BETHESDA, MdNational 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 NCIs 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
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 projectslimited (at the IOM
committees 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.
This is a very clear example where, for some reason, data was
not looked at, Dr. Klausner said. Even the $44 million figure
underestimates NCIs 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.