Today I'm giving a talk at my school, Stevens Institute of Technology, titled "The Cancer Industry: Hype Versus Reality." The talk focuses on the enormous gap between the grim reality of cancer medicine in the U.S. and the upbeat claims made by the cancer industry and its media enablers. Below are points I plan to make in my talk, which expand upon ones I've made .—John Horgan
BIG PROBLEM, BIG BUSINESS, BIG HYPE
First, some basic facts to convey the scale of the problem. Cancer is the second most lethal disease in the U.S., behind only heart disease. More than 1.7 million Americans were diagnosed with cancer in 2018, and more than 600,000 died. Over 15 million Americans cancer survivors are alive today. Almost four out of ten people will be diagnosed in their lifetime, according to .
Cancer has spawned a huge industrial complex involving government agencies, pharmaceutical and biomedical firms, hospitals and clinics, universities, professional societies, nonprofit foundations and media. The costs of cancer care have surged 40 percent in the last decade, from $125 billion in 2010 to ).
Research funding has also surged. The budget of the National Cancer Institute, a federal agency founded in 1937, now totals over $6 billion/year. That is a fraction of the total spent on research by nonprofit foundations ($6 billion a year, ), private firms and other government agencies. Total research spending since Richard Nixon declared a "war on cancer" in 1971 exceeds a quarter trillion dollars, .
Cancer-industry boosters claim that investments in research, testing and treatment have led to "incredible progress" and millions of "cancer deaths averted," as the , a nonprofit that receives money from biomedical firms, puts it. found that cancer experts and the media often describe new treatments with terms such as "breakthrough," "game changer," "miracle," "cure," "home run," "revolutionary," "transformative," "life saver," "groundbreaking" and "marvel."
There are more than 1,200 accredited cancer centers in the U.S. They spent $173 million on television and magazine ads directed at the public in 2014, , and 43 of the 48 top spenders "deceptively promot[ed] atypical patient experiences through the use of powerful testimonials." concluded that cancer centers "frequently promote cancer therapy with emotional appeals that evoke hope and fear while rarely providing information about risks, benefits, costs, or insurance availability."
LITTLE NET PROGRESS AFTER 90 YEARS, BESIDES ANTI-SMOKING EFFORTS
What's the reality behind the hype? "No one is winning the war on cancer," Azra Raza, an oncologist at Columbia, asserts in her 2019 book . Claims of progress are "mostly hype, the same rhetoric from the same self-important voices for the past half century." Trials have yielded improved treatments for childhood cancers and specific cancers of the blood, bone-marrow and lymph systems, Raza notes. But these successes, which involve uncommon cancers, are exceptions among a "litany of failures."
The best way to measure progress against cancer is to look at mortality rates, the number of people who succumb to cancer per unit of population per year. The risk of cancer grows with age. (Although childhood cancer gets a lot of attention, Americans under 20 years old account for .) Hence as the average life span of a population grows (because of advances against heart and respiratory disorders, infectious disease and so on), so does the cancer mortality rate. To calculate mortality trends over time, therefore, researchers adjust for the aging of the population.
With this adjustment—which, keep in mind, presents cancer medicine in a more favorable light--mortality rates have . This trend, according to cancer-industry boosters, shows that investments in research, tests and treatments have paid off. What boosters often fail to mention is that recent declines in cancer mortality follow at least 60 years of increases. The current age-adjusted mortality rate for all cancers in the U.S., 152.4 deaths per 100,000 people, is just under what it was in 1930, .
