BOOKS
Environmental Politics and Cancer Policy Reviewed by John H. Weisburger
' T h e Apocalyptics: Cancer and the Big Lie" is a landmark book that critically analyzes national policies in cancer prevention and research. At the beginning, the author, journalist Edith Efron, notes, 'This book is an intellectual detective story. . . . I discovered a cultural crime which should not be possible in a free society: a complex corruption of science and a prolonged deception of the public. " Efron's book deals specifically with public perception of the causes of cancer, based on what the public learns from the media. What has the public learned? The public is firmly convinced that: • Cancer stems in the main from industrial chemicals and the modern agricultural chemicals that give us crops that are bountiful but contaminated with pesticides and other harmful agents. • Food additives, including sweeteners, are likely cancer risks. • Air and water contain carcinogens. • School buildings should not contain asbestos. • Tobacco use is a risk to health. Those addicted to tobacco use often note that they live in a sea of carcinogens anyway, so they might as well keep on smoking. The public has the fatalistic view that there are so many carcinogens in the environment, mostly due to industrialized society, that there is just no hope. Even people in the scientific, medical, and legal worlds, who are supposed to be taught to reason and examine critically all of the data, hold such beliefs. 'The Apocalyptics" examines how the public has been conditioned to accept such views uncritically, and therefore to put the burden on government to protect it against cancer by regulating, banning, and eliminating suspect substances. Among the most common killing diseases, including heart disease,
Unbalanced media coverage may be why policies for preventing cancer stress chemicals and ignore life-style "The Apocalyptics: Cancer and the Big Lie" by Edith Efron, Simon & Schuster, 1230 Ave. of the Americas, New York, N.Y. 10020, 1984, 589 pages, $19.95 John H. Weisburger is vice president for research of the American Health Foundation, and director of the Naylor Dana Institute for Disease Prevention in Valhalla, N.Y. He has published about 350 papers on mechanisms of carcinogenesis and the causes of human cancers
hypertension, and stroke, the many types of cancer have been a topic of great interest and concern for decades. Thus, the public has demanded that the federal government support cancer research more than other health matters. For the past 40 years, Congress has usually voted more monies for cancer research than the executive branch requested. This generous funding has given the U.S. a leadership role in understanding etiologic factors and the nature of the carcinogenic process and in developing better tools for diagnosis and treatment of cancer. Voluntary agencies, like the American Cancer Society, also have been supported broadly by a public that wants protection. The apocalypse implies a cleansing through fire and hell, after which a new world is to be born, with the best of the old surviving and flourishing. The book discusses how contemporary environmentalist "evangelists" have convinced the
public that this nation, immersed in a sea of carcinogens, could be cleansed and redeemed—and thereafter cancer would disappear. Efron describes—with actual quotations from scientists, regulators, government officials, and politicians—the arguments that support and refute the idea that the environment is contaminated with carcinogens. She alludes to the central role of the media, printed and visual, in convincing the public of the cancer burden from industrial contamination of air, water, and food. Beginning in the 1960s, a crescendo of events, sparked in part by important books like Rachel Carson's "Silent Spring/' led the federal government to actions listed in Efron's book, including the creation of the Environmental Protection Agency and the Occupational Safety & Health Administration, the clean air and water acts, consumer protection laws, and the Toxic Substances Control Act. Not mentioned is the major reorganization, with enlarged funding, of the national cancer program in 1971. During that time regulatory agencies made unchallenged decisions, mostly in the guise of avoiding cancer hazards. The National Cancer Institute (NCI) bioassay program, combined with other programs under the umbrella of the national toxicology program, was given large resources to test chemicals for cancer-causing potential. The results of this test program led to the tagging of many important industrial compounds and food components like nitrite and saccharin with the dreaded word "carcinogenic." Some in the scientific establishment noted that such large efforts in animal testing still would not ensure safety from cancer. Although a positive finding of cancer-causing potential, they said, would be significant and thus lead to the imposition of protective measures, a negative result does not necessarily signify safety. Furthermore, the idea that even a single molecule of a carcinoNovember 12, 1984 C&EN
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Books gen could cause cancer was discussed widely. News reports passed on such findings in headlines.The researchers and regulators were interviewed on TV, with the interviewers eliciting the implications of such findings for the public. This, in turn, led to further headlines and Congressional hearings, which again provided headlines. The first part of ' T h e Apocalyptics" provides a detailed overview and critical discussion of the events and policies that led to the public perception of omnipresent carcinogens. It tabulates, reasonably authoritatively, substances in the environment labeled carcinogenic. The text and a series of appendices provide a detailed listing of citations for further reading. To the scientist used to peer-reviewed journal literature, the citations of major government actions are revealing: The underlying data are often not in scholarly journals but in government reports of limited circulation or in the Federal Register. It appears that Efron has done a phenomenal amount of reading. Efron then introduces the major advances of knowledge on the nature of malignancy and the complex processes leading to neoplastic transformation. This part of the book cites the major researchers and discusses the distinctions among chemicals that can react with DNA (usually after metabolism). The author notes how such agents can be detected by appropriate in-vitro tests like the Ames test. She also points out there are agents that play a role in cancer development as promoters and gives the reader a good perception of carcinogenesis. Subsequent chapters trace the application of this knowledge to the regulatory scene and indicate why most agencies do not distinguish carcinogens based on mechanism. Attempts to do so have led to name calling with political innuendos. Also, it appears that regulatory agencies do not have a clear vision of cancer because experts in carcinogenesis themselves hold diverse opinions—for example, on the question of interpretation of the results of bioassays for carcinogens. Here, Efron is taken in by arguments 32
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that chemicals can be called carcinogenic based on a strict interpretation of available data using statistical manipulation in the absence of biological reasoning and collateral evidence from in-vitro assays. Thus, Efron appears to hold the view that animal tests may not be very useful in developing information on possible human cancer risks. What seems to have transpired is a disregard for careful, objective interpretation of such tests based on an understanding of mechanisms by regulatory scientists themselves. In any case, in the 1970s, agents tested in bioassay programs were ruled to be carcinogenic, with all the consequent regulatory and legal involvement that such labeling implies. The book describes well the role of the media in publicizing the concept of environmental contamination with carcinogens that stemmed from these programs. The book further gets into the question of the quantitative aspects of carcinogenicity: Is there or is there not a threshold below which a substance is harmless? Efron eventually gives the reader a perception of the quandary of risk assessment and of extrapolating data from other species to humans. In the late 1970s, at an NCI-organized meeting, a manuscript purporting to calculate and project the percentage of cancer in the American public due to industrial activities was circulated widely. Joseph Califano, then Secretary of Health, Education & Welfare, used this unpublished document to further extend federal activities for protecting the public. Finally, the reader is led to an area that the dogma of the 1960s and 1970s essentially ignored: that there are carcinogens in this big world that occur naturally. A review of naturally occurring carcinogens—those stemming from personal habits and traditions or processes like cooking or preserving—leads to the more hopeful conclusion that the public actually does not live in a sea of carcinogens and that adjustments of personal habits or other self-protective actions might yield ways to lower the risk of cancer. The public needs only to ask the right question to get the right answer. Nonetheless, the insistent explo-
ration of the wrong question with the wrong answers for many years and the public attitude of seeking protection from // father ,/ rather than protecting itself are conditioned reflexes difficult to change. "The Appcalyptics // is written by a nonscientist for nonscientists. The style is enjoyable, even elegant. The writer is, in the main, quite conversant with the scientific intricacies of a complex field. The book uses quotations from diverse sources, supported by many references, to help the reader assess the status of a given area. It provides understanding as to how an entire country, with international repercussions, has developed a phobia against chemicals. Clearly, this public perception was encouraged by careless industrial practices, such as the pollution of the James River in Virginia with the pesticide Kepone and chemical dumps that contaminate the environment. These events reflect poor management practices by people who should have known better, including scientists and engineers. Efron's book helps the reader understand that, although reckless contamination of the soil, water, or air with chemicals should not occur, these contaminants in the main are not major causes of major cancers. This book is a must reading for scientists, for public servants and elected officials, and for the lay public. Industry needs to take note so it can avoid future actions giving rise to even the suspicion of environmental contamination. The regulatory agencies need to take note so they can interpret existing legislation to protect the public and not quibble about legalities that do not do so. Legislators need to rethink what kind of laws and actions would truly protect the public. Finally, lay people need to realize that the government cannot protect them if they continue to smoke, to be gluttons and eat the wrong foods at the wrong time, or otherwise abuse their bodies. The director of NCI, Vincent T. DeVita Jr., has proposed a challenging goal to reduce cancer mortality 50% by the year 2000. Careful application of the lessons in Efron's book and a redirection of national and international efforts in cancer control will meet this challenge. D
