American Journal of Public Health, December 1998, 88(12):1881-1882
In his 1978 book The Politics of Cancer,
Dr. Samuel S. Epstein threw down the gauntlet. Cancer, he said,
is a preventable
disease "caused mainly by exposure to chemical or physical agents
in the environment." There is no such thing as a safe level of
exposure to a carcinogen. Cancer risk and incidence have risen
steadily throughout the century in every age group, despite knowledge
and legal protections.
The first half of Dr. Epstein's 1998 sequel, The Politics
of Cancer Revisited, reprints the 1978 volume, detailing
the impact of cancer and describing the methods, uses, and
limitations of human and animal experiments; workplace and
environmental case studies; dangers of consumer products; and
problems with policies and data collection. The second half
of the book consists of 7 new chapters and 12 appendices.
Highly critical of the government's "war on cancer," and
of most government agencies charged with leading it, for their
complete disregard of cancer prevention and their cosy relationships
with industry, Dr. Epstein cites chapter and verse on conflicts
of interest, leadership defaults, administrative sabotage, scientific
inadequacies, barriers to public disclosure, and other factors
that have failed to protect the public from avoidable carcinogens.
Industry, labor, and public
interest groups fare no better under Dr. Epstein's scrutiny,
He notes industry's short term marketing
focus, outdated technology, and resistance to regulation. While
acknowledging the achievements of a few dedicated labor leaders,
the author laments the slow pace of union activism on employee
health and safety issues. With a few exceptions, professional
organizations "have been indifferent, if not hostile, to environmental
and occupational problems."
Special rebuke is reserved
for the American Cancer Society for its refusal to support
critical public health legislation and
for conflicts of interest, misdirection of its considerable financial
and political resources, misrepresentation of treatment success
rates, nearly exclusive focus on diagnosis and cure to the detriment
of prevention, and "basic failure to comprehend the importance
of environmental and occupational causes of cancer."
Dr. Epstein's 1987 report to Congress notes that 1 in 3 Americans
will be diagnosed with cancer and that 1 in 4 will die of it.
Both incidence and mortality rates continue to rise, particularly
among African Americans and the poor. Data through 10994 indicate
that only modest increases in 5-year survival rates, which are
most likely due to earlier detection and improved access to care
rather than improved treatments.
He states that annual U.S. production of synthetic organic chemicals
has increased from 1 billion pounds in the early 1940s to 400
billion in the 1980s. The great majority of these substances
have not been tested adequately or at all for toxic, carcinogenic,
or ecological effects, and much of the available data is suspect.
About 10 million American workers are exposed to high volume
carcinogens. An estimated 3 billion pounds of toxic industrial
emissions are discharged annually into the air. More than one
ton of toxic waste per person must be disposed of each year.
Rising cancer rates, which reflect exposure to much lower levels
of carcinogens in past decades, are rarely acknowledged, and
toxic effects other than cancer are not even investigated.
Industry leaders, government
agencies, and academic consultants continue to collude, says
the author, in supporting anti-regulatory,
antidisclosure policies. The National Cancer Institute and the
American Cancer Society continue to direct their research funds
toward treatment, refuse to investigate nontoxic alternative
treatments, and adhere to a "blame the victim" concept of cancer
causation, focusing on smoking, diet, and other lifestyle factors,
to avoid addressing environmental carcinogens. Dr. Epstein cites
the close association of these organizations with manufacturers
of mammogram equipment and cancer drugs and their public silence
on involuntary exposure to substances in the workplace and in
food, air, water, cosmetics, household cleaners, and other consumer
products that increase cancer risk.
The book includes a 1992 statement signed by 64 environmental
and preventive medicine specialists and published responses by
the National Cancer Institute and American Cancer Society, as
well as articles by scientists in the United States and United
Kingdom with rebuttals by Dr. Epstein. Two chapters outline what
individuals can do on personal and political levels to prevent
cancer. Appendices list known carcinogens, cancers resulting
from drug treatment, and a variety of documents including citizen
petitions to the Food and Drug Administration, press statements,
a summary of cancer risks from food, beverages, and household
products, and a list of resource groups with contact information.