breast cancer politics and interests

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Newsletter #52–February/March 1999

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From the Executive Director

Seeing Our Interests Clearly: Follow the Money II

by Barbara A. Brenner

 

In October 1998, Barbara Brenner was one of the featured speakers at

the Massachusetts Breast Cancer Coalition's half-day

conference, " Profit$ and Lo$$e$: The Political and Economic Context

of Breast Cancer Research. " At the urging of those in attendance at

the Boston conference, and with deep appreciation for the leadership

of the Women's Community Cancer Project on this very important issue,

her remarks from the Boston conference are reprinted here.

 

Sharon Batt, a Montreal breast cancer activist and author of Patient

No More: The Politics of Breast Cancer, described understanding

breast cancer politics as a matter of seeing our interests clearly.

Doing that means looking closely at some of the realities that are

often ignored in our day-to-day efforts to address the needs of women

with and at risk for breast cancer. My role today is to invite you to

take a step back and look at several examples of corporate

connections to breast cancer, and how those connections play out in

the political realities of the broader cancer epidemic.

 

Example 1: Zeneca and Breast Cancer Awareness Month

 

Zeneca is known to many of you as the manufacturer of tamoxifen, the

most commonly prescribed breast cancer drug, now also approved

for " risk reduction " in healthy women at high risk of developing

breast cancer. What is less well known is that the company holds

controlling interest in Salick Health Care Cancer Centers and also

produces pesticides, including a known carcinogen, Acetochlor. Zeneca

has a $300 million annual market in Acetochlor.

 

Zeneca is also the principal corporate sponsor of Breast Cancer

Awareness Month (BCAM). During BCAM, we all hear the refrain " early

detection is your best protection, " a slight modification of the

original BCAM mantra, " early detection is your best prevention. " Of

course, early detection neither prevents nor protects you from breast

cancer, but the meaning of words never seems to deter the corporate

public relations machine that operates at full tilt during October.

The subtext that runs throughout the month is that breast cancer

found early is " almost 100% curable, " when the reality is that 92% to

95% of women diagnosed with breast cancer by mammogram are still

alive five years later. And true prevention—finding and eradicating

the causes of breast cancer—is never mentioned at all.

 

Why is it that the reality of breast cancer is not featured during

Breast Cancer Awareness Month? In all likelihood, it's because Zeneca

controls the message. And, given the company's role in the

manufacturer of carcinogens, is it any wonder that, as far as we can

tell during October, nothing causes cancer?

 

Example 2: Rhone-Poulenc Rorer—Breast Cancer Drugs and Pesticides

 

Like Zeneca, Rhone-Poulenc Rorer produces a breast cancer drug, in

this case Taxotere (docetaxel), approved for the treatment of

metastatic disease. And, like Zeneca, it produces pesticides,

including the herbicide Bromoxynil.

 

Bromoxynil is marketed for use on cotton. It is known to cause cancer

and birth defects in lab mammals. These health effects prompted the

Environmental Protection Agency (EPA) to ban the use of Bromoxynil on

cotton. Rhone-Poulenc pulled out all the stops to reopen the matter,

submitting industry-developed data that Rhone-Poulenc claimed showed

that the herbicide was safe. Despite the fact that even the company's

data showed that use of Bromoxynil on cotton would violate the safety

standards of the Food Quality Protection Act, the EPA bowed to

company pressure and reversed its decision.

 

Example 3: Novartis—Breast Cancer, Pesticides and Academic Freedom

 

Novartis is one of the largest chemical companies in the world. Like

Zeneca and Rhone-Poulenc, the company also makes breast cancer drugs,

in this case pamidronate compounds for the treatment of bone

metastases. Like many drug companies, Novartis sponsors breast cancer

conferences, including a recent one on integrative medicine and

breast cancer in San Francisco. Novartis also manufactures what it

calls " crop protection products, " including insecticides, fungicides

and herbicides.

 

In a recent deal that threatens academic freedom and the independence

of one of the leading public education institutions in the U.S.,

Novartis and the University of California at Berkeley have entered

into a " public-private partnership " under the terms of which Novartis

will donate $50 million to the University's College of Natural

Resources. In exchange, Novartis will get the right to negotiate for

patent rights on discoveries made at the college, and Novartis

representatives will sit on college committees.

 

Example 4: Harvard School of Public Health—Preventing Cancer

 

As the Women's Community Cancer Project has so clearly demonstrated,

the list of funders for the Department of Health Policy and

Management at the Harvard School of Public Health reads like the

Fortune 500. A partial list of the department's 1996 funders included

ARCO Chemical Company; the American Crop Protection Association;

Ashland Oil, Inc.; Atlantic Richfield; the Chemical Manufacturers

Association; Chevron; Dow Chemical; Exxon; General Electric; Glaxo

Wellcome; Hoffman-LaRoche, and Monsanto.

 

In 1997, the Harvard School of Public Health issued the " Harvard

Report on Cancer Prevention. " The report was notable for its focus on

individual responsibility for cancer prevention, for its insistence

that the majority of environmental links to cancer are behavioral

(like smoking) and for the complete absence of either corporate or

governmental responsibility for reducing the incidence of cancer.

 

Making Connections

 

These examples highlight who controls the message when it comes to

cancer generally and breast cancer in particular. They help us

understand what gets studied in the field of breast cancer and,

ultimately, who benefits from those studies.

 

The links between where the money comes from and what gets said or

regulated are echoed throughout the breast cancer

movement...Companies that produce breast cancer drugs—which, as I

have indicated, are often also chemical companies—support a number of

breast cancer organizations. While disclosure of this sort of funding

is rarely made in organizational position papers or when

organizational representatives sit on policy or peer review panels,

the annual reports of organizations like the National Alliance of

Breast Cancer Organizations (NABCO) and the Susan G. Komen Foundation

read like a who's who of the pharmaceutical industry. And the funding

can certainly be perceived as affecting what is said and to whom.

NABCO's whole-hearted endorsement of tamoxifen for " prevention " of

breast cancer and their equally enthusiastic approval of the

structure of the STAR trial (comparing tamoxifen and raloxifene

for " prevention " with no placebo control group) cannot be separated

from the fact that the organization receives major funding from both

Zeneca and Eli Lilly (the manufacturer of raloxifene).

 

These sorts of links between those who profit from the breast cancer

epidemic and those who advocate to end it make it important to

examine who is making the decisions, and what their connections are.

For example, when breast cancer " consumers " sit on peer review panels

to evaluate proposed breast cancer research, are they representing a

constituency and, if so, which one? While we should insist that women

living with breast cancer who sit on peer review or advisory boards

represent more than their own personal interests, we are also

entitled to know who funds their work and to require disclosures of

their real or potential conflicts of interest, as we do of members of

the scientific community.

 

Seeing Our Interests Clearly—Toward the Precautionary Principle

 

Following the money makes it clear that true prevention of breast

cancer will not be found in a pill, because pills don't address what

causes the disease. And finding out what causes breast cancer will be

impossible unless we recognize the interests at stake and, wherever

necessary, work around them. The precautionary principle of public

health calls for us to act based on the weight of the evidence

because waiting for absolute " proof " is killing us. This principle,

which we at BCA call " First, Do No Harm, " is most recognizable to the

general public from the warning labels on cigarette packages. The

anti-tobacco effort in the U.S. was undertaken long before we had

proof of the biochemical process by which tobacco smoke leads to lung

cancer. The same precaution needs to be taken in every area of public

health, including breast cancer.

 

But real understanding of the precautionary principle and what it

requires demands a major public education effort. BCA looks forward

to working with the Massachusetts Breast Cancer Coalition, the

Women's Community Cancer Project, the National Women's Health Network

and other health and environmental organizations to build the

educational campaign that will permit the general public to see its

own interests clearly. The first premise of the campaign will be

this: the beginning of wisdom is to call things by their real names.