The year 1996 marks the 25th anniversary of the "war on cancer." It is an appropriate time to assess the situation in cancer treatment. In 1971, at President Nixon's urging, Congress voted to expand the mission of the National Cancer Institute (NCI) and utilize vast new resources for the newly created National Cancer Program.

Since that time, the budget of the NCI has grown to about $2 billion per year. Over $25 billion has been spent at the national level on the war on cancer, with another $25 billion or so in private research funds, mostly from the American Cancer Society.

Once established, such a huge industry, and powerful bureaucracy, will fight for its continued existence. Thus, as we approach the 25th anniversary, you can expect to hear a great many claims that this $25 billion has been well spent, and that we should prepare to spend not just an equivalent, but a greater sum in the future.

I would like to review with you some of the facts concerning the situation in the war on cancer.

--This year, there will be almost 1.4 million new cases of cancer. This does not include superficial skin cancers, of which there will be an additional 800,000 cases per year. The incidence of some kinds of cancer have risen astronomically. Thus there has been a 548 percent increase in lung cancer among women; a 347 percent increase in malignant melanomas; a 205 percent increase in multiple myeloma; and a 190 percent increase in prostate cancer (from 1950 to 1991).

--The cancer death rate was 163 per 100,000 population in 1970 but was 172 per 100,000 in 1992. Lung cancer, which was very rare in the early years of this century, has risen at an astronomical rate. Put another way, in 1962 there were 278,000 Americans dying of cancer. By 1982, that figure had risen to 433,000. Last year it was 547,000. This year, according to the American Cancer Society, there will be 554,000 deaths from cancer this year. This death rate is especially pronounced among the elderly, minorities, and the uninsured and under-served groups.

These are the basic facts. Whatever else may be promised from the "war on cancer," one thing is clear. It has not appreciably lessened either the incidence or the deaths from cancer. True, the death rates for some kinds of cancer have leveled off or even declined slightly. But the case of stomach cancer is illustrative. Since the turn of the century, and especially since 1930, both incidence and mortality from this cancer has declined precipitously. But not only is this not due to any conscious intervention on the part of the medical community, but no one even knows why this is happening. The same can be said about colon and rectum cancer. In the case of uterine cancer, there is also a decline, which is generally attributed to widescale use of the Pap smear. However, it will be noted that (like stomach cancer) that decline began much earlier and was well underway by the time the Pap test was instituted in the 1940s.

What does NCI say in rebuttal to these charges? You can get a copy of their "National Cancer Program: Pathways to Progress" to see. They claim:

--Cancer patients are living longer than ever before with a better quality of life. Forty years ago, 35% of cancer patients lived five years or more.

--Today, because of advances in detection and treatment, more than 50% of cancer patients live for five years or longer.

There are serious problems with this line of argument, however. One is "lead time bias." This was first explained in the pages of the Journal of the National Cancer Institute itself in the late 1960s (Hutchison, GB and Shapiro, S. JNCI 1968;41:666-673). This bias "extends the statistical length of a patient's survival without necessarily prolonging the duration of life."

"Even if the therapy is ineffectual," says Yale University School of Medicine Prof. Alvan R. Feinstein, "the period of survival will be increased" because of "added time that is provided by the early, pre-symptomatic detection of the disease." So the earlier the cancer is detected, the longer the patient seems to "survive." In actuality, however, no time has been added to the patient's years. They are dying with the same regularity as before. But the statistics look a whole lot better. It is hasty and unjustifiable to attribute this apparent improvement to any intervention by the medical community.

NCI also states, "8.5 million Americans who have had cancer are alive today." This is a dubious statistic, since it (a) reflects the great increase in cancer incidence, which is a bad thing, not a good thing. For instance, there is an explosion of incidence of prostate cancer, being detected through tests such as the PSA (Prostate Specific Antigen). Many of these cancers would never have been detected before, because they are "sleeping tumors," that never would have come to clinical attention in the past. Today, they are being routinely discovered and treated, and thus inflate not just the incidence rates but the numbers of people who "had cancer and are alive today."

Other claims from the NCI are that "quality of life for cancer patients, during and following treatment, has dramatically improved." I would like to see the documentation for this claim. In writing Questioning Chemotherapy last year, I investigated the question of "quality of life" in regards to chemical treatments. I found that there were few if any randomized studies yielding clear evidence of an improvement in quality of life through chemotherapy. In fact, subjective well-being is rarely measured in clinical trials. Experts in the U.S. and Europe bewail the fact that "there are few reliable objective measurements of the quality of life to enable documentation of such improvements." Dr. Ulrich Abel of Germany correctly points out that 'the clinician has the duty to furnish proof that cytotoxic treatment improves the quality of life; it is not the critic's task to demonstrate absence of evidence." NCI never provides proof of improvement of quality of life--just self-serving claims of the same.

NCI tries to gloss over the enormous financial cost of cancer to both individuals and society. Cancer is or will be an economic catastrophe for nearly two thirds of American families. Bone marrow transplantations cost in the neighborhood of $150,000. By my calculations, the overall cost of cancer treatment in America is now approximately $100 billion per year. Yet NCI comments that "basic research in cancer has spurred the growth of the biotechnology industry in America." As if the growth of an industry whose rationale is the continued existence of diseases like cancer is automatically a good thing. Shouldn't NCI be seeking to diminish both the incidence and the cost of such illnesses? The economic "benefits" of the existence of this industry are far outweighed by the harm done by cancer. Arguing in this way is unseemly. It smacks of the same rationale used by tobacco spokesperson use for the continued existence of their industry. (I.e., it is good for the country because it creates job).

I hardly need mention the other superficial arguments used by NCI to justify its course of action, e.g., that the program has "trained physicians and health professionals who specialize in caring for cancer patients" and that they have built a "network of cancer centers" across the country. They, quite simply, have lost focus and forgotten that the goal is to have no doctors specializing in cancer, just as we no longer have or need doctors specializing in beri-beri, scurvy or pellagra.

During the 1980s and early 1990s the NCI set itself the ambitious goal of halving the mortality rate of cancer. They had to quietly drop that goal when it became clear that in many groups cancer was increasing, not decreasing. They now seem quite at a loss as to what to do. Even their optimistic projections convey a negative tone. "The hope for a simple cure faded as research of the past two decades," they write. "Cancer is far more complex and formidable than previously realized." They complain how "complicated," cancer is, how "unique" each tumor is, how resistant to treatment, how it requires "time and effort...many years, even decades" to make progress.

We have heard this before. The leaders of the cancer war are so locked into their own rather narrow world view that they cannot see outside it. They cannot step outside it and consider that it may be the way they have conceived this disease that is at fault. That the system that has been set up to evaluate new treatments precludes real breakthroughs. That radical problems need radically new solutions.

How is the system at fault? It currently costs around $230 million to develop a new drug in the United States. Most of that money goes to fulfilling the bureaucratic requirements of the Food and Drug Administration. The pot of gold at the end of this rainbow is a patent, a 17-year legal monopoly. It allows the drug manufacturers to charge whatever the market will bear for their products. But to have a strong patent you have to have a unique product, something never seen before by others. That is one reason that scientists seek to synthesize agents in the test tube, so-called" rational drug design." It has not resulted in any conspicuous success in cancer treatment so far. It is not likely to do so any time soon.

What this set-up precludes is any serious investigation of non-toxic, less-toxic, natural, nutritional, or immunological approaches to cancer. These are square pegs trying to fit into round holes. I could speak about many such cases, but I will mention one, a product called MTH-68. This is an attenuated strain of the Newcastle Disease Virus. NDV causes a fatal disease in chickens, but is "apathogenic" in humans. The worst is causes is conjunctivitis, "pinkeye," and even this is very rare.

A Hungarian-American scientist named Laszlo Csatary, M.D., and his wife, Eva, developed this as a medicine after they saw a chicken farmer have a complete remission of cancer after his flock came down with Newcastle Disease. MTH-68 has undergone Phase II testing in Hungary, a test headed by the former director of the European Union Against Cancer. There are a number of possible mechanisms for its mode of action. It stimulates the immune system and may compete for uptake with certain carcinogenic or co-carcinogenic viruses.

The results in Hungary have been very positive. But although this is well-known to the American cancer establishment (NDV has been featured prominently and positively in the Journal of the National Cancer Institute) there is practically zero interest in this topic. The preliminary data gathered in Hungary show that this could be of benefit to thousands, probably tens of thousands of American patients.

How can you explain this lack of interest? To me it is simple. No drug company sustains an interest in this topic for long. Although the Csatarys do have a particular strain of the virus, essentially it is as free as the air. Once the drug company has spent $230 million on its development, anyone at all can come along and make a slight modification on that formula. Good-bye investment.

There are many other examples. There are 102 of them in my book Cancer Therapy. The basic fact is that economics rules cancer therapy. And unless the structure of drug development changes radically, I am afraid that either we or our descendants will be back here in another 25 years--to "celebrate" the 50th anniversary of the war on cancer. More expenditures, more cancer centers, more programs-and more excuses why a cure cannot be found.

--Ralph W. Moss, Ph.D.