In the following interview, Dr. Margaret I. Cuomo, author of the book A World Without Cancer, discusses the importance of cancer prevention with Motley Fool health care analyst Max Macaluso. A transcript is provided below the video (run time: 19:38).
Max Macaluso: Hi, welcome to The Motley Fool. I'm Max Macaluso, and I'm joined today by Dr. Margaret Cuomo. Thank you for joining us.
Margaret Cuomo: It's a pleasure to be here, thank you.
Macaluso: Dr. Cuomo is the author of the new book, A World Without Cancer, and she's also the daughter of our former Governor Cuomo, and the sister of our current Governor Cuomo.
Macaluso: Dr. Cuomo, I'd like to start with a general question. What inspired you to write the book now?
Cuomo: That's a very good question. It's been about 40 years -- actually more than 40 years -- since 1971, when the war on cancer was declared by President Richard Nixon. In that time, we've spent over $90 billion on cancer research, and yet we are still seeing cancer incidence rates rise.
We haven't come as far as you'd think we should have, for that amount of time and money spent, so I said to myself, with all the horrific effects of cancer on the lives of my patients, friends, and family, it was time to delve into the subject and give it a fresh perspective.
Macaluso: In your book you talk a lot about the misconceptions of cancer prevention. What do you think the top misconception is today?
Cuomo: I think most people, even people who are quite knowledgeable, think that cancer is an inevitability. "No matter what I do, I'm going to get cancer. Either I'll inherit it, or I'll grow old enough and I'll get cancer just because I've grown old."
That's clearly not the case. We know that over 50% of all cancers are preventable. Attention to diet, exercise, limiting alcohol, ending smoking, protecting our skin from the sun, and taking vitamin D all contribute to a cancer-free life and the environmental toxins that are in our midst can be eliminated, or at least limited so that they don't raise our risk of cancer.
Macaluso: Do you think the government is spending enough money on cancer prevention today?
Cuomo: Another very good question. Believe it or not, only 2% of the $5 billion budget of the National Cancer Institute is devoted to cancer prevention and control. The rest of it, $3.3 billion, is devoted to cancer treatment and research into the mechanism of cancer.
While that is important work, it is unbalanced to have very little attention on prevention, which the NCI itself has said is one of our most effective strategies against cancer. Why not devote more time and attention to it?
Macaluso: What are some of the specific things we're not paying enough attention to when it comes to prevention? Let's start with diet.
Cuomo: OK, diet. You know the old expression, "You are what you eat." To a large extent, that's very true. A plant-based diet is what nearly all the experts say is not only the healthiest in terms of preventing heart disease and diabetes, but also reducing our risk for cancer.
If you look at your plate, your daily plate, two-thirds of it should be fresh vegetables, fruits, whole grains like brown rice or quinoa, or even a whole grain pasta -- and then a very small amount of lean protein like fish or chicken, and a minimal amount of red meat. That is the cancer prevention diet, but it also, as I say, decreases your risk for heart disease and diabetes.
Limiting alcohol -- that means you really can't afford to go out once a week and binge. They say no more than one drink a day of alcohol -- that includes wine -- for a woman and no more than two for a man, and it may be even less than that, but certainly you want to watch your alcohol intake.
Macaluso: I can tell you, after reading your book I definitely modified my diet. I'm drinking more green tea and a lot more vegetables.
Cuomo: Excellent. Green tea has been shown to have anti-inflammatory and anti-cancer effects.
Macaluso: Let's shift the discussion from diet to environmental factors, that you alluded to in a previous question.
Cuomo: Yes, environment; very important. In fact, the United Nations just issued a report last week, that the World Health Organization was involved in as well, in which it said that there are so many of the so-called "endocrine disrupting chemicals," such as BPA, which are in our plastic water bottles, other beverages, also food containers, the lining of the cans of food, soup -- a can of soup, a can of beans -- etc. Even a cashier receipt can have BPA.
Macaluso: Oh, really?
Cuomo: Yes. Parabens -- parabens are in everything from facial wash to shampoo, toothpaste -- these are endocrine-disrupting chemicals. What does that mean?
That means they modify the development of hormones in our body. They affect our endocrine system, which has been linked to cancers of the breast, prostate, thyroid, and others. Also linked to obesity and diabetes, and they even drew a link to autism.
For all those reasons we want to rid our products, our personal care products at the very least, of these harmful chemicals, so there is good news on that note.
Macaluso: In your book, you talk a lot about BPAs and all the things in consumer packaging. I understand that Johnson & Johnson is leading the charge in making a commitment to rid their products of these chemicals. Can you speak a little bit about that?
Cuomo: Yes. I applaud Johnson & Johnson. They are the first major consumer products company in the United States to voluntarily commit to removing all harmful chemicals from their personal care products by the year 2015.
They just made this announcement this past summer, 2012. That includes Aveeno, Clean & Clear, Neutrogena. Those are all part of the Johnson & Johnson family. As I say, I applaud them for this action. It is very responsible.
I would like to see other major companies, like Procter & Gamble and Colgate and L'Oreal follow the good example of Johnson & Johnson. Why should consumers be at risk for washing their face or brushing their teeth?
Macaluso: Excellent point. Going along with that, are there any other companies like companies focused on organic products or specific foods, that you might applaud?
Cuomo: Yes. I am happy to share with you, in terms of being BPA-free in all of their food packaging materials, the Hain Celestial Group. First of all, they're the market leader in organic products, I've learned, and they include products such as Arrowhead Mills, Health Valley, Earth's Best baby food, Walnut Acres juices, DeBoles pasta, Imagine sauces and soups.
They have made a commitment to BPA-free in all of their food packaging, cans, etc., and they also are very conscious in terms of sustainability for their packaging materials, so big applause for Hain Celestial Group.
Also, Whole Foods 365 brands, many of their brands are BPA-free, Trader Joe's, and Eden Foods are some that come to mind.
Macaluso: Is there anything that consumers can do, or do we just have to wait for these companies to change their practices?
Cuomo: What you can do as an educated consumer is to read the labels. Certainly, if you don't see "BPA free," you have to question, "Does this packaging material contain BPA?"
In terms of your personal care products, read the labels. If you see anything with "paraben" in it -- that means methylparaben, butylparaben -- anything that has that phrase, "paraben," avoid it completely. Also another word, difficult to pronounce, phthalates, another endocrine disruptor.
Basically, Max, anything you can't pronounce you would be wise to stay away from it.
Macaluso: Yeah, I think that's a good rule of thumb. Let's talk a little bit about obesity. I think a lot of people might not realize that obesity is linked to certain types of cancers.
Cuomo: Yes. Obesity is linked to quite a few cancers. Scientists have pointed to the fact that breast cancer and colon cancer are definitely linked to obesity, but there are many other cancers that are as well.
What do we want to do? How do we avoid this epidemic? Do you realize, in the past 30 years the rate of obesity among children has tripled, and it has doubled for adults? Everyone agrees we have an epidemic. What do we do about it?
It's all about education, isn't it? We have to start with our very youngest children, teaching them what is a healthful diet. It's not a bag of chips at every meal. It's not a can of soda at every meal. If children don't have the tools, the strategies, how can we expect them to eat healthfully?
Often times, what children learn in school in terms of vegetables and a plant-based diet, they will take home and they will be the teachers for their parents and caregivers. Isn't that a wonderful thing?
I really feel education is the key here. I know the First Lady has made great strides in helping to get people moving, especially children, and help them to eat healthfully. I think we need more partnership from industry and a lot of the stakeholders here. We all need to work hard around this.
Macaluso: Once again, focused more on prevention than treatments.
Cuomo: Prevention is so important. Prevention is much more cost effective. In 2010, we spent $125 billion on cancer care. That's 5% of all health care expenditure and 10% of all Medicare expenditure. It's unsustainable.
At this point in time, we spend 18% of our Gross Domestic Product on health care itself. We all agree it's unsustainable. How are we going to change it? This is one way; by focusing on prevention.
Macaluso: Let's talk about tobacco products a little bit. Not all smokers get lung cancer, but it is a major risk factor.
Cuomo: It is.
Macaluso: What should we be doing to prevent lung cancer caused by tobacco products? Should we increase taxes on these products? Should we restrict marketing practices even more? What do you think should be done here?
Cuomo: Tobacco is a scourge and as you say, certainly we've proven that it causes lung cancer but it causes many other cancers as well; cancers of the digestive tract, even pancreas and bladder, have been linked to smoking.
What do we do? Well, years ago there was something called the Master Settlement Agreement, where all of the tobacco companies agreed to contribute billions of dollars to a fund that would later be given to the states with the intention that those funds be used for tobacco cessation programs and other tobacco elimination programs.
However, as I understand it the law is that the money goes to the states, but the states are not compelled to use it for that purpose. In these economically trying times, states are using it for infrastructure, they're using it for a lot of other reasons.
We have to get back to preserving that money for tobacco cessation. Right now we have an increasing trend in smoking among adolescents, and among people of low education and low income.
Again, the burden of their illnesses is going to impact all of us. It doesn't only impact the person who is going to be unfortunate enough to get lung cancer; it affects our health care costs, and we all absorb that, so it behooves all of us to make sure those funds are used properly.
Secondly, excise taxes are shown to be effective deterrents. Again, adolescents cannot afford the high taxes, and that's a very good tobacco cessation measure for them. In New York State, it's over $4 a pack in tax. How many people, young people especially, can afford that? That's a good way to avoid tobacco use.
The other thing, again going back to education, you need graphic images; yes, even on the tobacco product itself, the package. That's in the courts right now, as I understand it. A lot of tobacco companies appealed the law that would allow very graphic images and statements on the tobacco product saying how harmful this is to your health.
I hope that that will be sustained by the courts because people need to know, "This is what is likely to happen to me if I'm going to be a regular smoker," or even an occasional smoker. You can't smoke. You just can't smoke. There's a lot more that we could be doing.
I'd also like to see more people in the sports arena and celebrities -- people that would appeal, especially to the young, but to every segment of our society, people in the Latino culture -- coming forward and saying, "Don't smoke." Having somebody who another person can relate to, that is a very important piece of it.
Macaluso: Let's shift the conversation from prevention to treatment. Your book does talk about some major successes in medicine, in the treatment of cancer. One in particular is Novartis' Gleevec. This is a treatment for chronic myeloid leukemia.
What I was wondering, reading your book, was why haven't we been able to replicate the success of Gleevec and chronic myeloid leukemia with other types of cancer, namely solid tumors?
Cuomo: That's a very astute question. Chronic myeloid or myelogenous leukemia, CML, is based on a single genetic mutation. This terrible disease is actually a very simple disease, unlike breast cancer, prostate cancer, lung cancer -- these more common cancers -- which are several orders of magnitude more complicated than that.
Therefore, Gleevec can attack CML and effectively cure it because it's a very simple disease. Breast, prostate, lung cancer, are all much more complicated and it's not as easy to treat them with a single chemotherapeutic agent or a monoclonal antibody, and that's what Gleevec is.
Macaluso: Let's shift over to the pricing of cancer drugs. That's something you talk a lot about in your book. Recently there was a controversy of Sanofi and Regeneron's drug Zaltrap and the pricing there. Can you speak a little bit about why the cancer drugs cost so much money?
Cuomo: Why do they cost so much money?
Macaluso: In general.
Cuomo: We have no value element in our country. We're one of the few countries in the industrialized world that doesn't. Therefore, pharmaceutical companies have been able to charge whatever they choose for drugs.
The controversy with Zaltrap was very interesting because it was the first time in history that a major cancer center, Memorial Sloan-Kettering in this case, came forward and said, "No, we're not going to pay for it."
Why? Because it was proven to be no more effective than, but twice as expensive as, another drug that was being used to treat metastatic colorectal cancer. They said, "No, we're not going to accept it."
The makers of Zaltrap turned around, Sanofi and Regeneron, and said, "All right, then we will reduce the price."
It was a watershed moment in a lot of ways, for the medical community to stand up and say, "In any other market, if you were to sell a product that was no more effective than another one and charge twice as much for it, consumers just won't absorb it. They won't jump at it." That's what they said to the makers of Zaltrap.
But you're right; to charge $100,000 for a course of treatment for a drug that may extend your life by three or four months is not responsible. It's unsustainable for us, as a nation.
Macaluso: The FDA, when it approves a drug, takes into account safety and efficacy, but not pricing.
Macaluso: They do that overseas, like in the U.K. Do you think the FDA needs to incorporate pricing into its approval process?
Cuomo: I think that it's a compelling point, that we cannot sustain these high prices. Again, it's just not the responsibility of the family of the patient or the patient him or herself. It's all of us. We all absorb this, and we just can't afford it anymore.
We need to take a better look at this. Some people say we need a NICE light -- NICE being the United Kingdom's organization that does set pricing for cancer care and for care of other diseases -- but that's not the American culture. We don't want that kind of regulation, but we're going to need it.
If the pharmaceutical companies won't do it themselves, and the medical community can't achieve that, who else can do it? It has to be the government. All the stakeholders need to spend more time figuring this out.
Macaluso: I'd like to close with something that you addressed toward the end of your book. We already have the National Cancer Institute, which does amazing work in the research of cancer treatments. You propose the formation of the National Cancer Prevention Institute. Can you talk a little bit about your vision?
Cuomo: It grows out of the fact that prevention is the most effective strategy we have for ridding ourselves of cancer, and yet we devote so little time and attention to it.
My agenda is not to draw attention away from treatment. Again, there will always be patients who require treatment, and they should have it. What I am saying is that we have the intellectual resources and the financial capability to achieve both.
The National Cancer Prevention Institute would do just that. It would be based on a collaborative focused effort divided into teams, each team addressing a specific cancer type, and it would draw from many disciplines.
It would be a trans-disciplinary approach, including epidemiology, cancer biology, microbiology, immunology, engineering, pharmaceuticals, even urban planning; everything you need to decrease cancer incidence.
I don't see that happening right now, and a lot of people that have been studying this for a long time feel it is time now to do this kind of approach, the way we did for the moonshot and for the Human Genome Project, both of which took a collaborative effort which had team science at its core. That's what we should use for the prevention of cancer.
Macaluso: Dr. Cuomo, recently there was an Institute of Medicine report that addressed cancer care. Can you speak a little bit about that?
Cuomo: Yes. I was very pleased to see some experts in the country, such as Dr. Ezekiel Emanuel, Dr. Peter Bach, contribute to this workshop last October. They just issued a report from the Institute of Medicine addressing the question, "How do we contain cancer costs and what can we be doing better?"
Some of the key points were, what should a cancer therapy do? How do we assess its effectiveness and its value?
Well, it should increase our overall survival. It should increase the patient's survival. It should increase the patient's quality of life, while at the same time it should have very few side effects -- certainly not life-threatening side effects or side effects that degrade that quality of life -- and it should contain costs. It should not be an unsustainable cost.
I thought that was a very good way of focusing attention on the question of how do we end the spiral of cancer care cost in America.
Macaluso: Thank you very much. Once again, Dr. Margaret Cuomo, author of the book A World Without Cancer. Dr. Cuomo, thank you very much for joining me today.
Cuomo: Thank you, Max.
Editor's note: At 2:03, the speaker meant to say 4% of the NCI's total $5 billion budget is devoted to cancer prevention and control. $3.7 billion refers to programs for understanding the mechanisms of cancer, understanding the causes of cancer, improvements in early detection and diagnosis, and the development of effective and efficient treatments.