CANCER'S NEMESIS: RESEARCH OR BUREAUCRACY?

As Director of a Specialized cancer Center, Dr. Hoagland
recently participated in a 3-day meeting in Naples, Florida, of
officials of the National Cancer Institute and ‘Directors of most
of the nation's Cancer Centers. “The Centers are focal points
for the conduct of cancer research, funded by N.C.I., and the
meeting encouraged full discussion of concerns, problems, trends,
etc. Dr. Hoagland felt that the meeting failed to give weight
to basic research's role in the attack on cancer and, on the

third day asked and was granted permission to address the group.

The substance of his remarks follows:

"tT have listened to our deliberations for two days and have
become increasingly troubled.iIn spite of our abysmal ignorance
about cancer, and the statistics confirming our continued failure
to influence its overall morbidity and mortality there has been
essentially no mention of basic research, or the role of the
Specialized Cancer Center. Yet if an outsider were listening in
he'd be convinced that the cancer problem is on the verge of
being solved.

“To counteract my gloom I wrote a little parable last night
which I will now pass along to you, I ask you to imagine medicine

without Xrays: pretand that in the recent past the medical
2.

profession was confronted with the following major problem:
physicians all over the country were frustrated for lack of a way
of seeing inside their patients. Clearly if broken bones and
all sorts of internal pathology could be actually seen by doctors,
an enormous breakthrough in medicine would have been achieved.

"The federal government, patterning its response on the
earlier (1972) drive to conquer cancer, sets as an additional
national objective the Conquest of Opacity. The motto "See
Inside Soon" becomes a household word. Hundreds of consultants
are brought to Washington to prepare a PLAN which eventually

. :

fills several volumes. The PLAN contains a helpful summary of
_ the consultants' efforts consisting of a large diagram that cancer
professionals throughout the country can hang on their office
walls. The diagram is in the form of a circle and in the center
is THE ANSWER labeled triumphantly "Inside Seen". Concentrically
arranged outside the center are pie-shaped segments representing
the planners' suggestions for how to reach this central goal.
These ideas are mostly ingen; ous things to do to see through
patients: suspending them before powerful electric lights, thinning
them on low calorie diets, improving techniques of opening them
up surgically, widening bodily orifices, using mirrors; all supple-
mented by various psychiatric approaches to persuade the patient
the pathology isn't there. Since these various methods are

familiar to everyone, everyone is enthusiastic about them and they

are allocated large sums of money.
3.

"Some basic research scientists had been invited to join
the planners and they too got a piece of the pie. It would have
‘ been a larger piece had they not kept arguing that we simply |
have no idea how to see through people, or even animals, and we'll
have to do more basic research on bio-transparency. Also, they
blew it when they were asked for a timetable. They said that
when you don't know where you are, you can't tell when you'll get
"somewhere. They pointed out that Columbus in mid-Atlantic in
1492 also had this shortcoming, but subsequently made an important
breakthrough. This didn't go down well--it was considered

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evasive. Furthermore, when they were asked how they would go
about making people transparent, they spoke vaguely of picking
some very smart young people and letting them figure out what to
do. This was characterized as buckpassing.

"One scientist thought it would not be a bad idea to persuade
some specialists in the fundamental properties of electromagnetic
radiation to get into the act. Maybe nature produced some
hitherto unrecognized rays that could penetrate tissues better
than ordinary light. Most of the consultants agreed that this

man had lost the sense of the mission.

"I sense at these meetings that, contrary to the bald cancer
statistics, there is a widespread conviction that we're conquer-

ing cancer; that therefore basic science has little to contribute.
4.

"Since cancer statistics don't justify this attitude, I've
tried to find other explanations and have come up with the
following:

1) Science seems not to be strongly represented among the Cancer
Center leadership. This is largely a clinical gathering. But
this doesn't help in and of itself.

2) The natural human propensity for self-delusion: in particular,
the physicians' assumption that if he's treating someone, he's
curing them. Most physicians and care-oriented persons who are,

I would surmise, the majority of those represented here, support
goals and objectives related to things they're familiar with.
“Without basic research experience and indeed uneasy about research,
they see the solution of the cancer problem as related to patient
care. Failure to improve morbidity or mortality means that
something is wrong with the patient care modality. Or, at best,
that patient-oriented "research" is called for. They are con-
vinced that federal cancer funds are for them and their patients,
because they're on the firing line. They resent the use of that
resource for things that are foreign and unfamiliar and can't
easily be related to cancer.

"This group by pure numbers, if nothing else, cannot help
but strongly influence N.C.T. They convince the policy-makers
of the wisdom of the clinical approach. They are rewarded by the

shaping of policy to fit their needs. And at each turn of the
5.
cycle basic science--the only sure way to gain insight into the
problem--gets the squeeze.

“An immense cancer-care bureaucracy is building across the
country using monies the public thought would be used to help
fina a cure or prevention. “The bureaucracy is manned by physi-
cians whose patient-care activities acquire dignity and prestige
under the guise of clinical "research". The tragedy is that
these practitioners, who deal daily with the misery of cancer,
have become instruments in the stifling of fundamental research.

"you'll recall the tale of the Emperor's New Clothes? I
submit that too many clinical oncologists see the emperor fully
clothed. The basic scientist stands on the sidelines meekly
pointing to the reality of the emperor's nudity.

“The basic research community lacks the force of numbers
and eloquence to fight the battle alone.

“TF SCIENCE IS TO BUILD THE KNOWLEDGE-BASE NEEDED TO
ELIMINATE CANCER, THE CLINICAL PROFESSIONALS MUST STAND FIRMLY

WITH THE BASIC SCIENTISTS AS VIGOROUS ADVOCATES OF CONTINUED

GENEROUS SUPPORT OF FUNDAMENTAL RESEARCH."