Inequality and Cancer

From the American Cancer Society:

The death rate from cancer in the US has declined steadily over the past 25 years, according to annual statistics reporting from the American Cancer Society. As of 2016, the cancer death rate for men and women combined had fallen 27% from its peak in 1991. This decline translates to about 1.5% per year and more than 2.6 million deaths avoided between 1991 and 2016.

The drop in cancer mortality is mostly due to steady reductions in smoking and advances in early detection and treatment. But not all populations are benefitting. Although the racial gap in cancer deaths is slowly narrowing, socioeconomic inequalities are widening. “Cancer Statistics, 2019,” published in the American Cancer Society’s journal CA: A Cancer Journal for Clinicians, estimates the numbers of new cancer cases and deaths expected in the US this year. The estimates are some of the most widely quoted cancer statistics in the world. The information is also released in a companion report, Cancer Facts and Figures 2019, available on the interactive website, the Cancer Statistics Center.
...
The rates of new cancer cases and cancer deaths vary quite a bit among racial and ethnic groups, with rates generally highest among African Americans and lowest for Asian Americans. The cancer death rate in 2016 was 14% higher in blacks than in whites. That gap has narrowed from a peak of 33% in 1993. The progress is due to the steep drop in smoking rates among black teens from the late 1970s through the early 1990s.

Racial and ethnic differences in cancer burden reflect several factors related to socioeconomic status. People living in the poorest counties in the US are more likely to smoke and be obese. During 2012-2016, death rates in the poorest counties were 2 times higher for cervical cancer and 40% higher for male lung and liver cancers, compared with the richest counties. Poverty is also associated with lower rates of routine cancer screening, later stage at diagnosis, and a lower likelihood of getting the best treatment.

Moonshot

President Obama has compared the search for a cancer cure to the moon shot.

PZ Myers writes at ScienceBlogs:

Everyone admires John F. Kennedy’s ambition in setting a specific goal for the space program, way back in the 1960s. It was smart to focus. But here’s the difference: we knew where the moon was. There it is, 380,000km away, in a predictable orbit around the planet, and we had these technologies to fire off rockets that already contained the basic principles we needed to get to the moon. It was a nontrivial effort, but getting from here to there was an already specified problem.

Where is “cancer”? Can you even define the problem? Do you see a solution that you can reach by just throwing a lot of money at it and telling a team of doctors to fix it?

No, you can’t. Scientists who study cancer will even tell you flat out that cancer isn’t one disease, it’s a multitude of diseases. It’s more like a pattern of collapse of a complex structure, and there’s a million different ways it can happen. A “moonshot” is a terrible metaphor for how to approach the treatment of cancer.

Ike Swetlitz writes at STAT:

Nixon, of course, also invoked a “war on cancer.” Decades later, with the war still not won, the Clinton administration turned again to that militaristic metaphor.

“We want to be the first generation that finally wins the war on cancer,” then-Vice President Al Gore told the Toledo Blade in 1998. He said science was on the verge of a breakthrough: “For the first time, the enemy is outmatched.”

It wasn’t.

In the following campaign, Republican presidential nominee George W. Bush returned to the space metaphor. He promised to “fund and lead a medical moonshot to reach far beyond what seems possible today,” to cure not just cancer but many ills associated with aging.

Moon, Cancer, Nixon, Obama

"Last year, Vice President Biden said that with a new moonshot, America can cure cancer. Last month, he worked with this Congress to give scientists at the National Institutes of Health the strongest resources that they’ve had in over a decade. (Applause.) So tonight, I’m announcing a new national effort to get it done. And because he’s gone to the mat for all of us on so many issues over the past 40 years, I’m putting Joe in charge of Mission Control. (Applause.) For the loved ones we’ve all lost, for the families that we can still save, let’s make America the country that cures cancer once and for all."  -- Barack Obama, State of the Union, January 12, 2016.

Nixon said the same thing 45 years ago:

"I will also ask for an appropriation of an extra $100 million to launch an intensive campaign to find a cure for cancer, and I will ask later for whatever additional funds can effectively be used. The time has come in America when the same kind of concentrated effort that split the atom and took man to the moon should be turned toward conquering this dread disease. Let us make a total national commitment to achieve this goal." -- Richard Nixon, State of the Union, January 22, 1971

Charities and Lobbying

Our text explains that charities organized under section 501(c)(3) of the internal revenue code may spend a small portion of their income on lobbying. We note that they may also have ties to 501(c)(4) groups that do focus on lobbying. In The Washington Examiner, Timothy Carney offers the example of the Susan G. Komen Breast Cancer Foundation.

In 2009, the Komen Foundation -- a 501(c)3 charity and thus limited in the percentage of its money it can spend on lobbying -- gave its single-largest "education" grant, $4.4 million, to the Komen Advocacy Alliance, its public policy and lobbying arm, which is covered by section 501(c)4 of the tax code and thus unrestricted in its lobbying. A Komen spokesman said the Advocacy Alliance uses that money for its non-lobbying advocacy, such as grass-roots education, and that actual lobbying money doesn't come from the 501(c)3. However, the Advocacy Alliance currently operates on a loan from the main Komen foundation (the 501(c)3). Unless you ignore the fungibility of money, supporting Komen means supporting its lobbying operation.

Our chapter also includes a photo essay on the Podesta family, which is prominent in Washington interest-group circles. Carney notes:

Heather Podesta, the most famous of Komen's K Street hired guns (and a leading Democratic Party fundraiser), reports that her firm lobbied on Komen's behalf for "support [for] H.R. 3962, the Affordable Health Care for America Act/H.R. 3590, the Patient Protection and Affordable Care Act, as it relates to breast cancer prevention, screening, research, and treatment." In other words, Komen supported Obamacare insofar as it included provisions it supported. Komen spokesman Sean Tuffnell, however, told me that Komen "never did fully endorse the legislation."

Nevertheless, Carney argues that such activities pose a conflict for contributors who support the charity's overall aims but oppose specific measures for which it lobbies.