American Cancer Society Now a More Aggressive Advocate

WASHINGTON--This spring, the American Cancer Society (ACS) and theChildren's Defense Fund led an influential coalition of more than 150 groupsin active support of the CHILD Act, sponsored by Sen. Orrin G. Hatch (R-Utah)and Sen. Edward M. Kennedy (D-Mass).

In May, the Senate rejected the measure, which would have increasedthe federal cigarette tax by 43 cents a pack and used the new money toexpand health care for low-income children.

"If it weren't for the White House and the Republican leadershipworrying about the budget deal, we would have had it," says LindaHay Crawford, the ACS' national vice president for federal and state governmentrelations, who works out of Washington.

Now, the ACS is planning other bold steps into the public policyarena. In this interview with Oncology News International Washington bureauchief Patrick Young, Ms. Crawford discusses the ACS' aggressive new advocacyprogram.

ONI: What are the Society's goals in trying to influence the federaland state governments?

MS. CRAWFORD: Our number one priority is to get more federalfunds into cancer research. We still have a tremendous commitment to research.But a second goal is to get cancer prevention and control into the publicpolicy arena. We are looking at issues beyond individual patient care andquality care and toward more preventive issues.

For example, we are campaigning to mandate Medicare coverage of differentkinds of cancer screening. This can be difficult to do, since in our ageof cost containment in health care, mandates are not viewed as positive.

And we are deeply involved with tobacco control. This campaign has shownus that the closer you get to the people legislating or making public policy,the more effective your advocacy will be.

ONI: What is different today from yesterday in the ACS' advocacy?

MS. CRAWFORD: The main difference is a commitment to the ideathat through advocacy and public policy, we can make a real differencein cancer. That means finding new ways to get our message out through themedia, through the use of communications, and through the legislative process.

ONI: How will things be different in this new era?

MS. CRAWFORD: Traditionally the American Cancer Society has worked toincrease research appropriations, "getting more money." Now weare getting beyond just cancer research and looking at the bigger issuesof health care--preventive health for kids, for example--and so our issuesare becoming broader. We are not just looking for ways to cure cancer onall activities: research, advocacy, and education.

ONI: What other new directions do you envision for the Society?

MS. CRAWFORD: Working with elected officials, directly havingcontact with public interest groups, the National Governors' Association,the National Conference of State Legislatures, other legislative groups.We're going to be lobbying and advocating on health issues and gettingour message out by networking, by getting involved in new kinds of organizationswith political access.

The Society has been involved in tobacco-control advocacy since thesigning of the National Cancer Act and the release of the first SurgeonGeneral's report on tobacco. We added resources and a federal/state "integrated"campaign on the total tobacco-control issue when we received money fromthe Robert Wood Johnson Foundation.

We are today supporting--in better ways and with more resources--thoseissues that we know are successful in promoting antitobacco legislation,and we are also looking at overall campaigns.

ONI: What do you mean by an integrated campaign?

MS. CRAWFORD: We are working with groups with whom we have notbeen involved previously. With the Hatch-Kennedy bill, for example, weaffiliated with the Children's Defense Fund.

The second part of this integrated campaign is to work more closelywith local chapters. We are becoming one American Cancer Society, not justfor advocacy but for all of our activities.

The divisions are consolidating into regions, and we are providing them,through this office, with technical systems to upgrade their advocacy efforts.Some divisions are very sophisticated; some are not. We are creating alevel playing field among the regions for advocacy so they can work withstate legislatures and on federal issues.

As part of all that, we are using media and communications in a muchmore proactive way to get our message out. If you remember, while the tobaccosettlement talks were ongoing, we placed a full-page ad in the New YorkTimes and Washington Post. It was a letter to the American people on publichealth principles that we feel any settlement must uphold. That is a newemphasis for the American Cancer Society.

ONI: What is the ACS position on the current proposed tobacco settlement?

MS. CRAWFORD: A settlement is not going to solve the whole smokingissue. Our concern is: If you have a settlement and legislation goes toCongress, does Congress feel that's all they need to do on the tobaccowars?

It's not the way we feel. We feel the only way that you are really goingto get kids not to pick up that first cigarette is to constantly keep theissue before the legislatures, in the courts, and among the American people.

ACS Wants Changes in Proposed Tobacco Settlement

ATLANTA--Before the American Cancer Society can even consider supportingthe proposed tobacco settlement, two flaws must be corrected, said ACSpresident Myles Cunningham, MD.

The Society wants (1) absolute assurance that the FDA will have completeand unfettered authority over the regulation of nicotine and other cigaretteingredients, and (2) a significant strengthening of tobacco industry penaltiesfor failure to reach the document's smoking rate reduction goals.

The document as it stands would require the FDA to present a "preponderanceof evidence" that nicotine is harmful to health and that restrictingits use would not create a black market.

Dr. Cunningham noted that the FDA's jurisdiction over tobacco productshas been upheld by the Greensboro Federal Court decision. "There isno logical basis for backtracking on that victory here," he said.

As to the penalties for failing to reduce underage smoking, ACS Boardof Directors Chairman George Dessart said: "It needs to be so financiallypainful for the industry to miss these 30% and 60% decreases in youth smokingrates at five and 10 years, respectively, that working hard to achievethem is their only option."

ONI: So, where do you go from here on tobacco-related issues?

MS. CRAWFORD: There are many areas where legislation is needed;second-hand smoke and international tobacco use are still issues. Americantobacco companies are in business overseas, pushing their products, andthat is an issue for ACS, for all of us in cancer control.

Excise taxes remain an issue, and many states are looking to raise cigarettetaxes and use the moneys for tobacco control. Alaska's cigarette tax justwent up from 71 cents to $1.00 a pack, and Hawaii is expected to follownext year.

ONI: Have you detected any public backlash to the antismoking campaigns?

MS. CRAWFORD: Absolutely none. This is where the people are onthis issue. I don't know any parents who want their children to start smoking.I think just about everyone in this country feels like they have been liedto and manipulated by the tobacco companies over the last 30 years.

ONI: What about the verdicts in smoking lawsuits?

MS. CRAWFORD: As to individual claims, public sentiment isn'tthere at this point. People still blame those cancers you get through personalbehavior on the individual and so we are not seeing plaintiffs' verdicts.That's human nature. There is a lot of work still to be done in smoking-relatedcancers, and I think we've only just begun.