[As of 1997, the ACS stopped sending out its old "questionable
methods" sheets. The situation there is in flux.]
Barrie Cassileth, PhD, a psychosocial oncologist at Duke
University, has refused to resign from either the ad hoc advisory board
of the Office of Alternative Medicine or the American Cancer Society's Questionable
Methods subcommittee. In an editorial last issue, this newsletter called
on her to decide which side she was on.
The controversy between the Chronicles and Cassileth was the subject
of a full-page article in The Cancer Letter (vol. 19, no. 30), an industry
newsletter widely read at NCI. In it, Cassileth claimed, "I am disappointed
that [Ralph W.] Moss and [Frank] Wiewel would fear someone who promotes
honest and open evaluation of treatments.
"I am not easily intimidated, and I have no intention of resigning
from ACS. Whose side am I on?" she asked, echoing the editorial. "Exclusively
that of the patient, through efforts to distinguish between quackery and
useful therapies." Cassileth claimed that the two cancer activists
told her "unless she resigned from that [ACS] body she would not be
named advisor to OAM." And, in a follow-up letter to OAM board members,
she accused this newsletter of unspecified "goofs."
"No attempt has ever been made to 'intimidate' Dr. Cassileth,"
said Wiewel, president of People Against Cancer. "Nor would we ever
claim we had the power to bar her or anyone from being named an advisor
to the OAM. That is absurd. She complains about errors in our account, but
she has never pointed to any specific 'goofs.' The truth is, the ACS does
not promote 'honest and open evaluation of treatments,' as Dr. Cassileth
claims. Instead, it compiles a McCarthy--like blacklist of alternative treatments
while vigorously promoting toxic chemotherapy. Cassileth is a key ACS player
and therfore should have no place on the OAM board."
In an interview with The Cancer Letter, Jay Moskowitz, NIH Deputy Director,
said, "None of the people youve mentioned works for OAM, and no one
was speaking for OAM in those conversations....Everyone has a right to participate
in any panel they have been selected for."
A QUESTIONABLE COMMITTEE
Why the big fuss over Dr. Cassileth's membership on the American Cancer
Societys Subcommittee on Questionable Methods of Cancer Management? This
ACS subcommittee was founded nearly 50 years ago as the Committee on Quackery.
In the 1950s, it became the Committee on Unproven Methods of Cancer Management.
Several years ago, hard-liners pushed through the current designation.
Webster defines "questionable" as not just "subject to
inquiry" but "attended by well-grounded suspicions of being immoral,
crude, false, or unsound." Another definition is "liable to judicial
inquiry or action." And, in fact, it has always been a short step from
ACS condemnation to serious trouble with the FDA, medical boardsãeven
the Postal Service!
This ACS committee, whatever its name, has always led the attack on the
alternative cancer movement. Dr. Cassileth has now emerged as a key strategist
for the ACS "questionable" subcommittee, helping formulate their
policy papers on how to deal with the OAM.
The ACS was founded by people with strong ties to the pharmaceutical
industry (e.g., Elmer Bobst) and itself held the patent on the toxic drug
5-FU. The ACS today is a nearly $400 million fund-raising machine, which
has sought control over all cancer charity. This particular subcommittee
vilifies not just alternative methods, but rival organizations, such as
the International Association of Cancer Victors and Friends (IACVF) and
the Committee for Freedom of Choice in Medicine, Inc. The ACS "questionable"
list of unapproved methods strongly resembles that list of "subversives"
once maintained by the House Un-American Activities Committee, and many
of its members exhibit the same zeal for persecuting unorthodoxy as HUAC
did in the 1950s.
Merely including the name of a scientist in an ACS warning, distributed
via CA magazine to hundreds of thousands of doctors, can ruin a researchers
life work by putting the tag of quackery on his or her efforts. Many fine
pioneers have been crippled in this way. For 10 years, the ACS even included
the work of Dr. William B. Coley, father of immunotherapy, on this list.
Dr. Joseph Gold, whose name was on the list in the 1970s for his work on
hydrazine sulfate, noted that once this method was placed on the list, "we
could not get a renewal" of an NCI grant "by hook or crook, no
matter how good the application itself was."
Many of the innovative scientists OAM intends to work with have had similar
experiences. In fact, fear of unreasonable ACS condemnation has long inhibited
the field of innovative cancer research.
ACS claims that unconventional practitioners are without the requisite
knowledge of cancer to make intelligent statements about the disease. ACS
claims that only a "few" such proponents even have MDs or PhDs
and that many have "multiple unusual degrees." But in fact, over
77% of alternative proponents have medical degrees or doctorates in relevant
scientific disciplines, many from outstanding institutions. A "few"
in this case equals 77%!
The ACS also claims it can spot questionable methods because they are
weird and exotic. Would that life were so simple. ACS ignores the fact that
most of todays conventional methods were once considered bizarre: mad scientist
x-rays, poisonous mustard gas, weeds, molds, and the like.
As the late Sloan-Kettering chemotherapist, Dr. David Karnofsky, once
noted:
"The relevant matter in examining any form of treatment is not the
reputation of its proponent, the persuasiveness of his theory, the eminence
of its lay supporters, the testimony of patients, or the existence of public
controversy, but simplyãdoes the treatment work?"
Yet the ACS routinely condemns methods and organizations without any
investigation. Of the 63 methods on their list in the 1970s and 1980s, none
was seriously investigated. The ACS often relies upon anecdotal reports
in newspapers and magazines as its primary source of information. Of 63
methods condemned, over 44% were never investigated at all. Over 11% were
investigated and found to be positive. In only 29% of the cases was the
method actually found to be ineffective. Yet Cassileth would have us believe
that her subcommittee conducts "honest and open evaluations of treatments."
In private, Dr. Cassileth sometimes claims to be a "reformer"
within the ACS, working on behalf of patients for a fair evaluation of alternative
treatments. But one does not ordinarily join a racist country club in order
to combat racism. We in the alternative field have suffered obnoxious and
harmful discrimination at the hands of the ACS. Cassileth has joined with
the sworn enemies of fair play.
With the creation of the OAM, the alternative cancer movement for the
first time has a real chance at a fair evaluation from the government. Many
forces in society are still arrayed against such evaluations, the ACS Questionable
Subcommittee being the main one. Now we are being asked to allow in our
midst individuals from their camp, who not only can sit in on OAM meetings,
but work their way into key positions on various OAM committees and shape
policy and decisions in both obvious and subtle ways.
This is a prescription for disaster. The problem is this: the OAM has
been charged by Congress with a revolutionary job, fairly evaluating alternative
medicine. Cancer has always been the hub of this medical controversy.But
even a single positive evaluation of an ACS-certified "questionable"
method will rock American medicine to its foundations.
It will call into question the legitimacy of the ACS itself. When that day
comes, the OAM will have to stand united, for we can confidently predict
a tremendous struggle, inside and outside the NIH, over how--in fact,
over whether--to publicize this astonishing news to the American people.
Since the ACS has seen fit to place one of its representatives in our
midst, will the ACS reciprocate by allowing some reasonable defenders
of alternatives onto their Questionable Methods Subcommittee? We nominate
former Congressman Berkley Bedell, who would certainly bring a new vitality
to their moribund group.
