1. Young, Robert C. MD

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Generally I avoid reading books purporting to tell the "truth" about controversial topics written by insiders, particularly when written soon after the events. Although the topics are often intriguing and important, such books frequently disappoint because the author has a singular perspective on the events and is not often given to a disinterested analysis of the controversy. I made an exception here because the Komen Foundation is one of the most successful and visible cancer-related organizations around and has just recently found itself the centerpiece of a controversy of epic proportions.

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REVIEWED BY ROBERT C... - Click to enlarge in new windowREVIEWED BY ROBERT C. YOUNG, MD, Chairman,

The best books on controversial topics tend to be those written by knowledgeable and skilled third parties such as Too Big to Fail by Andrew Ross Sorkin or Science on Trial by Marcia Angell about the breast implant controversy, or by insiders written long after the events where time puts decisions in a clearer perspective like In Retrospect by Robert McNamara about the Vietnam War.


True to form, Planned Bullyhood by Karen Handel, former Senior Vice President for Public Policy for Komen, reveals more about how the author feels about the events and about her role in the events than it does about the basis for the breakdown of the Komen/Planned Parenthood relationship, which had been successful for decades.


It doesn't take much reading to find out where the author stands. On page 5 of the introduction she states, "This is a story of how Planned Parenthood, in partnership with the liberal establishment, made Komen pay for daring to put its mission above the ideology of the almighty left. Planned Parenthood became the left's ultimate tip of the spear in an election battle to maintain the White House, willing to destroy anyone or any organization that might get in its way." Now you have a flavor of the book.


Since it is impossible to put my review in context without some knowledge of my political orientation, let me say that I generally fit into the progressive Republican mold, which no longer seems to exist as both parties seem intent on eliminating centrists from their midst. I am fiscally conservative, socially moderate, and pro-choice but agnostic about Planned Parenthood. My deepest passions center on trying to advance cancer research and access to high-quality cancer care. Enough said.


To her credit Handel provides almost 40 pages of the book describing her pro-life positions in Georgia politics where she was criticized for not supporting an absolute ban on abortion under any circumstances, as well as her personal heart-wrenching journey to try to have children. This revealing background makes it difficult to square with her insistence that the abortion issue did not factor into her stance on the Planned Parenthood/Komen controversy.


She maintains that the Komen change in position was a longstanding desire to improve the granting criteria and the quality of the grants provided by Komen. They wanted to eliminate the "crappy" grants and focus more on measurable outcomes. Fair enough. Unfortunately she offers the reader little information on what these new criteria are, nor does she provide insight into how the Planned Parenthood grants failed to meet the new criteria other than that they don't provide mammograms. Without this background the reader is left with the finger pointing and an inability to explore how a productive compromise might have been achieved between two organizations.


After all, Nancy Brinker, the CEO and founder of Komen, once served on the board of the North Texas Planned Parenthood and said, "The grants in question supplied breast health counseling, screening, and treatments to rural women, poor women, Native American women, many women of color who were underserved-if served at all-in areas where Planned Parenthood facilities were often the only infrastructure available."


If that is correct, it would seem to be the basis for collaboration, and that some effort to improve the outcomes of the Planned Parenthood grants would have been preferable to eliminating them.


I will not attempt to delve into the internecine warfare between the two organizations described in the book. As an outsider, it seems that Komen is comprised of a heterogeneous group of supporters of all political persuasions bound together by their desire to make a positive impact on breast cancer and breast health. Planned Parenthood, in contrast, is a more politically defined constituency linked by their passion for women's rights and the right to choose. Because of the overlapping but not mutually inclusive missions and because positions on abortion do not lend themselves well to compromise, perhaps the breakup between these two organizations was inevitable.


Unfortunately the book does not help the reader sort through the complex issues surrounding the controversy. The author seems to find fault with everyone in the process-Planned Parenthood, Komen, the leadership of organizations, the staff of Komen, the press, and the "liberal establishment."


The author's only acknowledged failure was "I was upset with myself for not better anticipating how Planned Parenthood would attack. I was angry at what I believed was betrayal by my Komen teammates and our consultants. And I was deeply disappointed that Nancy had not the courage to stand up for Komen and what she knew was the best decision for our organization." Yes, she is upset and angry.


I agree with one of the author's conclusions. If the decision made by Komen was to improve the quality of their grants and to make them more productive and outcomes oriented; and if those criteria were well defined and widely distributed to potential grantees; and if they allowed all potential grantees to compete for future grants, then Komen should have resisted the firestorm of criticism, held its ground, and I suspect would have ultimately prevailed. Alas, the book does not give the reader sufficient information to conclude that that was Komen's intent.


The book is full of conspiracy theories, unsubstantiated conclusions, and political vitriol, and is light on information that would allow readers to draw their own conclusions. Save your money and your time and pass this one up.