International Journal of Occupational and Environmental Health,
April/June 2000
A primary criterion for a new book is whether it fills a unique
niche or builds significantly on previous material; Dr. Epstein's
1998 The Politics of Cancer, Revisited is exemplary on
both counts. A follow-up to his 1978 prize-winning The Politics
of Cancer (which posits environmental and occupational carcinogens
as underappreciated by the powerful, if not hostile or indifferent,
National Cancer Institute and American Cancer Society), this
newly revised and updated treatise addresses the subject of cancer
funding priorities and policy debates from a vantage point that
I have not found remotely replicated elsewhere. In my review,
while noting interesting theses (e.g., Robert Proctor's Cancer
Wars) from historians and alternative medicine gurus, I have
not found another work of this scope by a recognized expert in
the field of environmental carcinogenesis and cancer prevention.
Given that Epstein is a professor at a major university, author
of ten books and nearly 300 scientific articles, and recipient
of the 1998 Right Livelihood Award (the "alternative Nobel Peace
Prize"), it is extremely difficult to doubt Dr. Epstein's expertise
or integrity, and my reading on ly enforced this impression.
At fist intimidated by its 770 no-nonsense pages, I soon found
myself impressed by its organization and enthralled by its message.
Dr. Epstein is skilled in presenting complicated, comprehensive
information in a readable but undiluted fashion, as reflected
by the inclusion of the original 1978 The Politics of Cancer in
the "Revisited" version. At first questioning the wisdom of duplicating
its 300-plus pages in this text, I soon found myself flipping
frequently back to its well-referenced case studies and suggestions
for policy changes, which was critical for following the subsequent
long-term debates included in the new text (e.g., regarding the
evidence for saccharin's carcinogenicity). Furthermore, Part
I served as powerful and inspiring documentation of the dedication
and consistency with which Dr. Epstein has pursued these issues.
Part II, the new text, powerfully supports the assertion that
in spite of the past 20 years' increasing budgets at the NCI
and the ACS, relatively little has been accomplished in terms
of big-picture endpoints, i.e., reduction of overall cancer incidence
and attributable mortality. In fact, the incidence of cancer
has escalated to epidemic proportions over recent decades while
our ability to treat and cure most cancers has barely improved.
The 400-plus pages of Part II make no attempt to shy away from
the complexity or controversy of the above assertions. Instead,
they document meticulously, through basic science references,
public health literature, published committee meetings, and media
coverage, the evidence for Dr. Epstein's thesis that the cancer
establishment is myopically fixated on damage-control treatment
and diagnosis and basic genetic research, with not-always-benign
indifference if not hostility to cancer prevention. Particularly
enlightening are the sections on mammography and its overuse,
especially in premenopausal women, and the evidence for the escalating
incidences of a wide range of non-smoking related lung cancers.
The presentation includes full text of the published dialog between
Epstein and his critics. This refreshing material, bridging the
confusing but critical overlap between science and politics,
is perhaps the book's greatest attribute. Additionally, the 17
appendices, including sections on risks of consumer products
and activist/resource groups, are very practical and thoroughly
documented.
Is Dr. Epstein "right"?
I am personally compelled by the strength of his argument,
to believe that environmental and occupational
cancers are vastly underappreciated, and that major reforms of
NCI and ACS priorities are well overdue. However, the point of
this review is to assess the quality of the book, which is outstanding
in every way. It is a presentation that is unique and brave in
its willingness to challenge the cancer establishment. It is
readable, current, and comprehensive, and elaborates Epstein's
important assertions of over two decades ago. I strongly recommend
that you read the book and benefit by becoming informed about
the debate.
Christopher Carlsten, M.D.
Stanford University Medical Center
Stanford, California
