In 1971, President Nixon declared the "war on cancer. " The National Cancer Institute's (NCI's) budget swelled with the promise that cancer death rates would be cut in half by the year 2000. It has not happened. Three decades later, the disease now threatens one in three women and one in two men.

The war on cancer has had none of the single-mindedness shown a decade earlier when John Kennedy targeted a moon landing and put NASA's resources to work. In targeting cancer, NCI and private foundations have dispensed research grants haphazardly, taking each grant application as it comes and sending checks to hundreds of institutions with little overall strategy. The idea was that, since we have almost no idea what the best approach may be, we should foster creativity and even serendipity. In hindsight, major research institutions took a gamble and lost.

A notable exception has been what we might call "big picture" research. Rather than focusing on rats and mice, or on drugs and radiation, some teams carefully studied the characteristics that separate people with cancer from those without it. Clear patterns emerged. Smokers had a high risk of lung cancer. Meat-eaters had three times the risk of colon cancer compared to vegetarians, and carcinogens were identified on cooked poultry and beef. Sun exposure was linked to melanoma. Alcohol was linked to breast and colon cancer.

The next step was to put these culprits to the test. This occurred in the field of heart disease. Researchers identified risk factors and changed them. They lowered patients' cholesterol levels and blood pressure, helped them quit smoking, and then watched their risk drop within months. They saw how vegetarian diets, exercise, and stress reduction reopened blocked arteries. Why these changes worked was less important than proving that they did work and could be offered to those at risk without delay.

With cancer, this sequence—finding risk factors, testing them, and then educating the public—has been derailed by researchers caught up in minutiae. They dissected cigarette smoke to see which of its hundreds of components was "the" culprit. Others teased apart plant-based diets to separate the effect of beta-carotene versus vitamin C versus selenium versus fiber versus phytochemicals. And many are still ignoring cancer causes altogether and focusing on powerful drugs and radiation beams. While there is a vital role for cancer treatments, ignoring its causes is a deadly mistake, because tackling the factors that cause cancer can also help us treat it.

No doubt, some public health findings may singe tobacco growers and ruffle a few feathers among chicken farmers. The cattlemen already have a beef with health advocates. But they, too, are our families and friends, and are at the same risk as everyone else. Winning a war means stepping back, rethinking our battle plan, and then setting out to win.

Neal Barnard, M.D.
President of PCRM