Title American Cancer Society: The World’s Wealthiest “Non-profit” Institution
Source International Journal of Health Services, Volume 29, number 3, 1999
Author Samuel S. Epstein
Faculty Evaluator Cindy Stearns Ph.D.
Student Researcher Jennifer Acio-Peters & Lisa Desmond
The American Cancer Society (ACS) is growing increasingly wealthy, thanks to donations from the public and funding from surgeons, drug companies, and corporations that profit from cancer cures. More than half the funds raised by the ACS go for overhead, salaries, and fringe benefits for its executives and other employees, while most direct community services are handled by unpaid volunteers. The value of cash reserves and real estate totals over $1 billion, yet only 16 percent of funds go into direct services for cancer victims. Conflicts of interest affect ACS’s approach to cancer prevention. With a philosophy that emphasizes faulty lifestyles rather than environmental hazards, the ACS has refused to provide scientific testimony needed for the regulation of occupational and environmental carcinogens. The Board of Trustees includes corporate executives from pharmaceutical industries with a vested interest in the manufacture of both environmental carcinogens and anti-cancer drugs.
The American Cancer Society continues to conduct business as usual with little mainstream media coverage of its activities. There are a few notable exceptions.
The United Way of Los Angeles has changed its approach toward charitable donations, resulting in the ACS regional office standing to lose about $700,000 in United Way funding. Needless to say, it opposes the fundraiser’s decision. Whether the United Way can adhere to its new policy or must capitulate to the demands of large national institutions like the ACS remains to be seen.
The Ohio Division of the ACS made local and regional news when its chief administrative officer was accused of embezzling nearly half the organization’s $15 million annual budget. Daniel Stephen Wiant wired $6,936,250 from an ACS account to an investment banker in Kufstein, Austria, and then promptly left the country. The ACS Ohio Division was unaware the money was gone until six days later when notified by the FBI. The incident underscores the lax financial control within the organization. As the Columbus Dispatch commented, “[T]he claim by one society official that the organization has ‘superlative’ financial controls is simply unbelievable.” Wiant had a recent criminal record spanning 10 years including convictions in Hawaii, California, and Ohio. The ACS started doing background checks on its employees since Wiant’s hire, especially of those, like Wiant, who are put in charge of finances. Curiously, this incident followed an earlier embezzlement of $150,000 by another individual.
The Dispatch raised the issue of general ACS credibility, referring to a May 1998 survey that showed that while 96 percent of Americans recognize the organization by name, only 5 percent know what it does with its money. In his book, Unhealthy Charities, Thomas DiLorenzo points out that $140 million of the $556 million the ACS raised in 1998 went to administrative and advertising costs.
Information regarding ACS revenues and compensation for high level officials also found its way into print in 2000. A National Journal article listed the American Cancer Society’s 1998 Internal Revenue filings. According to the IRS, the ACS had revenues totaling $241,577,836. The CEO at the time, John R. Seffrin, received a $325,000 salary along with $94,571 in benefits and allowances.
Incidentally, President Clinton’s fiscal year 2001 budget is reported to include an unprecedented funding increase to explore the environmental causes of diseases like breast and prostate cancer. Undoubtedly, some of these funds will find their way to the American Cancer Society. Along the way, the investment practices of charitable foundations in general came under scrutiny. The Bill and Melinda Gates Foundation, the largest charitable foundation with a $22 billion endowment, spends much of its money on efforts to help “improve people’s lives through health and learning.” However, the New York Times discovered that while it supports charities like Cancer Lifeline and ACS, it also owns bonds in the Philip Morris tobacco company.
Tamoxifen, championed by ACS, reappeared in the news. AstraZeneca’s product remains controversial and has been challenged by reportedly more effective drugs, according to the San Antonio Breast Cancer Symposium. The symposium took place in late 1999, yet tamoxifen is still widely used. Despite new information, the Food and Drug Administration (FDA) is still conducting research on the drug.
The FDA has had its own problems with AstraZeneca this past year. In August, they had to caution the makers of tamoxifen against publishing misleading information in journal ads and promotional brochures, which suggesting that their drug was more effective than studies had actually demonstrated. They also understated its side effects. Such advertisements had appeared in journals targeting obstetricians, gynecologists, and other doctors who care for women.
Sources: PR Newswire, December 10, 1999, & March 14, 2000; The National Journal, Inc., January 15, 2000; The Los Angeles Times, January 20, 2000; International Journal of Health Service, Volume 30, Number 2, 2000, “Legislative Proposals for Reversing the Cancer Epidemic and Controlling Run-Away Industrial Technologies, by Samuel S. Epstein; The Plain Dealer, June 8, June 19, & August 24, 2000; The Columbus Dispatch, June 11, & July 8, 2000; The New York Times, June 11, 2000, “Charities’ investing: Left Hand, Meet Right,” by Reed Abelson; USA Today, August 8, 2000.
2000 Update by author Samuel S. Epstein
The American Cancer Society Threatens the National Cancer Program
Operating behind closed doors and with powerful political connections, the American Cancer Society (ACS) is charged with forging a questionable and possibly illegal alliance with the federal Centers for Disease Control and Prevention (CDC) in attempts to hijack the National Cancer Program. The background to the ACS political agenda reveals a pattern of self-interest, conflicts of interest, lack of accountability, and non-transparency, to which the media have responded with deafening silence.
President Nixon’s 1971 National Cancer Act, mandating the National Cancer Program directed by the National Cancer Institute (NCI), is under powerful attack by the ACS, the world’s largest non-religious charity. The ACS is lobbying to replace the 1971 Act by new legislation, assigning responsibility to and requiring coordination between the private sector, patient advocacy groups, and the public sector, the NCI, and CDC. Of major concern are the highly questionable close CDC-ACS relationship and efforts to divert emphasis and funds away from NCI’s peer-reviewed scientific research to CDC’s state and community public health programs primarily focused on screening and behavioral intervention.
The September 26, 1998, “March: Coming Together to Conquer Cancer,” brought several advocacy groups representing 125,000 survivors to Washington, DC. However, it failed to create a community of scientists and patients unified by a common political agenda, and even strained their willingness to collaborate. The ACS was a minor and reluctant player in the march, recognizing that breast, prostate, and other advocacy groups posed a growing threat to its fundraising. However, the ACS deftly used the march to capture its PR fallout by creating the National Dialogue on Cancer (NDC), a purportedly independent forum co-chaired by former President George Bush and Barbara Bush, vice-chaired by Senator Dianne Feinstein (D-CA), and including Governors Tom Ridge of Pennsylvania and Tommy Thompson of Wisconsin. The NDC activities are managed by a 16-member steering committee, with representation from ACS, CDC, NCI, cancer survivors, the underserved, and the pharmaceutical industry, which meets behind closed doors; NCI’s involvement has been nominal, at best.
In turn, the NDC leadership selected a group of more than 100 collaborating partners, including representatives of major advocacy groups, some of whom declined the invitation, while others failed to attend meetings or frankly suspected their agenda as a thinly disguised vehicle for furthering ACS special interests. On August 8, 1999, the NDC shocked its collaborating partners by suddenly announcing the formation of a National Cancer Legislation Advisory Committee to advise Senator Feinstein on rewriting the National Cancer Act. This 25-member committee was co-chaired by Dr. John Seffrin, CEO of the ACS, and Dr. Vincent DeVita, Director of the Yale Cancer Center and former NCI director, without any participation by the Steering Committee and NDC’s collaborating partners. Apart from NDC’s high-handed conduct and supposedly independent legislation committee spinoff, there are major concerns on interlocking ACS-CDC interests. CDC has improperly and possibly illegally funded ACS with close to $3 million for a sole source four-year cooperative agreement, and also the NDC with $100,000. In turn, ACS has made strong efforts to upgrade CDC’s role in the National Cancer Program, and also to increase appropriations for its non-peer reviewed cancer programs.
The relationship between the ACS, NDC, and the Legislation Committee raises fundamental questions on conflicts of interest. As reported in The Cancer Letter, a Washington, DC, newsletter widely read within the cancer establishment, John Durant, former executive president of the American Society for Clinical Oncology, charged: “It has always seemed to me that this was an issue of control by the ACS over the cancer agenda.…They are protecting their own fundraising capacity…against competition by advocacy groups.” More seriously, the leading U.S. charity watchdog, The Chronicle of Philanthropy, concluded: “The ACS is more interested in accumulating wealth than saving lives.”
DeVita, the legislation committee co-chair, is also chairman of the Medical Advisory Board of CancerSource.com, a website launched by Jones & Bartlett (Sudbury, MA) that publishes the ACS “Consumers Guide to Cancer Drugs”; three members of the legislation committee also serve on the same board. Thus, DeVita appears to be developing his personal interests in a publicly-funded forum. The ACS priority for tobacco cessation programs is inconsistent with its industry relationships. According to The Cancer Letter, Shandwick International, via its Division Management subsidiary, which represents R.J. Reynolds, has been a major PR firm for the NDC and Legislation Committee. Also, Edelman PR, representing Brown & Williamson Tobacco Company, which handles publicity for Team KOOL Green championship auto racing, was hired by ACS to conduct voter education programs aimed at making cancer a major issue in the 2000 presidential campaign. Further improprieties relate to questionably legal ACS contributions to Democratic and Republican governors associations. “We wanted to look like players and be players,” ACS explained.
More disturbing is ACS’s three-decade track record of indifference and even hostility to cancer prevention. Examples include issuing a joint statement with the Chlorine Institute justifying the continued global use of persistent organochlorine pesticides, and also supporting the industry in trivializing dietary pesticide residues as avoidable risks of childhood cancer. ACS policies are further exemplified by its allocation of less than 0.1 percent of its $700 million annual budget to environmental and occupational causes of cancer.
In this connection, there are also growing and urgent concerns with regard to the NCI’s imbalanced preoccupation with basic research, besides damage control-screening, diagnosis and treatment-with minimal priorities and budgetary allocations for mission research on primary prevention and public outreach on avoidable causes of cancer. ACS, with its NDC and legislation spinoffs, has disqualified itself from any leadership role in the National Cancer Program. The public should be encouraged to redirect its funding away from the ACS to patient and prevention advocacy groups. The conduct of ACS, particularly its political lobbying and possibly illegal relationship to CDC, should be investigated by the House and Senate appropriations and oversight committees. Finally, Congress should ensure that the National Cancer Program directs the highest priority to cancer prevention.
2000 Update by Barbara Seaman, Project Censored National Judge
Dr. Samuel Epstein’s thoroughly documented exposé of pervasive conflicts of interest in the “cancer establishment,” particularly the American Cancer Society (ACS), has already demonstrated a measurable impact. A major step toward full disclosure, which could lead to the reduction of female cancers, was taken on December 15, 2000, when a blue-ribbon government panel-the NIH’s National Toxicology Advisory Committee-voted 8-1 to add prescription estrogens to the official list of “known carcinogens.”
The ACS, along with much of the OB/Gyn establishment, has been so thoroughly influenced, lulled, perhaps even “brainwashed” by the prescription drug industry that 60 years-during which the frequency of hormone dependent female cancers has more than doubled in the United States-elapsed before the official labeling of steroid estrogens as carcinogens could be openly acknowledged. There was no suggestion that estrogen use be restricted or banned, but at meetings of the Toxicology Advisory Committee some scientists did express hope that prescribing physicians might become more cautionary. Toxicologist Michelle Medinsky stated, “They only discuss benefits. Listing might force it on the table…. Is knowledge power or is ignorance bliss? Everyone has to make their own decision.”
My concerned colleagues and I have difficulty understanding why so many well-intentioned environmental cancer-prevention activists often fail to identify the estrogen products themselves in their research radar. Winning pieces on cancer factors in the environment that looked for estrogenic chemicals, phyto estrogens, xeno estrogens, and so on, seemed oblivious to the fact that prescription and veterinary estrogens should be placed in square one. It seems like a waste of research money to examine these other factors without looking simultaneously at exposure to prescription and (in so far as possible) veterinary estrogens in the same populations. To give one example, breast cancer activists on New York State’s Long Island have investigated possible environmental causes of atypically high rates without also including questions on exposure to diethelstilbestrol (DES). In the post-World War II era, Long Island was one of the major “hotbeds” of routine DES-prescribing to pregnant women, based on the unjustified belief that it prevented miscarriages. This practice ended abruptly in 1971, when some of the daughters exposed in utero were diagnosed with reproductive tract abnormalities, particularly vaginal adenocarcinoma, which is often lethal. By 1978, when I served on the U.S. Surgeon General’s task force on DES, an increased frequency of breast cancer in the DES-exposed mothers was also recognized. Twenty-three years later, in 2001, this finding was reconfirmed in the British Medical Journal, Volume 84, Number 1.
“Veterinary” estrogens may be incurred through vocational exposure in laboratories and feedlots or through dangerously high dietary consumption of estrogen-fed meat and poultry. But further, most commercial estrogen products are not biodegradable by the stomach acids, and therefore residues are normally excreted in urine. Some eminent European scientists have posited in the Lancet that excreted estrogens in the food chain and water (supplied in the United States not only by women on prescription drugs, but by livestock as well) may have us “swimming in a sea of estrogens.” This, the theory goes, would account for the lockstep rise in certain male cancers, and infertility in some aquatic creatures, along with the rise in female cancers.
In fact, the carcinogenicity of synthetic estrogens in laboratory animals that have similar patterns to humans was established in historic experiments performed by Michael B. Shimkin and Hugh C. Grady, and published in the Journal of the National Cancer Institute in 1940. In December 1947, less than a decade after estrogen products for treating menopause first came on the market, the Journal Of Obstetrics and Gynecology published Dr. Saul Gusberg’s report on 29 cases of cancers and pre-cancers of the uterus associated with such therapy. By 1971, as mentioned, Dr. Arthur Herbst confirmed the tragic outcome of DES estrogens in pregnancy. In 1975 the FDA commissioner sent emergency notification to all U.S. physicians that four separate studies had confirmed a four- to eightfold increase in uterine cancer in long-term users of estrogens for menopause.
By the 1990s it was demonstrated that adding progestin to the estrogen regimen gives considerable protection against uterine cancer, but, at the same time, raises the patient’s risk of breast cancer to three times greater than taking estrogens alone. The longer a woman stays on hormones, the more her chances of uterine and breast cancer keep rising. If you have a uterus and take estrogens without progestins, you invite cancer of the uterine lining. If you add progestins to the estrogen you avoid the cancer “down there,” but substantially increase your chances of getting it “up front” in your breast.
“Keep Heron Premarin”
The major hormone-product manufacturers, including Ortho (Johnson and Johnson) and Wyeth Ayerst, are vigilant in censoring journalists and physicians who criticize or question their products. Hormone drugs are extraordinary sources of income simply because (unlike drugs for the sick) so many healthy women stay on them indefinitely. (For example, 12 million menopausal and postmenopausal U.S. women take estrogen alone, while 8.6 million take it in combination with progestin. Perhaps another 10 million to 14 million take the birth-control pill.) Ortho is the world’s largest manufacturer of oral contraceptives; while Wyeth-Ayerst’s Premarin (which stands for PREgnant MARes urINe) is the only prescription drug to remain in the top 50 bestsellers for more than half a century, and remained number one in 1999.
I am used to having Ortho and Wyeth Ayerst withdraw their ads from magazines to which I contribute, and their funds from medical conferences that include me on their programs. Indeed, when asked to speak at an event that may have industry sponsorship, I often warn the inviters thatthey may have to cancel me. Industry blacklists have become commonplace, extending to physicians and scientists, as well as journalists, who are deemed “unfriendly.” But what I never expected was that Wyeth Ayerst would succeed in blackballing me at my own journalism school, Columbia University, where I was a Sloan Rockefeller Advanced Science Writing Fellow in 1967-68, the year that I began The Doctors’ Case Against the Pill, the very book that first brought the hormone industry’s wrath down upon me.
By the 1990s Kenneth Goldstein, then teaching the science writing courses, was accepting funds from Wyeth Ayerst for student junkets, sending them to cover pro-estrogen conferences, which they were expected to write up for a Wyeth-Ayerst puff publication on menopause. One student became disturbed about the assignment and contacted me for advice. From the moment I confronted Goldstein, I was repeatedly excluded from speaking at any and all journalism-school panels or forums on medical or population issues. Kenneth Goldstein retired recently, and I am waiting to see whether or not I am to be resuscitated.
A period of public comment follows additions to our federal lists of carcinogens. Manufacturers of hormone products, as well as some doctors who heavily prescribe them will, if true to form, object to this classification and try to have it modified. I hope that Project Censored readers who value full disclosure and informed consent will write to the NIH in support of the Toxicology Advisory Committee’s long- overdue move. Comments on estrogens (supporting or opposing) can be sent to: National Institute of Environmental Health Sciences/National Toxicology Program (NIEHS/NTP), Dr. C.W. Jameson, EC-14, P.O. Box 12233, Research Triangle Park, N.C. 27709. Copies may be sent to Barbara Seaman, c/o Project Censored, Seven Stories Press, 140 Watts Street, New York, NY 10013. The exact language of the recommendation can be viewed in The Federal Register.