Nearly three decades ago, in response to America's growing fear of a most elusive and deadly foe, Richard Nixon declared a "war on cancer." Behind this charge was the notion that personifying cancer as a battlefield enemy would lead to its "defeat." Politicians, keen on the potency of this issue, have followed his lead, picking up votes along the way. This "war" may contribute more to a congressman's longevity in the house than to a constituent's longevity. Yet, as politicians funnel money towards a "good cause," cancer provides the perfect alibi for dubious motives and wasteful appropriations.
The political obsession with cancer is out of proportion to its real risks. Contrary to the warnings of more apocalyptic observers, there is no cancer epidemic in this country. The irony of waging this modern war on cancer is that Americans are living longer and healthier than ever. The disease is primarily one of the old, not the young. Famed cancer researcher, Richard Peto, wrote in 1994, "The common belief that there is an epidemic of death from cancer in developed countries is a myth, except for the effects of tobacco... But if we take away the cancer deaths that are attributed to smoking then the cancer death rates that remain are, if anything, declining... For most non-smokers, the health benefits of modern society outweigh the new hazards. Apart from tobacco (and in many places, HIV), the Western world is a remarkably healthy place to live." [R. Peto et al., Mortality from Smoking in Developed Countries, 1950-2000 (Oxford: Oxford University Press, 1994)].
Despite this reality, politicians are fueling misconceptions of cancer risk, fanning public fears, then offering protection in exchange for votes, especially from women.
To hear New York Sen. Alfonse D'Amato describe it, he wasn't running for re-election against any ordinary opponent. He was running against cancer. With voter support, Dr. D'Amato would continue the fight once safely back in office. He advertised his support for greater breast-cancer research funding. He vowed to create "mayhem" in the Senate when Democratic lawmakers foolishly allied themselves with cancer by temporarily blocking his legislation to require insurance companies to cover the cost of reconstructive breast surgery. And when Geraldine Ferraro, then seeking the Democratic Party nomination to run against him, dared to suggest that Mr. D'Amato was "politicizing" the issue, the senator said he was outraged and demanded an apology.
Mr. D'Amato may or may not defeat cancer in the fall campaign. But his efforts have certainly strengthened him in the race against his Democratic opponents. Independent pollster John Zogby told Capitol Hill newspaper Roll Call that the breast-cancer campaign helped reposition the senator as a political moderate, one obsessed not with the Whitewater investigation he led as head of the Senate Banking Committee, but with the environment, gay rights, restitution for Holocaust victims from Swiss banks and, yes, "women's issues." As a lawmaker who opposes abortion rights, Mr. D'Amato used the breast-cancer issue to lessen the appeal of Democratic candidates to women. It's a campaign tactic whose success is measured not in new cancer research but in polling percentages. "He's shaved a few points off the gender gap," Mr. Zogby said.
Mr. D'Amato isn't the only lawmaker running against cancer.
In North Carolina, Republican Sen. Faircloth has used ads to show his support for the creation of a postage stamp that would raise about $16 million a year for breast cancer research. "To most people, a stamp is a way to send a letter," says a narrator in a Faircloth TV ad. "For one man, it's a way to provide hope. Now when you use this special postage stamp, more money goes to breast cancer research." The ad is expected to help Mr. Faircloth close the "gender gap" that might hurt him in his race against Democrat John Edwards.
Mr. Edwards struck back saying that in fact Mr. Faircloth had been AWOL in the war on cancer. The Senator, he said, opposed votes that would have increased research funding by far more than a stamp would. "It's going to take more than a postage stamp to cover up Lauch Faircloth's poor record on women's health," an Edwards campaign spokeswoman told Roll Call.
In South Carolina, Democratic Sen. Ernest Hollings ran hundreds of thousands of dollars worth of TV advertising showcasing two breast cancer victims praising the senator for his work on the issue. His good intentions about women's health notwithstanding, observers suggested there were more mundane, political ends at work too.
"The educated, white man is not voting for Democrats anymore in the South, so to win here (Democrats) have to create a gender gap by talking about education and health care, things that get you a second look among women," said one prominent South Carolina Democrat. "Republicans like Faircloth and [South Carolina Republican Senate candidate Bob Inglis] can only win by closing that gap, and that's what they're trying to do."
In Indiana, a Democratic House candidate attacked her opponent for refusing to meet with women who lived through breast cancer. The allegedly insensitive opponent declared the meeting was a set-up.
In Illinois, Democratic gubernatorial candidate Glenn Poshard pledged to give any money left over from his campaign to a national breast cancer education and support group. It's doubtful that he will have to pay up since it's unlikely he will have any left over.
The "war on cancer" doesn't just crop up during the fall election season; it's an integral part of the Washington political scene. New Jersey Sens. Robert Torricelli and Frank Lautenberg pressed President Clinton to restore federal funding for a study of an alleged "cancer cluster" in Dover Township. In New York, Rep. Rick Lazio touted a Long Island "cancer forum" to bring together medical experts and parents whose children suffer from the disease. New York Democratic Representative Louise Slaughter boasted of a half-million-dollar grant to help researchers determine the needs of parents of children with cancer and ensure that appropriate services are available.
The politics of cancer is by no means new. In 1969, a woman named Mary Lasker organized a Citizens' Committee for the Conquest of Cancer, which launched its campaign in newspaper advertisements, saying, "This year, Mr. President, you have it in your power to begin to end this curse ... We are so close to a cure for cancer. We lack only the will and the kind of money ... that went into putting a man on the moon. Why don't we try to conquer cancer by America's 200th birthday" in 1976. Mrs. Lasker, like other members of the crusade, had known cancer victims, including her husband, and set out to reduce the number of future victims.
Maybe Mr. President heard these pleas, because in 1971, Massachusetts Sen. Edward Kennedy joined other members of a Senate health subcommittee trying to get enough money to enable the National Cancer Institute to make defeating cancer a "national crusade." Standing in the way was then-President Nixon, who refused to sign the bill so long as the senator was a chief sponsor. Mr. Nixon had lost to the senator's brother in the 1960 race and, the Boston Globe reported, didn't want the Kennedy family to get the credit for the legislation. The senator removed his name from the bill, an administration bill was substituted with a different sponsor, and the president signed the bill. Mr. Kennedy later attended the White House signing ceremony.
For Senator Kennedy, the politics would come to matter less. His son developed a rare cancer that invades both the cartilage and bone, but survived. The expensive war on cancer helped, Mr. Kennedy said. "Has the $34 billion we've spent been worth it? I can speak as a father," the senator told the Globe. Without the medical innovations supported by the war on cancer, he says, his son "never would have made it."
But it wasn't just the toll the disease took that helped drive this crusade. Calls for cancer action tap into feelings of helplessness in the face of human mortality. Politicians feel compelled to respond, often by pandering blindly to hysteria regardless of marginal benefits. Scientific reasoning when inconsistent with public opinion does little to placate a desperate electorate. The public has a lingering fear that somehow the United States and the industrial world in general had loosed cancer on themselves, that the very technological breakthroughs and scientific progress some hoped would cure cancer were actually infected with it. They carried the cancer "germ" in their pesticides, food additives and other synthetic, man-made potions.
In 1959 concerned lawmakers passed into law the so-called Delaney Clause, another front in the war on cancer which prohibited the addition of animal carcinogens to the food supply. In 1962, Rachel Carson published "Silent Spring," which linked pesticides and other man-made substances not just to "poison" but to an unnamed long-latency disease (cancer), aggravating public fears about an already fearful and mysterious disease. A growing environmental movement and the media played up those concerns.
In 1975, Dan Rather famously opened a documentary entitled "The American Way of Death," saying, "The news tonight is that the United States is number one in cancer. The National Cancer Institute estimates that if you're living in America your chances of getting cancer are higher than anywhere else in the world." Politicians responded with a host of laws designed to limit exposure to threatening substances.
The fallout from this particular aspect of the cancer war continues to this day, notwithstanding the good news from the front. A Sept. 21, 1998, article in the New York Times recounted the grim tale of a New Jersey woman who had noticed that an unusual number of children, among them her son, had developed similar types of cancers. "She reasoned," the Times reported, "that it must be something in the water or air, some unnoticed chemical lurking under a toxic-waste dump or factory but in any case, a specific factor that she assumed could be located, analyzed and then eradicated."
She and other like-minded citizens have turned their discontent into political action. Having held a high-profile meeting with President Clinton in August and having appeared in some of Sen. D'Amato's campaign ads, the paper reported, "they have become a driving force behind tens of millions of dollars' worth of new research into cancer clusters."
Mr. D'Amato has done nothing to discourage such fears. Legislation he introduced to allow breast-cancer patients an indefinite stay in the hospital is, he said in a press release, "particularly important for the women of Long Island. Our families have been ravaged by this horrible disease. Our grandmothers, mothers and daughters, sisters and wives, children and friends have been afflicted at rates that are unexplained and far too high."
It's possible, although unlikely, that some "cancer clusters" are more than just a statistical fluke. One can't rule out the possibility that someone, someday may find that minimal, non-occupational exposures to this or that chemical of the kind people in New Jersey might face elevates cancer incidence. But to date there just isn't any evidence to link such exposures to "cancer clusters." It remains a hypothetical risk.
But the costs of such fear-mongering are definitely not hypothetical. These are just two of many similar episodes:
The late '70s evacuation of the New York community known as Love Canal, where tiny exposures to chemicals leaking from a waste repository, did not mean greater protection from cancer for local residents. Scientists could find no link between the two. It did mean a tear in the social fabric, researchers noted, because fathers tended to play down the health risks of Love Canal and resisted leaving; mothers tended to leave with the children. In too many cases, divorce followed.
The 1989 Alar scare over a growth regulator applied to apples, which CBS "60 Minutes" called the most carcinogenic substance in the food supply, sent panicked parents chasing after school buses to remove the offending fruit from lunch boxes. The scare also had the effect of discouraging the consumption of fresh fruits and vegetables, of which researchers said children should be eating more, not less.
There is one other major cost associated with cancer scares. While concern in communities about higher-than-expected cases of cancer is understandable, the intense pressure to find such a connection diverts both money and attention from basic cancer research. Moreover, it encourages people to disregard known cancer risks, such as smoking and over-exposure to sunlight, in favor of hunting down theoretical risks. And it can encourage politicians sensitive to public opinion to implement policies that target the wrong enemies.
Politicians can affect public health for better or for worse. They should not focus on unfounded health scares, nor substitute campaign slogans for scientific principles. While the toll of the disease on sufferers and their families is undeniably terrible, the relentless fear of cancer and its "invisible agents" poses social and psychological problems of its own, particularly to persons living in alleged cancer clusters. If politicians are committed to "defeating" cancer, they should focus on sound strategies, like discouraging tobacco use, a truly preventable risk factor for numerous cancers. Rigorous science, not the agendas of campaign-crazed politicians, should direct our cancer resources. It is important to make sure in this "war on cancer," that when victory comes, it is not a Pyrrhic one.