Director Defends NCI Against IOM Assertions

BETHESDA, Md—National Cancer Institute director Richard D. Klausner, MD, has taken strong exception to two criticisms leveled at NCI in a recent Institute of Medicine (IOM) report on NIH research programs for minorities and the medically underserved . Dr. Klausner told the National Cancer Advisory Board (NCAB), “there are clearly either misunderstandings or profound philosophical differences.”

The report questioned NCI’s assessment that it allocated $124 million in FY1997 to research and training efforts aimed at minorities and the medically underserved. It also stated that NCI lacks a strategic plan to address the needs of cancer survivors in the two groups.

The IOM report said that rather than $124 million, NCI actually spent $24 million on minority research and training. The difference, it said, was that NCI derived its estimate from the percentage of minorities enrolled in research studies, and the committee based its estimate on the number of projects specifically focused on minority health issues.

Dr. Klausner challenged both the dollar amount and the way the IOM committee calculated it. “I think there is a real misunderstanding about relevancy vs targeting,” he said. First, he said, NCI sent a list of 128 projects—limited (at the IOM committee’s request) to those funded by NCI research project grants (RPGs)—that targeted minorities and the medically underserved. These projects alone totaled $44 million, or $20 million more than the IOM total.

Conservative Estimates

“This is a very clear example where, for some reason, data was not looked at,” Dr. Klausner said. Even the $44 million figure “underestimates NCI’s 100% targeted commitments because it is only in the grants pool,” he added. “In addition to the RPG pool, there are 61 other projects, raising the total level to $64 million of 100% targeted funding.”

Furthermore, NCI was being conservative in estimating its total funding aimed at addressing the unequal burden of cancer in the United States, the NCI director argued. For one thing, the Institute did not include the money spent addressing minority issues within the Surveillance, Epidemiology, and End Results (SEER) program. For another, it allocated specific percentages of 47 projects, funded at $89 million, to minority issues.

For example, a study investigating prostate, multiple myeloma, pancreatic, and esophageal cancers in blacks and whites was rated as only 50% targeted at minorities; one looking at racial differences in breast cancer survival was considered 28% targeted to minorities.

Taken altogether, NCI spent about $164 million in FY1997 targeted specifically to cancer issues involving minorities and the medically underserved, Dr. Klausner asserted.

With regard to strategic planning, NCI does not have a separate plan for minorities and the medically underserved, but that is not the same as lacking a plan, the NCI director said. “I feel very comfortable, as I did when I talked to the IOM committee, that we engage in strategic planning,” Dr. Klausner said. “We have made the strategic, and I think sensible decision, that in all of our strategic planning, we will explicitly incorporate planning related to minorities and the underserved.”

He noted that “it is reasonable to argue whether this is the best way, but it is not reasonable to conclude that, therefore, there was no planning. All of our programs incorporate and recognize and address these issues not through gimmicks, not from smoke and mirrors, but through specifically addressing the question of unequal burden.”

When asked to respond, the IOM committee chairman, M. Alfred Haynes, MD, former president and dean of the Drew Postgraduate Medical School, said that NCI had reviewed the report prior to its release. “I can assure that that not only did we look at your data but we sent it back to you to ask if our summary was correct,” Dr. Haynes said. “It came back to us without changes. Therefore, we concluded the summary was correct.”