IMPRESSIONS OF ASCO:
THE ROAD TO INTEGRATED ONCOLOGY
The Cancer Chronicles Spring 1998
© 1998 by Ralph W. Moss, Ph.D.
May 20--I have just returned from the meeting in Los Angeles of the American
Society for Clinical Oncology (ASCO). This is one of the premiere annual
events in the cancer world, one of the two famous "spring meetings."
(The other is the American Association for Cancer Research.)
I have been attending these meetings in a desultory way for years, but
for the first time, our cancer report service, The Moss Reports, took a
booth in the massive Exhibition Hall at the Los Angeles Convention Center.
Anne Beattie, coordinator of The Moss Reports,
Melissa Wolf, our outreach director, and I spent several days meeting and
talking with a wide variety of cancer specialists. We engaged scores of
them in fruitful discussions about The Moss Reports and our books, especially
The Cancer Industry and Questioning Chemotherapy, which were
prominently displayed at our booth.
A highlight for me was a conversation with David Rosenthal, M.D., the
Harvard professor who is current president of the American Cancer Society.
This was a entirely friendly encounter, and I had a chance to review with
him the figures in my book, The Cancer Industry, on ACS's now discarded
evaluations of non-conventional methods. Dr. Rosenthal explained that he
has tried to launch a new era of openness towards such ideas. He and I will,
in fact, be speaking on the same podium June 12-14, 1998 at the Center for
Mind-Body Medicine Conference on Integrating Cancer Care in Arlington, VA.
I am sure many readers would like to hear about the scientific presentations,
on Herceptin, Camptothecin, Angiostatin and the like. Unfortunately, I did
not get to attend many scientific presentations. I spent my time this year
at the booth as well as "schmoozing" with various friends and
acquaintances whom I ran into.
IMPRESSIONS OF AN EXHIBITOR
I would like to share with you my impressions of the meeting from the
perspective of an exhibitor. One of the astonishing things about ASCO these
days is the size. Old-timers recall when ASCO was a relatively small organization,
and the exhibition area was a modest appendage. This year it was huge. The
New York Times (5/18/98) reported that there were 19,000 cancer specialists
in L.A. for the meeting. And that's just a fraction of the organization.
Nineteen thousand! They seemed to be everywhere. Hotels 15 miles away from
"ground zero," the massive L.A. Convention Center, were packed
with oncologists. You could see greetings to ASCO members on the white fluorescent
display signs all over town. About 20 special busses were zipping all over
the sprawling city carrying attendees back and forth from their hotels.
I couldn't help but think of the laetrile-era complaint, "There are
more people living off cancer than dying of it." Unfair, but there's
a grain of truth to it. Cancer treatment, for better or worse, has become
a big business all over the world.
Another surprising feature was how many non-Americans were in attendance
at the "American" Society for Clinical Oncology. There were large
numbers of doctors from Latin America (especially it seemed Argentina),
Europe, the Middle East, etc. Our guess was that 50 percent of the people
who came to our booth were not from the U.S.A. and many of the Americans
were foreign born. We also were surprised by how male-dominated this profession
still is. This was even more so for the South American doctors. I know very
well that a woman (Karen Antman of Columbia-Presbyterian) has been president
of ASCO. However, many of the women we met seemed to hold less prestigious
or even subordinate jobs (such as in public health services). The high-powered
honchos are still mostly male.
The Exhibition Hall was taken up mainly with the displays of cancer drug
manufacturers, such as Bristol-Myers Squibb, Amgen, Genentech, and the like.
And what displays these were! Each of the drug companies active in the chemotherapy
field was there, and each display vied with the others for glitziness and
or even gaudiness. As you entered the hall there was a high-tech loudspeaker
that announced something like, "Oncologists! Your hard work has finally
paid off. The American public salutes you for your acknowledged victories
in the war on cancer. Come visit our booth...." and so forth. Amgen
was selling Neupogen, a drug which basically enables doctors to give their
patients a "fighting chance" by giving them more chemotherapy.
Since Neupogen gives patients a "fighting chance," the theme this
year was militaristic. The company posted guards in white Napoleonic- type
uniforms at each corner of the display. Each guard wore a white visor and
his face was also painted white. It was eerie. These guards stood at erect
attention at the strategic corners of the rented space. They were so immobile
that one of my companions was convinced they were statues! Occasionally,
they left their assigned spaces and marched single-file through the exhibit
hall. In front of them they carrying not rifles but streamlined silver N's,
presumably for Neupogen. Unlike the guards outside Buckingham Palace, we
discovered you could talk to the Neupogen soldiers, and they would talk
back. It was strange standing in the middle of a carpeted, two-story high
chemotherapy display chatting about L.A. weather with a Neupogen soldier.
I can't tell you how large the Exhibition Hall actually was. Six football
fields would be a good guess. The hall was probably five or six stories
high. But these are guesses. Everything associated with this huge room suggested
that you had left the ordinary world behind, that you were in a Borg-like
space where resistance was futile. Even my friend Jim McCoy said it reminded
him somehow of "Star Trek."The high tech theme was sounded again
and again. Doctors stood on platforms trying out Virtual Reality devices.
There was even a walk-through Virtual Reality display, where you could seek
enlightenment by recreating the feeling of a cancer's patients fatigue.
I didn't see anyone signing up for that one. I fled from there to the freeze-dried
ice cream pellet dispensary.
Yes, I admit it, I sold out for a mass of giveaways. Bristol Myers Squibb,
the self-declared "World Leader in Chemotherapy," was giving away
box loads of L.L. Bean-style floppysided attache briefcases. Each one would
cost you $30 or $40 in the store. Greedy people (none of them known to me)
were grabbing five or six for friends back home. Plenty of people were giving
away tote bags of course, but the tactfulness of BM-S was especially appreciated
since these bags did not carry any crass advertising on the outside. Only
when you open the briefcase do you see the company's name inside. This reminds
you over and over again of the company's generosity and good taste. Not
for nothing are they the world leader.
There were at least four booths offering doctors prizes or money for
filling out survey forms. One came right out and gave each oncologist $150
in cash just for answering a few marketing questions. Suddenly, I realized
my parents were right--I should have gone to medical school! There were
also free sherbet, soft drinks, bottled water and water holders, cappuccino,
espresso and latte, the aforementioned freeze-dried ice cream pellets ("They
can't cure cancer but they can make a dry ice cream," cracked one wit),
in fact anything at all to get those doctors away from their meeting and
onto the floor of the exhibition hall.
I am sure many very important lectures were given. But spending my time
in the nitty-gritty world of sales gave me a peculiar impression of this
august meeting. My overall impression was one of fabulous wealth and power.
I mean, I literally wrote the book on The Cancer Industry. I have followed
the growth and consolidation of this industry in many of my writings. But
it has all remained rather academic for me. I kept thinking of the argument
I had with the late Lawrence Burton, Ph.D. in
1988, when I visited him in his Bahamian exile. "You just don't get
it," he yelled at me in his insulting way. "It's a biz-ness!
It's a biz-ness!"
In this rah-rah atmosphere of the ASCO meeting it was certainly strange
to be displaying my book, "Questioning Chemotherapy." The only
other people questioning chemotherapy at that meeting, oddly enough, were
the editors of The Lancet. The Lancet did a special feature on cancer (presumably
to coincide with the event) which called into question the use of high-dose
chemotherapy for most solid tumors of adults. A great article. I didn't
notice any huge crowds around their booth. Most people seemed too preoccupied
seeking out attache cases.
Yet most reactions to Questioning Chemotherapy were friendly or
at least intrigued. We went with the goal in mind of meeting about 20 oncologists
we could work with at various levels. We had personal encounters with several
hundred and handed out our colorful flyer. We exchanged cards with many
of them. Only two people were downright hostile. One thought our views were
"too negative." From this meeting I conclude that there there
is a significant minority of oncologists who are upset by the commercialization
of their field and are looking for answers. Once we engaged them in conversation
we were able to find many points of agreement.
We weren't entirely alone, either. We shared a space with James McCoy,
Ph.D., whose company, ImmunoComp, markets an experimental tumor vaccine.
Right behind us, by serendipity, was the display of Robert Nagourney,
M.D, an unconventional oncologist from Long Beach, California. Also
present was one herbalist whose product could seemingly reduce the side
effects of chemotherapy. (They reported very little interest from the attendees.)
Also, Lane Laboratories, makers of a popular brand of shark cartilage. Although
they were promoting clinical trials of their product they encountered more
hostility. There was also a wide variety of patient groups, and representatives
of the forthcoming March, an event that seems to have garnered quite a bit
of pharmaceutical company support.
By and large ASCO--1998 was a very positive experience for us. We hope
that others who march to a different drummer will be heartened by this field
report and come to next year's meeting in Atlanta. The future of cancer
treatment for a long time to come will involve a skillful combination of
both conventional and nonconventional medicine. Such a synthesis will be
made not just by alternative practitioners but by many of the people who
attended this meeting. The sooner non-conventional practitioners and innovators
seek out such encounters with oncologists, the sooner will a truly useful
integrated approach emerge.
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