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AMERICA'S DIET: ARE WE LOSING THE WAR
AGAINST CANCER?
Y 4. G 74/7: AM 3/6
Anerica's Diet: Are Me Losing the «...
HEARING
BEFORE THE
HUMAN RESOURCES AND INTERGOVERNMENTAL
RELATIONS SUBCOMMITTEE
OF THE
COMMITTEE ON
GOVERNMENT OPERATIONS
HOUSE OF REPRESENTATIVES
ONE HUNDRED THIRD CONGRESS
FIRST SESSION
SEPTEMBER 13, 1993
Printed for the use of the Committee on Government Operations
r
JUL 2
1 J994
U.S. GOVERNMENT PRINTING OFFICE
74-905 CC WASHINGTON : 1994
ForsalebytheU.S.GovernmentPrintingOffice
SuperintendentofDocuments,CongressionalSalesOffice,Washington,DC 20402
ISBN 0-16-044341-5
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AMERICA'S DIET: ARE WE LOSING THE WAR
AGAINST CANCER?
4. G 74/7: AM 3/6
Pica's Diet: Are Ue Losing the H. . .
HEARING
BEFORE THE
HUMAN RESOURCES AND INTERGOVERNMENTAL
RELATIONS SUBCOMMITTEE
OF THE
COMMITTEE ON
GOVERNMENT OPERATIONS
HOUSE OF REPRESENTATIVES
ONE HUNDRED THIRD CONGRESS
FIRST SESSION
SEPTEMBER 13, 1993
Printed for the use of the Committee on Government Operations
JUL 2
J J994
U.S. GOVERNMENT PRINTING OFFICE
74-905 CC WASHINGTON : 1994
ForsalebytheU.S.GovernmentPrintingOffice
SuperintendentofDocuments,CongressionalSalesOffice,Washington,DC 20402
ISBN 0-16-044341-5
COMMITTEE ON GOVERNMENT OPERATIONS
JOHN CONYERS, JR., Michigan, Chairman
CARDISS COLLINS, Illinois WILLIAM F. CLINGER, JR., Pennsylvania
GLENN ENGLISH, Oklahoma AL MCCANDLESS, California
HENRY A. WAXMAN, California J. DENNIS HASTERT, Illinois
MIKE SYNAR, Oklahoma JON L. KYL, Arizona
STEPHEN L. NEAL, North Carolina CHRISTOPHER SHAYS, Connecticut
TOM LANTOS, California STEVEN SCHIFF, New Mexico
MAJOR R. OWENS, New York C. CHRISTOPHER COX, California
EDOLPHUS TOWNS, New York CRAIG THOMAS, Wyoming
JOHN M. SPRATT, JR., South Carolina ILEANA ROS-LEHTINEN, Florida
GARY A. CONDIT, California RONALD K. MACHTLEY, Rhode Island
COLLIN C. PETERSON, Minnesota DICK ZIMMER, New Jersey
KAREN L. THURMAN, Florida WILLIAM H. ZELIFF, Jr., New Hampshire
BOBBY L. RUSH, Illinois JOHN M. MCHUGH, New York
CAROLYN B. MALONEY, New York STEPHEN HORN, California
THOMAS M. BARRETT, Wisconsin DEBORAH PRYCE, Ohio
DONALD M. PAYNE, New Jersey JOHN L. MICA, Florida
FLOYD H. FLAKE, New York ROB PORTMAN, Ohio
JAMES A. HAYES, Louisiana
CRAIG A. WASHINGTON, Texas BERNARD SANDERS, Vermont
BARBARA-ROSE COLLINS, Michigan (Independent)
CORRINE BROWN, Florida
MARJORIE MARGOLIES-MEZVINSKY,
Pennsylvania
LYNN C. WOOLSEY, California
GENE GREEN, Texas
BART STUPAK, Michigan
Julian Epstein StaffDirector
Matthew R. Fletcher, Minority StaffDirector
Human Resources and Intergovernmental Relations Subcommittee
EDOLPHUS TOWNS, New York, Chairman
HENRY A. WAXMAN, California STEVEN SCHIFF, New Mexico
THOMAS M. BARRETT, Wisconsin STEPHEN HORN, California
DONALD M. PAYNE, New Jersey JOHN L. MICA, Florida
CRAIG A. WASHINGTON, Texas
BERNARD SANDERS, Vermont (Ind.)
Ex Officio
JOHN CONYERS, JR., Michigan WILLIAM F. CLINGER, JR., Pennsylvania
RONALD A. Stroman, StaffDirector
ALLEGRA A. PACHECO, Professional StaffMember
MARTINE M. DlCROCE, Clerk
Martha MORGAN, Minority Professional Staff
CONTENTS
Page
Hearingheldon September 13, 1993 1
Statementof:
Catmipobne,laln,dTdeidr,ectsoerc,reStUarPyE-tRrVeaAsuLrUer,StoPrreosduce for Better Health Founda- 103
Foerster, Susan, M.P.H., R.D., chief, nutrition and cancer prevention
program, California DepartmentofHealthServices 115
Freeman, Harold, M.D., directorofsurgery, HarlemHospital Center 72
Fugh-Berman, Adriane, M.D., medical advisor, National Women's Health
Network 57
Greenwald, Peter, Director, Division of Cancer Prevention and Control,
National CancerInstitute 37
Haas, Ellen, Assistant Secretary for Food and Consumer Services, U.S.
Department ofAgriculture 12
Jacobson, Michael, Ph.D., executive director, Center for Science in the
PublicInterest 79
McGinnis, J. Michael, Deputy Assistant Secretary for Health, Disease
Prevention and Health Promotion, Department of Health and Human
Services 26
Towns, Hon. Edolphus, a Representative in Congress from the State
ofNew York, and chairman, Human Resources and Intergovernmental
RelationsSubcommittee: Opening statement 1
Wynder, Ernst, M.D., founder and president, American Health Founda-
tion 66
Letters, statements, etc., submitted forthe recordby:
Campbell, Ted, secretary-treasurer, Produce for Better Health Founda-
tion, anddirector, SUPERVALUStores: Prepared statement 105
Foerster, Susan, M.P.H., R.D., chief, nutrition and cancer prevention
program, California Department of Health Services: Prepared state-
ment 118
Freeman, Harold, M.D., director of surgery, Harlem Hospital Center:
Prepared statement 75
Fugh-Berman, Adriane, M.D., medical advisor, National Women's Health
Network: Prepared statement 60
Greenwald, Peter, Director, Division of Cancer Prevention and Control,
National CancerInstitute: Prepared statement 39
Haas, Ellen, Assistant Secretary for Food and Consumer Services, U.S.
Department ofAgriculture:Prepared statement 15
Jacobson, Michael, Ph.D., executive director, Center for Science in the
Public Interest: Prepared statement 82
McGinnis, J. Michael, Deputy Assistant Secretary for Health, Disease
Prevention and Health Promotion, Department of Health and Human
Services: Prepared statement 28
Sanders, Hon. Bernard, a Representative in Congress from the State
ofVermont: Prepared statement 9
Towns, Hon. Edolphus, a Representative in Congress from the State
ofNew York, and chairman, Human Resources and Intergovernmental
RelationsSubcommittee:
Information regarding estimates spent at National Cancer Institute
on dissemination activities for fiscalyear 1993 53
Prepared statement 3
Wynder, Ernst, M.D., founder and president, American Health Founda-
tion: Prepared statement 68
(III)
rv
Page
APPENDIXES
—
Appendix 1.—Prepared statement ofHon. Steven Schiff 143
Appendix 2. NCI's response to subcommittee inquiry 144
AMERICA'S DIET: ARE WE LOSING THE WAR
AGAINST CANCER?
monday, september 13, 1993
House of Representatives,
Human Resources and
Intergovernmental Relations Subcommittee
of the Committee on Government Operations,
Washington, DC.
The subcommittee met, pursuant to notice, at 11 a.m., in room
2247, Rayburn House Office Building, Hon. Edolphus Towns (chair-
man ofthe subcommittee) presiding.
Present: Representatives Edolphus Towns and Bernard Sanders.
Also present: Ronald A. Stroman, staff director; Allegra A.
Pacheco, professional staffmember; Martine M. DiCroce, clerk; and
Martha Morgan, minority professional staff, Committee on Govern-
ment
Operations.
OPENING STATEMENT OF CHAIRMAN TOWNS
Mr. Towns. The Committee on Government Operations, Human
Resources and Intergovernmental Relations Subcommittee will
come to order.
Today is an historic day. Peace in the Middle East is finally
being achieved. However, while this peace agreement may put an
end to the battles of the Middle East, our war against cancer con-
tinues.
Cancer is becoming the Nation's greatest medical epidemic. It
comprises almost 2 percent of our GNP. It costs over $100 billion
in health care. It strikes one in three Americans. It kills over half
a million Americans each year.
This year, we provided the National Cancer Institute with almost
$2 billion in their budget, and what did we come up with? An inci-
dence rate of cancer that has increased by 32 percent in the last
decade; a statistic that ca—ncer is set to become the leading cause
of death by the year 2000 less than 7 years from now; and a con-
fession by NCI's Director that the death rate from cancer in Afri-
can-Americans and other minority populations due to totally pre-
ventable cancers is, catastrophic. Almost $2 billion to NCI, and
more and more Americans are getting cancer.
This concerns me personally. I come from a family offour, where
my mother, father, and younger brother all died from cancer.
Our war on cancer is not nearing victory. It doesn't even seem
close. That is because our national cancer strategy is devoted more
to developing high-priced treatments and elaborate cures rather
than eliminating the epidemic from our society.
(1)
We will win the war against can—cer when we begin to reduce the
incidence of —cancer in this country not by treating it, curing it, or
mitigating it but by preventing it in the first place. In this period
ofhealth care reform and progressive science, prevention must take
priority. As Dr. Samuel Broder, the Director of NCI has stated,
"prevention is the most cost-effective approach to cancer."
Unfortunately, primary prevention remains a low priority at our
national cancer research center. Out of a $2.1 billion bud—get, NCI
states that it spends $334 million on primary prevention 15 per-
cent of its entire budget. Most of NCI s funding goes toward diag-
nosis, treatment, and cures, which are important, but not more im-
portant than preventing Americans from getting cancer in the first
place. —
This week is the National 5-A-Day for Better Health Week a
good start by NCI and the produce industry to tell Americans that
they can reduce one-third of all cancers by incorporating more
fruits and vegetables into their daily die—t. Yet NCI allocated $4
million this year to the 5-A-Day Program a mere two-tenths of 1
percent of its budget. This is not enough. The prevention message
must be louder. It must be clearer. And it must move a lot faster.
The priorities must change. Today, the priority is prevention, and
this must manifest itself in a monumental shift offunding and re-
sources. The Federal Government can begin to do this by integrat-
ing NCI's dietary recommendations into Federal feeding programs:
In this way, one-sixth ofall Americans will be able to improve their
diet, almost overnight. NCI can do this by shifting its focus on pri-
mary prevention and control. Not enough Americans are aware of
the extensive link between diet and cancer. The message must get
out.
We must info—rm Americans that cancer is not a mysterious or in-
evitable disease that Amer—icans can prevent many cancers just by
taking actions themselves increasing their intake of fruits and
vegetables, reducingfat, eating fiber.
This hearing is one of many forums we hope will be established
to tell Americans that cancer is preventable. Today, we will empha-
size the cancer prevention message, examine the administration's
cancer strategy and explore ways to expand cancer prevention and
integrate NCI's dietary recommendations into our national cancer
strategy.
As you can see from the witness list, we have an ambitious agen-
da, and I ask for everyone's cooperation in adhering to the 5-
minute rule.
I look forward to hearing from all ofour distinguished witnesses.
[The prepared statement ofMr. Towns follows:]
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OPENING STATEMENT OF THE HONORABLE EDOLPHUS TOWNS, CHAIRMAN
SUBCOMMITTEE ON HUMAN RESOURCES AND INTERGOVERNMENTAL RELATIONS
"AMERICA'S DIET: ARE WE LOSING THE WAR AGAINST CANCER?"
SEPTEMBER 13, 1993
2247 RHOB
—
TODAY IS AN HISTORIC DAY PEACE IN THE MIDDLE EAST IS
FINALLY BEING ACHIEVED. HOWEVER, WHILE THIS PEACE AGREEMENT MAY
PUT AN END TO THE BATTLES OF THE MIDDLE EAST, OUR WAR AGAINST
CANCER CONTINUES.
CANCER IS BECOMING OUR NATION'S GREATEST MEDICAL EPIDEMIC. IT
COMPRISES ALMOST 2% OF OUR GNP. IT COSTS OVER $100 BILLION IN
HEALTH CARE. IT STRIKES ONE IN THREE AMERICANS. IT KILLS OVER HALF
A MILLION AMERICANS EACH YEAR.
THIS YEAR, WE PROVIDED THE NATIONAL CANCER INSTITUTE WITH
ALMOST 2 BILLION DOLLARS AND WHAT DID WE COME UP WITH?
A INCIDENCE RATE OF CANCER THAT HAS INCREASED BY 32% IN
THE LAST DECADE;
A STATISTIC THAT CANCER IS SET TO BECOME THE LEADING
CAUSE OF DEATH BY THE YEAR 2000, LESS THAN SEVEN YEARS
FROM NOW; AND
A CONFESSION BY NCI'S DIRECTOR THAT THE DEATH RATE FROM
CANCER IN AFRICAN-AMERICANS AND OTHER MINORITY
POPULATIONS, DUE TO TOTALLY PREVENTABLE CANCERS IS
CATASTROPHIC
.
ALMOST TWO BILLION DOLLARS TO NCI AND MORE AND MORE AMERICANS
ARE GETTING CANCER. OUR WAR ON CANCER IS NOT NEARING VICTORY; IT
DOESN'T EVEN SEEM CLOSE. THAT IS BECAUSE OUR NATIONAL CANCER
STRATEGY IS DEVOTED MORE TO DEVELOPING HIGH-PRICED TREATMENTS AND
ELABORATE CURES, RATHER THAN ELIMINATING THE EPIDEMIC FROM OUR
SOCIETY.
WE WILL WIN THE WAR ON CANCER WHEN WE BEGIN TO REDUCE THE
—
INCIDENCE OF CANCER IN THIS COUNTRY NOT BY TREATING IT, CURING
—
IT, OR MITIGATING IT BUT BY PREVENTING IT IN THE FIRST PLACE.
IN THIS PERIOD OF HEALTH CARE REFORM AND PROGRESSIVE SCIENCE,
PREVENTION MUST TAKE PRIORITY. AS DR. SAMUEL BRODER, THE DIRECTOR
OF NCI HAS STATED, PREVENTION IS THE MOST COST-EFFECTIVE APPROACH
TO CANCER.
UNFORTUNATELY, PRIMARY PREVENTION REMAINS A LOW PRIORITY AT
OUR NATIONAL CANCER RESEARCH CENTER. OUT OF A 2.1 BILLION DOLLAR
BUDGET, THE NATIONAL CANCER INSTITUTE STATES THAT IT SPENDS $334
—
MILLION ON PRIMARY PREVENTION 15% OF NCI'S ENTIRE BUDGET. MOST
