsuccessful, managing only to point up more flaws in the official claims and to reveal an even greater capacity for distortion than had previously been exhibited.
When all was said and done, the “awful numbers” Greenberg marshalled with the assistance of an unnamed “government health economist who is well-versed in cancer statistics” remain dolefully intact, unscathed by the attempts of Dr. Rauscher, cancer researcher Emil Frei, NCI statistician Sidney Cutler, ACS science editor Alan Davis and others to undo them.2 The facts, to which NCI statistics bear witness, are these: most of the “progress” ACS/NCI take credit for occurred before the early 1950s, in a period when cancer research funding was very small. The most compelling explanation for the pre-1955 improvement in survival rates is the post-war introduction of blood transfusions and antibiotics, both of which enabled more victims to survive not cancer per se but cancer surgery and attendant infections.
Since the 1950s, the five-year-survival rate for patients diagnosed as having forms of cancer which, together, constitute 66 percent of the total incidence of the disease increased by five percentage points or fewer. The three biggest killers fall into this disappointing category ”” lung cancer, with one percent increase in survival, breast cancer with a four percent increase and cancer of the colon with a one percent increase. In another category, accounting for 12 percent of the incidence, survival rates actually declined since the 1950s. Cancers of the vulva, penis, lip, bone and esophagus are among those that fall into this group. Survival rates for those stricken with cancers accounting for the remaining 22 percent may be said, by some standards, to have improved more than five percent, but this is scarcely enough to justify calling cancer “one of the most curable of the major diseases.”
UCLA cancer researcher and epidemiologist Dr. James Enstrom cautions, moreover, that “the situation is really significantly worse than the official statistics [used by Greenberg and others] suggest.” If one resists the convenient, arbitrary separation of cancers by body-organ affected (for there is still no proof that one cancer differs fundamentally from another) and examine all cancers together, then, Dr. Enstrom says, Dr. Watson is absolutely right: “survival rates have remained virtually constant since the 1950s.” Furthermore, the data that is used to calculate the official statistics, he adds, “is heavily biased to begin with” because only the “best” hospitals, with better ancillary care, are allowed to contribute. Poorer hospitals with lower general standards of care and without the capacity to calculate “reliable” statistics are excluded. It is not unusual, Dr. Enstrom observes, to find twice as many patients dying of cancer in those poorer hospitals, yet these deaths are not represented in the final statistical sample. Dr. Enstrom and a colleague at the California Tumor Registry, a major contributor to the NCI’s official compilation of statistics, are conducting a thorough analysis of the cancer statistics and are finding, they say, biometrical errors of sufficient magnitude to render “almost entirely unreliable” the five-year survival data that has been used to support claims of “progress” in the cancer war.
A government authority on cancer statistics, economist Morton Klein of the Department of Health, Education and Welfare, says his findings agree with those of Dr. Enstrom. Klein, who may now be identified as the statistician who assisted Greenberg, asserts that credit is often taken by the ACS/NCI where no credit is due. Much has been claimed for the efficacy of “early detection” in cutting cancer mortality, for example, but in fact, says Klein, there is no real evidence that the Pap smears, which are the leading edge of early detection today, have had any true impact. The “positive progress” that has been claimed in the battle against cervical cancer, he points out, is “not progress in terms of early detection or effective therapy; it just happens that the incidence, the number of women coming down with cervical cancer, has been declining dramatically for reasons no one understands. Those women who still get it, however, are not surviving any longer than they used to. The Pap smear, meanwhile, did not come into effect until the middle or later stages of the observed decline in incidence; in other words, the mortality was declining at the same slope [rate] that it is today well before Pap smears were used.”
Dr. Hardin B. Jones, a professor of physiology and medical physics at the University of California, Berkeley, has painstakingly analyzed cancer statistics for decades. He finds today, as he found in the 1950s and 1960s, that “evidence for benefit from cancer therapy has depended on systematic biometric errors,” that “in the matter of duration of malignant tumors before treatment, no studies have established the much-talked-about relationship between early detection and favorable survival after treatment,” that “neither the timing nor the extent of treatment of the true malignancies has appreciably altered the average course of the disease,” and that “the possibility exists that treatment makes the average situation worse.”
A number of independent studies, reports, researchers tend to confirm this bleak outlook. Here is a sampling:
- Dr. Ian MacDonald, an internationally known cancer surgeon, now deceased, presented extensive data on breast cancer in the American Journal of Surgery (March 1966) and concluded that “the massive educational, diagnostic and therapeutic attack on mammary carcinoma of the past two decades has failed to alter rates of incidence and mortality of this most frequent malignant neoplasm in female patients. Reports on the therapy of mammary cancer in the surgical literature often lack significance through selected samples of small size and the lack of statistical validation.” When the statistical errors are accounted for, he added, the corrected data “lend little if any support to the case for ‘early’ diagnosis.”
- In 1968, speaking at the Sixth National Cancer Conference, Dr. Phillip Rubin, director of the Division of Radiation Therapy at Washington University School of Medicine, said: “The clinical evidence and statistical data in numerous reviews are cited to illustrate that no increase in survival has been achieved by the addition of irradiation.” Sharing the same platform, Dr. Vera Peters of Princess Margaret Hospital in Toronto added: “In carcinoma of the breast the mortality rate still parallels the incidence rate, thus proving that there has been no true improvement in the successful treatment of the disease over the past 30 years, even though there has been technical improvement in both surgery and radiotherapy during this time.”
- Seven researchers studied individuals afflicted with inoperable lung cancer, comparing survival times of those who received radiation therapy against those who received placebos (sugar pills). The results were published in the journal Radiology (April 1968). The authors conclude: “In several respects, the present study may be regarded as unique in character. It is prospective, large-scale, and multi-discipline. It involves strict randomization of concurrent, well-matched, inoperable male subjects between radiation, anti-tumor agents and placebo….Our results show that even though the difference in survival between the irradiated group and the control group was statistically real, the actual prolongation of life was discouragingly small. Of the patients given radiation, only four percent more were alive at the end of one year, and their median survival time was only 30 days longer than that of those who received an inert compound (lactose).” Scrupulously honest in their presentation, the researchers, who had clearly hoped to find a significant positive effect from radiation, noted that “patients given radiation therapy generally received better supportive care than control patients. Irradiated subjects had longer hospitalization and there was a general effort to maintain general health and to treat infections more vigorously during the course of radiation therapy. To what extent this affected the slightly better survival experience cannot be assessed.”
- A group of researchers at Oxford University in England have published (a 1975 issue of the journal Lancet) a paper, which confirms a previous study. Both studies reach the astonishing conclusion that the best treatment for inoperable lung cancer is no treatment. In the confirming study, patients were divided into three groups, those receiving no treatment, those receiving continuous single-agent chemotherapy and those receiving an intermittent combination of chemotherapies. The conclusion: no treatment “proved a significantly better policy for patients’ survival and for quality of remaining life.”
- Chemotherapies, in general, have been assessed by some to be largely ineffective ”” or worse. Dr. Dean Burk, while serving as head of the Cytochemistry Division of the NCI, addressed a letter to his boss, Dr. Rauscher, critical of the latter’s 1972 White House statement that “the chemotherapy program is one of the best program components that the NCI ever had.” Dr. Burk observed: “Frankly, I fail to follow you here. I submit that a program of FDA-approved compounds that yield only five-to-ten percent ‘effectiveness’ can scarcely be described as ‘excellent,’ the more so since it represents the total production of a 30-year effort on the part of all of us in the cancer-therapy field.” Even that five-to-ten “effectiveness,” he adds, is suspect, possibly being more than offset (in the majority of patients who do not benefit from chemotherapy) by shorter survival and lower quality of remaining life occasioned by the (widely acknowledged) great toxicity of nearly all approved chemotherapies, most of which, Dr. Burk has observed, are capable of causing cancer in their own right.
- Dr. Matthew Block, professor of medicine at the University of Colorado Medical Center states (in a letter-to-the-editor, Medical World News, July 5, 1974) that by far the most valid way or assessing adequacy of cancer therapies is by comparing individuals treated with those therapies with individuals who receive no treatment at all. Therapies for Hodgkin’s disease (where great progress is frequently claimed), he says, have not been evaluated in this fashion, with the result that those claims are not necessarily valid. “In the case of chronic lymphatic leukemia as we see it in adults,” he continues, “if the survival time is no better than it was 30 years ago, then we must conclude that there is something we are doing to these people that is making their survival shorter.” Why shorter? Because, he explains, we have now largely overcome those “incidental” infections, such as pneumonia, which, 20 and 30 years ago, killed so many chronic sufferers of leukemia. “Furthermore,” he goes on, “the use of transfusions as well as other aspects of better ancillary care should have increased longevity in this disease, and if it is not any better we must then conclude that [despite] all the advantages now available, indeed longevity has been decreased by treatment [emphasis added].”
- Three researchers reporting on Hodgkin’s disease in the Archives of Internal Medicine (December 1974) compare treated and untreated individuals suffering from the disease (much as suggested by Dr. Block above). “The group that was given no therapy initially, yet survived long enough to be treated subsequently, is important in showing the extent of basic variation in the natural history of the disease and, indeed, that their eventual treatment may have had little effect on their survival. It should also be noted that, after one year from diagnosis, the survival of untreated patients is better than that of those who received subsequent therapy.”
- Dr. John C. Bailar, writing in The Annals of Internal Medicine, says that the “promotion” of the latest effort at early detection, routine mammography (X-ray examination of the breast) is “premature.” He documents the carcinogenic risks of such radiation and “regretfully” concludes, “that there seems to be a possibility that the routine use of mammography in screening a symptomatic women may eventually take almost as many lives as it saves.” Later he emphasizes that the “radiation hazards may be of the same order of magnitude as the benefits.” Yet Dr. Rauscher and spokesman of the ACS have been pointing with pride to programs encompassing mammography, citing these programs as evidence of new progress.
- Finally, there comes news that the cancer mortality rate, which has been going up by about one percent per year for some time, rose by roughly three percent in 1975. NCI and officials at the National Center for Health Statistics have attempted to characterize the rise as illusory, the stuff of statistical artifacts. They have also sought to “explain away” the rise by attributing it, in part, to the influenza epidemic of 1975, the idea being that flu is sufficient to kill sufferers of chronic diseases, such as cancer. But this hypothesis, swallowed wholesale by much of the press, including The New York Times (which further embarrassed itself, in this writer’s view, with an editorial called “Statistical Hypochondria,” insisting that more “illuminating commentary” accompany the next batch of frightening statistics lest we again overlook something like the flu factor), has more holes in it than the Watergate tapes.
Dr. Enstrom points out that the mortality rate for cancer was, during the first ten months of the year “3.5 percent higher for cancer but 3.7 percent lower for heart disease, whereas both should have increased if flu was a major factor.” Moreover, in years when flu epidemics nearly paralleled the 1975 epidemic (1951, 1953, 1957 and 1960) there was, he says, “only a small increase in the cancer rate,” as opposed to the whopping three-fold increase last year.
Meanwhile the National Cancer Rocket clunks along, blissfully far off course, which is exactly where the cancer generals, representing the varied vested interests of chemotherapy, radiotherapy, immunotherapy and virology, want to keep it, according to their critics. Despite overwhelming evidence that most cancers are caused by environmental factors, the obvious, preventive approach to cancer has been studiously ignored by those who control the cancer program. This fact was emphasized recently by a subcommittee of the National Cancer Program’s highest level advisory board, which reported: “There was an obvious sense of general astonishment … that the National Cancer Program does not appear to have accorded an adequate priority nor sense of urgency to the field of environmental chemical carcinogenesis….it would seem that the problem has been accorded a low priority…and, as far as could be judged, to absorb perhaps ten percent of the budget….” The lion’s share of the cancer “cause-and-prevention budget” is being siphoned off in pursuit of a human cancer virus, the existence of which remains wholly unproved after decades of study costing millions. Mindful of this, the subcommittee, which does not, however, have the power to set policy, recommended a sharp cutback in viral research, noting that “a viral etiology for most human cancers is an unlikely eventuality.”
Another National Cancer Advisory Board subcommittee, chaired by one of the most distinguished names in cancer research, Dr. Norton Zinder, microbial genetics professor at Rockefeller University, investigated the viral research effort and observed: “It was only natural that when the SVCP [Special Virus Cancer Program] was formed, a small group of investigators was involved ”” an ‘in group.’ It now represents a somewhat larger ‘in group’ of investigators. Administratively, its procedures lack vigor, are apparently attuned to the benefit of staff personnel and are full of conflicts of interest …. the program seems to have become an end in itself, its existence justifying its further existence.” In the wake of this scorching evaluation, which went on to specify several conflicts of interest, SVCP cleaned out some of the administrative cobwebs, but Dr. Zinder still doesn’t believe anyone is going to come up with a viral anti-cancer vaccine. Ever. Dr. Rauscher, however, has indicated that he will resist a significant cutback in viral research ”” which is, incidentally, his own field of expertise and the centerpiece of the National Cancer Program.
Is the situation entirely hopeless? No. Most of those knowledgeable in the realm of cancer politics say that pressure from the public (through Congress) and from those segments of the scientific community which have not already been compromised by the cancer money can, in time, effect the shift from attempted cure (so far a dismal failure) to prevention, where a solid basis for defending against the disease clearly exists. When Congress insisted last year that NCI spend a couple million on nutritional aspects of cancer (a mandate NCI actually resisted) it was indulging in gross tokenism (given the total budget of nearly a billion dollars) but at least it was tokenism in the right direction. More recently President Ford’s Council on Environmental Quality issued a 763-page report which concludes that up to 90 percent of all cancers are caused by factors in the environment, most of them man-made. And this group of scientific experts, at least, didn’t bother to try to justify past mistakes by juggling the statistics. They simply stated that the incidence of cancer in the United States has more than doubled since the start of the century and that there has been only barely discernible improvement in survival rates since the 1950s, the cancer establishment’s self-serving protestations to the contrary notwithstanding.
Dr. Weeks’ Comment:
It is a potent truth: “Today there are more people living off cancer than dying from cancer.”