[Senate Hearing 109-1008]
[From the U.S. Government Publishing Office]
S. Hrg. 109-1008
WINNING THE RACE AGAINST CANCER
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HEARING
before a
SUBCOMMITTEE OF THE
COMMITTEE ON APPROPRIATIONS UNITED STATES SENATE
ONE HUNDRED NINTH CONGRESS
SECOND SESSION
__________
SPECIAL HEARING
JULY 28, 2006--IOWA CITY, IA
__________
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COMMITTEE ON APPROPRIATIONS
THAD COCHRAN, Mississippi, Chairman
TED STEVENS, Alaska ROBERT C. BYRD, West Virginia
ARLEN SPECTER, Pennsylvania DANIEL K. INOUYE, Hawaii
PETE V. DOMENICI, New Mexico PATRICK J. LEAHY, Vermont
CHRISTOPHER S. BOND, Missouri TOM HARKIN, Iowa
MITCH McCONNELL, Kentucky BARBARA A. MIKULSKI, Maryland
CONRAD BURNS, Montana HARRY REID, Nevada
RICHARD C. SHELBY, Alabama HERB KOHL, Wisconsin
JUDD GREGG, New Hampshire PATTY MURRAY, Washington
ROBERT F. BENNETT, Utah BYRON L. DORGAN, North Dakota
LARRY CRAIG, Idaho DIANNE FEINSTEIN, California
KAY BAILEY HUTCHISON, Texas RICHARD J. DURBIN, Illinois
MIKE DeWINE, Ohio TIM JOHNSON, South Dakota
SAM BROWNBACK, Kansas MARY L. LANDRIEU, Louisiana
WAYNE ALLARD, Colorado
J. Keith Kennedy, Staff Director
Terrence E. Sauvain, Minority Staff Director
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Subcommittee on Departments of Labor, Health and Human Services, and
Education, and Related Agencies
ARLEN SPECTER, Pennsylvania, Chairman
THAD COCHRAN, Mississippi TOM HARKIN, Iowa
JUDD GREGG, New Hampshire DANIEL K. INOUYE, Hawaii
LARRY CRAIG, Idaho HARRY REID, Nevada
KAY BAILEY HUTCHISON, Texas HERB KOHL, Wisconsin
TED STEVENS, Alaska PATTY MURRAY, Washington
MIKE DeWINE, Ohio MARY L. LANDRIEU, Louisiana
RICHARD C. SHELBY, Alabama RICHARD J. DURBIN, Illinois
ROBERT C. BYRD, West Virginia (Ex
officio)
Professional Staff
Bettilou Taylor
Jim Sourwine
Mark Laisch
Sudip Shrikant Parikh
Candice Ngo
Lisa Bernhardt
Ellen Murray (Minority)
Erik Fatemi (Minority)
Adrienne Hallett (Minority)
Administrative Support
Jeff Kratz
C O N T E N T S
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Page
Opening statement of Senator Tom Harkin.......................... 1
Statement of Senator John Kerry.................................. 3
Statement of Gary Streit, Cedar Rapids, Iowa..................... 6
Statement of Dr. George Weiner, director, the Holden
Comprehensive Cancer Center, University of Iowa, Chair, the
State of Iowa's Comprehensive Cancer Control Consortium........ 9
Statement of Shirley Ruedy, author, the Cancer Update Column in
the Cedar Rapids Gazette....................................... 11
Statement of Lance Armstrong..................................... 13
WINNING THE RACE AGAINST CANCER
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FRIDAY, JULY 28, 2006
U.S. Senate,
Subcommittee on Labor, Health and Human,
Services, Education, and Related Agencies,
Committee on Appropriations,
Iowa City, IA.
The subcommittee met at 8:30 a.m., at the University of
Iowa, Iowa Memorial Union, 2nd Floor Ballroom, Iowa City, Iowa,
Hon. Tom Harkin presiding.
Present: Senators Harkin and Specter.
Also present: Senator John Kerry.
opening statement of senator tom harkin
Senator Harkin. Good morning, everyone and I do mean
everyone. I just opened the paper this morning and I see I've
got some things to watch today or to get online and see online.
There is ``Where is Lance Today?''
I can go online and see that. Lance is right across the
isle--I can also get that online but the best one that I want
to get is, Watch Lance Eat Pie.
I've always wanted to watch Lance Armstrong eat pie for
some reason, I don't know. Coconut cream pie, that's right.
Exactly.
Well, good morning everyone. The Senate Appropriations
Committee on Labor, Health, Human Services, Education, and
Related Agencies will come to order. This is an official
hearing of the Appropriations Committee of the Senate on
Health, Labor, Education, amd Related Agencies. Let me thank
the University of Iowa for making this excellent facility
available to us this morning, given the obvious interest in
Lance Armstrong's testimony, perhaps we should render the
Keynes Stadium for this, this morning. Folks in Iowa have been
thrilled to have Lance in our State this week for RAGBRAI
(Register's Annual Great Bicycle Ride Across Iowa). We just
made him promise to not ride the whole thing in one day.
Mr. Armstrong. You guys!
Senator Harkin. The focus of this morning's hearing is to
determine where we stand in cancer research and in providing
access to quality care. I also want to explore whether we are
adequately supporting prevention and screening. Unfortunately,
I'm obliged to begin this morning's hearing by acknowledging a
harsh reality. Since the Second World War, the United States is
the undisputed leader in biomedical research, much of which
goes on right here at this great University.
With the Federal Government providing both the vision and
the funding necessary to maintain that leadership. But today
our leadership is threatened. Last week, the President vetoed
H.R. 810, the Stem Cell Research Enhancement Act. That bill
passed by a bipartisan vote in both the House and the Senate.
That decision means that many of America's top scientists will
remain in a strait jacket, unable to move forward in the most
promising field of medical research in our time, research that
has a very special interest to cancer researchers and Dr.
Weiner will speak to that.
Meanwhile, the President's budget for fiscal year 2007
would cut the funding for the National Cancer Institute by $40
million. That comes on the heels of a $35 million cut this
year. The President's budget also cuts cancer programs at the
Centers for Disease Control and Prevention, including
reductions to breast and cervical cancer screening programs as
well as to the Survivorship Program, which of course works in
collaboration with Lance Armstrong Foundation. In our markup of
the bill last week, we were able to cobble together a small
increase for NIH and the CDC Cancer Programs but that was just
to try to get us back to the 2005 level, not any increases, but
try to get us back just to the 2005 level and again, I want to
make sure this is not a partisan thing.
My friend, Arlen Specter, who is the Chair of this
subcommittee, a Republican from Pennsylvania said the bill
represents, and I quote his words exactly, ``the disintegration
of the appropriate Federal role in health, education and worker
safety.'' So, in the President's budget, funding is cut for 18
of the 19 Institutes of the National Institute of Health. As I
said, the National Cancer Institute gets cut for the second
year in a row.
So today, we're going backward. Instead of funding a war on
cancer, the President's budget would fund a retreat in the war
on cancer. How many of us in this audience have had someone in
our family or a loved one who has cancer or themselves have had
cancer? See what I mean? My own family has been hit hard by
cancer. I had five sibling, six kids. Four of them have already
died of cancer. Two were breast cancer, one prostate, one
thyroid. So it hit our family pretty darn hard. Well, that's
why this hearing and the testimony of our witnesses are so
important.
If we are going to win the race against cancer, we need a
sustained, relentless and stoppable focused commitment to
victory, a sort of a Lance Armstrong-type of commitment to
winning and that attitude is what all our witnesses this
morning share in common. I will read them all and when I
introduce them, I'll just call them by name. First, my friend
and my colleague, Senator John Kerry of Massachusetts, himself.
He himself waged a successful personal battle against
prostate cancer. He has been, in the all the years that we've
served together and we came together to the Senate in 1984. He
has been an outspoken champion of cancer research and he is a
recognized leader in the Senate to improve health care, the
whole health care system in America. Lieutenant Governor first
in Massachusetts and as I said, a Senator since 1984 and of
course, the Democratic Party nominee for President in 2004.
Lance Armstrong needs no introduction. I'll just skip over
Lance, everybody knows Lance.
Gary Streit is a native Iowan, a graduate of Iowa State and
the University of Iowa, College of Law. He is an attorney in
Cedar Rapids. Mr. Streit has been an active volunteer for the
American Cancer Society for three decades, Chair of the
Society's National Board in 2002-2003 and he played a major
role in founding the Society's Cancer Action Network.
Dr. George Weiner, Director of the Holden Comprehensive
Cancer Center here at the University, Chair of the State of
Iowa's Comprehensive Cancer Control Consortium. He earned his
undergraduate degree at Johns Hopkins and medical degree from
Ohio State and has been a faculty member here since 1989.
Shirley Ruedy, a three-time cancer survivor and award-
winning author of the Cancer Update column in the Cedar Rapids
Gazette. She is a recipient of the American Cancer Society's
Courage Award, among many other distinctions. Shirley Ruedy,
thank you again.
At the end of when the witnesses formally testify, I'll
have a few questions for them and then I intend to have an open
mike and somebody has a mike to run around the room with here
and we'll try to have as much interaction as possible. If you
have questions or comments or suggestions, we'd like to hear
from all of you. Now, I'll just say to all our witnesses, any
statements you have will made part of the record in their
entirety. If you could sum it up in 5-7 minutes, I would sure
appreciate it and we first turn to my colleague and good
friend, Senator John Kerry.
STATEMENT OF SENATOR JOHN KERRY
Senator Kerry. Thank you, Tom.
Tom Harkin, thank you very, very much for inviting me to be
here. It's wonderful to be back here in Iowa. It is wonderful
to be here in Iowa City and back at the University, which I've
visited many times and always being back at the University
reminds me of a lot of memories from college days, most of
which I can now talk about since the statute of limitations has
passed.
It is special to be here with this panel, Lance Armstrong
and each of the experts who are going to share some thoughts
with us about cancer and cancer research today. We're here for
a very simple reason, to protect, to guard our Government's
commitment to fighting and to one day, curing cancer. As
Senator Harkin said to you, he and I came to the Senate
together in 1984, we were elected. We were then number 98 and
99 in seniority in the U.S. Senate and I think we are now both
lower than 20, to tell you how time passes. In that time, Iowa
and the country have been so extraordinarily represented in all
of the issues of education and health, by Tom Harkin.
I am grateful for his friendship. As you know, Tom was very
close to Paul Wellstone, Paul Wellstone was thought to be sort
of the conscience of the Senate and I will tell you, Tom
Harkin, with his commitment to the Americans with Disabilities
Act, to his funding of health care programs and education has
been absolutely superb. He is today, in my judgment, our
conscience of the Senate. I'm grateful to him for his
leadership and all the work he does.
Lance Armstrong, besides watching him eat pie, is obviously
an inspiration to all of us and to people all over the world. I
was here in Iowa, on the banks of the Missouri River at a
rally. When I came down after talking and a woman with tears in
her eyes, with an obvious level of just upset and anxiety and
passion, grabbed me and said, ``You gotta wear this'' and she
handed me my first--this is not the same one, that one broke
and I had to replace it but I have it--she handed me my first
bracelet and said, ``you have to wear this for cancer.'' So
literally, I put it on then and I never took it off and I've
never taken it off since. It's a reminder of this fight that
was represented by all those hands that just went up in here, a
fight that Tom just told you took so many members of his
family, a fight that cost my grandfather his life with colon
cancer, my father, his life with prostate cancer, and my ex-
wife 3 months ago with bladder cancer.
I can't tell you how many people I've met in the course of
traveling this Nation of ours who noticed my bracelet and would
share with me the stories of their fight and their battle to
try and cure cancer. This bracelet and Lance's work have
created an enormous sense of community and most importantly, a
sense of the possibilities, of hope, of what we can achieve if
we tap into the best of the American spirit.
The fact is, that all of you sitting here who raised your
hands have either beaten it yourself or known somebody who has
or on the other side, lost somebody because we didn't go far
enough in this battle. So I was lucky. I was also diagnosed in
2003, about 2 months after I announced that I was going to try
and run for President. You can imagine, literally--I think it
was about Christmas Eve when I got the phone call and you go
through this incredible process of questioning and wondering.
You don't know anything at first so you go through this, you
know--what are the options? How bad is it? Where am I?
I determined, like a lot of others, like Lance and others,
that this wasn't going to get in the way, somehow I was going
to beat it. But I was lucky. I had early detection. I had the
best health care in the world and too many people in our
country don't get that. They don't know the options, they don't
get early detection, they don't have the availability of the
best health care. So that's really what we have to talk about,
about--I mean, just understanding those options and realizing
what choices I had made an enormous difference psychologically,
to the ability to be able to go out and deal. That experience
makes me more determined than ever and something I've always
believed: Number one, that everybody in this country ought to
be able to get a healthcare plan that is just as good as the
one that Members of Congress give themselves. That's number
one.
Number two, that cancer research, the number one killer of
people in America under the age of 85, cancer research has got
to be a real national priority, not a rhetorical one but a real
one in every sense of the word. Now we've seen what we can do
when we invest in research. The rewards are probably
immeasurable. In 1971, fewer than half of all the cancer
patients lived 5 years beyond their diagnosis. Today it is up
to 64 percent for adults, 79 percent, which is remarkable, for
children under the age of 14 and since 1971, we've more than
tripled the number of cancer survivors. That is real progress
and it is progress that you just can't put a price tag on.
There is no greater success and there is no greater return to
public life or to community life, than saving lives. You can't
quantify it. We have been made better as a whole, as a Nation,
as a community, because of this research and this effort. But
folks, we got miles to go to alleviate a lot of suffering.
This year, nearly 565,000 Americans are going to die of
cancer. That's more than 1,500 people a day or every 2 days,
the equivalent of what we lost in New York City. It's America's
number one killer, as I said, under the age of 85. The National
Cancer Institute is our frontline for the fight. Lance, I'm
very grateful to him. He helped connect me to that from my ex-
wife's battle and they are fighting so hard to move forward.
George Weiner, a moment ago, was telling me about what they
are doing here at Holden and how so many projects are on hold.
They're ready to go but it takes a lot of time to take things
from laboratory out into the marketplace and we are sitting on
that ability to be able to move forward and we shouldn't be.
So today's Field Hearing here in Iowa is a wonderful
setting to really renew this commitment and understand in the
heartland of America, how we can communicate to public
officials and guarantee this commitment. Right here in Iowa, at
the Holden Center, you've got world-class care, world-class
education, world-class research but again, it is restrained by
the lack of funding. For an incomprehensible reason and I do
mean incomprehensible, without any party label attached to it,
we saw cuts to the cancer research budget this year compared to
last year's funding. It is impossible to pretend and Chairman
Harkin knows this, you can't pretend that this is being done to
cope with record budget deficits. It's not. There is no
shortage of money fundamentally. There is a deficit of
willpower and this is, if anything is, a fundamental question
of values.
In Congress, we measure our values in the priorities and
choices that we live out every day in our budget. That's where
you put your values so we're here today to state emphatically,
it is wrong and shortsighted for the Federal Government to cut
funding for fighting cancer. We're here because it is so
fundamentally contradictory to the values of America that we
can find and borrow even, maybe up to $1 trillion, for the war
in Iraq and yet, we are $40 million shy of where we were last
year in the President's budget in the fight. Now, Tom Harkin
and his Committee have made a difference in that but it is only
a difference by $9 million, folks. That's less than 1 percent
and we should be making a commitment of least a 5 percent
increase per year until we have found the cure to this scourge.
So to all who come in contact with this disease, the impact of
the research is just undeniable. What happens when you cut the
research is, you create uncertainty in all of the centers. You
put projects on hold--who knows whether it is the project that
is going to be difference with one particular cancer or
another?
So, Mr. Chairman, there is one thing you find out when you
talk to folks with cancer and their families, is when you get
the result back and you hear that diagnosis, cancer doesn't
discriminate between the rich and the poor, the middleclass. It
is a fundamental test of our priorities and I'll tell you, the
wealthiest people in this country, in my judgment, would
welcome a cure for cancer before they get another tax cut.
So Mr. Chairman, I close and I look forward to joining you
as part of the panel here. I just say, the American spirit is
defined by our ability to explore. We explored the human genome
system, we explored the universe, we mapped the stars and the
planets, we've broken through because a couple of bicycle
mechanics went from Ohio to Kittyhawk and we took fight and it
changed history. That's who we are. The life sciences are the
future. We need to make that kind of commitment because in the
end, it is that kind of commitment that defines the special
spirit of being American. It is my privilege to be here today.
I look forward to the testimony of those who follow and I look
much more forward to us fulfilling our commitment to ourselves,
as human beings and as a country. Thank you.
Senator Harkin. Thank you very much, John. Senator Kerry,
thank you very much and join us here at the table. Next we'll
turn to Gary Streit of Cedar Rapids.
STATEMENT OF GARY STREIT, CEDAR RAPIDS, IOWA
Mr. Streit. Senator Harkin, Senator Kerry, Mr. Armstrong,
Dr. Weiner, my good friend, Shirley Ruedy, other honored
guests, ladies and gentlemen. This is truly an honor for me to
be here today to represent the American Cancer Society and
offer a few brief comments on the progress that researchers
made over the past several decades and what the promise is that
is held for the future.
Senator Harkin, I want to thank you for your singular
effort on many broad issues relating to cancer care and cancer
research. You have demonstrated that cancer is truly a
political as well as policy issue in addition to being a
scientific and medical one. I've been an American Cancer
Society volunteer for almost 30 years. I'm not an incredibly
talented scientist like Dr. Weiner. I'm not a powerful Senator
like Senators Harkin or Kerry who can appropriate millions and
billions of dollars to fight cancer research. I'm not a person
of the uncommon courage and strength like that of Lance
Armstrong but like many people in this room and across the
country, we all want, in small way, to give a part of our life
to helping others. When I started as an ACS volunteer in the
1970s, the 5-year survival rate for cancer was less than 50
percent.
Today, as Senator Kerry mentioned, it is over 64 percent
for adults and 79 percent for young people under the age of 14.
Back in the 1970s, if a young man was diagnosed with testicular
cancer that had spread to his lymph nodes, lungs and brain, he
had no chance of survival, none. Today, that young man is
sitting three persons to my right. Lance Armstrong survives
today because of the breakthroughs that have been made in
scientific research in cancer. All Iowans are honored by your
presence with us today, Lance. The American Cancer Society has
been working with your Foundation in Washington on many issues
that we both care deeply about and we look forward to that
partnership.
I'm a little monochromatic, as my kids will quickly tell
you, so I can only kind of do one color at a time so I chose a
yellow tie instead of my yellow bracelet. We have a purple
bracelet that has the word written on it, hope, and that is
really what the research efforts that I'm going to talk about
in a few minutes, really addresses. There are 10 million cancer
survivors today, compared with 3 million when the National
Cancer Act was passed in 1971. Since 1991, there has been a 10
percent decline in age-adjusted mortality rate from cancer and
in 2005, for the first time in our country's history, there has
been an actual decline in the number of people dying from
cancer. So don't let anyone tell you we're not making progress.
The advances in research have come on many, many fronts:
improved treatment methods, vaccines, and chemotherapies,
unlocking the secrets of molecular transformations with cancer
through basic research and broad-based epidemiology studies.
As recently reported by John Neterhuber, the Deputy
Director of the NCI, we've found that adding Herceptin to
standard adjuvant chemotherapy significantly reduces the risk
of recurrence in women with certain types of early stage breast
cancer. Dr. Neterhuber also reported equally stunning results
from the trial of vaccine that protects against two strains of
the HPV virus that causes over 70 percent of cervical cancers,
a disease that kills more than 200,000 each year, many in
developing countries. As we have seen with Gleevec, Avastin,
and Herceptin, we are now dealing with targeted therapies,
drugs that attack the cancer itself and eliminate the horrible
impact of chemotherapy on the healthy tissues around the site
of the cancer. Right here in Iowa City, amazing research is
going on in the basic sciences but as well in the applied
sciences.
The National Cancer Institute is conducting a trial
involving 53,000 smokers and nonsmokers across the country to
determine whether one of two methods is far more effective in
detecting early lung cancer when it can be treatable. Dr.
Weiner and the Holden Cancer Center pulled off a remarkable
collaboration with the American Cancer Society and other
community-based organizations to recruit a full cohort of
participants in this study and are moving well ahead of pace.
Despite the remarkable progress of the past decades, in the
words of Dr. von Eschenbach, the former Director of the NCI and
currently the Director of the FDA, ``we have been crawling and
now we can fly,'' in referring to the progression from
macroscopic care to microscopic medicine to molecular medicine.
Dr. Len Licktenfeld, of the American Cancer Society recently
wrote, where we used to treat patients with their cancers, we
are now treating the actual cancer cell itself. Research has
opened the era where we now understand how the cancer cell
works and what avenues are available to reverse those changes
and push the cell back into normality. In short, we are on the
verge of some truly amazing breakthroughs, all of which lead me
to four concluding themes.
The first is, the importance of supporting and sustaining
efforts such as those led by Dr. Weiner at the University of
Iowa and by his peers at the other NCI-designated Comprehensive
Cancer Centers, to translate research from the bench to the
bedside and to help assure that all Americans have access to
quality cancer care and treatment. It is a cruel paradox that
many of our fellow citizens are denied the ability to benefit
from the truly remarkable scientific breakthroughs of the past
several years.
The second is to support all forms of research, from basic
science to clinical trials to translational investigations, to
behavioral and psycho-social research that can help design the
products that will lead all of us as Americans to get off the
couch, to be more physically active, to get involved in the
screening and other prevention activities that will lead to
early detection when cancer can be treated.
The third is to look beyond our borders and appreciate that
cancer is a global issue. It is our moral imperative to do all
that is within our power to share the products of research in
the United States with developing countries around the world.
Concurrently, the United States needs to assume a greater role
in reducing the deadly effects of tobacco usage around the
world, starting with the President sending the Framework
Convention on Tobacco Control treaty to the Senate for
ratification. As Dr. John Seffrin, the CEO of the American
Cancer Society recently reported, 10 million cigarettes are
smoked every minute of every day around the world. In the last
century, tobacco use world-wide killed 100 million people. If
left unchecked, tobacco use will kill more than 1 billion
people in this century and if we let that happen, it will be
the worst case of avoidable loss of life in world history.
Finally, we must adequately fund our cancer research
efforts. In 2003, I stood in the East Room of the White House
at a ceremony in which President Bush paid tribute to Lance
Armstrong for one of his many Tour de France victories. I kind
of lost track, Lance. But as President Bush said at that time,
to win the war against cancer, we must fund the war against
cancer. This pronouncement was made in the midst of doubling
the NIH budget.
Now Congress and the administration are undermining that
promise by not providing the funding that is necessary to
sustain grant commitments, maintain new infrastructure, attract
and retain talented scientists and pursue the promising leads
generated by ongoing research. Funding shortfalls, such as the
$40 million cut proposed this year and last year's $35 million
cut, disrupt research efforts for years to come. Americans say
that cancer is their most feared disease and our funding
priorities should reflect that.
The NCI budget amounts to $16 per American per year.
Compare that with the $6,800 per year that we spend on our
health care costs. Compare that to the $100 per American per
year that gets spent on pork. It cost our country $210 billion
this year in lost lives and lost productivity, yet we can only
find $5 billion to support our research and cancer prevention
issues. It is not for lack of opportunities. As Dr. Weiner will
tell you, we are on the precipice of great breakthroughs. There
are far more research applications worthy of funding that can
ever begin to be funded by the NCI and the NIH. It is not for
lack of return on our investment, as 321,000 people are alive
today that would have died between 1991 and this morning.
Whether measured in dollars or lives, the cancer investment
pays off. Recent breakthroughs have set the stage for
exponential progress if we make the right decisions today.
Here in Iowa City, we think we play a pretty good game of
football. I was telling Senator Harkin that it is a little bit
like Iowa playing for the National Championship, when at the
end of the fourth quarter, it is a tie game. Kirk Ferentz's
team is driving down the field. The other team and I won't pick
on Texas but I wish it were Texas--has no time outs left. We
get the ball, first and goal on the one-inch line. We call time
out and let the other team regroup. That is what we are about
to do if we pull back today, ladies and gentlemen. So thank you
for this opportunity and thank you for your support.
Senator Harkin. Gary, that was great testimony, thank you
very much. Now we turn to Dr. Weiner.
STATEMENT OF DR. GEORGE WEINER, DIRECTOR, THE HOLDEN
COMPREHENSIVE CANCER CENTER, UNIVERSITY OF
IOWA, CHAIR, THE STATE OF IOWA'S
COMPREHENSIVE CANCER CONTROL CONSORTIUM
Dr. Weiner. Thank you very much. It is indeed an honor to
be able to speak to you today about cancer research and our
ability to apply the advances we make to benefit all of us.
Many of my comments will reflect what you've already heard from
Senator Harkin, Senator Kerry and Gary. My comments are based
on both professional and personal experiences with cancer. I am
a cancer physician and researcher. My research works on
developing new approaches to using the immune system to treat
cancer. I also have the privilege of being the Director of the
University of Iowa Holden Comprehensive Cancer Center and the
Chair of the Iowa Consortium for Comprehensive Cancer Control,
a state-wide consortium composed of over 50 organizations in
Iowa and a group of wonderful, diverse people, all dedicated to
decreasing the burden of cancer, particularly here in Iowa.
Finally, like many of you, I have been touched personally by
cancer. Both of my parents died from cancer, my mother when I
was a young teenager and my father, just a couple of years ago.
First, some of the good news that reflects what Gary
already spoke to you about. In Iowa, cancer deaths are
decreasing. Between 1996 and 2001, there was a significant drop
in age-adjusted death rates and this progress is continuing. We
estimate that there are 1,500 Iowans alive today who would have
died of cancer if no progress had been made during this 5-year
period. The most dramatic improvement has occurred where we
have invested most heavily in research and where we have
implemented new approaches to early detection and treatment.
Mortality in Iowa from breast cancer dropped 17 percent and
from prostate cancer, dropped 19 percent during this period of
time. However, I don't need to tell anybody here that this
progress is not fast enough. Cancer still kills over 6,000
Iowans each year and research is the key to progress and must
be supported. Every day I'm faced with the fact in my job at
the Cancer Center, that there are outstanding young physicians
and researchers with outstanding ideas that are not being
supported. Currently only about 15 percent of the grants that
are approved by peer review committees at the NCI receive
support and there are just unbelievable numbers of outstanding
ideas that are going untested. In addition, we must bring
advances made possible by research to the people who need them.
The American Cancer Society estimates that up to 50 percent
of today's cancer deaths could have been prevented if all of us
had access to and took advantage of state-of-the-art cancer
prevention, early detection and therapy. At the top of this
list is tobacco use, which is far and away the greatest cause
of preventable cancer death, as Gary has reviewed with you. Our
efforts to discourage tobacco use here at home, particularly
among our youth, remain highly inadequate. Tobacco-induced
diseases, including cancer, are more common among those with
fewer financial and social resources. There are other,
unacceptable disparities in the burden on cancer. Cancer
screening is significantly lower among underserved ethnic
populations and this leads to more advanced cancers that are
harder to treat when they are found. Access to high quality
care for cancer survivors is extremely uneven and this is an
important focus of the Lance Armstrong Foundation and also
needs attention in Iowa and across the country.
Fortunately, there is growing recognition of the enormous
value to health and the economy that would result if these
disparities were addressed and more cancers were prevented,
detected early and treated effectively, a concept broadly known
as cancer control. The Centers for Disease Control, the
National Cancer Institute, State Departments and Public Health,
American Cancer Society and many other organizations are
increasing their commitment to cancer control. The Holden
Comprehensive Cancer Center provides highly specialized multi-
disciplinary individualized care and follow-up for Iowans with
cancer irrespective of their ability to pay. In addition, the
Cancer Center has made major commitments to Iowa's statewide
cancer control efforts. This fall, the Directors of the NCI
designed cancer centers will release a blueprint that will
outline how the academic cancer centers, such as ours, as a
whole, can contribute even more to reducing the burden from
cancer across the Nation.
Sections of this report will focus not only on research but
on prevention, early detection, treatment, survivorship, and
dissemination of the research advances to the community. While
the profile of cancer control is increasing in the Nation and
in Iowa, there is little consensus on who should coordinate and
pay for cancer control efforts. Financial support for cancer
control is fragmented and inadequate. In Iowa, our consortium
has established a comprehensive cancer control plan initially
in 2003. We have just revised this plan but because of a lack
of resources, we have been unable to implement many aspects of
this plan.
In summary, as a cancer physician, researcher and
administrator, I can state unequivocally that we are making
progress against cancer faster than ever before. Thousands of
our loved ones of all ages are here today because of the
progress we have made yet we still have such a long way to go.
We need to redouble our investment in cancer research and in
cancer control. These efforts will require teamwork,
commitment, resources, and coherent policies that encourage
researchers, public health officials and leaders in academia,
government and the private sector to all work together.
With apologies to Mr. Armstrong for my technical language,
I would like to conclude by using the bicycle as an analogy for
the fight against cancer. The power of knowledge provided
through research is represented by the back wheel of the
bicycle. Funding for research helps us find the right gear and
allows us to peddle as effectively as possible. Cancer control
allows us to direct the power of that knowledge in the right
direction and is represented by the front wheel of the bicycle.
To benefit from our advances in cancer research, we must steer
effectively so that the advances we have made propel us towards
our goal. Finally, we must keep the pressure off both in the
front and back tires so our effort is not wasted and we must be
sure that we are all working together and in a coordinated
fashion if we are to win the race against cancer. Thank you
again for your wonderful support.
Senator Harkin. Shirley Ruedy, welcome.
STATEMENT OF SHIRLEY RUEDY, AUTHOR, THE CANCER UPDATE
COLUMN IN THE CEDAR RAPIDS GAZETTE
Ms. Ruedy. Senator Harkin asked me a few minutes ago just
to speak from the heart and I said, Senator Harkin, I do speak
from the heart but I am a child of the printed page and I can't
get up in front of hundreds of people and just wing it.
Maybe Lance Armstrong can, but I can't. Anyway, what I do
want to say prior to my planned remarks is that cancer happens
to a lot of celebrities but the best thing that has happened to
the war on cancer in a long time is Lance Armstrong. He is one
of the few celebrities willing to cash in his cache on the war
of cancer. He is putting in not only his name and his fame but
his time and his money and making sure that beating cancer is
on the minds of every American, from the man on the street to
the man in the White House.
My story, I've had a strange odyssey in the land of cancer.
Family members for years dropped like flies from the disease--
aunts, uncles, cousins, and then my oldest brother was
diagnosed with a rare male breast cancer. He was 48. Knowing
nothing about cancer at the time, I thought it was just a fluke
but it was a red flag. In 1979, on the 14th of November, a
magnificent, sunny day, I learned I had breast cancer. I was a
pre-menopausal 43 years old. I had a mastectomy. The cancer was
estrogen negative, odd because most breast cancers are estrogen
positive, depending upon that hormone for growth. Another red
flag. Fast forward to 1994. My husband and I planned to go out
to dinner on November 14 to celebrate 15 years of my being
cancer free. Instead we were sitting in the oncologist's
office, hearing for the second time that I had breast cancer.
The gods of irony must have been rolling in the aisles except
now, the doctors thought it was metastatic. We drove, white-
lipped and white-knuckled, to Mayo Clinic, to my friend, Dr.
Lynn Hartman, who believed the cancer was primary. I had a
second mastectomy. Because the tumor had gone to the chest
wall, 4 months of chemotherapy and 7 weeks of radiation
followed. Fast forward to 2005. Post-menopausal bleeding led to
a D&C at Mayo. The surgeons and I agreed, no hysterectomy
unless it was cancer. I woke up and my husband told me they had
done a hysterectomy. It was endometrio uterine cancer. I was
stunned. At age 69, the score was Shirley zero, cancer three.
As is with so many people, I turned to God. I said, ``What is
this, God? It seems to me I'm taking somebody else's turn
here.''
``Let's lay off Shirley for a while.'' But God smiled. I
know he smiled because only 5 percent of endometrio cancers are
caught that early, Mayo said, and the surgery was considered
curative. When I was first diagnosed with cancer, I became
curious about this disease that could take my life so I went to
the library and I took out a book and then another and another
and I've been reading on cancer since 1979. Not like Dr. Weiner
reads but--I came up with the idea of a newspaper column. What
the American public needed, I felt, was a regular platform on
cancer, not just a mediocre story that flashes across the sky
when a study is released. The column needed to illuminate not
just the science of cancer but the emotions. Anyone who has
been touched with cancer knows that the body is just part of
the picture. Your emotions are rolling around like the eye of a
hurricane. Those who care for you are in tumult. There is no
manual on how to handle cancer. The Gazette's Managing Editor,
Mark Bowden, went out on a limb and started running Cancer
Update on September 5, 1991.
Response has been tremendously gratifying. Readers trust me
for I have walked the road. The medical community trusts me for
I value accuracy and honesty above all else. But I am here to
tell you today that the only reason I am here at all today is
because of the National Cancer Institute and the American
Cancer Society. In 1975, I joined a study that they jointly
sponsored to compare methods then available for the early
detection of breast cancer: mammography, thermography, and
clinical examination. It was the fifth and final year of that
trial, that my breast cancer was found and I want to make this
abundantly clear. If it had not been for that research study, I
would have died because I never would have found that breast
cancer in time on my own. What I also know now is that all
those red flags, male breast cancer in the family, pre-
menopausal breast cancer, cancer in both breasts, estrogen-
negative cancer, all pointed to hereditary breast cancer and
the BRCA I and BRCA II genes, only identified through research
since that long-ago day in 1979, which brings me to an issue of
profound significance in my mind: research. As a cancer
columnist, I know that at the beginning of the 1900s, almost no
one who had cancer ever lived to tell about it.
Now, in 2006, it has soared to a 64 percent survival rate,
as has already been pointed out. This is a phenomenal
achievement. As it stands today, 1 of every 3 Americans will
die of cancer and 3 and out of every 4 households will be
affected by it, either directly or indirectly. Cancer is the
king of dread in the American mind and our Government's
proposed budget for 2007 has slashed an incredible $40 million
from the National Cancer Institute. The cost of research is
cheap when you equate it to the increased growth in the economy
because of lives not lost, productivity gained, and health
costs saved. Crucial studies that save lives will not be funded
with the budget cut. Bright, young researchers will not find
jobs because of staffing cuts and we will have a brain drain to
countries who will fund our best and our brightest.
I hope that Congress will approve the budget amendment
proposed by Democratic Senator Tom Harkin and Republican
Senator Arlen Specter. It will restore the $40 million to the
National Cancer Institute, which already suffered a devastating
cut of $31 million. We have 10 million cancer survivors alive
today. Outstanding survivors like Lance Armstrong and average
Americans like me. We all owe our lives to men and women in lab
coats. Indeed, we have to realize that research is not our main
hope--it is our only hope.
Senator Harkin. Thank you very much, Shirley, for that and
just thank you again for your example of courage. It means a
lot to all of us. Now, what can I say about Lance Armstrong
that hasn't already been said, I guess. You know, John Kerry
and I--I guess people in our positions, we meet a lot of people
who have obtained a celebrity status, whether they are in
athletics, the performing arts, the business world, politics of
course, and you wonder sometimes, what are they doing with
their position?
What are they doing with the fact that people to look to
them for inspiration, look to them for leadership, look to them
for some kind of guidance? Martin Luther King, Jr.--Lance once
made this statement. He said that life's most important and
persistent question is what are you doing for other? Lance
Armstrong has answered that question in a very powerful way. He
is using his status, the fact that he is the athlete of the
decade, the fact that he has shown great courage in surviving
cancer and going on to win the Tour de France seven times. Yes,
people do look to him for guidance. They look to people like
Lance Armstrong for--you know, what are you doing?
What Lance Armstrong is doing is setting up the Lance
Armstrong Foundation. What he has done is to focus the Nation's
attention on winning the race against cancer. We all know,
since the first time I met Lance a few years ago, I could see
that he was focused on two things: winning the Tour de France
and winning the war against cancer. Lance Armstrong showed that
no obstacle was big enough for him to overcome to win the Tour
de France and I'll bet you no obstacle is going to be big
enough for him and the Lance Armstrong Foundation and all of us
working together to win the war and the race against cancer.
Lance Armstrong.
STATEMENT OF LANCE ARMSTRONG
Mr. Armstrong. Well, I'm not going to wing it. Thank you,
thank you. It is a pleasure to be here. This is my second trip
to Iowa and it's a special place, special bike ride, special
experience. I think I've said many, many times how--I guess I
am winging it for a second here but this has been something
that I really didn't expect. The atmosphere and the attitude
around RAGBRAI--there is some debate on how we say it but
RAGBRAI--never, just a little editorial here, I've never seen
people drink beer and ride bikes at the same time.
Cyclists tend to be a little geeky and they worry about the
tire pressure and how long the ride is tomorrow and where the
hills are, meanwhile you people ride along and worry about the
next town, where the beer garden or a pork chop is. I mean,
beer and pork chops on a bike? I love it!
Anyways, Senator Harkin, thank you for having this hearing
today. This is huge. I want to thank you for your tireless
efforts in the U.S. Senate to support cancer research,
prevention, early detection, treatment, and survivorship. I
know, like so many millions of Americans, you and your family,
as you just said, have been personally affected by this
disease. As the founder of the Lance Armstrong Foundation, it
is indeed an honor for me to appear here with such a
distinguished panel. This October 2 marks the tenth anniversary
of my cancer diagnosis and as I reflect back on what has
transpired over the past 10 years, I realize how much my life
has changed since October 2, 1996. At the time, I knew nothing
about cancer. I had no idea how many people were diagnosed with
cancer each year. I had no idea how many people were likely to
be diagnosed with cancer in their lifetime. I had no idea how
many people are killed by cancer each year. I had no idea what
the chances were to survive a cancer diagnosis. I had no idea
how many cancer survivors are living with, through or beyond
cancer.
But today I know. I know that 1.3 million people will be
diagnosed with cancer this year, 16,000 in the State of Iowa. I
know that 1 in 2 men and 1 in 3 women will be diagnosed at some
point in their lives. I know that over half a million people
will die from cancer this year in the United States, 6,300 of
those from Iowa. While these numbers are sobering and in some
ways, impossible to comprehend, they represent incredible
advancements since 1971, when President Nixon declared war on
cancer and signed the National Cancer Act into law. In 1971,
only 3 million cancer survivors were living in the United
States. At that time, cancer was largely a death sentence.
Thirty-five years later, as everybody here has said and I think
we all need to recognize, we have made remarkable progress.
There are now more than 10 million cancer survivors living
in the United States today. But today, our goal and our mission
must be to redouble our efforts until cancer is truly a chronic
disease that you can live with rather than die from. After I
was diagnosed, I founded the Lance Armstrong Foundation, a 501-
C(3) national, nonprofit organization based in Austin, Texas.
Sorry about the football joke but--I'll win that debate today,
I promise. LAF's mission was to inspire and empower people
affected by cancer. We help people with cancer focus on living.
We believe in unity of strength, knowledge is power and
attitude is everything. From the moment of diagnosis, the Lance
Armstrong Foundation provides the practical information and the
tools that people affected by cancer need to live their life on
their own terms. We are committed to making cancer a national
priority through our advocacy initiatives. I fear that too many
people, especially those in positions of power in Washington,
DC., do not share this view.
Everyone says they support cancer research, of course and
programs and they are willing to do whatever they can but as we
speak, our elected officials and our leaders who provide the
resources that the experts say are necessary to effectively
beat this disease. Actions speak louder than words. It
mentioned earlier--you know, I sometimes forget about that
visit to the White House--I think that was 2001.
I looked at the President and I'm going off the cuff here
but I said, I think this ought to be a priority for our country
and this is a President that lost, at a young age, lost a
sister to cancer. I looked at him and I said, I think this
needs to be a focus and a priority and he said, in order to win
the war against cancer, we must fund it. That's the kind of
stuff that we love to have on tape. In life, we all must be
held accountable and thank you for reminding all of us of that
quote. That's powerful. This State will be in that very same
position in 2008, when all these guys come through again.
Just keep those cameras rolling when they come through,
okay? Don't turn them off. Here is the bottom line. The bottom
line is that people have become complacent about cancer. It is
an old disease. It's not a priority in Washington because
Members of Congress do not believe cancer is a priority back
home, some Members. That has to change. As we've heard, there
is too much hope, too much progress, and too much promise to
accept anything else. Simple steps, steps we should be taking
today could virtually overnight cut cancer deaths by one-third,
by improving access to early detection, screenings, existing
treatments, all of this stuff to the people that slip through
the cracks and are diagnosed too late or don't receive the best
treatment. We could reduce cancer deaths by one third. Think
about it. Almost 200,000 people a year could be saved: a
friend, a child, a sibling, a parent, a grandparent--all will
be needlessly lost to cancer.
The Centers for Disease Control and Prevention support a
number of programs that will help us reach these people and get
them services they need. Unfortunately, these Federal programs
are woefully under funded. The CDC Comprehensive Cancer Control
program supports a collaborative process through which a
community and its partners pool resources to promote cancer
prevention, improve cancer detection, increase access to health
and social services and reduce the burden of cancer. These
efforts will contribute to reducing cancer risk, detecting
cancers earlier, improving treatments and enhancing
survivorship and the quality of life for cancer patients. Every
State, including Iowa, has spent time and energy pulling
together the key people to develop the plan that best meets the
needs of their citizens but to effectively implement these
plans, we need to fund these plans. This year, just over $16
million was available to implement the plans of all 50 States,
the District of Columbia, the U.S. Territories, and Native
American Tribes.
I applaud you and Senator Specter for adding an additional
$5.1 million in the Senate LHH appropriations bill for this
very important program. Unfortunately, too few of your
colleagues were willing to make cancer a high enough priority
to allow this program to be fully funded. Likewise, the CDC
provides access to critical breast and cervical cancer
screening services for underserved women throughout the United
States, including the four U.S. Territories and 13 American
Indian/Alaska Native organizations.
These types of early detection programs have proven to
reduce mortality and improve survivorship but due to funding
limitations, the CDC estimates the program currently only
reaches 20 percent--just 20 percent--of all eligible women,
aged 50 to 64. If we increased our investment in this program
by $47,000 million, we could serve an additional 130,000 women.
We already know how to do so much more than we are doing. We
need to implement what we already know. It is the difference
between what we know and what we do. We have to make cancer a
national priority and make the investments that save lives.
Again, that number was startling, the doctor mentioned, of real
time savings of $210 billion. I think everybody in this room
can understand math enough to know that $5 billion versus $210
billion speaks for itself.
Last year, for the first time since 1970, Congress passed a
funding cut for the National Cancer Institute, a few years
after President Bush told me at the White House, as I just
said, in order to win the war, we have to fund the war. On the
heels of that cut, the House of Representatives has proposed
another $40 million reduction for cancer research at the NCI
this year and the Senate is only slightly better, proposing a
$9 million increase, which fails to keep pace with medical
inflation. These funding levels are the direct result of
Congress, in spite of their efforts by Senator Harkin and
Senator Specter, failing to provide adequate resources for
medical research and other health programs. This isn't how you
treat a priority in this country.
This is a time when we should be significantly increasing,
not decreasing our investment and promising extraordinary
Federal research opportunities. Federal investments in cancer
research have yielded remarkable results, as we've all said.
Several drugs developed and are tested by the NHI supportive
scientists have proven effective in treating and sometimes
preventing certain types of cancer. NCI designated
Comprehensive Cancer Centers, like the Holden Comprehensive
Cancer Center here at the University of Iowa, are doing great
work, serving as hubs for cutting edge research, cancer care
and education for healthcare providers.
We must do all we can to protect our cancer research
enterprise and maintain the current pace of discovery by
increasing our investment in the National Cancer Institute's
research portfolio. It is clear to me that the only way to make
cancer a national priority is for the people fighting this
disease to join that fight or their loved ones. I am more
determined than ever to lead this effort.
Now that I've retired from cycling--I think--I get asked
all the time, what are you going to do? My friends and my loved
ones know that I couldn't just sit around and be retired. I
need a fight. I'm a fighter, I was always a fighter. I fought
to win seven Tours and I am proud of that.
But I get asked all the time, what are you going to do so
you don't get bored? Well, the answer is this: the answer is a
room like this and the answer is 3 days in Iowa and the answer
is next year, 7 days in Iowa.
The answer is we have something here that we are discussing
that I don't even need to remind people that we'll make 7
tours, 20 tours, 100 tours, looks so incredibly small. This is
my priority. This is the priority of this room and I truly
believe it is the priority of the two distinguished Senators
sitting to my right. We have to do it. Now is not the time to
slow down. This is something that I take very seriously and if
it is my time and attention, it is a great fight and I am fully
committed and I truly believe that we will make a difference. I
never entered a race to lose and I'm not entering this one to
lose. We have to be realistic. We have to understand what our
goals are and clearly state those but we have to make progress
and we have to hold our leaders accountable. So when they come
through this great State in 2008, folks, ask them. What's your
plan?
In case you forget, I'll be back here next year to remind
you.
Senator Harkin. Thank you very much, Lance. Thank all of
you. Wasn't this a great panel? It was just a great panel!
Well, I just have a couple of questions. I'd like to get to
an open mic though, because I do want to hear from some people
here this morning. I am compelled first, just again, Lance,
just off the top of your head, just sort of, through your
Foundation, you've been following what we've been doing in
cancer. I thank you for your prodding. There is no reason that
we're not funding this the way we ought to be funding it,
absolutely no reason whatsoever. But--and I'm glad you
mentioned the Comprehensive Control Program. Dr. Weiner runs
that here in the State of Iowa and the fact that we are under
funding it--I guess--I'm just musing here. All the things you
see out there, what would be a priority? I mean, what would be
something you would like to, in your Foundation, would really
like us to really start focusing on? Is there something out
there that is kind of a priority?
Mr. Armstrong. Without being a scientist but just being a
citizen, if when I wake up, if I had a choice between--let's
just say I was starting the Tour de France and I had a choice
between a 14-pound bike to climb the mountains or a 20-pound
bike. I don't have to tell you which one I would choose. They
are both safe. I would definitely choose the 14-pound bike.
It's faster, it's lighter, and it's better. That's an easy
choice; an easy decision and an easy thought process. To me,
the ability to immediately save 200,000 lives has to be a
priority. It's not a question of--and as much as I love
research and I believe that that has to be totally accelerated,
this is stuff we know.
A few months ago, I was in Harlem, at a cancer center and a
guy named Dr. Freeman, who runs this cancer center in Harlem,
he has lived almost his whole life in Harlem and totally
committed to the people there, a beautiful man. He chaired the
President's Cancer Panel when I first came on to it. He said to
me, ``Lance.'' He speaks very slowly but it is just music when
he talks. He said, Lance, it's just the difference and as I sit
here, it's the difference of what we know and what we do. If
that delta between the two is 200,000 lives. So just applying
what we know--and again, these are people that they didn't do
anything wrong. They were born into their situation or to their
neighborhood. They deserve better. Just by giving them what I
would receive or what you would receive, we save their lives.
That delta has to come down and that delta can come down, just
by applying the information and the technology and the data
that we have. I say all the time, it's almost like a Cancer
Bill of Rights, that we are all, as Americans--the greatest
country in the world, the most progressive, smartest country in
the world.
This is the stuff we can do. We can give that to our
citizens. Beyond that, of course, is the realm of science and
research. That is also critically important. That is an issue
of funding, which to me, I see a lot of times when you talk to
people at the NCI, imagine if you had a great program that was
being cut or wasn't being funded. What does that do to a team
of young scientists? Well, it kills their morale and for
anybody who has ever been on a team, you have to have morale.
If it is a team at RAGBRAI, if it is a team trying to win the
Tour de France, if you don't have any money or you don't have
the resources, then you don't have morale and that is a deadly
thing.
Senator Harkin. Thanks, Lance. Just one thing. Dr. Weiner,
would you--before we came up here, I had read some of the
things Dr. Weiner had written and as you know, we just had a
big battle on stem cells. I think I mentioned that in my
remarks. We'll be back on that, by the way, next year.
Stem cell research, embryonic stem cell research has always
been looked upon as culling so much hope for juvenile diabetes,
Alzheimer's, ALS, spinal cord injuries, and a host of other
neurological disorders but it has now become clear that there
is a nexus between embryonic stem cell research, and cancer. So
Dr. Weiner, would you just again, enlighten all of us a little
bit about that connection?
Dr. Weiner. Well, there is lots of research taking place
now, on a concept known as cancer stem cells. This concept is
based on the understanding that every cell in a cancer can't
divide forever. There are really only a very small percentage
of those that really are responsible for the cancer continuing
to grow and spread. These may look very different than the
regular cancer cell. Many of our treatments today are designed
to treat all of the cells in a cancer. Perhaps what we should
be doing is looking more carefully at these cancer stem cells
so we can target those guys who are responsible for the
continued growth of the cancer. This growing recognition that
stem cells, whether embryonic or cancer stem cells, may have
lots of similarities. So by studying embryonic stem cells, I
think we will learn more about the nature of the cancer stem
cell and hopefully learn to develop new, more targeted
approaches that nip those cancers in the bud, right at the root
of where they are growing.
Senator Harkin. Again, I want to thank Gary, you, and the
whole American Cancer Society for all your great leadership in
this area but also in being in the forefront of the battle for
stem cell research. We thank you very much for that.
I'll turn to John for a question and then I really want to
get an open mike.
Senator Kerry. I do too and I want to try to move there as
quick as I can. Just one question. Shirley, first of all, your
testimony was just superb and so personal. I'd like to ask you
and Dr. Weiner, just really compactly, for a lot of Americans
listening when they sort of hear, well, we need more money. How
is the money really going to make a difference? We're spending
a lot of money. Are we really getting something for it,
etcetera. Just in the shortest terms, if you were given an
instant to persuade somebody, Shirley from the patient
perspective and Dr. Weiner from the research perspective, what
is the additional money going to bring to people, in your
judgment?
Dr. Weiner. First of all, given that the fact that 40
percent of us are going to get cancer, I would argue that we're
not investing a lot of money. It's the equivalent of 5 cents
per person per day in the United States, is our investment in
cancer research. That being said, I think what we are investing
in is hope and that hope is not a false hope. We are making
progress and the speed of progress is going to be dependent on
our investment. So we're going to make progress against cancer.
We have--many of the people out here are active investigators
in the Cancer Center and they are not going to quit. Their
ability to make progress and to bring those advances to people
is going to depend upon how much we invest in it. So you invest
your money in a place where you can get a return and I can't
imagine a better place to get a return than cancer research.
Senator Kerry. You said earlier that there are a lot of
projects, right on the cusp, that you can't--can you just share
quickly some of what----
Dr. Weiner. Taking a laboratory advance and turning it into
a promising treatment is very difficult and very challenging
from an investment point of view. To make a material that you
might test as a treatment that has passed all the testing to be
safe and effective, takes millions and millions of dollars.
There is a bottleneck and there are many wonderfully promising
treatments, again many being worked on by people here today,
that we can't get through that bottleneck. We can't get them to
the point where we can even test them in patients, much less
know if they work. So they are just sitting there, waiting.
There are many of the treatments we have today, which are
promising, which had to wait in line for a long time before
they were able to be used. One of them is a medication known as
Fludara that is very effective against lymphoma. It sat for a
long time before people could figure out how to use it and make
it useful.
Senator Kerry. Thank you very much.
Senator Harkin. Thanks, Senator. Anybody else want to
respond to that? Shirley?
Senator Kerry. Shirley was about to.
Senator Harkin. Wing it.
Ms. Ruedy. It's so hard. I would like to see Medicare
equitable to cancer patients for funding the drugs that they
need. Someone told me the other day that they had been in a
clinical trial and then in the course of it, went on Medicare
because of turning 65 and the drug that he had been taking was
no longer paid for because it was not specific to the type of
cancer that he had, bladder, but could be used for other
disorders as well, so they wouldn't fund it and I think that is
grotesquely unfair. Also, Medicare does not cover compression
sleeves for women who have lymphedema as a result of breast
cancer, as I do, things like that. If I could have a dream
scenario, and touching on the topic of implementing the things
that we already know, it would be for the United States to have
to enforce a Federal ban on smoking in public places.
Senator Harkin. Shirley, you can wing it any time you'd
like.
Ms. Ruedy. Many countries have, including--I don't even
know if I'm pronouncing it correctly. Bhutan? In Ireland? For
crying out loud, if Bhutan in Ireland can, it seems to me the
United States of America can.
Senator Harkin. Bhutan in Ireland! That's good.
We'll try to get out to the audience. On my left is Nathan.
He has the mike and over here is Beth. We have a mike. Just try
to raise your hand. I just asked for the record, that unless
your name is Jones or Armstrong, could you just spell it if it
is a complicated name. Spell it for the record just so that our
recorder gets it correctly. So I'd just ask if anyone has any
questions for our panel, any observations? Here is a man right
over here. Nate? Right back here.
Mr. Sodak. My name is Jack Sodak and to the Senators, as
someone who writes a lot of letters to my public officials, I
was wondering what we as voters can do specifically to let you
and your colleagues know that we need--this needs to be a huge
priority to fund our cancer research and to Lance Armstrong,
when are we going to see you run for Congress?
Mr. Armstrong. I was strongly advised not to by the guys on
my right.
Senator Kerry. You should have added, ``from Iowa.''
Senator Harkin. We're going to adopt him here. We're going
to bring him to Iowa. What can you do? Well, that's a question
we always get asked about a lot of things like that. We just
have to network, grassroots work, I love grassroots types of
organizations. We've got a lot of them out there that we have
to network with and understand and get them to understand, just
like Lance said, that this kind of begins with who is in office
and what they are supporting.
So these grassroots networks, whether it is the Cancer
Society or the Parkinson's Network or the Lance Armstrong
Foundation, they're out there and we've got to work through
those organizations to build up that kind of pressure. It's got
to be on the State level, for people who represent you at the
State level, as well as the National level. It's really got to
come up, from the bottom up. Sooner or later, Congress
responds. Sometimes more later than not. But they will respond
to the pressure and I think what has happened with the funding
for NIH over the last couple years, I'm sensing that people are
saying this is not the way we want to go and we've got to hold
people's feet to the fire. It's not--let me just add this, it's
not just how they vote or what they do on a specific funding
measure.
See, everything that controls what we do on Appropriations
is set by the budget. It is what you vote and the budget
controls everything. So it is not just how--somebody said, well
gee, I'm all for cancer research and stuff like that but gosh,
the budget doesn't allow me to do it. Well, how did you vote on
the budget? What did you do when the budget came along and we
had a minus?
Senator Specter and I had a $7 billion amendment on the
budget, to add $7 billion to this bill. We won it. We got 73
votes. That's pretty bipartisan, 73 to 27. Well, why did we
have to do that? Because it wasn't in the budget. We had to
overcome the budget to do that and then we've lost it and we've
come back, as you've heard others say, we're now back at about
a $5 billion level. I just say that. Work through grassroots
organizations to build up the pressure on people in office and
hold their feet to the fire. Like Lance said, you've got to
hold their feet to the fire. I don't know if John's got any
other observations or not.
Senator Kerry. I'd be very blunt about it and I don't mean
to date myself but you go back to 1970, right after I got back
from Vietnam, many of us became involved in something called
the Earth Day and we still have it but not at that level. What
happened is, suddenly something bubbled up and it bubbled up
because of activists and energy and I think that is part of
what Lance is doing right now. That bubbling up came to a head
on one single day in April 1970, when 20 million Americans came
out into the streets of our country and said, we want a change.
We're tired of seeing the Cuyahoga River in Ohio light on fire.
We're tired of seeing our families live next to a toxic waste
site in which they get cancer from the water they drink,
etcetera.
The result of that was not just to go out and say, like you
are all here today, I'm concerned. It was to translate that
concern into action--and disdainful as it may seem to you and I
know it does to many people--you look at the political process
and it just looks awful. It is dysfunctional, it's broken. But
the way you fix it in a democracy is to actually go in and get
your hands dirty and sweat it out a little bit and do the work.
The work is holding those people in office accountable. What
happened in 1970 is, they targeted 12 Congressmen with the
worst voting records on the environment and 7 out of 12 of them
were beaten in the next election. What did that do? It
unleashed the floodgates.
That's when we passed the Clean Air Act, the Clean Water
Act, the Safe Drinking Water Act, the Marine Mammal Protection
Act, the Coastal Zone Management Act and that's when Richard
Nixon signed the EPA into existence. We didn't even have an EPA
until then. We've lost that accountability and what we need now
is for people to take this concern, just as Lance said, take it
into the voting booth and if they're not with you on the
budget, vote them out. Kick them out and create the
accountability.
Mr. Williams. Good morning. My name is Dick Williams. I am
a urologic oncologist here at the University of Iowa. I want to
make a couple of comments. First, thank you all very much for
your commitment to cancer and curing it because that's exactly
what we are trying to do and we need your help to do it, so
thank you so much. I'd like to mention a couple of things. You
heard already the story about testicular cancer not being
curable years ago and now it is.
I was a resident in my training in 1970 and during that
period of time, almost every young man I saw with testicular
cancer died. It was painful. I couldn't do anything to help
them. I could remove their tumor but I couldn't cure the
metastases and it was because of a urologic oncologist, John
Donahue, and because of the medical oncologist, who in fact,
treated you, Larry Einhorn, who, Larry is, in fact, a UI
graduate, who took a chance and took a new drug, Platinum, and
directly translated it to the patient, that we now can cure
cancer, testicular cancer. Those are the kinds of things that--
the point I'm--I want to make--is translation, is where the
money needs to be put to some degree. We need a lot of the
things you've mentioned today.
Those of us that are trying to get the laboratory to
produce things, which I have a wonderful group of laboratory
people, researchers, Ph.D.s that are working on cancer
research. They have some new drugs. They have some new
vaccines. Getting them to the patient is the hardest thing for
us to do. One, to get the money to produce the new vaccine that
they've produced for us and two, to get it approved and then
finally to the patient. If I were to ask you to do one thing
for us, help us get the translational research dollars back in.
They are not as much as they should be. Finally, as we talk
about young researchers, as we talk about people trying to get
grants today to do fundamental cancer research, we used to fund
in the range of 22-25 percent of the grants. That's not a large
number but okay, you pick the best grants. Today it is 12-14
percent, depending on which group you're in. Folks, that's not
going to cure cancer. It's not going to cure a number of the
diseases we're out there trying to treat. So we need your help.
We're going to stand behind you and thank you very much for
being here.
Senator Harkin. I've often likened research, basic research
as--you have 10 doors that are closed. The answer that you are
looking for may be behind 1 of those 10 doors. If you're only
going to open 1 door, what are the odds? If you open 2 doors,
what are the odds? If you open 5 doors, 8--you get the picture,
right? Right now, we're opening 1 out of every 7 doors,
basically, in cancer research. So what are the odds? That's why
we need to do more of this research and get more of it out
there. I'm concerned--back to your question about what can you
do, there is a group called Coalition for Sensible Priorities.
You can go on the web and find it. They are here in Iowa,
they have an Iowa group. I think they have pointed out, if
you're talking about research, people say, well we've put all
this money into medical research and we still haven't found a
cure for cancer. Well, look at it this way. In the last 3
years--in the last 3 years, we have spent more money on
military research and development than we have on all
biomedical research in the last 100 years. We need better
priorities, you say. That's where the money is. We need better
priorities. Thank you. I just wanted to point that out.
Senator Harkin. I don't know--someone back here. Here,
Beth?
Off Mic. Senator, you only have time for one more question.
Audience Member. Since you mentioned the stem cell
research, I was wondering also about using umbilical cords
because I had a baby 10 months ago and I asked and no one
seemed to know where it was going. So how, if it could be used,
how do you ask that it be used for some kind of research?
Off Mic. Who do you want to answer?
Audience Member. Probably one of the Senators. How do you
ask to have the umbilical cord used for research or are they
already being used for research?
Dr. Weiner. The fact is, in part because we don't have
funding to support as much of the research as we'd like to do,
we can't use all of the cells from all of the umbilical cords
that are available. So we do research with those and some of
them are now being used, actually, for bone marrow transplants
in children with cancer. But there are more umbilical cords
than we are able to take advantage of right now, to be honest.
Perhaps we can talk about it later.
Senator Harkin. Did we have one more? Did you have one?
Mr. Lucy. Nick Lucy. Lucy as in I Love, if you want to
spell it that way. A quick observation. You folks are here
today to remind us to get a perspective on the war on cancer
and we heard a lot about that there is not enough funding and
money available. If we are fighting a war on cancer, I would
suggest that you go back to your colleagues as veterans in the
Senate and military veterans and remind them if we're going to
fight a war on cancer, we should apply the same philosophy as
when we went into Iraq. We did not ask how much it was going to
cost, we just did it and I suggest we do the same thing with
cancer. Let's just do it!
Senator Harkin. We have time for one more before we have to
finish.
Ms. Pasker. Hi, I'm Dana Pasker and mine isn't a question,
it is just a thank you. My dad also has breast cancer and he
was diagnosed in 2001. As of today, he is under control and I
think that if there wasn't the research that he would have been
gone a long time ago. So thank you.
Senator Harkin. I'd ask any of our panelists, anything else
you would like to say?
Mr. Armstrong. Just a quick invitation. On September 20,
10,000 American Cancer Society volunteers and survivors are
going to be on the Hill, asking Congress to make good on some
of the promises we talked about today, so we'd love to see all
three or all of our panelists there with us, joining in and
delivering that message.
Senator Harkin. Good for you! September 20.
Dr. Weiner?
Dr. Weiner. There was a question earlier on about what
single thing could we do right now. In Iowa, my personal
opinion is the single thing we need to do, is we need to raise
the tax on the tobacco and invest that money.
Senator Harkin. That's good!
Dr. Weiner. Invest that money in cancer control and cancer
research as well as tobacco control.
Senator Harkin. Very good. Shirley?
Ms. Ruedy. Ditto!
Senator Harkin. Lance?
Mr. Armstrong. I would just echo what you guys said to this
fellow's question, about what you can do. Listen, this room--
these guys have some power, some power. The man in the White
House has some power. But this room has a lot more power.
That's the way you make the difference because whatever your
interest is, if it is the environment, if it is religion, if it
is a gun, if it is a lot of different special interests, this
has to become a special interest and one that bands together
and says, we're voting that way. That's how you make the
difference. So the power of this room, the ability for them to
come together and pull together and say that we care about this
and we're sick of the complacency and we're sick of this war,
that's how we'll make a difference. So I can't stress enough,
join--if it is a Live-Strong Army, if it is the American Cancer
Society, or if it is an endless amount of other great
organizations out there, stand up and say, ``that's it!'' I've
had enough and I want to make a difference and I'm going to
vote that way. That's how we ultimately make a serious
difference, once and for all.
Senator Harkin. Thank you.
I thank all our panelists. I thank all of you for being
here. What a great audience. Thank you for being here and
showing your support for better cancer research and for
changing our priorities. Go on site, livestrong.org. Okay,
livestrong.org. You can go on the Lance Armstrong Foundation
website. We need their help. I say that forthrightly. We need
their help in marshalling up public opinion and getting all of
you people working together in this effort. Again, I just want
to thank all of you for being here.
CONCLUSION OF HEARING
I thank Senator Kerry for his great leadership through all
these years, his friendship, and to Lance Armstrong, thank you
for your great, great personal involvement in this and what
you've done to focus the public's attention on this. We're
going to win this one, folks. We just have to make sure that we
emulate Lance Armstrong and don't ever give up. Thank you.
[Whereupon at 10:01 a.m., Friday, July 28, the hearing was
concluded, and the subcommittee was recessed, to reconvene
subject to the call of the Chair.]
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