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Spring 2004 Volume 5, Issue 10:
Cancer Research and Medicare: Political Pork?
By Greg Brozeit
An ominous climate is developing around the cancer community and threatening to stick around. But unlike the weather, everyone can talk about it and do something to change it. And change it we must, otherwise we will have denied our children a legacy free of death and suffering due to cancer.

The end of the last appropriations cycle—with the lone exception of funding for the Centers for Disease Control cancer programs—and the passage of the Medicare reform bill, represented potentially momentous setbacks for all current and future cancer patients.

Congress and the administration approved the smallest increases in recent memory for medical and cancer research funding. In the long term, this will result in the loss of hundreds of research grants.

The new Medicare laws have lowered reimbursements for oncology drugs and promise to lower other reimbursement rates within a year. Recent reports call into question if and how many off-label drugs for cancer patients will be covered under the new prescription drug benefit scheduled to take effect on January 1, 2006.

All of this comes at a time when congressional critics on the left and right have deplored the extent of pork barrel projects contained in the most recent omnibus appropriations bill—the same legislation with only minor increases for cancer research; increase that will be wiped out by cost of living adjustments and obligated funds. Moreover, these cuts and policy changes are coming at a time of unprecedented progress in the development of genetically targeted drugs—arguably the greatest development in the history of cancer research.

The failure of the cancer community to win big victories last year both in the appropriations process and in the Medicare reform bill must be reversed. The silver lining may be that these actions will motivate the cancer advocacy community to be more vocal and reverse these trends.

Pork Barrel Spending: the Lord’s Work?

A former colleague of mine who served as director of a senator’s state projects used to introduce himself by saying: “Some people say what I do for a living is pork barrel spending, but I like to think I’m doing the Lord’s work.”

Pork barrel spending sums up how members of Congress prioritize much of their political decision making process. In most cases it transcends traditional or ideological affiliations. Critics of pork often ignore the fact that patrons usually have very sound reasons for support and approval of their projects.

A project in the home district or state translates into something tangible: a known number of people—constituents—who care enough about it which, in turn, makes it a priority for them too.

That highway bridge that needs to be built to ease congestion and create safe bypass zones for families and children also creates jobs. This after-school community program which takes kids off the street and reduces truancy and vandalism can improve their in-school performance. And those scientific research projects on marine parasites actually help the seafood industry in your town to provide more plentiful supplies to benefit fishermen, cooks, and restaurant goers alike.

Of course, if that highway is built in a sparsely populated area and is named after a congressman, many may call it pork. Should that after-school program focus on recruiting kids through the use of midnight basketball leagues and rap music, some might be skeptical about why the federal government should support it. And those far-out projects looking into the mating behavior of coastal jellyfish might just seem like some sort of payoff for a well connected university. It depends on your perspective.

In other words, political pork, like beauty, really is in the eye of the beholder—or, to stick with the theme of this piece: the eye of the constituent. Pork barrel spending is not always as bad as it is made out to be. Individual projects, duly considered on their own merit, can withstand the charge of being frivolous or inappropriate. Moreover, there are members of Congress who are willing to go to bat for programs and promote alliances to assure funding for them.

The questions remain: How can we apply the rules of pork to the cancer patient and family community? Is it possible for a critical mass within Congress to identify with the National Institutes of Health, the National Cancer Institute, and Medicare funding in the same way that they do for public works projects in their states and districts? How do advocates work together to form a collective vision of cancer issues as accountable political pork?

Newsweek columnist Robert Samuelson wrote an essay titled “Medicare as Pork Barrel” shortly after the Medicare reform bill was passed by Congress. Rather than traditional definition of pork—highways, bridges, community programs, scientific research projects—Samuelson said the Medicare bill became a tool for satisfying a number of constituencies with influence over lawmakers.

The process behind the Medicare reform bill may provide a valuable lesson, but only if it can be linked to the real opportunities and probable outcomes of research. Policy makers must understand that unfulfilled opportunities in research will literally cost tens—if not hundreds—of thousands of lives over the course of the next couple of decades.

Note: For more information about how to become an effective advocate, please check regular updates in the IMF email newsletter, The Myeloma Minute, or contact Greg Brozeit at greg.brozeit@sbcglobal.net or 330-865-0046.

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