Document yrgMpeR6p14vJRan1o0w5L1VD

URL 04929 Information as a " Cure" for Cancer The National Cancer Institute (NCI) has launched a test every month to peer-review hew data as they come along of the interesting hypothesis that information can reduce and to evaluate information already on-line. It is expected cancer mortality in the United States. In collaboration with that some of the information in PDQ will be so new that it BRS/Saunders, a private medical data base, the cancer will be available through the query system before it appears institute is sponsoring a new nationwide information sys in a scientific journal. DeVita cites therapeutic approaches tem that will allow any library or practicing doctor with a to a particular stage of Hodgkin's disease (stage 3A) as an personal computer to tap into Physician Data Query (PDQ) example. Radiation has been considered the most effective to get data on treatment for more than 80 types of cancer. way to treat these patients. However, within the past 6 The cancer institute, which has been working on PDQ months, three separate studies have come in showing that for several years, has had it on-line through the National chemotherapy is equally effective. "As far as I know, there Library of Medicine since March 1984. As of this month, is no single scientific paper that explicitly says radiation NCI carried its experiment further when licensing agree . and chemotherapy are equally effective," he told Science. ments with BRS/Saunders were completed. Subscribers But PDQ does. can access PDQ nearly any time, day or night.* Cancer institute officials see PDQ as the fulfillment of a Cancer institute director Vincent T. DeVita, Jr., hopes mandate given them in the National Cancer Act of 1971, that widespread use of PDQ will give community physi the legislation that launched the "war on cancer" and cians information about cancer treatment that will enable called for the transmission of data to practicing physicians them to save the lives of patients who are now dying "insofar as feasible." At the time, there were fewer than because their doctors do not have ready access to informa 100 medical oncologists in the country and only 300 radia tion about new and successful therapies. tion therapists who specialized in cancer. Today, 3000 According to cancer institute figures, cancer should be physicians are Board-certified oncologists and the number curable today in 50 percent of patients with serious tumors. of certified cancer radiologists is close to 2000. The number But to achieve and, DeVita hopes, improve on this cure of NCI cancer centers has grown from three to 53. Effec rate, patients must have access to the best therapy. Devel tive therapy has been discovered for tumors that formerly opments in cancer treatment, often subtle but crucial, are were not treatable. And the home computer has arrived. occurring with unprecedented frequency; the trick is to "What we're doing now with PDQ simply would not have spread the word. According to DeVita, 80 to 85 percent of been feasible before," DeVita observes. The question now cancer patients are seen by community physicians. "The is whether physicians will use it. Says DeVita, if patients greatest problem for these doctors is keeping up," he says, know about it, they will. PDQ offers three types of information at the push of a PDQ was not developed without controversy. One was home computer button. First, it reports slate of the an over access. One school of thought held that PDQ should treatment regimens by tumor and stage of growth for those be available. directly to patients. Others argued that the cancers for which an effective therapy is available. Second, data would be presented in too much technical detail, that PDQ contains detailed data on more than 1000 experimen they could confuse, or, in the case of tumors with a poor tal treatment protocols for those tumors (still the majority) prognosis, unduly frighten patients. The latter group pre that cannot yet be cured. Third, it offers a directory listing vailed, although the public has access to an NCI informa by name, address, and phone number some 10,000 cancer tion line.t specialists, along with 2000 institutions that have NCI- Another source of contention is the directory of physi designated cancer centers or cancer programs approved by cians. The cancer institute's plan to list by name and phone some medical group. For instance, the directory lists number those doctors who spend most of their time taking hospitals whose cancer surgery programs have been ac care of cancer patients angered the American Medical credited by the American College of Surgeons. All of this Association (AMA), which opposes such lists and also information is arranged geographically so that a nonspe vehemently objected to the idea of a government agency in cialist can easily locate an oncologist in the region for effect certifying certain physicians. In an effort to sidestep consultation or referral. the appearance of being a certifying agency, the NCI The range of information on PDQ, as DeVita describes decided merely to reproduce lists of doctors already com it, is considerable. For instance, it will tell a questioner that piled from medical specialty groups including the American testicular cancer, once fatal, is now nearly always curable Society of Clinical Oncology, the American Society of in early stages and explain the therapy of choice. It will Hematology, the Society of Gynecologic Oncologists, and also report that in treating a rare melanoma of the eye, two so on. The AMA remains firm in its opposition. The NCI centers with proton beam accelerators (one at Berkeley remains convinced that PDQ would not be worth much if a and one at the Massachusetts General Hospital) can cure community physician could not use it for a reaJ-ltfe referral. the disease and save the eye. PDQ will tell an interested And the two have "agreed to disagree." physician how to refer a patient with occular melanoma to The ultimate value of this experiment in information- one of these highly specialized, experimental programs. sharing will be indications that more patients with curable PDQ is managed by a two-tiered editorial board of 72 cancers are being successfully treated. An evaluation pro specialists, the core of which meets at the cancer institute tocol is in place but it likely will be several years before anyone knows whether PDQ is lifesaving. 'PDQ is available to subscribers to the BRS/Saunders' COLLEAGUE system. For information, call 1-800-468-0908. or write to PDQ. R. A. Bloch Building, Rm 105. Bethesda, Maryland 20205. --Barbara J. Cuujton tlndividuah may call 1-800-4-CANCER. 752 SCIENCE. VOL. 227 <D 5-7 URL 04930 THE WAIL STREET JOURNAL THURSDAY, ^JANUARY 24, 1985 J Higher Cancer Risk Is Seen for 250,000 Exposed to Toxins on Job, Data Show 4>- By Cathy Trost, *,>' cause of concerns that workers would sue Staff Reporter of The Wall Street Journal , their employers. ' . . ! j WASHINGTON -- Newly released gov But a spokeswoman for the Department ernment documents show that about 250,-, of Health and Human Services said the Na--' ' 000 workers run higher-thah-normal risks tional Institute for Occupational Safety and. , of developing cancer or other diseases Health, which compiled the worker list, from exposure to toxic substances qn the had .notified Companies .and unions about ; job. " s ' ` * the exposures." Plans 'Jo notily\iridividual Documents obtained by consumer activ workers had been delayed, she said, while ist Ralph Nader's Health Research Group the government "tries to figure out how to identified 249 industrial plants and mines tell someone without scaring him to where workers have been exposed to po death." tentially hazardous materials. . She said there were problems in deter- j Mr. Nader charged that the government mining the extent to which individual j hasn't warned the workers of potential workers have been exposed to toxic sub- j health risks so they could obtain medical stances, and what kind of medical treat- { care. In a letter to President Reagan, he ment is available. -. i accused the administration of withholding List Assembled in 1980-81 j fun<js for worker notification programs be- The occupational safety and health in- " > stitute assembled its list In 1980" and 1981 j inkAmeri^a Unit from government studies that linked a va- [ riety of workplace chemicals and other f ' substances to .cancer, heart and lung dis- ', lins Court Ruling ease. and other ailments. The dilemma of ' ' whether to notify workers was referred in . \ 1983 to ah ethics committee of the Centers '; fiduciary Suit for Disease Control, which oversees the In stitute. , . The ethics committee said the govern By Eric Larson j Staff Reporter of The Wall Street Journal LOS ANGELES-Bank of America said a state judge ruled In Its favor in an $80 million class-action lawsuit that charged the bank with breach of its fiduciary duty. The suit, closely watched by bank trust departments around the country, was tried befcw^-Judge Lester E. Olson, who issued h!$eision yesterday. SJFfie class action suit, brought by Ted E. Van'de Kamp, a retired Los Angeles busi ment generally does have the duty to in form workers, particularly when the insti: * tute possesses the only records of the expo- j sure and when medical treatment is possi- ble. But the Reagan, administration ! rejected budget requests for full-scale j funding of a pilot notification program. \ Mr. Nader said he' received a letter' from a Health and Human Services official in November saying, "We believe individ ual worker notification is an important is sue." But no explanation was given for the lack of funding. nessman. and others, including the Damon 4 THE WALL STREET JOURNAL THURSDAY, FEBRUARY 14, 1985 If 1 Doctor Cites Benzene Exposure as Likely Cause Of High Cancer Death Rate at a Shell Refinery By Barry Meier And Cathy Trost Staff Reporters of Tub Wall Street Journal WASH1NGTON-A doctOT who directed a study of an abnormally high rate of can cer deaths among workers at a Shell Oil Co. refinery in Illinois says the cause 'most likely" was exposure to benzene produced at the facility. But the company, quoting the doctor's own report, told the refinery workers that no scientific link had been established be tween the benzene exposure and the leuke mia cases studied. The varying viewpoints held by the doc tor and by Shell reflect the difference be tween informed opinion and scientific proof. But they raise questions about how companies inform their workers about industriai health hazards. The problem also is part of a broader and growing concern, in the wake of the Bhopal, India, chemical plant disaster, over the right of workers and the public to know about hazardous products and processes. The Occupational Safety and Health Ad ministration, which sets and enforces workplace safety standards, says that about 600,000 U.S- workers are exposed to benzene on the job. Benzene is used as an intermediate chemical in the manufacture of plastics and solvents, in addition to pet roleum products. The controversy over the study's find ings steins from research conducted by Dr. Philip Cole into the possible cause of a high rate of acute myelogenous leukemia at Shell's refinery in Wood River, 111. A 1983 company study reported that between 1973 and 1981. eight workers employed at the refinery died from the illness. Statistical Averages Based on statistical averages, only two workers should have died from the illness during that period. Dr. Cole, who told Shell the increase was "highly statistically sig nificant," was hired to review company re search and try to determine the cause of the deaths. Dr. Cole issued his report in December. Government and industry studies indi cate that occupational exposure to benzene is a likely cause of cancer. Scientists also say that workplace exposure to certain sol vents and radiation can cause the dis ease. "At present, I remain of the persuasion that the most likely cause of the leukemias is benzene," Dr. Cole said in an interview this week. He acknowledged that his study didn't scientifically link benzene to the high leukemia death rate, but added: "Common sense tells me it's benzene, but you can't establish scientific fact on that." Shell maintains it has been "fully open" in presenting results of the studies to em ployees and the public. It says that while it hasn't ruled out benzene as the cause of leukemia-related deaths, it has drastically reduced levels of the chemical in the air at its refineries in recent years. However, a union representing the re finery workers says Shell never provided it with a full copy of Dr. Cote's report. A comparison of Dr. Cole's reports to Shell and company statements based on it show that: -Quoting Dr. Cole's report. Shell told workers the study "produced no distinctly positive result, not even for benzene" as the cause of the leukemias. The company didn't indicate, as Dr. Cole did in his re port, that the entire study may be incon clusive because, among other things, pre cise data on worker exposure ieveis wasn't available. -Shell said recently that its interpreta tion was that Dr. Cole's work "found there was no apparent difference in (workplace) benzene exposure levels between those who died of leukemia and those who didn't." Dr. Cole states in his report, however, that available data suggests the leukemia-af flicted cases were "more heavily exposed" to the chemical. -Dr. Cole reported that it was very possible that an abnormal rate of leukemia would continue at the Wood River facility. Shell never relayed this comment to workers there. Reports to Workers Dr. Cole said he wasn't familiar enough with Shell's reports to its workers about his research to comment. He added that If the choice were his, he would tell em ployees that benzene was the "likely cause" of the leukemia problem at the Illi nois refinery. Shell says that in reporting Dr. Cole's study in company bulletin board announce ments, it didn't try to explain all of the re port's details. "We made some judgments on interpreting and summarizing," a com pany spokesman said this week. As for whether the leukemia victims were more heavily exposed to benzene than other workers. Shell says the report's data wasn't consistent. "You could argue it ei ther way," the spokesman said. As for Dr. Cole's comments that more cancer deaths were possible, Shell said it believed it conveyed this idea simply by reporting on the study. Shell also said it discussed Dr. Cole's report with workers in plant discussion groups, but it didn't elabo rate on what was said. George Machino, vice president of Lo cal 525 of the International Union of Oper ating Engineers, which represents about 500 Wood River workers, said he believes that even if Shell only suspected that the leukemia deaths were benzene-caused, it had a duty to alert workers. "Even if it's not scientific, but only sup position by the people contracted to do the study, we should have been told, " said Mr. Machino, who also heads a committee of several unions working with Shell on health and safety issues at the Illinois plaint. A Shell spokesman said a complete text of Dr. Cole's reports wasn't given to union officials at the Wood River facility. He said the union hadn't asked for it until yester day, and that it would be provided. Since the mid-1970's, Shell has tested re finery workers at Wood River and other lo cations for reduced white blood cell or platelet counts, the spokesman said. Signif icant lowering of either can indicate a pre leukemia condition. The spokesman said that as a result of the monitoring program, two Wood River workers had been re moved from jobs where they had been ex posed to benzene. An official of the National Institute of Occupational Safety and Health, a federal agency that investigates workplace haz ards, recently criticized Shell in a letter for being "overly reassuring" in telling workers about the health risks of ben zene. While Shell has maintained in employee communications that leukemia is linked to "high" benzene exposure levels, a NIOSH official noted that leukemia also has been found in workers exposed to low levels of benzene, "We believe that it is not possible to firmly establish a (benzene exposure* level at which one is assured that no risk exists," J. Donald Millar, NIOSH's assis tant surgeon general, wrote to Shell in Sep tember 1983. Shell says that during the 1950s and 1960s benzene levels in the air at its refin eries were as high as 100 parts per million. But it Insists current levels are "far be low" federal standards, which limit expo sure to 10 pm. In 1978, OSHA tried to lower the ben zene worker exposure standard to one part per million, but that attempt was over turned in a Supreme Court decision follow ing an industry challenge. OSHA promised a stronger benzene rule last summer, but none has been proposed yet. 14MU T-.tw.-~..- Vm m 9 198S Arota.