Gauling Behaviour – France failing in cancer prevention
WHEN IT COMES TO CANCER PREVENTION, SAYS THIERRY JACCAUD FRANCE IS STILL IN THE DARK.
CANCER PREVENTION POLICY? What cancer prevention policy? France doesn’t have one. We make hardly any effort to prevent cancer, and we don’t discuss the subject very often. Only in France would you find the president announcing one strategy, the health minister presenting another one, and one of the main cancer charities putting forward its own priorities for action, all over a few days and with no co-ordination between them.
At the beginning of this year, Jacques Chirac proclaimed a Paris Charter against Cancer.  A few days later, health secretary Dominique Gillot announced a series of government measures in this area.  Finally, the Ligue Nationale Contre le Cancer grandly claimed to be ‘co-ordinating large-scale French cancer research in a programme to establish a molecular identity card for tumours’,  as though this was a job for a charity rather than government. Professor Michel Marty, director of research at the Institut Gustave-Roussy in Villejuif, describes this situation as ‘a caricature which illustrates the lack of overall coordination at all levels where cancer is concerned’. 
As early as 1994, the Inspection Generale des Affaires Sociales deplored ‘the absence of a policy to combat cancer’.  And the senate recently expressed profound regret that ‘cancer policy is still the subject of such dispersion of resources and, most importantly, a complete lack of transparency’.  In fact we know precisely what resources have been allocated by the Health Ministry: its cancer unit comprises precisely one and a half people. Yes, that’s right, one and a half. As the senate finance committee notes, ‘This inevitably limits its ambitions’. 
THE PARIS CHARTER: A SCANDALOUS FRAUD
The Paris Charter launched by President Chirac on 4 February 2000 was just one of many speeches and programmes dealing with cancer. It was certainly a very representative document, being signed by nearly 50 organisations around the world, including the Institut Gustave-Roussy, the Federation Nationale des Centres de Lutte Contre le Cancer, the Salpetriere Hospital, the ARC and heavyweight international bodies such as the National Cancer Institute and the American Cancer Society. 
The charter, which consists of 10 articles, reaches new heights of cynicism. The signatories begin by expressing concern at the effects of cancer on ‘the productivity of nations’. They return to this theme in article 2, which describes the ‘loss of productivity’ caused by cancer sufferers as an ‘obstacle to progress’!
Prevention is not mentioned until article 5, which makes very brief reference to pollution and the need to protect the environment. This very vague objective is then rendered completely irrelevant by the very precise following paragraph, which calls on the signatories to ‘organise support for industry [sic] and governments to improve cancer prevention using medical technology [sic again] wherever possible’. It may be possible to diagnose cancer using medical technology, but not to prevent it. Medical equipment manufacturers clearly had a big say in the Paris Charter, assuming they didn’t write the whole thing themselves.
Article 3 is also crystal clear: it calls on the signatories to ‘make every effort to obtain increased research funding from government and industry’ in order to ‘push back the existing boundaries of knowledge with every passing day’. This is incredible. They’re supposed to go on financing research until kingdom come, not to increase recovery rates, but to pursue knowledge for its own sake. And rightly so, because as any freelance lobbyist will tell you, overall recovery rates have increased only very slightly, whereas research spending has grown exponentially. In its editorial of February 1996, La Recherche wrote: ‘If all the cancer research being carried out in France was stopped tomorrow, it is not certain that this would have any effect whatsoever’. It also published an article by cancer specialist Laurent Schwartz: ‘Despite the enormous resources devoted to it by the Western nations over the past 35 years, the baffle against cancer has been a failure’.
The preamble to the Paris Charter also makes the scandalous statement that the signatories ‘anticipate a rapid rise in the incidence of cancer throughout the world’. The Charter is therefore a means of planning the growth of what is already a huge market for cancer treatment. In order to put pressure on governments and obtain additional funding, it is also being circulated among the public with the aim of gaining one million signatures within a year. Let’s be frank: people shouldn’t sign this document, because it’s an utter disgrace.
The Charter embodies a particular view of cancer which has long been espoused by Professor Maurice Tubiana, one of the doyens of French oncology  and a lobby in his own right. His numerous writings have been widely read, and are regarded as authoritative, despite his explicit support for industry and ‘progress’ and his hostility to environmentalism. ‘Prevention’ means finding ways of stopping diseases from occurring, but this is not the view expressed by Professor Tubiana in his book La Prevention des Cancers.  The illustration on the cover shows a woman undergoing a mammogram which, as everyone knows, is a way of identifying cancer, not preventing it. Confusion sets in from the start, and can only be combated by oncologists who adopt a more rigorous approach; unfortunately, they tend to be less media-friendly. 
More seriously, Tubiana says that prevention involves reducing the incidence of smoking, not things like chemical and nuclear pollution. To be fair, he does mention these, wondering ingenuously whether ‘the fact that thousands of new chemicals have been allowed to escape into the environment’ could be the cause of the cancer ‘epidemic’  and then triumphantly concluding that this is not the case. His response is based mainly on the incorrect assertion that cancer rates are increasing solely because of the ageing population.
As an advocate of an industrialised society, Professor Tubiana’s ideological reasons are even more interesting.  He states: ‘In fact, it is industrialisation and increased agricultural output which provide the Western nations with the financial resources they need to fight pollution… It is important not to encourage irrational fears, because they can be just as dangerous as industrial pollution, if not more so’.  Professor Tubiana describes the victims of the Seveso accident as suffering from ‘irrational anxiety’. Similarly, he cites ‘experts’ who claim that there has not been ‘any increase in the frequency of congenital malformations, leukaemia or cancer in the region around Chernobyl’. Rather, he continues, it is fear of the effects of radiation which is the main problem. In his latest book, he generalises: ‘The French are periodically subject to what can only be described as psychosis’. He believes that fear of hormone-treated veal is ‘absurd’, and mad cow disease is not a real problem: ‘There i s no biological contra-indication for the ingestion of animal proteins by a herbivore.’ And he claims that GMOs are creating ‘irrational fears about science’, and concerns about nuclear pollution are ‘a phobia’. 
When people in the forefront of French oncology are saying things like this, it is not surprising that the Bulletin du Cancer, a 100-page monthly published by eminent specialists at the Societe Francaise du Cancer, rarely if ever discusses prevention. The last time it published an article on the subject was in April 1998.
It is also not surprising that when cancer specialists speak in public, they rarely make any reference to prevention. For example, a supposedly serious annual conference on cancer , supported by the ARC as part of a trade fair sponsored by the Ordre des Medecins, deals only with treatment and does not make a single mention of prevention. Or, to take another important example, a brochure on the prevention of major diseases, widely distributed by Paris City Council, talks about prevention in terms of reducing smoking, drinking and exposure to the sun, and does not say a single word about carcinogenic pollutants. 
A low-profile National Assembly report in 1998 noted: ‘No one knows exactly what proportion of health insurance spending is devoted to cancer prevention, nor whether these sums are used effectively’.  The first recommendation made by the senate finance committee was simply to ‘identify the total public funds devoted to cancer prevention’. In the year 2000, it is scarcely credible that we should not have a clear picture of the amount spent on fighting the biggest disease affecting French people.
Cancer organisations are just as vague. The accounts of the Ligue Nationale Contre le Cancer include a single expense item headed ‘information, prevention and identification’, which makes it impossible to work out how much it spent on prevention. An inquiry by the Cour des Comptes established that this item mainly consisted of advertising and operating costs.  On the other hand the ARC, France’s other main cancer organisation, did run its first-ever campaign on occupational cancers in 1999. But generally speaking, the lack of reference to carcinogenic pollutants by these two major bodies is very surprising.
At national level, the senate report states: ‘It is not possible to isolate that proportion of spending on prevention which is specifically devoted to cancer’.  It says that 18.3 billion francs were spent on prevention in 1995, representing only 2.3 per cent of a total health expenditure of 682.3 billion francs. And it is likely that the same proportion applies as far as cancer is concerned.
In 1975, the health minister Simone Veil tried to tilt the balance between prevention and treatment in the opposite direction. She came in for a hail of criticism in the media by cancer specialists, led by Professor Georges Mathe.  They used the example of the United States, where President Nixon had ‘declared war on cancer’ by drastically increasing expenditure a few years previously. However, their sole aim was to increase spending on the treatment of cancer, and they had no interest in prevention.
CANCER CONTROLLED BY THE LOBBIES
According to the senate report, an estimated 1.2 billion francs is spent on cancer research, the annual cost of hospital treatment for cancer is between 20 and 30 billion francs, and 2.25 billion francs was spent on cancer medicines in 1995, a 35 per cent increase on 1990. There is a huge amount of money in cancer treatment, which is why Pierre Desproges sardonically commented that more people make a living out of cancer than die from it.  The people who work in this sector are undoubtedly sincere and committed, but they do not appear to give any thought to tilting the balance towards spending on prevention.
For example, the senate commission notes that clinical research is dominated by the pharmaceutical industry: of 9,000 research protocols in progress, more than 6,000 were initiated by pharmaceutical laboratories. The report comments: ‘The great majority of clinical research expenditure is guided by the pharmaceutical industry, although it makes only a marginal contribution to funding this spending…the industry also helps to finance clinical research by less direct routes such as pen-hospital associations and establishment competition funds, but the amounts are unknown’.
In its report on the Ligue Nationale Contre le Cancer,  the Cour des Comptes points out that a number of the league’s committees and scientific councils are chaired by the head of the radiotherapy service or local anti-cancer centre, who collects donations with one hand and keeps them for treatment, not prevention.
It is clear that the emphasis of cancer policy needs to be switched towards prevention. Why not adopt the rule that for every franc you spend on treatment, you spend one on prevention? Associations, government bodies and specialist institutions must carry out such reforms as quickly as possible. In the US, Dr Epstein’s Cancer Prevention Coalition  launched a boycott campaign against the main US cancer association, the American Cancer Society, because of its failure to take account of industrial pollutants. Let us hope that in France, leading cancer charities will take the lead in the fight against pollution-induced cancer.
Thierry Jaccaud is editor of l’Ecologiste, the sister title to The Ecologist published independently in France. For more information contact +33 1 46 287032.
(2.) Bursaux, Elisabeth. “La secretaire d’Etat a la sante a presente un plan global de lutte contre le cancer” Le Mande, 3 February 2000.
(3.) Bursaux, Elisabeth. “Un programme qui sort la Ligue de son habituelle discretion” Le Monde, 26 January 2000.
(4.) Marty, Michel. “Cancer: une lutte desordonnee en France”- interview with Dr Martine Perez. Le Figaro, 31 January 2000.
(5.) IGAS, Ministere des Affaires Sociales. 1994 annual report, page 110.
(6.) French Senate budget report. 2000.
(7.) French Senate finance commission “Le financement et ‘organisation de la politique de lutte contre le cancer”. Presented by Senator Jacques Oudin, 21 October 1998.
(8.) see www.charteragainstcancer.org
(9.) President of the French Ministry of Health’s cancer committee 1975-1979, president of the European Community’s expert committee on cancer 1986-1994, member of the Academie des Sciences, author of numerous works on cancer.
(10.) Maurice Tubiana. La prevention des cancers (Flammarion, 1997)
(11.) “Do not confuse early identification with prevention. Early identification seeks to spot tumours before they have given rise to any symptoms. Prevention aims to prevent normal cells becoming cancerous.”
Professor Lucien Israel. Cancer, les strategies du futur (Editions Espace 34, 1989)
(12.) ibid. page 69
(13.) La lumiere dons l’omnbre. Le cancer hier et demain. (Editions Odile Jacob, 1991)
(14.) ibid. page 45
(15.) L’education et la vie (Editions Odile Jacob, 1999)
(16.) Salon Forme et Sante, Paris (held in November of each year). Cf. Programme Forme & Sante, 1999 Saus le haut patronage de I’Ordre des medecins.
(17.) Mairie de Paris, direction de l’Action sociale et de la Sante, June 1999. La prevention des grandes maladies. Tubercutose, sida, MST, cancer.
(18.) French Senate finance committee. Le financement et I’organisation de la politique de lutte contre le cancer
Presented by Senator Jacques Oudin, 21 October 1998.
(19.) Cour des comptes. Controle des orgonismes faisant appel a la generosite publique. La ligue nationale contre le cancer. (Les Editions des journaux officiels. Paris, October 1999). (In 1995, the expenses item for “information, prevention and identification” was 39.5 million francs, of which 25.1 million francs was allocated to external communication and the communication departments’ operating costs. See pages 16-18)
(20.) Acedemle des sciences. La pollution atmospherique (Lavoisier, 1999)
(21.) see, in particular, Paris Match, 15 November 1975
(22.) attributed to Pierre Desproges
(23.) op. cit. p 56
(24.) Cancer Prevention Coalition. www.preventcancer.com
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