Press, an MIT professor and former science adviser to President Jimmy Carter, was a seasoned diplomat and not a person I would ever play poker with, even if I knew how. He nodded as I told him of my plans and then said gravely, “It had better be a good book.”
I replied, “I guess they think it will be. They’re offering me more than half my annual salary. That’s quite a lot for a first-time author.”
“It had better be a really, really good book,” he said.
I didn’t understand. “Of course they expect it to be good,” I said. “So do I.”
“Well,” he explained, “it had better be, because you won’t be able to work here after you write it.”
He quickly added, “Of course, I’m not telling you what to do. That is completely your decision.You are free to do whatever you want. I’m just telling you that you can’t write a book critical of the cancer enterprise and hold a senior position at this institution.”
Frank Press had achieved positions of eminent authority by dint of remarkable diplomatic skills and impeccable timing. We were then living through a period that would later be termed the Reagan Revolution. The nation’s leaders bragged of lessening the power of government across the board. Under the charismatic but underestimated President Ronald Reagan, the White House set up an ambitious program aimed at easing the burdens of regulations across the board. Proposals to expand government’s control of anything, even cancer-causing agents in the environment, had little chance of survival.
At about the same time that Press offered his reflections on my proposed book project, I got some friendly advice from a man who was temporarily running the National Institutes of Health. He called me into his spacious office overlooking what was then the green campus of the NIH.
“This work you’ve been publishing on cancer patterns is pretty interesting.
You know, I started out my career interested in the environment and cancer.
I’m pretty sure that some of the lung cancer we see in women in southwestern Pennsylvania, where you come from, has something to do with the environment. I actually tried to do a study on that when I started out doing research, but I decided against it.”
“What made you change your mind?” I asked.
He leaned back in his chair and put his hands atop the back of his head, rocking in thought. “You ever hear of Wilhelm Hueper?”
I shook my head.
“Hueper started out like you. Lots of good ideas about the environment. He thought the exclusive focus on smoking would lead us away from other causes of cancer that were far more deadly. He was railroaded out of here. He wasn’t the easiest fellow to work with and rubbed lots of people the wrong way, but not necessarily for the wrong reasons. I decided after seeing what happened to him that I was better off sticking to basic research. Somebody like you should think about that.”
I did. I stayed with NAS for a decade, working with some of the most talented experts on some of the most fascinating and challenging problems in science at the time. We put out more than two dozen thoroughly referenced NAS reports, every one of which struggled to gauge evidence of the ways the world in which we live and work affects our health and environment.
Whether about smoking in public spaces or the chlorination of drinking water, each volume navigated treacherous and uncertain waters, and each ended with the familiar message: we need more research before we can be sure. I watched the maturing of the science of doubt promotion—the concerted and well-funded effort to identify, magnify and exaggerate doubts about what we could say that we know as a way of delaying actions to change the way the world operates.
How did we get to this point? Since its formal launch more than thirty-five years ago, the war on cancer has been fighting many of the wrong battles with the wrong weapons and the wrong leaders. Officially declared by President Nixon in 1971, the American effort aggressively targeted the illness but left its myriad causes untouched. Less than a decade after the famed U.S.
Surgeon General’s report of 1964 indicted tobacco as a cause of lung cancer, the president announced a national attack on cancer. Left off the table completely were tobacco, radiation, asbestos and benzene—materials that for decades had been well understood to be hazardous.
Years before any modern industrial nation started an official war on the disease, in the 1930s, researchers in Germany, Japan, Italy, Scotland, Austria, England, Argentina, the United States and France had shown that where people lived and worked affected their chances of getting cancer.5 Hueper published a sweeping synthesis of industrial, pharmaceutical and natural sources of cancer—at an especially inauspicious time, right after the Japanese attack on Pearl Harbor in 1941.6 The war against those things that cause cancer has always been hampered whenever nations have traded metaphorical wars for real ones.
If some scientists had figured out nearly a century ago that the world around us affects the chance that we will develop cancer, why have we made so little headway in controlling these causes? My goal in this book is to explain when, how, why and by whom the spotlight has been kept away from many of the things that produce cancer. I will show how two radically different sets of standards have been applied to learning how to treat the disease on the one hand, and figuring out what produces it on the other.
Where animal studies on the causes of cancer exist, they are often faulted as not relevant to humans. Yet when studies of almost identical design are employed to craft novel treatments and therapies, the physiological differences between animals and humans suddenly become insignificant.
Many people think that the reason large numbers of us no longer die from infectious diseases is the miraculous breakthroughs of scientific discovery.
Not so. In fact, the decline of epidemics in the nineteenth century had nothing to do with breathtaking scientific advances; all of these came much later.
Deaths from germ-fed contagious diseases began to ebb long before microscopes or drugs could find or kill them. This decline happened because dirty water, crowded housing, rotten food and dangerous jobs became much less common in developed nations. As a result, diphtheria, typhoid and tuberculosis claim far fewer lives in industrialized nations today than at any time in human history.
While some may question whether filling the world with iPods and text-messaging has made us better human beings, none can question that other achievements of modern life have allowed us to live longer and better than our grandparents. If medicine didn’t vanquish lethal epidemics of the past, surely today the story is more nuanced. New medications and fast-paced information technology undoubtedly afford us the capacity to confront new ailments, like looming pandemics of bird flu, providing that governments don’t lie or cover up early reports.
But what about cancer? Can modern medicine, with its reliance on finding and treating diseases one at a time, alter the ways that the disease presents itself? We know how to cure relatively rare cancers, like those of children.
We have made spectacular advances against many forms of the disease.
That’s why in the U.S. alone, there are more than 10 million cancer survivors.
Why, then, are the rates of many forms of cancer increasing, especially when fewer people are smoking?
The complexities of the real world make unequivocal evidence on the causes of cancer in humans quite hard to come by. In truth, there is much bona fide scientific uncertainty about such a complicated illness. The existence of this doubt is easily exploited. Since World War II, whenever and however information on the cancer hazards of the workplace and the environment has been generated, it has typically been discredited, dismissed, or disparaged.7 The tobacco companies’ long struggle to obscure and muddy findings on the dangers of cigarettes, successful for many decades, serves as the model.
Other, larger industries, following Big Tobacco’s lead, continue to use a combination of deceptive advertising, sophisticated scientific spin and strongarm politics, and have been even more successful: they remain mostly unscathed to this day.8 Scientists who tackled industrial causes of cancer often found themselves facing subtle and sometimes not so subtle warnings.
Those who resisted pressure to back off often found their funding cut.9 In some cases, scientific research was stopped in its tracks, and many careers, like Hueper’s, were derailed. 10 In retrospect it seems clear that Frank Press was correct about many things.
It’s not enough to write the right book. The world has to be ready to listen.
I’m certainly not the first person to try to shine light on the lopsided nature of the effort against cancer, nor am I unique in commenting on the arrogance of environmental policies. But there are signs that the world may be more ready to listen.
The modern critique of our failure to ferret out and act on preventable causes of cancer goes back more than four decades, to Murray Bookchin and Rachel Carson. 11 Valiant but little heeded efforts were mounted right before or during the Reagan Revolution by Larry Agran, Sam Epstein and Janette Sherman.12 In 1996, Robert Proctor published a book called Cancer Wars, adopting the title from my own waylaid effort at the time.13 He chronicled the successes of the producers of tobacco and other cancer-causing materials in crafting scientific doubt about their hazards and the politically problematic efforts of the Carter administration to rein in tobacco and industrial chemicals.
14 Sandra Steingraber drew well-deserved attention with her haunting, sometimes humorous books Living Downstream and Having Faith —the latter about becoming a mother as a cancer survivor in a world full of chemical risks.15 Mitchell Gaynor, one of America’s top oncologists, lambastes environmental and industrial sources of cancer in his recent works.
16 More recently, David Michaels, Gerald Markowitz and David Rosner have used original industry records to detail the duplicity of researchers and companies in keeping the dangers of a number of industrial materials hidden.17 While some of these works got critical accolades and even made it onto public television and radio, their impact on public policy has been limited.
One of the reasons I allow myself to think the time is right for this book is the response from the business community. As word got out about my intentions, I began to hear from people I’d never met and others I’d never imagined were sympathetic. They offered me stories I’d never heard before and documents I could never find in libraries or government dockets, some of which form the bones of this book. I thought I had a pretty fair notion of what went on behind the scenes, but I was stunned by what I found out.
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