TMA Takes on Cancer: Association, Allies Pass Bill to Create Research Institute

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Public Health Feature - August 2007

By  Crystal Conde
Associate Editor  

We reformed the makeup of the Texas Supreme Court by electing objective justices, made the insurance industry change the way it does business with a nationwide antiracketeering lawsuit, and reduced frivolous liability lawsuits against physicians and improved patients' access to care with the landmark 2003 tort reforms.

Cancer doesn't stand a chance.

When the legislature convened this year, Texas Medical Association physicians and staff joined key lawmakers and cancer prevention groups in declaring war against the menace that attacks 95,000 Texans a year and kills 37,000 of them. The result was a major victory - passage of House Bill 14 to elevate our state to the forefront of cancer research by establishing the Cancer Prevention and Research Institute of Texas.

 The institute will not take shape as a physical entity and will require little infrastructure; instead it will encompass a statewide investment in the research, treatment, and prevention of cancer.

The institute will enhance existing and create new cancer research facilities. Its main goals are:

  • To create and expedite innovation in cancer research and enhance the potential for medical or scientific breakthroughs in preventing and curing cancer;
  • To attract, create, or expand research capabilities of public or private entities and universities to increase cancer research and create high-quality new jobs; and
  • To implement the Texas Cancer Plan, a statewide guide for cancer prevention and control in Texas created by the Texas Cancer Council (the plan is online at ).

Among HB 14's biggest supporters are health care professionals, who recognize the need for funding to move proposed research projects from the "approved but unfunded" lists, where they can linger for months.

In creating the institute, legislators approved House Joint Resolution 90 to submit a proposed amendment to the state constitution to voters on Nov. 6. If approved, $300 million a year for 10 years will be allocated to cancer research, prevention, and treatment in Texas. The money would be used for tobacco prevention programs, education outreach initiatives, implementation of the recommendations outlined in the Texas Cancer Plan, prevention and treatment, and research. 

A Big Win  

Passage of HB 14 was one of the many public health wins TMA secured for its members and their patients during the legislative session. (See " TMA Scores Big on Public Health .") The bill survived in the legislature thanks to tremendous backing from TMA member physicians; the tireless work of TMA staff and dedicated members of the House of Representatives and Senate, especially Rep. Jim Keffer (R-Eastland), the bill's author, and Sen. Jane Nelson (R-Lewisville); and advocacy efforts spearheaded by cancer prevention organizations such as KillCancer, the Lance Armstrong Foundation, the American Cancer Society, and Susan G. Komen for the Cure.

"TMA supported House Bill 14 from inception through to final approval. We did that by joint efforts of our various committees, councils, and officers who worked very hard with the legislators to make them realize the value of this bill to improving the health of all Texans," said Ladon Homer, MD, TMA immediate past president, who testified in support of the bill at a House Public Health Committee hearing.

Rep. Patrick Rose (D-Dripping Springs), who cosponsored the bill in the House, acknowledges the work of TMA and its physician members throughout the session. "TMA staff was integral to the success of House Bill 14 and House Joint Resolution 90, as were the physicians who testified," he said.

On the Senate floor, it was a hard-won victory, according to Senator Nelson. She encountered some resistance, recalling one senator who compared the $3 billion investment with spending money on colonizing the moon.

"One would think an investment in cancer research would have unanimous support. This disease affects all of us, directly or indirectly," she said. "But I fielded questions on the Senate floor for more than three hours on the wisdom of this investment. It was one of the hardest-fought legislative victories in my career."

The acknowledgment that cancer touches the lives of many Texans inspired Representative Keffer to write the bill. Last December, the Lance Armstrong Foundation and Cathy Bonner, founder of KillCancer, a group of Texas citizens who worked to pass HJR 90, contacted Representative Keffer. They asked him to consider developing legislation similar to a 2004 California bill that devotes $3 billion to human embryonic stem cell experiments.

"When they were first talking, it took me a little while to warm up to it. In conversations I had with them, I realized how close we are to looking at finding a cure. I realized Texas could be at the forefront of cancer research and prevention," he said. 

More Work to Do  

With bipartisan support in the House and Senate, HB 14 endured the scrutiny of legislators and moved on to be signed into law, but that was only half the battle. The second half will be convincing voters to approve the constitutional amendment to authorize the sale of $3 billion in general revenue bonds to fund the program.

TMA President William Hinchey, MD, says the $3 billion would provide a new source of funds for cancer prevention, treatment, and research at a time when funds from traditional sources such as the National Cancer Institute are declining. Through this much-needed investment, he foresees an improvement in cancer prevention and treatment services to patients, as well as a mechanism to attract the leaders in cancer prevention, treatment, and research to Texas.

Marilyn Leitch, MD, chair of the steering committee for TMA's Physician Oncology Education Program (POEP) and a surgical oncologist at The University of Texas Southwestern Medical Center in Dallas, witnessed Governor Perry sign HB 14 into law. As a physician who participates in clinical research trials, she appreciates the potential impact of the funding outlined in HJR 90.

"We need to encourage physicians and the people of Texas to vote for the funding in November," she said. "If it doesn't get funded, then it's not going to happen. If we make a commitment and have the intellectual resources here to use that funding, Texas can make a difference."

Physicians working in research and academia aren't the only ones who would reap benefits from the creation of the cancer prevention and research institute. For the state to realize the full impact of the $300 million a year allocated to cancer prevention, research, and treatment, Lewis Foxhall, MD, member of TMA's Council on Legislation and POEP, believes the entity created by HB 14 must devise programs and products that practicing physicians can offer and disperse at the community level.

To persuade legislators of the need for funding research that will yield efforts focused on preventive medicine, health promotion, and health services, Dr. Foxhall and a group of stakeholders from the Texas Comprehensive Cancer Control Coalition convened during the session to give lawmakers a broad definition of research. By outlining the academic areas of cancer research as well as applications research, the group aimed to show that funding could be used by frontline physicians to develop effective educational intervention, translate research findings into practical applications, improve quality of life, and address health disparities.

"This new entity will need to develop its own rules and definitions of exactly what sorts of research it will fund," Dr. Foxhall said. "Hopefully, the suggestions we've provided will give them a broad framework from which to draw so that they can include the sorts of cancer control programs that we've worked with for some time through the cancer coalition."

But before money can be allocated, voters must approve this large financial investment. "If people are educated on how this will be set up, as far as checks and balances and how the grants will be awarded, it is reachable," Representative Keffer said.

Ensuring the appropriate expenditure of funds is essential to the success of the institute. Once the Scientific Research Committee has reviewed grant and loan applications, an oversight committee will hear recommendations on awarding research, therapy development, and clinical trial grants and loans.

The creation of a Cancer Research Fund under the institute calls for matching funds from federal or private sources of 50 cents on every dollar spent in state funding. The fund would consist of money received from the sale of bonds; patent, royalty, and license fees and other income; legislative appropriations; gifts, grants, and other donations; and interest earned on investments in the fund. In addition to paying for grants and loans, the money will be used to operate the institute, as well as purchase needed laboratory facilities by or on behalf of a state agency or grant recipient.

Dr. Homer views approval of the constitutional amendment as an opportunity for physicians to enhance and expand cancer treatment. "I think the physicians of Texas will support this endeavor because it will give them the tools they need to provide relief from suffering and perhaps even a cure for some of the most deadly diseases that exist today," he said.

Crystal Conde   can be reached at (800) 880-1300, ext. 1385, or (512) 370-1385; by fax at (512) 370-1629; or by email at Crystal Conde.   


TMA Scores Big on Public Health

TMA physician leaders worked overtime to make certain that legislators clearly understood one thing: Texas' future is in jeopardy. They emphasized that now is the time for Texas to invest in improving our physical and fiscal health. TMA asked lawmakers to invest in public health initiatives that will reduce obesity and tobacco use and improve immunization rates. Legislators listened and took steps to address many of TMA's Healthy Vision 2010 goals.

Here's a brief recap of what TMA accomplished in enhancing public health in Texas during the 2007 legislative session:


  • Senate Bill 530 increases physical education in grades K-5 and middle school. The bill also requires an annual physical fitness assessment of students in grades K-5 and middle school and makes the Texas Education Agency (TEA) responsible for implementation. The bill also directs TEA to analyze the results by school district, correlating results to student academic achievement levels, attendance levels, obesity, disciplinary problems, and school meal programs.
  • Senate Bill 556 creates the interagency obesity council with the commissioner of agriculture, commissioner of state health services, and commissioner of education. The council is responsible for a report about programs in the state that are active in preventing and treating obesity.
  • Senate Bill 415 creates an advisory council to help direct the Risk Assessment for Type II Diabetes program and increases the level of information participating schools receive from the program.

Worksite   Wellness  

  • House Bill 1297 creates a statewide worksite wellness advisory committee to help public and private companies implement a worksite wellness program. It also creates a worksite wellness program for state employees.
  • Senate Bill 10 creates a pilot program and other programs to promote healthy lifestyles among Medicaid recipients. The pilot program will be managed by the Health and Human Services Commission in one region of Texas. Through the pilot program, the commission will provide participants with positive incentives, such as expanded health care benefits or services for Medicaid recipients who participate in certain weight loss or smoking cessation programs.


  • Senate Bill 811 requires the Texas Department of State Health Services (DSHS) to allow physicians in the federal Vaccines for Children program to select any influenza vaccine from the federal list.
  • House Bill 1059 requires DSHS to prepare a list of required and recommended vaccinations for school entry for posting on school districts' Web sites. The information must be available in English and Spanish. The bill also specifies that information on immunization exemption be posted.
  • House Bill 1098 rescinds Gov. Rick Perry's mandate to immunize sixth-grade girls with the human papillomavirus vaccine. TMA supports the vaccine but opposed the mandate. (See " The HPV Controversy ," April 2007 Texas Medicine , pages 29-32.)

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Physician Education Key to TMA's Cancer Battle

Since 1987, TMA's Physician Oncology Education Program (POEP) has strived to educate primary care physicians in Texas on the lifetime screening guidelines for detecting cancer. Funded largely by the Texas Cancer Council, POEP carries out the recommendations of the Texas Cancer Plan regarding physician education, including providing additional cancer prevention information needed to reduce the burden of cancer on Texans.

A 21-member steering committee of cancer prevention and control experts advises POEP. Marilyn Leitch, MD, chair of the POEP steering committee, is a surgical oncologist at The University of Texas Southwestern Medical Center, where she most commonly treats patients with breast cancer. She views POEP's main goal as educating primary care physicians about advances in cancer care so they have the most up-to-date information that reflects current developments in research.

"We see ourselves as the bridge between what happens in the research world and how we can apply that to the people of Texas through their physicians so that we'll reduce the chance people will get cancer," she said. "But if they're going to get cancer, we want to ensure that it's detected early and that the patient is directed by a physician to receive treatment that reflects advancements we've learned through the research process."

POEP's educational efforts have had an impact on Texas. For fiscal year 2006, POEP provided council-funded training or materials on cancer education and training to more than 183,000 health care professionals, including physicians, residents and residency directors, and medical students. So far this fiscal year, POEP has provided council-funded training or materials to more than 78,000 health care professionals.

Learn more about POEP on  TMA's Web site .



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