The American Cancer Society's ability to fund research may have been diminished as an unforeseen consequence of the ACS' commitment to reboot its governance structure, according to former NCI Director ., MD, who played a significant role in that reorganization.
DeVita served for 7 years as a member of the ACS Board of Directors, capped by 14-months as the ACS president ending in 2013, but not before he recommended eliminating the celebrated public position he had held.
In an exclusive interview with 51˶ in January -- as the cancer society was poised to name its next CEO to replace the retiring John Seffrin, PhD -- DeVita talked about his reasoning behind making that suggestion, the Society's ongoing "transformation plan," and reflected on what has happened in the intervening 12 months.
Topping his list of concerns is the ACS' traditional commitment to funding research explaining that in 1945 wanted 25% of all monies raised by ACS to go to research, a goal that is consistently missed.
"When I joined the Board, funding for external research grants was 22% and when I left it was down to 10%," he said, a situation he called "scandalous," especially since ACS has presented itself to the grassroots public as a research organization while putting its money into other projects.
He said that before his term as president was over he got the Board to agree to double the research budget over the next 10 years, but doesn't know if that will be implemented.
"What worries me most is the research budget, and I hope it is increased, otherwise the organization will become a total advocacy organization and that's when you lose the grassroots support."
Physician Presidents
Since ACS' founding in 1913, 78 physicians have served varying-length terms as the volunteer ACS president -- generally regarded as the public face of the organization.
Transformation was ACS' 3-year reorganization that sought to reestablish the ACS as a single corporate entity, which eliminated divisional autonomy and decreased the seats on its Board of Directors from 43 members to 21.
The Society's 11 divisions were merged into a central organization and the 143-member National Assembly comprised of grassroots representatives from throughout the U.S. voted itself out of existence. When Seffrin was named CEO in 1991, ACS had 57 divisions, which were gradually consolidated over the years.
Transformation also included a cutback in staff with remaining staff having to reapply for newly created positions, and resulted in three members of the eight-person executive leadership team resigning in little more than a year.
DeVita, who is currently Amy and Joseph Perella Professor of Medicine at Yale Cancer Center and Smilow Cancer Hospital at Yale-New Haven, and had formerly served as the cancer center's director; was also physician-in-chief at Memorial Sloan Kettering Cancer Center. He was director of the National Cancer Institute from 1980-1988 when he was appointed by President Jimmy Carter and reappointed by President Ronald Reagan.
Well-known for his role in developing combination chemotherapy regimens that led to effective curative treatments for Hodgkin's disease and diffuse large cell lymphomas, DeVita has received many honors, including the Albert and Mary Lasker medical research award in 1972, and is one of three principal editors of "DeVita, Hellman, and Rosenberg's Cancer: Principles and Practice of Oncology." He is currently writing a book about the "war on cancer."
President of What?
He said that when the National Assembly was dissolved it made little sense to have a president who presided over a body (as its chair) that no longer existed, and so he suggested ending the position.
ACS then created the position of board scientific officer, which is currently held by Arnold M. Baskies, MD, a surgical oncologist and medical director with Virtua Medical Group. The society's staff chief medical and scientific officer and executive vice president is
of the University of Colorado, served as ACS volunteer president-elect during DeVita's presidency. He confirmed via email that he was afforded the opportunity to run for any of the new officer positions, including board scientific officer -- as were all the board members whose terms were ending -- but declined that offer.
To help confuse matters, COO Gregory Bontrager, who was one of the three society executives to resign suddenly (in December 2014), was given the title of ACS "staff" president in 2012, and then president following the demise of the volunteer presidency position on Dec. 31, 2013.
DeVita said that before the staff president title was created, the word "volunteer" never preceded president and was added to distinguish the two positions.
Streamlining for Efficiency
DeVita explained the rationale for consolidation: "Before transformation the ACS had 13 separate divisions [at that time] and each had its own board of directors and each was essentially independent," he said, noting that the only requirement was for each division to send 40% of the money it had collected to the home office in Atlanta.
"But anytime the ACS wanted to do something it essentially had to get approval of 14 boards, including the national board. So it was very difficult to operate with any speed, and the organization was often behind the curve."
He said that when the National Assembly existed it had basically one function -- to elect the members of the national Board of Directors and the president, and that after transformation, the divisional boards no longer had any fiduciary responsibility but were involved in policy, with all authority now held by the national Board.
DeVita added, at that time the board had 43 members and the reduction to 21 members made it more corporate in structure, but now members were elected by expertise rather than regional representation, with one-third coming from the medical community.
And so once the Assembly disappeared, DeVita said it made no sense to have a president, and it was an easy suggestion to do away with the position.
Not So Fast
However, he also said that he and a minority of board members thought that ACS should keep the Assembly for another 5 years
"What worried me most about transformation, and still does, is the loss of grassroots support. Under the new organization, divisions don't feel as if they have any input, which existed when the assembly members were elected by the divisions.
"Is transformation going to work? Well the jury is still out and only time will tell," he said, noting the real reason for transformation was that revenues were dropping and the organization was not able to move fast enough to adapt to changing times.
He added that the majority of traditional contributors to the ACS make $20 to $50 donations, and if they aren't replaced with larger donors then the whole transformation will be a failure.
DeVita sat on the Board when transformation was first discussed, and said there was no mention then of the presidency going away, and that it was actually one of the last things done during the reorganization.
"The thinking at the time was if you're going to make changes, then you should go all the way, and John Seffrin was in favor of dissolving the Assembly. But that may have been a mistake," he said.
He explained that the Board compensated for not having an Assembly by creating a National Leadership Forum representing the divisions -- that shift moved the organization away from its grassroots because Forum members were selected by ACS staff in Atlanta, not selected by grassroots organizations. As a result, the Forum was perceived as a "mouthpiece" for the national office.
DeVita concluded by saying that he was hopeful the new CEO would "right that part of the ship" and restore funding levels for research grants.