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Review of The Politics of Cancer Revisited

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

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