Medicine: Cancer's Apollo Program

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"Simply throwing money at problems does not solve anything."

—Richard Nixon, March 1973

Many doctors would agree with the President's opinion. That is one of the reasons why they have been rallying to oppose the aims of the Administration-backed National Cancer Act of 1971, which authorized an ambitious and costly program to wipe out cancer through a coordinated attack. Cancer, they argue, cannot be conquered by a massive, single-minded effort.

As directed by Congress, the National Cancer Institute has spent more than a year preparing its project for submission to the President. The resulting five-year National Cancer Plan, produced through the efforts of 250 scientists, has as its objective to "develop the means to reduce the incidence, morbidity and mortality of cancer in humans." It calls for the expenditure of $426 million this year and $500 million next year—at a time when funds for other areas of medical research are being sharply curtailed.

The plan lists a series of goals —from prevention of cancer to rehabilitation of its victims—and outlines a number of approaches for the accomplishment of each. It also would concentrate the nationwide anti-cancer effort in the NCI, and leaves little doubt about where the emphasis will be placed. "Direct application to treat people has to be the first priority," says Dr. Frank Rauscher Jr., head of NCI. "This could mean that as funds get tighter, basic research could be deprived of adequate funds. I can't see any other way." Outside the NCI, the National Cancer Plan has won few friends in the medical world. A committee from the National Academy of Sciences' Institute of Medicine has criticized the plan for leaving the impression that "all shots can be called from a central headquarters." It has also taken issue with the assumption that most of the knowledge needed to conquer cancer is already in hand. Says the committee: "It seems to us a defect of the N.C.P. that the enormity of our ignorance receives less emphasis than it merits."

Built-in Rigidity. Many biological researchers believe that the plan has built-in rigidity that they fear could stifle creative thinking. But the most frequently heard criticism of the plan concerns the de-emphasis of basic research. "It's ridiculous to compare the conquest of cancer with putting a man on the moon,"* says Dr. Robert Good, director of Sloan-Kettering Institute for Cancer Research in New York City. "At the time the Apollo project was initiated, we knew all the basic information we had to know in order to go to the moon. We simply do not have that information about cancer."

To overcome this deficit, Good urges the NCI to expand its budget for basic research, while continuing to apply current knowledge whenever possible. He also advocates abandoning the plan to limit NCI support to scientists working in cancer-related fields. "If we're going to make a thrust on cancer," says Good, "it must be in addition to what is being done in other areas. If we try to solve the cancer problem while ignoring others, we're not going to solve anything."