Five years into the National Cancer Program.

President Brewster, Dr. Cole, Dr. Berliner, ladies and gentlemen: As Chairman of the President's Cancer Panel, I am delighted to be in New Haven for the groundbreaking ceremonies for the Comprehensive Cancer Center at Yale. This great university has been preeminent in biomedical science, and the establishment of a Comprehensive Cancer Center will, I am sure, enhance Yale's contribution both to the fundamental understanding of cancer and to the quality of clinical care for the cancer patient. These are very interesting days for those of us responsible for the National Cancer Program. While the cancer program has had the strong support of the Congress, the administration, the public, and a large segment of the scientific community, criticisms are still coming in from many quarters and these criticisms need careful listening to and even more careful sorting out. There are hard things being said, and we need to think our way carefully through the answers. This morning I would like to deal with several of the important questions that continue to arise and see if we can, to some extent at least, separate myth and misconceptions from valid criticisms. The two most persistent questions about the cancer program deal with opposite sides of the same issue. On the one hand it is said that there is not a sufficient recognition in the cancer program of the importance of fundamental basic research. The opposite and equally vehement criticism is that we are spending too much on fundamental basic research and not enough on applied and clinical research oriented toward a more immediate payoff. Other criticisms of the program include the suggestion that those in charge of the program are under the mistaken impression that techniques of business management can be used to unravel the profound mystery of biology; that an attempt is being made to target research that cannot be targeted; that we have become shackled by our own efforts at planning in areas where planning is impossible; that our insistence on targeting has resulted in an enhanced use of contracts at the expense of grants, and that contracts mean less effective research; that our preoccupation with centers is causing us to fund second-rate research at places called centers while first-rate research applications go begging in our traditionally excellent educational institutions; that control, demonstration and service expenditures are siphoning off the funds which should be used for research; that there is a lack of appreciation of the necessity for training the manpower that is needed to provide for the continuity of excellence that good research demands; and that the cancer program is raising false hopes and false expectations that will result in disillusionment and ultimate abandonment of the program to the detriment of all