John Bailar’s Righteous Attack on the “War on Cancer”

Barron H. Lerner in Slate:

When then-President Richard Nixon launched the “war on cancer” in 1971, there was no more admirable cause to support. The dreaded disease was the second leading cause of death that year for Americans, after heart disease, and has maintained that spot for decades. Yet John C. Bailar III, a physician and epidemiologist who died in September at age 83, persistently challenged the war—at a time when doing so was almost sacrilege. In recent years, others have picked up Bailar’s points, such as the notion that early cancer detection may not save lives. And we’ve moved on to a new metaphor for cancer control: the “moonshot,” championed by Vice President Joe Biden. But, in an era in which even a cancer moonshot is likely to be politicized, it is worth remembering a critic like Bailar, who thoughtfully opposed quick fixes for a complicated disease. Bailar would have been the first to say that it is impossible to separate science and rhetoric, but as a scientist and an advocate, he always tried to focus on what he believed the data showed.

…Bailar’s salvo, “Mammography: A Contrary View,” appeared in the well-respected medical journal the Annals of Internal Medicine. In it, he registered several concerns, many of them drawing from his statistical background. First, he wrote, the benefits of screening mammography “have not been determined.” Although a research study then being run by the Health Insurance Plan of New York suggested its value for women over 50, no such data existed for younger women. “Not every lesion discovered by screening should be considered a success of the program,” Bailar wrote. This conclusion drew on the epidemiologic concepts of lead-time and length-time bias, which falsely elevate actual survival rates by focusing on the date of cancer detection rather than a patient’s actual outcome. Second, according to Bailar, the risks of mammography “may be greater than are commonly understood.” Among his concerns was the worry that the radiation from repeated mammograms could actually cause breast cancer and that many of the machines being used in the BCDDP were using higher-than-necessary doses of radiation.

More here.