The Health Industry's Secret History of Delaying the Fight Against Cancer
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What is the relationship between the mass production of synthetic chemicals, workplace chemical exposure, environmental pollution and rising cancer rates in the 20th and 21st centuries? In her new book, The Secret History of the War on Cancer , Devra Davis, director of the Center for Environmental Oncology at the University of Pittsburgh Cancer Institute, argues not only are there links between these developments, but the industries responsible for producing these chemicals and wastes have long been well aware of these connections and have sought, with much success, to downplay or dismiss them. As a result, industry has altered the very terms of the public and medical discussion of cancer, resulting in an overwhelming emphasis on cure rather than prevention. This approach has been far better for the industrial status quo rather than for the public health; the increase in cancer is not an artifact of improved diagnoses or the aging of the population.
Davis' book is a call for a fundamental shift in how we think about cancer in the early 21st century. The narrative proceeds as a series of almost freestanding essays. Topics range from the Nazi fight against cancer -- Hitler's scientists were among the first to connect smoking and carcinoma of the lung -- to the transformation of WWI mustard gas bombs into chemotherapy; the relationship between exposure to laboratory chemicals and cancer in medical researchers; the still-shocking history of the American tobacco industry; cancer in industrial workers and the ineffectiveness of safety regulations; genetic damage caused by Ritalin that can then lead to cancer; tumors caused by Aspartame; the very mixed track record of the mammogram; and the link between cancer and environmental hormones, asbestos, hair spray and cell phones (yes, they do seem to cause brain tumors in heavy users). In every case, scientific research into health effects is fundamentally intertwined with corporate interests.
Davis tells us that her book took 20 years to write, in part because she was told that she would lose her job at the National Academy of Sciences when she first proposed the project in 1986. In those 20 years, important works have been published on many of her topics, such as Robert Proctor's The Nazi War on Cancer and Allan Brandt's The Cigarette Century . Davis' work is different, however, in that it brings a cancer epidemiologist's eyewitness account into the story. She has composed her book as a memoir as well as a history, and she relates numerous personal conversations with colleagues over the years as well as the story of her parents' and a close friend's deaths from cancer.
Davis' narrative is compelling. The "war on cancer" announced by Richard Nixon in 1971, she writes, was a colossal misdirection. By 1971, senior researchers around the world already had known for decades that "smoking, sunlight, industrial chemicals, hormones, bad nutrition, alcoho and bum luck all affect the chance we will get cancer." Yet from the start, industry blocked the examination of these known causes and instead poured resources into finding a cure. But after 40 years and $69 billion poured into this war, "it is still easier for people to become cancer statistics than to understand them." We now spend $100 billion on cancer treatments in a single year, yet when it comes to prevention, we have been mostly standing in place.
The problem for those who want to change course in how we think about cancer is that industry misdirection is now so well-established that it is has become fact: It is almost impossible to examine the long-term health effects of any industrial substance without relying in part on research conducted by industry itself. Likewise, discussion of environmental hazards in the popular media continues to be infected by skepticism and politicization -- most of which is not warranted by the scientific evidence but has been deliberately crafted and inserted into public discourse by masters of public relations like Edward Bernays, beginning more than 60 years ago. Finding an expert without baggage is a difficult task; many major 20th century cancer researchers have ended up working for industry, including the revered Sir Richard Doll, the British epidemiologist who in the 1950s proved that cigarette smoking causes cancer. The American Cancer Society was stocked with industry heads and paid-off scientists almost from the start.
Finally, because bodily contamination with hundreds of synthetic industrial chemicals is ubiquitous -- everyone from newborn babies in Iowa to grandfathers in Nepal now lives with a cocktail of pesticides, heavy metals, PCBs and plastics in their bodies -- it is basically impossible to find an uncontaminated control group, in man or beast, to study their effects. This means that using current epidemiological techniques, which rely on the comparison of large groups, it is almost no longer possible to determine the health effects of environmental and workplace pollutants.
Our legal system has also evolved in conjunction with these developments; the only industry money comparable to that spent on marketing is spent on lawyers. And, in order to win a lawsuit against a company for causing your cancer, there must be scientific proof that your cancer was caused by your chemical exposure -- which is basically impossible because of the infinite number of ways these environmental chemicals might be working in combination in a particular person. Even current medical theory and practice can contribute to the problem of proof: When we think about what diseases are and what causes them, we still work, consciously or not, largely from a germ-theory model, in which individual diseases are always caused by individual entities. But this idea makes no sense when you're talking about the effects of hundreds of different industrial chemicals working in combination.
Another tactic is to simply not do any research into health effects at all, or to deliberately perform such research in a way that minimizes results. In many instances, "the absence of epidemiologic findings becomes a surefire way to postpone, avoid, or delay regulatory controls ... So long as things can be made out to be uncertain and unresolved, production -- and profits -- continue uninterrupted."
Davis also brings in cultural elements that have contributed to the problem. One is the powerful public belief in the existence of "magic bullets" for diseases and the inevitability of medical progress. Another is what Davis calls our Judeo-Christian, moralistic approach to sickness -- the idea that your disease is somehow your punishment for sin. (New Agers say disease is caused by suppressed anger or an inability to achieve oneness with the universe, but it's the same idea.) Ideas about genetic susceptibility to disease have in some ways replaced this moralistic approach, but the result is the same: Disease is primarily the fault of the individual.
Industry has long taken advantage of this philosophy. Research into the genetic causes of cancer has been a welcome pastime in their laboratories, even though, Davis writes, genetics might contribute to only 10 percent of cancers at most.
To solve these problems, Davis argues that we need to re-examine the most basic questions about what cancer is and what we can do about it, both epidemiologically and in the popular mind. In the United States, this has already happened with tobacco; the drop in smoking-related deaths among many groups is "no accident" and is the result of educating the public. But this was far too long in coming. "Those who forced us to wait for incontrovertible proof exacted a heavy price in premature deaths. Millions perished while the debate on tobacco lingered far longer than it should have."
Thus, Davis is also arguing that we need to dislodge the belief in the existence of incontrovertible scientific proof from the public and legal mind as well; after all, most scientists would be the last to say their conclusions represented some forever-undeniable truth. "If we insist on having at hand absolute proof that harm has happened before we move to prevent or control damage," Davis writes, "we are dooming future generations." But the time is right, she says, for a paradigm shift in how we think about cancer; and she argues that we are beginning to make major breakthroughs -- in part due to the help of industry insiders -- that can help bring about this fundamental change.
AlterNet talked to Davis recently about the connection between disease and the environment, the way medical specialization may have affected medical thinking about cancer, and the Bush administration's unwillingness to take a preventative approach to public health.
Christine Wenc: It's so hard for me to imagine that people in industry can sleep at night after everything they've done. I always ask myself, how do they really feel about it?
Devra Davis: Actually, this is how I was able to write the book, because many people in industry are giving me information. A guy from Mobile Oil -- he could have just taken his $10 million [and disappeared, without talking to me]. But he didn't. So, I really think that the time is different now [than it was] at the beginning, when Frank Press told me not to write the book. He gave me good advice, you understand.
Well, what would have happened if I had written the book then? I wouldn't have been working in the mainstream of science, which I am now. I am now working for a major corporation -- the University of Pittsburgh. We're a major medical center, and we are telling people [about the hazards of environmental chemicals].
Do you think the germ theory, which tends to reduce disease to an isolated interaction between an individual body and a single bacteria or virus, has contributed to our misunderstanding of the cancer problem?
Well, Occam's Razor (the principle used by scientists stating that the simplest, most succinct solution is usually the best) is a very attractive notion, and parsimony is a beautiful concept. The gold standard has really been the clinical trial. You have a germ and you have a remedy, and you take people and give them the remedy, and other people don't get the remedy, and at the end of the time you see whether there's a difference. You want to get things down to the most simple, efficient explanation that you can.
In clinical trials of drugs, that's easy. But in studying the environment, it's almost impossible. Life is a mixture. That's why the challenges are real.
Could you explain a bit more how the idea of individuals being responsible for their own diseases might fit into this picture?
As Max Weber pointed out in the Protestant Ethic and the Spirit of Capitalism , the core of the idea of Protestantism was that if you were of the elect, if you had a calling, you would work hard, you would be successful. Accumulating capital was a sign of your worth as a human being. Therefore, poverty is a sign of a lack of being a good person. A variation on this is that illness was thought of as a curse from God. So if you got sick, it was because you weren't a good enough person. The first thing people ask when they get sick is: What did I do wrong?
They don't seem to make a connection between their disease and the larger environment.
The other part of this is almost an epistemological aspect of medicine. Doctors treat individuals, one at a time, and they tend to treat their organs, one at a time. The specialization of medicine has done remarkable things. But it's also Balkanized the body, so that the ability to look at the whole has been impeded by the degree of specialization.
Some experts say that we are in the process of an epidemiological transition into a period when a major part of the public disease burden will be caused or made worse by industrial chemicals and pollution. What do you think of this idea?
I think we're going to look back in 10 years and say, "Remember when we treated people for disease without asking what was in their bodies first?" Right now, for instance, more and more doctors are starting to ask about metals. We need standard tests for measuring metals. We don't have them. And yet we know that heavy metals make an enormous difference in your health. Your blood pressure, your arthritis, other issues as well. We ought to be able to order a test for metals just like we order one for white count.
What I do think, and I am a Kantian, I believe in the categorical imperative. If we act as if there is goodness, truth and justice, right? People have a right to know, democracy rests on informed consent, freely given. People consent to be governed. Well, how do you consent to be governed if you don't even know what you're being exposed to as a result of government policy? [There is] the movement for labeling, the whole REACH program in Europe, which is the registration, evaluation and assessment of chemical hazards under a program that's been started by the European Union. Those are examples of efforts to expand the right to know. Of course, under the GATT and the WTO, there is tremendous pressure brought by American-led multinationals to weaken all this.
The Bush administration has generally moved in the direction of insisting that the only proof we have that something is a carcinogen comes from when we have enough sick or dead people in a statistically significant number with clear enough exposures under proscribed circumstances, so we can say that that gun fired that bullet into that organ at that time. And that's where some people got hung up, because they said, "Well, from a narrow epidemiological point of view, you don't have definitive proof. " And while that may be true, it's really not the point. The point is we should not confuse the absence of proof of human harm with evidence that there is not a hazard.
Christine Wenc is completing a graduate degree in the history of science at Harvard. She is the former editor of Seattle's alternative weekly the Stranger .