SCIENCE
Cancer words
BERNARD DIXON
After the Great American Debate on Cancer Research, it's time we had a debate on cancer research. Such was the argument deployed by Professor Seymour Cohen in last week's issue of the journal Science. For those who have been disgusted, frustrated, or merely bored by the way in which cancer research has become a political football in the United States over the past year — with President Nixon and Senator Edward Kennedy as principal players — such a suggestion may sound unoriginal, to say the least. But Seymour Cohen is right, for two reasons. He discusses one of them in his article; the other falls outside its scope but is of equal importance.
Put in the crudest terms, the Great American Debate on Cancer Research has been about which politician can seize the most spectacular initiative in mounting a new, massive scientific onslaught on the mystery of cancer. In particular, Kennedy has advocated removing the National Cancer Instit,,tp frrwn the NA tion/1 Institutes of Health, Bethesda, and turning it into a mission-orientated Cancer kestufch Authority, with all the dedication and glamour of a Space Agency. Nixon wants to mount the new campaign within the existing structure of the NIH. The argument between the two has been raging for the best part of a year and is still unsettled, the latest news being that a compromise plan will probably emerge.
The scandal of the whole business is that the protagonists have not been arguing about research priorities, or about how to create the best working climate for the scientist. 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. Cohen's point is that is it wrong to argue about administrative forms without first discussing goals, priorities and programmes with the scientists themselves.
Admittedly, cancer poses some of the most baffling riddles anywhere in modern science, making intellectual comparison of research targets particularly frustrating. For that very reason, the history of cancer research includes many bitter reminders of mistaken priorities in the past. At one extreme, a massive but largely empirical screening programme, for anti-tumour drugs, conducted at the NIH, produced disappointingly poor returns. A costly mission-orientated project of just the type Nixon and Kennedy have been arguing over, it was a comparative failure. On the other hand, the policy of supporting any scientist with a convincing theory or idea can also be unduly wasteful. On that basis, virtually any biologist studying cells, for whatever purpose, can justify financial support. Cancer is a disorder of growth. So any research on cells just might give a clue to the riddle of malignancy. QED.
Before beginning this article*I checked through my files on cancer research for the past five years. It was a depressing exercise. Even forgetting the poorer work immortalized in the literature, there was a disquieting number of former breakthroughs and "highly p'romising " reports — on the role of viruses in cancer, means of inducing malignant ce: s to revert to normal, and so on—which have not yet borne fruit. Several, alas, have disappeared from view completely. Today, again, there are encouraging signs that those molecular biologists who study the fundamental hereditary and metabolic behaviour of cells, rather than pursue cancer research per se, may be on the verge of real progress that throw light on the process of cancer. But all the experience of the past underlines the need for caution.
All the more reason, then, for scientists to be involved in the hard thinking that ought to precede new administrative initiatives in research. And because science, like cancer itself, is international, scientists in all countries should be involved. But there is also a wider debate that should take place, in a wider forum. How much money ought to go into fundamental cancer research, aimed at understanding what happens when cells become malignant, and how much into the discovery and perfection of treatments, and the development of diagnostic methods? What of the allocation of money between research as such and the making available of existing know-how in diagnosis and treatment?, These questions concern not only scientists and clinicians, but all of us as citizens. My own view is that, while it is vital to continue with fundamental cancer research, we should plough rather more of our resources into diagnosis — and into research on new methods of diagnosis. We simply don't make the best use of the excellent tools already at our disposal. Last year an expert committee convened by the World Health Organization concluded that over half of all cancers could now be treated successfully if diagnosed early. That fact ought to be spelled out loud and clear whenever anyone anywhere discusseS cancer. And we should act on it.
Previous page
