NEWS

Report Questions Status of National Cancer Institute

Charles Marwick

Among the recommendations of the report by the National Research Council and the Institute of Medicine that would, it is argued, enable the National Institutes of Health to meet emerging challenges and move its research programs forward is one calling for Congress to reassess the provisions of the National Cancer Act of 1971. By doing so it has opened a Pandora’s box.

"I think this is a nonviable, politically charged distraction which would have been better off not being in the report," declared David Korn, M.D., senior vice president for research at the Association of American Medical Colleges (AAMC), adding that this was his own opinion and not that of the AAMC. It has almost no chance of going anywhere, but it will upset the strong, vocal, and well-organized cancer advocacy community, he predicted.

Korn was for 7 years chair of the National Cancer Advisory Board. However, from the NIH director’s seat it is not a felicitous situation. As Korn put it, "different NIH directors have lived with a separate NCI with varying degrees of discomfort."

A representative of this "well organized advocacy community" in essence agrees. John Seffrin, M.D., chief executive officer of the American Cancer Society, said that the society would be very reluctant to see any diminution of the NCI.

The report did not recommend any change in the NCI’s present status nor diminution in its authority. Rather it called for a re-evaluation. "We did not recommend that the present arrangement should be eliminated. But we were struck by the anomaly that 17% of the NIH budget is outside the control of the NIH director," said Harold T. Shapiro, Ph.D., president emeritus, Princeton University, and chair of the committee that wrote the report.

Under the 1971 Act, the president appoints the NCI director and its budget bypasses that of NIH. "So you have roughly one-fifth of the organization that doesn’t have to pay any attention [to the director] and that leads to substantial problems. We think it ought to be reexamined. I don’t want to predict what that examination would yield, but it does strike us as an anomaly," Shapiro said.

Supporting the recommendation to review the status of NCI, Richard Rettig, Ph.D., senior social scientist with RAND Corp. in Arlington, Va., said that the organizational changes that created substantial autonomy for NCI "have weakened the NIH and the office of the director." Rettig is the author of Cancer Crusade, a history of the 1971 act.

Perhaps more important, Rettig said, is the fact that the National Cancer Act has had "little discernible effect on scientific and clinical progress for the diagnosis, treatment, or prevention of cancer. A review by Congress of the effect of the 1971 Act and its effect on NIH and the war on cancer would be salutory."



             
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