Max Beer

In 1997, my wife and I attended the first World Conference on Breast Cancer in Kingston Ontario. During the four-day event, delegates discussed and debated major breast cancer issues. One day was devoted to environmental concerns and to the possible links that chemicals might have to breast cancer.

Things have changed! The last World Conference on Breast Cancer — held in Victoria, B.C. in June 2002 — focused on many issues but environmentalism certainly was low on the list. I notice, looking at the literature that emanated from this conference, that pharmaceutical companies have become major sponsors of the event and have also entered into "partnerships" with several breast cancer groups.

Why have pharmaceutical companies become so interested in advocacy groups? And, conversely, why are some breast cancer groups actively seeking out pharmaceutical funding?

Environmentalism has become an important issue for many breast cancer activists. Pharmaceutical/chemical corporations have been accused of being involved in the production of cancer-causing chemicals, while simultaneously being involved in the production of cancer-fighting drugs. Before its recent reorganization, Astra-Zeneca, the pharmaceutical company that produces tamoxifen (a breast-cancer-fighting drug), was a branch of ICI, Imperial Chemicals Industries.

Corporations need the support of breast cancer groups for a variety of reasons. Advocacy groups have been scrutinizing and criticizing corporate behavior. Sharon Batt, CIHR PhD Fellow at Dalhousie University and former president of Breast Cancer Action Montreal, in an article entitled, "You, Your Breast Cancer Group and Prescription Drug Ads," describes how health advocates have launched successful campaigns to prevent drug companies from misleading the public about the benefits of cancer-fighting drugs. In October 1998, AstraZeneca was granted permission by the U. S. Food and Drug Administration to advertise the use of tamoxifen to American women. Prevention First, a coalition of activists, forced the drug manufacturer to withdraw two advertisements which had overstated tamoxifen's benefits and understated the risks. Sharon Batt was one of the few voices at the 2002 conference expressing concern over pharmaceutical influence on breast cancer policy. She was especially wary of recent incursions by the industry into the breast cancer community.

Funding breast cancer groups is one way for pharmaceutical corporations to blunt criticism. But the aim of the pharmaceuticals is not only to silence their vociferous critics but also to enlist their support. Besides funding, pharmaceutical corporations have now started creating "pharma partnerships" within the breast cancer community. These partnerships not only legitimize the actions of the corporations but at the same time place the companies on the side of the angels.

The growth of pharmaceutical dominance both within the medical/scientific community and government goes back more than two decades. The conservative agenda of the Reagan and Mulroney governments in the 1980s meant a reduction in government funding and support for scientific research. In both Canada and the United States, government cutbacks to scientific research in the 1980s led to an "alliance" between the pharmaceutical corporations and the medical community. This created what has been referred to as the "Medical-Industrial Complex." While it is possible to point to very significant gains made to medical research by corporate funding, there are underlying problems associated with the cozy relationship that has developed between scientists and the private sector.

In this country, the Pharmaceutical Manufacturing Association has established close ties with the Health Protection Branch of Health Canada. In 1998 six HPB scientists testified that they had been pressured by bureaucrats to approve the bovine growth hormone manufactured by pharmaceutical giant, Monsanto. One witness testified that Monsanto had offered the department a million dollars in research funding, which she interpreted as a kind of bribe to ensure Health Canada approval.

Pharmaceutical corporations claim to be sympathetic to a wide variety of illnesses and express compassion and understanding for the suffering of the afflicted. However, their main goal as multinationals in the free market economy is to produce profits for themselves and their investors. Sometimes this goal blinds them. Public safety and public concern take a back seat in the search to create drugs that will sell. Pharmaceutical companies, to insure profits, accentuate the positive benefits of their drugs and minimize harmful side effects. Because of the large sums of money involved, and because the private sector has now become the major source of funding for medical research, a kind of moral divide has been breached.

This is not to suggest that pharmaceutical corporations are evil or that the people within these organizations have no regard for human life. But a culture has been set up in the pharmaceutical corporate world that regards disease as a sort of cash cow. A mindset has been established that looks on the development of new drugs as a way of gaining access to a lucrative market. This market is competitive and, in some cases, filled with older drugs that may be as effective as the newer ones that may have cost millions to create. And what is one to do with a new drug that is a dud? Marketing thus becomes a top priority.

In 1998, Dr. Nancy Olivieri, a blood specialist at the Hospital for Sick Children in Toronto, discovered that a drug undergoing trials posed a risk to patients. The doctor went public. The drug manufacturer threatened legal action if Dr. Olivieri alerted her patients and the public to the potential hazards of the drug. One shudders to think of similar situations when medical scientists have simply adhered to confidentiality agreements and remained silent when drugs failed or caused adverse reactions.

An article in the New York Times, "Hormone Replacement Study a Shock to the Medical System," explored the current revelations of the dangers of estrogen therapy during menopause. The son of the late Dr. Robert Wilson, one of the pioneers of this kind of therapy, and a staunch proponent of supplementary hormones, told reporters that Wyeth-Ayerst, the pharmaceutical company that produces Premarin (historically the top-selling estrogen), had paid the expenses of Dr. Wilson's blockbuster book Feminine Forever and had also financed the Wilson Research Foundation. In addition, the company had paid Dr. Wilson and his wife to tour the country and lecture to women's groups, promoting the book and the benefits of estrogens.

For more than three decades, hormone therapy was hailed as a wonder drug for women, but some were still skeptical. The National Women's Health Network continued to question both the message and the data. Cynthia Pearson, executive director of the NWHN, said the message was "sexist and ageist." It was claimed that HRT could make women look younger and also make them less of a pain to their husbands.

Pharmaceutical companies were also accused of ignoring any negative effects and basically delivering an upbeat message on the drug. Pearson stated: "The claims were too good to be true. Each time there was anything negative about the drug, a new claim arose to keep it alive."

Another New York Times article, "Race to Fill Void in Menopause Drug Market", reports on the search by both drug manufacturers and "natural" remedy providers to replace the now discredited drug Prempro (a combination of estrogen and progestins) used in the recent Women's Health Initiative study on HRT. Some drug manufacturers have begun promoting new drugs with slightly different formulations, drugs that have been less studied than Prempro.

Breast cancer is a big business
In Canada, approximately 175,000 women live with breast cancer. In the United States, the figure surpasses two million. These figures represent a huge market for the pharmaceutical corporations. Barbara Ehrenreich, in a Harper's article entitled "Welcome to Cancerland," details the kind of love affair that has developed between sectors of the breast cancer community and the corporate world. Breast cancer has become the darling of Corporate America: "It is the very blandness of breast cancer, at least in mainstream perceptions, that makes it an attractive object of corporate charity and a way for companies to brand themselves friends of the middle-aged market." Pharmaceutical companies with their recent spate of ads have become the saviours of the breast cancer community. Look at their ads and you see the happy faces of women who have successfully endured the pain of surgery, radiation and chemotherapy. It is the pharmaceuticals who are to be thanked for their endless efforts in fighting this dread disease. Whether some claims are exaggerated does not matter.

As funds for breast cancer advocates shrink, the groups have been placed in an unenviable position. Lacking sufficient financial resources, some breast cancer groups have started to seek support beyond their membership in order to promote their agenda and to survive.

Pharmaceutical companies have been only too happy to provide financial support to these organizations. While accepting money — and even becoming 'pharma partners' — some still cling to the notion that they are independent, that although they have accepted corporate support, they are uncompromising in their principles. But once funding increases the coffers of an organization, the organization itself becomes more reliant on this source for its finances. Policies change slowly and insidiously. Once a group has become reliant on any financial backer, the group starts to modify its stance. Decision-making now takes into account the feelings and the concerns of the generous patrons. Voices of protest become more subdued.

One of the workshops at the Conference on Breast Cancer in Victoria was run by a breast cancer group which advocates pharmaceutical funding and partnership. The literature pertaining to this workshop spoke of "values needed to support ethical relationships and corporate citizenship." In the language of Orwellian doublespeak the abstract for this workshop stated, "The convergence of interests among grassroots organizations, pharmaceutical interests, and public demands for accountability and transparency, are an important factor in creating the readiness for leadership, learning and positive growth to emerge." The idea that "positive growth" can result in a partnership with these multinationals is absurd. Breast cancer groups seeking to acquire pharmaceutical support must adapt, and adopt many of the views of these corporations. Whether this transformation is immediate or is a sort of slow evolution as these groups, through self-delusion, rationalize their new status, there is no doubt that eventually they will parrot the mantras of their corporate sponsors or partners.

Ed. : BCAM will not knowingly accept funding from the following categories of corporations. 1. Pharmaceutical companies; 2. Chemical manufacturers; 3. Biotech and agri-business; 4. Oil companies; 5. Tobacco companies; 6. Private cancer diagnosis and treatment facilities; 7. Companies that develop and market cancer-related technology.