Focus: Sydney

Changing of the cancer guard

Nominations for the new board were vetted by the Minister for Health's office, and several people highly experienced in cancer research were rejected. A group including a trade union official, a rural nurse, a consultant to the Aboriginal community, and a former Labor party minder was announced in September.

The new board elected Deborah Saltman as chairwoman. Saltman is Australia's first woman professor of general practice. She is a feminist with a solid background as a women's health advocate, and foremost among her concerns are that the organisation should reflect community priorities on cancer before it serves the interests of any group claiming research funding. At its first meeting, the board froze the award of all new research grants that were due to start in 1997, suspended all advisory committees, and announced a sweeping review of the council's functions and procedures.

All hell has broken loose, with all the main medical research agencies condemning the freeze as an attack on the peer review process. Professor Rick Kefford of Westmead Hospital, whose melanoma research group has received several grants in the past, has convened a Save Our Cancer Council group, which is threatening to set up an alternative body to attract bequests for research. Kefford fears that much of the board is captive to interest groups antipathetic to science. He cites radio comments by one member who, two weeks after his appointment, declared there was too much "test tube research" and that he considered researchers were not stakeholders in the cancer council. Epidemiological, behavioural, and palliative care research already account for 43% of the council's research funding--a proportion vastly in excess of that distributed by the National Health and Medical Research Council, so any view that money had been cosily distributed to a biomedical old boys' club is difficult to sustain.

Saltman and her board are in an invidious position. She argues that they accepted the baton of reform that was passed to them by the actions of previous boards, which had instigated the changes to the board she now leads. To the accusation that the freeze on new research breaches a legitimate expectation that research selected through peer review should proceed, she counters that with only a three year term to proceed unquestioningly with major expenditure reflecting previous priorities would be to abrogate her mandate to make changes. If you've got to crack eggs to bake cakes, Saltman's group has rushed into the kitchen, but has yet to post its menu.

The American Cancer Society reported last month that total mortality from cancer in the US had fallen for the first time since records began. The major reason has been the continuing decline in smoking among men. This year's smoking control budget in the New South Wales health department was halved on the orders of health minister Dr Andrew Refshauge, whose office prattles soft left slogans about smoking control being an attack on workers. A plainer and more important test of the board's duty "to advise the minister on such other matters relating to cancer as the minister may from time to time require" would be harder to find.--SIMON CHAPMAN, associate professor of public health and community medicine, University of Sydney

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