Cancer

Cancer

Research and Treatment

In 1993 1.1 million new cases of cancer were reported in the United States. Cancer of the lung ranked first in number of occurrences, followed by cancer of the colon. Researchers found that a faulty MSH2 gene, detectable by a blood test, predisposed one in two hundred people to the development of colon cancer. Another blood test, the PSA (prostate specific antigen), showed an elevation in the presence of prostate cancer and became an effective screening technique for the early stages of the disease. Basic research on multiple fronts sought new ways to treat or prevent cancer. Dr. Judah Folkman, director of the Surgical Research Laboratories, Children's Hospital of Boston, discovered two drugs, endostatin and angiostatin, which could cure cancer in mice by altering new blood vessel growth. Although there was no evidence that this treatment would work in humans, the price of stock in his biotech firm increased from $12 to $85 a share. Folkman once quipped, "As long as there is an unconquered disease, we have an obligation to pursue research… [For now], if you have cancer and you are a mouse, we can take good care of you." On a less high-tech level, phytochemicals (plant-derived nutrients) and other naturally occurring compounds were promoted as cancer preventives and widely marketed as food supplements.

Breast Cancer

Women became more politically active and vocal in asserting their demands for research into breast cancer and other diseases that affected them. In 1990 there were 43,700 deaths from breast cancer, while annual government research funding was $77 million; the same year 23,739 people died from AIDS, whereas funding for research into this disease was $1.1 billion. By 1997 research funding for breast cancer increased to $340 million per year (compared to $220 million for AIDS and $125 million for lung cancer). Despite the paucity of funding, new techniques for diagnosis were developed, such as the stereotactic biopsy, where the suspicious mass is marked with a wire and the nonsurgical, needle biopsy is carried out under digitalized X-ray control. Clinical trials with medications such as B-Oval (a birth control pill) and tamoxifen (an estrogen inhibitor) were undertaken; the latter seemed to decrease the incidence of breast cancer in high-risk women. A Mayo Clinic study showed that prophylactic mastectomy (the removal of a breast with no known disease) could reduce the risk of developing breast cancer by 90 percent. In the area of early detection, a debate raged over recommendations regarding mammography for younger women. The National Cancer Institute reversed its original recommendation and backed mammography for women beginning at age forty. This change was significant since insurance companies might have balked at paying for the screening study if the first recommendation had remained in effect Politicians endorsed the new shift, but changing a medical policy because of public pressure rather than new data troubled some scientists.

GULF WAR SYNDROME

About 697,000 men and women of the U.S. military served in the Persian Gulf War during 1990 and 1991. Some returned home with various illnesses such as rash, asthma, short-term memory loss, fatigue, muscle aches and pains, and weakness. This grouping of diverse symptoms affecting returning veterans became known as the Gulf War syndrome. In spite of receiving medical discharges, some veterans were denied full disability pay. The military and the Veterans Affairs Department initially dismissed the complaints as not being related to service in the Persian Gulf.

Spouses of some veterans came down with some of the symptoms as well, and some of the pregnancies following service in the Gulf resulted in premature births and an elevated incidence of birth defects and neonatal illnesses. The potential causes of the syndrome are as varied as its symptoms. Soldiers breathed smoke from burning waste clumps and oil wells and encountered a variety of paints, solvents, and pesticides. Some veterans believe they were exposed to chemical or germ warfare agents that were dispersed into the air after the allied bombing of Iraqi storage facilities. The Pentagon acknowledged that it had detected minute traces of sarin (a nerve agent) and mustard gas in the desert. Another potential source of the problem may have been medications administered to the soldiers, such as pyridostigmine bromide, a drug given to four hundred thousand soldiers to protect them against chemical weapons.

Researchers at Duke University and the University of Texas linked the veterans' problems to chemicals used to protect them from insects and nerve gas. The study showed that even in small amounts, cholinesterase inhibitors used in combinations can cause an illness resembling Gulf War syndrome. Animals treated with only one of the drugs in question did not develop illnesses, but those receiving both the anti-nerve-gas pill and the insect repellents did exhibit symptoms.

In 1999 a report prepared for the Defense Department "could not rule out" the drug pyridostigmine bromide (PB) as a possible cause of the syndrome. The Defense Department has spent $100 million on Gulf War Health Research since 1994, and had $17 million worth of studies on PB underway. While no definitive answer was determined as to the etiology' of the Gulf War illness, the Department of Veterans Affairs and the Department of Defense now recognize that the syndrome is a real entity.

Sources:

David Brown, "'Gulf War Syndrome' Study Looks at Nerve Gas Protection," The Washington Post. 19 October 1999.

Geoffrey Cowley. "Coming Home to Pain: Why Are So Many Gulf War Veterans So Siokr?" Newsweek, 121 (28 June 1993): 58-59.

Cowley. "Tracking the Second Storm." Newsweek, 123 (16 May 1994): 56-57. Cowley and Mary Hager. "Poisoned in the Gulf?: New Clues to the Veterms' Mysterious Illness," Newsweek, 127 (29 April 1996): 74.

Politics and Smoking

Public pressure, along with concern by state governments about medical-care costs, led to an attack on the cigarette industry. As Dr. Thomas D. MacKenzie argued in a New England Journal of Medicine (1994) article, "cigarettes remain the only consumer product sold legally in the U.S. that is unequivocally carcinogenic when used as directed." Dr. William L. Roper, director of the Centers for Disease Control and Prevention (CDC), noted in 1991 that it can take up to twenty years for cancer caused by smoking to develop. In 1993 the University of California and the CDC calculated that the cost of tobacco-related illness was at least $50 billion per year. Secretary of the Department of Health and Human Services (HHS), Dr. Louis W. Sullivan, denounced the tobacco industry for test-marketing cigarettes aimed at African Americans, and the R. J. Reynolds Company canceled the introduction of a new brand aimed specifically at blacks. Sullivan also criticized tobacco industry sponsorship of athletic events, as well as ads directed toward women, minorities, and the young. "Joe Camel" ads, featuring a suave cartoon camel, came under the strongest attacks since they seemed to effectively target children; the macho image of the "Marlboro Man" was also targeted. Americans were not the only people vulnerable to these illnesses and advertisements. In order to offset domestic declines in cigarette consumption the U.S. tobacco companies aggressively marketed their product abroad.

Side Effects

Secondhand smoke was implicated in multiple health problems. The Environmental Protection Agency (EPA) reported that such smoke caused 3,000 lung cancer deaths, contributed to 105,000 to 300,000 respiratory infections in infants, triggered 8,000 to 26,000 new cases of asthma, and exacerbated symptoms in 400,000 to 1 million asthmatic children per year. Based on this evidence, multiple lawsuits were filed against cigarette manufacturers. They had faced suits before but were uniformly victorious in the courtrooms, utilizing the defense that they produced a legal product that people could use or not as they wished, and if they chose to use it, they were freely accepting any risks involved.

Tobacco Under Attack

During the new legal siege, executives of the cigarette-producing companies were forced to give testimony. Each new suit seemed to introduce new information about what the tobacco company executives knew concerning the health hazards of the product, such as whether it caused cancer and was addictive, as well as about alleged manipulation of cigarette ingredients to increase nicotine levels. Evidence mounted that the industry targeted teenagers in order to maintain a steady supply of customers. After contentious argument within Congress and between Congress and President Bill Clinton, a deal was finally reached. The industry agreed to a settlement of close to $400 billion, in part to stop the onslaught of suits in virtually every state. Data for 1999 showed a 7 to 9 percent decrease in cigarette consumption, which may be attributed to the price jump of 45 cents per pack. Many of the states chose to use the money as general revenue rather than designating it for antismoking or education programs or for health programs. According to the National Conference of State Legislatures, only 8 percent of the $206 billion that the tobacco companies were to pay the states under the settlement went to antismoking efforts.

Sources:

Carl E. Bartecchi, Thomas D. MacKenzie, and Robert W. Schrier, "The Global Tobacco Epidemic," Scientific American, 272 (May 1995): 44-51.

Melinda Beck and Lucille Beachy, "The Politics of Breast Cancer," Newsweek, 116 (10 December 1990): 62-64.

Sharon Begley, "Beyond Vitamins," Newsweek, 123 (25 April 1994): 45-48.

Begley, "The Mammogram War," Newsweek, 129 (24 February 1997): 54-57.

Begley, "New Hope for Women at Risk, " Newsweek, 131 (20 April 1998): 68-70.

Begley and Claudia Kalb, "One Man's Quest to Cure Cancer," Newsweek, 131 (18 May 1998): 55.

Geoffrey Cowley, "Are Supplements Still Worth Taking," Newsweek, 123 (25 April 1994): 47.

Cowley, "I'd Toddle a Mile for a Camel" Newsweek, 118 (23 December 1991): 70.

Cowley, "A Needle Instead of a Knife" Newsweek, 119 (13 April 1992): 62.

Cowley, "Poison at Home and at Work," Newsweek, 119 (29 June 1992): 55.

"A Grim Legacy for Longtime Smokers," Newsweek, 118 (11 February 1991): 58.

Claudia Kalb, "Hype, Hope, Cancer," Newsweek, 132 (28 December 1998): 73.

Jeffrey Kluger, "Mammogram Two-Step," Time, 149 (7 April 1997): 67.

Richard Lacayo, "Smoke Gets in Your Aye," Time, 151 (26 January 1998): 50.

Charles Leerhsen, "Searching for a Better Pill: Can It Deter Breast Cancer?" Newsweek, 117 (8 April 1991): 56.

John Leland, "A Whiff of Smoking Guns," Newsweek, 126 (7 August 1995): 56-57.

Thomas D. MacKenzie, Carl E. Bartecchi, and Robert W. Schrier, "The Human Costs of Tobacco Use (Second of Two Parts)," New England Journal of Medicine, 330 (7 April 1994): 975-980.

Tom Morganthau, "Sullivan: Bush's Aide Makes Waves," Newsweek, 115 (5 March 1990): 19.

"A Radical Solution," Newsweek, 133 (25 January 1999): 68.

"Tobacco Wars, Still," Washington Post, 29 December 1999.