Donna's promise

According to Donna Shalala, Secretary of the Department of Health and Human Services, the standard for working for her is to have "passion and a big mouth"--traits she might own up to herself. The always outspoken Shalala recently spoke with us:

How does the Clinton administration represent a new policy regarding women and their rights and needs?

All of the political appointments in this department are women, for example. That translates into real change in terms of openness and access. These women are committed to changing the culture as well as the policy of government.

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In terms of breast cancer, what's the evidence of this?

We've escalated the National Cancer Institute's and Centers for Disease Control's budgets on cancer prevention. We put in another $10 million to fund our Action Plan [from the breast cancer summit convened by Shalala last year]. And I chose to chair a new, interagency cabinet task force on breast cancer to signal that we're dead serious about getting something done.

Have you lost any family or close friends to breast cancer?

Yes. Two aunts and numerous friends have had breast cancer. It's made me more conscious. When women talk to me about the lack of government commitment to women's health, and how they're wary of what DHHS or anybody else is doing on breast cancer--they're right. We don't have a lot of credibility. Women feel their issues have been underfunded, underdiagnosed, and undertreated. The system tends to look at issues involving men, not women--whether it's research, prevention, or the way we put together our budget.

As you may know, our May/June cover story was about the environmental links to breast cancer in women.

I'll have you know I'm the only member of my senior staff that actually read the whole issue. I had to point out to them that you had done an issue on the subject.

Did you like the issue?

I like Mother Jones very much. It's gutsy.

So, do you think environmental toxins are contributing to the rise in breast cancer rates?

That's a scientific question that requires that we continue to invest in the linkages between the environment and breast cancer. We shouldn't limit ourselves in our search to understand breast cancer; no scientist should narrow down the issue too fast. I hope this administration will act firmly on scientific finding, whether popular or not.

The much-delayed DHHS list of "substances reasonably anticipated to cause cancer"--when will that be published?

I know everybody would like me to say "soon." It's unconscionable that it is always behind schedule. What happens is that lobbyists and bureaucrats get pulled in different directions; they're so cautious that it takes too long to get the reports out.

Are you concerned about medical ethics and proprietary issues because such companies as Zeneca, that profit from breast cancer treatment, also produce carcinogenic chemicals?

I don't know whether the fact that a chemical company owns a pharmaceutical company means there's necessarily any conspiracy. [But] there's no question that we have to keep our eyes and ears open, to make absolutely sure that there's nothing inappropriate going on. An educated press corps is as good in terms of oversight as anything that we've got.

How do you respond to charges that in the past the NCI overpromoted mammograms in support of the medical industry's campaign to attract new customers?

Now we're being accused of underselling the use of mammograms. The best thing is to give your best judgment based on the science of the moment. One reason people get confused is [that] science changes, so we change the rules and guidelines. We have confused women; they have good reason to be cynical about whether this country cares about women's health.

Does the president seek your counsel on breast cancer?

I talk to him all the time. I had dinner with him last night. He told me right off that I'd lead the administration's effort on this subject and said, "Go do it!"

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