American Cancer Society & Its Conflicts of Interest by Samuel S. Epstein M. D.

CONFLICTS OF INTEREST 
Of the members of the ACS board, about half are clinicians, oncologists, surgeons, radiologists, and basic molecular scientists— and most are closely tied in with the NCI. Many board members and their institutional colleagues apply for and obtain funding from both the ACS and the NCI. Substantial NCI funds go to ACS directors who sit on key NCI committees. Although the ACS asks board members to leave the room when the rest of the board discusses their funding 
proposals, this is just a token formality. In this private club, easy access to funding is one of the "perks," and the board routinely rubber-stamps approvals. A significant amount of ACS research funding goes to this extended membership. Such conflicts of interest are evident in many ACS priorities, including their policy on mammography and their National Breast Cancer Awareness campaign (6).

Mammography 
The ACS has close connections to the mammography industry. Five radiologists have served as ACS presidents, and in its every move, the ACS reflects the interests of the major manufacturers of mammogram machines and films, including Siemens, DuPont, General Electric, Eastman Kodak, and Piker. In fact, if every woman were to follow ACS and NCI mammography guidelines, the annual revenue to health care facilities would be a staggering $5 billion, including at least $2.5 billion for premenopausal women. Promotions of the ACS continue to 
lure women of all ages into mammography centers, leading them to believe that mammography is their best hope against breast cancer. A leading Massachusetts newspaper featured a photograph of two women in their twenties in an ACS advertisement that promised early detection results in a cure "nearly 100 percent of the time." An ACS communications director, questioned by journalist Kate Dempsey, responded in an article published by the Massachusetts Women's 
Community's journal Cancer: "The ad isn't based on a study. When you make an advertisement, you just say what you can to get women in the door. You exaggerate a point. . . . Mammography today is a lucrative [and] highly competitive business."

In addition, the mammography industry conducts research for the ACS and its grantees, serves on advisory boards, and donates considerable funds. DuPont also is a substantial backer of the ACS Breast Health Awareness Program; sponsors television shows and other media productions touting mammography; produces advertising, promotional, and information literature for hospitals, clinics, medical organizations, and doctors; produces educational films; and, of course, lobbies Congress for legislation promoting availability of mammography services. In virtually all of its important actions, the ACS has been strongly linked with the mammography industry, ignoring the development of viable alternatives to mammography.

The ACS exposes premenopausal women to radiation hazards from mammography with little or no evidence of benefits. The ACS also fails to tell them that their breasts will change so much over time that the "baseline" images have little or no future relevance. This is truly an American Cancer Society crusade. But against whom, or rather, for whom?

National Breast Cancer Awareness Month 
The highly publicized National Breast Cancer Awareness Month campaign further illustrates these institutionalized conflicts of interest. Every October, ACS and NCI representatives help sponsor promotional events, hold interviews, and stress the need for mammography. The flagship of this month-long series of 
events is National Mammography Day, on October 17 in 1997. 
Conspicuously absent from the public relations campaign of the National Breast Cancer Awareness Month is any information on environmental and other avoidable causes of breast cancer. This is no accident. Zeneca Pharmaceuticals— a spin-off of Imperial Chemical Industries, one of the world's largest manufacturers of chlorinated and other industrial chemicals, including those incriminated as causes of breast cancer— has been the sole multimillion-dollar funder of 
National Breast Cancer Awareness Month since its inception in 1984. Zeneca is also the sole manufacturer of tamoxifen, the world's top-selling anticancer and breast cancer "prevention" drug, with $400 million in annual sales. Furthermore, Zeneca recently assumed direct management of 11 cancer centers in U. S. hospitals. Zeneca owns a 50 percent stake in these centers known collectively as Salick 
Health Care.

The link between the ACS and NCI and Zeneca is especially strong when it comes to tamoxifen. The ACS and NCI continue aggressively to promote the tamoxifen trial, which is the cornerstone of its minimal prevention program. On March 7, 1997, the NCI Press Office released a four-page "For Response to Inquiries on Breast Cancer." The brief section on prevention reads:

“ Researchers are looking for a way to prevent breast cancer in women at high risk. ... Alargestudy [is underway] to see if the drug tamoxifen will reduce cancer risk in women age 60 or older and in women 35 to 59 who have a pattern of risk factors for breast cancer. This study is also a model for future studies of cancer prevention. Studies of diet and nutrition could also lead to preventive strategies.”

Since Zeneca influences every leaflet, poster, publication, and commercial produced by National Breast Cancer Awareness Month, it is no wonder these publications make no mention of carcinogenic industrial chemicals and their relation to breast cancer. Imperial Chemical Industries, Zeneca's parent company, profits by manufacturing breast cancer– causing chemicals. Zeneca profits from treatment of breast cancer, and hopes to profit still more from the prospects of large-scale national use of tamoxifen for breast cancer prevention. National Breast Cancer Awareness Month is a masterful public relations coup for Zeneca, providing the company with valuable, if ill-placed, good will from millions of American women. 

The Pesticide Industry 
Just how inbred the relations between the ACS and the chemical industry are became clear in the spring of 1993 to Marty Koughan, a public television producer. Koughan was about to broadcast a documentary on the dangers of pesticides to children for the Public Broadcasting Service's hour-long show, Frontline. Koughan's investigation relied heavily on an embargoed, ground-breaking report 
issued by the National Academy of Sciences in June of 1993 entitled "Pesticides in the Diet of Children." This report declared the nation's food supply "inadequately protected" from cancer-causing pesticides and a significant threat to the health of children.

An earlier report, issued by the Natural Resources Defense Council in 1989," Intolerable Risk: Pesticides in our Children's Food," had also given pesticide manufacturers failing marks. The report was released in high profile testimony to Congress by movie actress Meryl Streep. A mother of young children, Streep explained to a packed House chamber the report's findings, namely, that children were most at risk from cancer-causing pesticides on our food because they consume 
a disproportionate amount of fruits, fruit juices, and vegetables relative to their size, and because their bodies are still forming. Shortly before Koughan's program was due to air, a draft of the script was mysteriously leaked to Porter- Novelli, a powerful public relations firm for produce growers and the agrichemical industry. In true Washington fashion, Porter-Novelli plays both sides of the fence, representing both government agencies and the industries they regulate. Its client list in 1993 included Ciba-Geigy, DuPont, Monsanto, Burroughs 
Wellcome, American Petroleum Institute, Bristol-Meyers-Squibb, 
Hoffman-LaRoche, Hoechst Celanese, Hoechst Roussel Pharmaceutical, Janssen Pharmaceutical, Johnson & Johnson, the Center for Produce Quality, as well as the U. S. Department of Agriculture, the NCI, plus other National Institutes of Health.

Porter-Novelli first crafted a rebuttal to help the manufacturers quell public fears about pesticide-contaminated food. Next, Porter-Novelli called up another client, the American Cancer Society, for whom Porter-Novelli had done pro bono work for years. The rebuttal that Porter-Novelli had just sent off to its industry clients was faxed to ACS Atlanta headquarters. It was then circulated by e-mail on March 22, 1993, internally— virtually verbatim from the memo Porter-Novelli 
had crafted for a backgrounder for 3,000 regional ACS offices to have in hand to help field calls from the public after the show aired.

" The program makes unfounded suggestions . . . that pesticide residue in food may be at hazardous levels," the ACS memo read. "Its use of `cancer cluster' leukemia case reports and non-specific community illnesses as alleged evidence of pesticide effects in people is unfortunate. We know of no community cancer clusters 
which have been shown to be anything other than chance grouping of cases and none in which pesticide use was confirmed as the cause." 
This bold, unabashed defense of the pesticide industry, crafted by Porter- Novelli, was then rehashed a third time, this time by the right-wing group, Accuracy in Media (AIM). AIM's newsletter gleefully published quotes from the ACS memo in an article with the banner headline: "Junk Science on PBS." The article opened with "Can we afford the Public Broadcasting Service?" and went on to disparage Koughan's documentary on pesticides and children. "In Our 
Children's Food . . . exemplified what the media have done to produce these `popular panics' and the enormously costly waste [at PBS] cited by the New York Times."

When Koughan saw the AIM article he was initially outraged that the ACS was being used to defend the pesticide industry. "At first, I assumed complete ignorance on the part of the ACS," said Koughan. But after repeatedly trying, without success, to get the national office to rebut the AIM article, Koughan began to see what was really going on. "When I realized Porter-Novelli represented five agrichemical companies, and that the ACS had been a client for years, 
it became obvious that the ACS had not been fooled at all," said Koughan. "They were willing partners in the deception, and were in fact doing a favor for a friend— by flakking for the agrichemical industry." 
Charles Benbrook, former director of the National Academy of Sciences Board of Agriculture, worked on the pesticide report by the Academy of Sciences that the PBS special would preview. He charged that the role of the ACS as a source of information for the media representing the pesticide and produce industry was "unconscionable" (11). Investigative reporter Sheila Kaplan, in a 1993 
Legal Times article, went further: "What they did was clearly and unequivocally over the line, and constitutes a major conflict of interest" (12). 

Cancer Drug Industry 
The intimate association between the ACS and the cancer drug industry, with cur-rent annual sales of about $12 billion, is further illustrated by the unbridled aggression which the Society has directed at potential competitors of the industry (13). Just as Senator Joseph McCarthy had his "black list" of suspected communists and Richard Nixon his environmental activist "enemies list," so too the ACS 
maintains a "Committee on Unproven Methods of Cancer Management" which periodically "reviews" unorthodox or alternative therapies. This Committee is comprised of "volunteer health care professionals," carefully selected proponents of orthodox, expensive, and usually toxic drugs patented by major pharmaceutical companies, and opponents of alternative or "unproven" therapies which are 
generally cheap, nonpatentable, and minimally toxic (13).

Periodically, the Committee updates its statements on "unproven methods," which are then widely disseminated to clinicians, cheerleader science writers, and the public. Once a clinician or oncologist becomes associated with "unproven methods," he or she is blackballed by the cancer establishment. Funding for the 
accused "quack" becomes inaccessible, followed by systematic harassment. The highly biased ACS witch-hunts against alternative practitioners is in striking contrast to its extravagant and uncritical endorsement of conventional toxic chemotherapy. This in spite of the absence of any objective evidence of improved survival rates or reduced mortality following chemotherapy for all but some relatively 
rare cancers.

In response to pressure from People Against Cancer, a grassroots group of cancer patients disillusioned with conventional cancer therapy, in 1986 some 40 members of Congress requested the Office of Technology Assessment (OTA), a Congressional think tank, to evaluate available information on alternative innovative therapies. While initially resistant, OTA eventually published a September 1990 report that identified some 200 promising studies on alternative 
therapies. OTA concluded that the NCI had "a mandated responsibility to pursue this information and facilitate examination of widely used `unconventional cancer treatments' for therapeutic potential" (14).

Yet the ACS and NCI remain resistant, if not frankly hostile, to OTA's recommendations. In the January 1991 issue of its Cancer Journal for Clinicians ACS referred to the Hoxsey therapy, a nontoxic combination of herb extracts developed in the 1940s by populist Harry Hoxsey, as a "worthless tonic for cancer." However, a detailed critique of Hoxsey's treatment by Dr. Patricia Spain Ward, a leading contributor to the OTA report, concluded just the opposite:" More recent literature leaves no doubt that Hoxsey's formula does indeed contain many plant substances of marked therapeutic activity" (13).

Nor is this the first time that the Society's claims of quackery have been called into question or discredited. A growing number of other innovative therapies originally attacked by the ACS have recently found less disfavor and even acceptance. These include hyperthermia, tumor necrosis factor (originally called Coley's toxin), hydrazine sulfate, and Burzynski's antineoplastons. Well over 100 promising alternative nonpatented and nontoxic therapies have already been identified (15). Clearly, such treatments merit clinical testing and evaluation by 
the NCI using similar statistical techniques and criteria as established for conventional chemotherapy. However, while the FDA has approved approximately 40 patented drugs for cancer treatment, it has still not approved a single nonpatented alternative drug.

Subsequent events have further isolated the ACS in its fixation on orthodox treatments. Bypassing the ACS and NCI, the National Institutes of Health in June 1992 opened a new Office of Alternative Medicine for the investigation of unconventional treatment of cancer and other diseases. Leading proponents of conventional therapy were invited to participate. The ACS refused and still refuses. The NCI grudgingly and nominally participates while actively attacking 
alternative therapy with its widely circulated Cancer Information Services. Meanwhile, the NCI's police partner, the FDA, uses its enforcement authority against distributors and practitioners of innovative and nontoxic therapies. In an interesting recent development, the Center for Mind-Body Medicine in Washington, D. C., held a two-day conference on Comprehensive Cancer Care: Integrating Complementary and Alternative Medicine. According to Dr. James Gordon, president of the Center and chair of the Program Advisory Council of the NIH Office of Alternative Medicine, the object of the conference was to bring together practitioners of mainstream and alternative medicine, together with cancer patients and high-ranking officials of the ACS and NCI. Dr. Gordon warned alternative practitioners that "they're going to need to get more rigorous
with their work— to be accepted by the mainstream community" (16). However, no such warning was directed at the highly questionable claims by the NCI and ACS for the efficacy of conventional cancer chemotherapy. As significantly, criticism of the establishment's minimalistic priority for cancer prevention was effectively discouraged.

THE ROLE OF ACS IN THE WAR AGAINST CANCER 
The launching of the 1971 War Against Cancer provided the ACS with a well-exploited opportunity to pursue it own myopic and self-interested agenda. Its strategies remain based on two myths— that there has been dramatic progress in the treatment and cure of cancer, and that any increase in the incidence and mortality of cancer is due to aging of the population and smoking, while denying any significant role for involuntary exposures to industrial carcinogens in air, water, consumer products, and the workplace.

As the world's largest nonreligious "charity," with powerful allies in the private and public sectors, ACS policies and priorities remain unchanged. Despite periodic protests, threats of boycotts, and questions on its finances, the Society leadership responds with powerful public relations campaigns reflecting denial and manipulated information and pillorying its opponents with scientific McCarthyism.

The verdict is unassailable. The ACS bears a major responsibility for losing the winnable war against cancer. Reforming the ACS is, in principle, relatively easy and directly achievable. Boycott the ACS. Instead, give your charitable contributions to public interest and environmental groups involved in cancer prevention. Such a boycott is well overdue and will send the only message this "charity" can no longer ignore. The Cancer Prevention Coalition (chaired by the author) in April 1999 formally announced a nationwide campaign for an economic boycott of the ACS ( http://www.preventcancer.com). 

Published in:  International Journal of Health Services Vol. 29, No. 3, 1999.

11. Kaplan, S. PR Giant makes hay from client cross-pollination: Porter/ Novelli plays all sides. PR Watch, First quarter, 1994, p. 4. 

12. Kaplan, S. Porter-Novelli plays all sides. Legal Times 16( 27) :1, November 23, 1993. 

13. Moss, R. W. Questioning Chemotherapy. Equinox Press, Brooklyn, N. Y., 1995. 

14. U. S. Congress Office of Technology Assessment. Unconventional Cancer Treatments. U. S. Government Printing Office, Washington, D. C., 1990. 

15. Moss. R. W. Cancer Therapy: The Independent Consumer's Guide to Non-toxic Treatment and Prevention. Equinox Press, Brooklyn, N. Y., 1992. 

16. Castellucci, L. Practitioners seek common ground in unconventional forum. J. Natl. Cancer Inst. 90: 1036– 1037, 1998.