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Requests or suggestions have been received for further investigation or evaluation of 62 of the different proposals in the latter group. You can see what this means to us to be suddenly thrown a number this great. So our committee has had to look at this from the standpoint of its possibilities, from the standpoint of its national impact and its possibilities from the standpoint of a real attack on cancer and from the standpoint of exciting a lot of people's curiosity and perhaps misgivings later on. We have had a very difficult problem in trying to sift out what really is the most important matter.
We have been fortunate in having as the executive secretary of this committee one of the most diligent and conscientious individuals I have ever known who is completely devoted to this thing. She has worked beyond what anyone could expect her to do in this work and she is Dr. Isabelle Wason, executive secretary of our committee.
The committee will accept proposals from three sources; they will accept proposals for study from the sponsoring agencies; they accept proposals from members of the medical division of the National Research Council or from the chairman of this division, Dr. Cameron, or from its own membership. Those are the ways in which the proposals are put before the committee. The committee then propounds questions about it in this fashion: These are the steps in the investigation of a procedure or proposal after request is received; the assembly of information comes from the proponents-those who propose the treatment-and others, by correspondence, personal conferences and review of literature, if such is available. There should be full information on the nature of the procedure, the composition and preparation of the products used, the method of clinical usage, with emphasis on the safety to patients, and the results that have been observed in the treatment of proven cancer.
Frequently, the product or method of preparation is secret and details of clincial usage may be withheld. In many instances there is no biopsy proof that the disease was actually a cancer or, if so, of what type.
The information having been assembled is then subject to review by the committee. A decision concerning further action is based on the completeness of the available information, other previous or current studies of this therapy, the scientific and clinical significance of the data presented, public welfare, with particular attention to the local or national status.
Procurement of further information on the nature of the agent requires a good deal of technical advice which requires the assistance of scientists with specialized training in different fields.
We then, if the proposal is accepted by the committee on the basis I have tried to indicate, try to make arrangements for clinical trials of this material. Efforts in this direction are being made with some preparations and we hope that in the near future we will have these under full study. And we receive assistance from institutions where there is no reason to believe that any individual has any particular interest in this thing because he is doing this on a completely voluntary basis to help the committee.
Now, with regard to the last aspect of this, the most difficult situation that we have to contend with is the fact that as was pointed out this morning, cancer in its natural course has a wide variety of growth
rates. There are patients who may live with cancer of the breast for 10 or 12 years without treatment, the disease growing very, very, slowly. There are other individuals that may find cancer of the breast not any larger than my small fingernail, in which the patient would be dead in 6 months from rapid dissemination throughout the entire body. Therefore it presents much for us to review with regard to the natural history of the disease.
Attempts have been made in this regard by myself and another individual some years ago, and by English workers and by others working in this country now proceeding along the same line. In order for us to understand if an individual's life expectancy can be increased we must know what the cancer will do in its natural course. This is very difficult to evaluate. Also we have to take into consideration what we call subjective response to a treatment, which does not necessarily mean that it has an effect on the tumor. Subjective response is a feeling of well-being on the part of the patient, which may be accomplished by a number of measures. It may be relief of the pain, which may be a very difficult thing to evaluate. It may be a sense of well-being in a sense that the patient says he feels better or it may be other factors psychologically which enter into this, with the patient having the idea that something is being done, and that is a very important consideration.
But if one looks at this scientifically as one should, we have to depend upon what we call objective response. What happened to the cancer, because if the cancer undergoes certain changes and begins to slow down in growth or becomes smaller in size, generally the patient improves without any question. Her weight might increase and her appetite might also increase and she wants to go back to her housework and get out of bed. These measures can be accomplished by several agents. These are objective responses. In other words, I am trying to distinguish between the expression "I feel well" as against "What has really happened to the tumor?"
We have measurements for this type of thing, which were alluded to this morning, chemical measurements, which will tell us whether a tumor is undergoing a good response. We have X-rays to tell us whether lung tumors have become smaller under treatment. Again, by means of X-rays, we can tell if bone diseases, cancers of the bone, are improved by the changes in the bone which tend to return to normal. We have these objective measurements which lead us to believe that if these things do exist even in a few patients, we must then go ahead and really look into the situation. We must remember also and I am going to close by saying this: That cancer may also undergo spontaneous changes. In other words, some cancer may disappear without any treatment that we know of. This is characteristic of some types of cancer. One type is the so-called malignant mole or malignant malinoma, which may spread very rapidly and then, for some reason or other, disappear. It does not mean it will not appear again. There are examples of such cases. Cancer may grow in spurts and it may slow down for a year or two and then increase in size again. As Dr. Farber pointed out this morning the cancer may be quiet and for some reason it appears again.
Therefore, in closing, I would like to say our committee is making every attempt to critically, neutrally evaluate any proposal that is
presented to us in the same ways as those presented to us through the ordinary scientific journals. The methods by which we do this are the same methods by which we ourselves do our own research work and we have set up standards identical to those set up for ourselves which are accepted methods for cancer therapy and diagnosis. Thank you very much.
The CHAIRMAN. Doctor, this has been a very interesting statement that you have made and I think that the work of this committee is exceedingly important, because in our groping, so to speak, there is a desire to get the ultimate result.
We can readily realize that in cases such as this disease there may be many well-intentioned individuals who have seen some improvement as the result of some particular treatment and who feel that they have the answer.
On the other hand, it may be that the proposed remedy has no value whatsoever, and it was only incidental that it seemed to have value. Now, I take it that your organization seeks, so far as you can with the knowledge that is available to you, and with the assistance of such chemists and laboratory tests and what not, to try to evaluate in the interest of the people these different remedies that come to your attention.
Under the circumstances, I would assume that you would be unable to make a complete study unless the individual who possesses the particular so-called remedy or treatment is willing to make it available to your committee in all of its detail; is that right?
Dr. NATHANSON. That is correct, sir.
The CHAIRMAN. Well, I can readily understand that if you do not have the details you could hardly be expected to express a judgment that would be good.
Now, in the event that there is a proposed therapy, and the individual who has it fails to supply the necessary detailed information to the committee for evaluation, I take it, then, that there is no general action taken by your committee with respect to that particular remedy, due to the inusufficiency of the details that are presented to you? Dr. NATHANSON. That is correct.
The CHAIRMAN. Their failure or refusal to do so?
Dr. NATHANSON. That is correct, sir.
The CHAIRMAN. Are there any further questions, gentlemen?
The CHAIRMAN. Yes, sir.
Dr. HELLER. Mr. Chairman, we shall avail ourselves of your invitation to submit additional data that you would like to have in the record and with your permission we shall submit to the clerk of your committee such additional information.
I should also like to say, sir, on behalf of the panel, since this was our final panelist, that we appreciate tremendously the graciousness of the chairman, the courteous attention of the committee and the opportunity to appear here to explain cancer research, cancer control, and the opportunities to submit to the Congress the progress that has been made so that you may be better informed of this particular important activity. Thank you, sir.
The CHAIRMAN. Dr. Heller, before I reply directly to what you have just said, I want to give Mr. Teeter of the Damon Runyon Foundation an opportunity to present any facts that he may wish in connection with that fund.
STATEMENT OF JOHN TEETER, DAMON RUNYON FOUNDATION
Mr. TEETER. Mr. Chairman, may I present this statement to the committee and I will not take your time, because it is in more detail than I would be able to give to the committee.
The CHAIRMAN. Yes, sir, you certainly may. (The matter referred to is as follows:)
DAMON RUNYON FUND, SEPT. 25, 1953
DAMON RUNYON MEMORIAL FUND FOR CANCER RESEARCH, INC., NEW YORK, N. Y.
MEMO RE THE DAMON RUNYON FUND
Damon Runyon died December 10, 1946. The following Sunday night Walter Winchell founded the Damon Runyon fund by asking for nickels, dimes, and dollars to help fight cancer. Before Damon died, from cancer of the throat, he had scribbled a note to Walter: "You can keep the things of bronze and stone; give me one man to remember me once a year.”
This monument has now reached $7,818,652, measured in dollars for want of a better measuring stick. Perhaps a more permanent recognition is in the 388 grants and 256 fellowships given in 170 institutions in 47 States, the District of Columbia, and 14 foreign countries. And all this without deducting a penny for expenses. Mr. Winchell and a few friends pay all expenses through the Walter Winchell Foundation. Even then, these expenses are less than 5 percent of the sum collected by the fund; $7,246,786 has been allocated in grants and fellowships.
The fund is devoted entirely to seeking the cause and control of cancer, by supporting cancer research and training men to conduct this research. If the disease can be brought under control by research the annual economic loss to the Nation can be brought within manageable proportions. Over 200,000 die each year from cancer, another 600,000 suffer. The annual hospitalization cost of those who die exceeds $300 million. The limited funds of private agencies cannot hope to meet the cost of patient care. For this reason the fund concentrates on research seeking the cause and control of cancer.
The Damon Runyon fund was incorporated in New York State in 1947 and enjoys Federal tax exemption. Organizationally it includes members, directors, and officers. Membership is unlimited. Directors may be not more than nine. Officers are elected by the directors. Members elect the directors.
Members: Dan Parker, Leo Lindy, Walter Winchell, Arthur Godfrey, Milton Berle, Robert Christenberry, John Daly, Marlene Dietrich, Joe DiMaggio, Morton Downey, Bob Hope, Louis R. Lurie, Sugar Ray Robinson, and Paul Small.
Directors: Dan Parker, Leo Lindy, Walter Winchell, Arthur Godfrey, Robert Christenberry, Morton Downey, Louis R. Lurie, Clendenin J. Ryan, and Paul Small.
Officers: Dan Parker, president; Bob Hope, assistant to president; Leon Lindy, vice president; Walter Winchell, treasurer; and Arthur Godfrey, secretary.
All of the above men and women serve without compensation. Functionally, the fund receives contributions from any source and sends out receipts and "in memory" cards in time of death or any other suitable occasion. There is no regular drive. Most of the funds come from special events, such as the Tournament of Champions. There have been 143 bequests from estates totaling $800,000. A remarkable record for so young a fund.
Any institution or, graduate M. D. or Ph. D. may apply to the fund for the support of a cancer-research project within the institution or for a Damon Runyon Fund Fellowship. Application is made on forms obtained from this office. They are reviewed monthly by the attached committee of scientists and doctors specializing in cancer. Applications are graded competitively. Approximately one-third of the best applications are approved, that being the maximum
possible for the money available. The recommendations of this committeealso serving without compensation-are forwarded by the executive director, John H. Teeter, to the officers of the fund, who are asked to approve or disapprove. The fund is unique in that it passes on grants monthly. The Government agency, the National Cancer Institute, takes almost a year and the American Cancer Society over a year. Each grantee is required to submit a budget and file a progress report. The fund spot checks expenditure reports and reviews progress reports.
Ten million dollars spent annually on cancer research is the largest medicalresearch effort in the world. The Runyon fund's share is about $1,300,000. The National Cancer Institute (Government) and the American Cancer Society carry about $3,500,000 each and the Atomic Energy Commission and other smaller agencies, the balance. The Runyon fund is the only agency devoted entirely to research-supporting salaries, equipment, and expendable supplies used in cancer research. We do not provide money for bricks and mortar (buildings). The cause of cancer is not known-but its control is within the possibility of research. The combined efforts of the agencies in the field are tied together in a radial fashion-much like the hub and spokes of a wagon wheel. There are competing teams working on the same unsolved problems-but not needless duplication.
Organized cancer research started in 1945. The Runyon fund entered the team in 1947. Chemicals to control cell growth, and differentiate between cancer and normal cells are being developed and tested-more than 5,000 so far. X-ray methods are being improved, voltages in the millions, and the poor man's radium (the cobalt bomb), are credits to the fund. Improved surgery, sometimes known as radical or experimental surgery, is currently saving lives considered hopeless 2 years ago. As parts of the cancer puzzle fit into the total research effort there is reason to believe cancer control is possible within our life span.
The prominence of the fund's membership results in many calls for guidance in patient care. Advice is given, but no funds are available for patient care. Many sincere and honest people believe they have a cure for cancer-but sincerity and honesty are not substitutes for competence where human life is at stake. The Committee for Cancer Diagnosis and Therapy, 2101 Constitution Avenue, Washington, D. C., has been created by the cancer agencies, including the Runyon fund, to meet the prolific reports of cures and to screen those whose claims of cures are unproven in medical and scientific channels. All cancertherapy claims may be referred to this unbiased committee. There is no reason for any person or group to claim persecution. The fund does, however, insist that any research project be judged competitively-there are no back doors for grants based on pressure.
The pen and microphone of the fund's treasurer have served a most useful public service in bringing the word "cancer" into public use. An even greater service has been the exposé of cancer fund raising frauds and those claiming cures. This has been a one-man task in which no other single individual could have been so useful to the public. Every dollar saved from frauds or questionable cures is a dollar available for the Damon Runyon Fund.
DAMON RUNYON FUND ADVISORY COMMITTEE
JOHN H. TEETER.
Dr. Emerson Day, Strang Cancer Prevention Clinic, 419 East 68th Street, New York 21, N. Y.
Dr. Anthony J. Lanza, New York University, Bellevue Medical Center, Institute of Industrial Medicine, 477 First Avenue, New York City.
Dr. Antonio Rottino, St. Vincent's Hospital, 7th Avenue and 11th Street, New York City.
Dr. Howard Canning Taylor, Jr., Columbia Presbyterian Medical Center, 630 West 168th Street, New York City.
Dr. Albert Tannenbaum, Michael Reese Hospital, 29th Street, and Ellis Avenue, Chicago 16, Ill.
Dr. John G. Trump, Massachusetts Institute of Technology, Cambridge 39, Mass. Prof. J. A. Reyniers, Lobund Institute, University of Notre Dame, Notre Dame, Ind.
Prof. M. J. Kopac, New York University, Washington Square College of Arts and Sciences, Washington Square 3, N. Y.
Prof. Cavett O. Prickett, E. I. du Pont de Nemours & Co., Grasselli Division, Wilmington 98, Del.