The American Cancer Debate
Sir: We are in debt to The Spectator and Dr Bernard Dixon for bringing to public notice what he calls "the Great American Debate on Cancer Research " in his article 'Cancer words' (July 3). Unfortunately, he misses the nature of the key issue in this difficult controversy. " Put in the crudest terms," he writes, the debate "has been about which politician can seize the most spectacular initiative in mounting a new, massive scientific onslaught on the mystery of cancer." Dr Dixon pictures the two protagonists, President Nixon, who wants an intensified attack on the disease centred in the existing structure of the National Institutes of Heath, and Senator Edward Kennedy, who proposes removing the National Cancer Institute from the NIH and reorganizing it into an in
dependent National Cancer Authority, avoiding the problems of setting research priorities and creating the best working climate for the scientists. At issue, Dr Dixon thinks, is presidential politics, for "the debate has had as much to do with who will succeed to the White House in 1972 as with the benchwork or philosophy of cancer research." He agrees with Professor Seymour S. Cohen, whose article " Cancer Research and the Scientific Community" in the journal Science (June 18) is the starting point for his own essay, that an appropriate administrative form cannot be chosen in the absence of well-defined goals, programs and priorities, a process requiring the participation of scientists at every stage.
Surely politics and personalities play a role in the American cancer research debate. It is a mistake, however, to think that once the goals and priorities of a major biomedical undertaking are decided the administrative form becomes apparent. This is obvious from the debate among scientists who agree on the objectives of an intensified cancer research program but disagree about the details of institutional structure and operation. At the heart of the argument between Nixon and Kennedy is not Presidential politics but which organizational set-up will best facilitate a sustained attack on cancer. Kennedy concurs with the report of the National Panel of Consultants on the Conquest of Cancer, established by a Senate resolution, that "there is real doubt whether the kind of organization that is required for this program can in fact be achieved within the National Institutes of Health or within the Department of Health, Education, and Welfare." In view of this conclusion Kennedy and his colleague Senator Jacob Javits proposed the creation of an independent agency within the executive branch of the Federal government to be known as the National Cancer Authority and having as its objective the conquest of cancer at the earliest possible time. Supporters of an independent agency argue that it would be free of the bureaucracy in HEW and thereby able to mobilize and direct the scientific effort needed. Opponents, which includes the Nixon Administration, contend that the removal of cancer research from the mainstream of biological investigation represented by the various units of the NIH threatens the viability of the government's primary bio-medical enterprise. On July 7 the Senate approved a compromise, by a vote of 79 to 1, which creates the Conquest of Cancer Agency. It would absorb the old National Cancer Institute and be part of the NIH but with virtually independent status, having its own budget not subject to approval by the NIH. The Agency's director would report to the President. The compromise Bill has received Nixon's public blessing, and passage in the House of Representatives, where there is considerable support for a cancer agency, is expected. Last January Nixon announced he would ask Congress for $100 million to fund the program.
The difficulty of a large operation of this nature is that means and ends interact so that thinking about them separately does not take one very far. Even though the broad outlines of the new agency have been determined the scientists and administrators must work as hard as ever on defining goals, programs and priorities. As Dr Dixon notes, the questions about the allocation of money for cancer research and diagnosis concern not only American scientists but the international scientific community and the world public. He calls for a wider debate of the issues in a wider forum. Whether this happens remains to be seen. Only with time can a judgement be made about the effectiveness of the Conquest of Cancer Agency and whether it can serve as a model for other countries or the United Nations.
Harold Fruchtbaum Professor of the History and Philosophy of Public Health, Columbia University, New York
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