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Once upon a time, the B.C. Cancer Agency had a reputation as a leader in its field. So far ahead of other similar operations was it, the agency became a model for other cancer control centres around the world. Some of the biggest stars in the cancer galaxy wanted to work in Vancouver because of the clinical and scientific advancements being made at what had become a cutting-edge medical complex.

Not so much anymore.

Earlier this month, Max Coppes announced his resignation as leader of the BCCA after barely two years on the job. The Dutch-born U.S. resident left for greener pastures back home, just as his predecessor from Britain did after only 18 months in the position. Now the agency is looking for its third head in four years. It wasn't always this way. It used to be that the centre had the power to attract and keep the best in the business.

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What is now clear is there is a serious problem at a medical institution that is vitally important to the province. Having a centre globally lauded in a discipline so valued as cancer research was something of which everyone in the province was immensely proud. If you had to get cancer, it was often said, Vancouver was a great place to get it because of the superior outcomes that existed for people treated here.

Now all the headway the BCCA made is disintegrating.

In a devastating critique of what has gone wrong, Donald Carlow points the blame directly at the provincial government. He said the problems began when the direct reporting relationship that the agency once had with Victoria was changed in 2001, and the BCCA was put under the control of a regional health board that has many competing priorities. Suddenly, the president of the cancer agency reported to an underling of the president of the regional health board who, in turn, reported to a board that reported to the ministry of health.

Overnight, the position of cancer agency president ranked far lower than peers in the rest of Canada and internationally, Dr. Carlow wrote in a letter published this week in The Vancouver Sun.

"The experiment of placing the BC Cancer Agency within the PHSA [Provincial Health Services Authority] has been done," Dr. Carlow wrote. "It is not working. The oncology community in Canada and internationally are aware of the declining pre-eminence and staff morale at BCCA. This is not healthy for recruitment. The agency has truly lost its way."

It is hard to imagine a more shattering assessment, given who it has come from. Dr. Carlow is a past-president of the agency, one of those who helped build its once envious reputation. He also formerly led the Ontario Cancer Institute/Princess Margaret Hospital and the Canadian Association of Provincial Cancer Agencies. This is one of the most respected names in the cancer industry, calling out the provincial government for the dismal state of affairs at one of the most important institutions in B.C. This is a voice that can't be ignored.

Currently, most of the senior executives at the cancer agency have "interim" tags on their positions – a sign of operational turmoil. The title of president and CEO has been downgraded to vice-president of provincial cancer care, which does not help when trying to lure top people here. The salary was clawed back by $50,000 to $450,000, which isn't enough to persuade those already being paid more elsewhere to come.

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Under the circumstances, the job is certainly far less attractive than it once was.

Given the recent experience it has had with two foreigners at the helm, the agency has apparently decided to focus on Canadian candidates. There are most certainly solid contenders in our own country, but for a post as important as this one it's unimaginable the BCCA has decided not to look worldwide for the best person because it fears an international might quit after a short while because of the untenable working environment.

Cancer is the scourge of our lifetime. Two of five people will get the disease at some point. Most of us hope to see a cure born before we die. At one time, it wasn't farfetched to imagine that cure being discovered right here, at the B.C. Cancer Agency. Now that seems like fantasy.

"There is no comprehensive strategy for cancer control in B.C. that would meet international standards," Dr. Carlow wrote.

A withering indictment the province must address.

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