Journal of the American Medical Association, 283(17):2304
For Dr. Samuel Epstein cancer prevention is of utmost importance.
Epstein, who is professor of occupational medicine at the school
of public health, University of Illinois Medical Center, has
written some 250 articles and 10 books on toxic, carcinogenic,
and mutagenic effects of occupational and environmental contaminants.
Epstein's logical proposition, simply put, is that the majority
of cancer are caused by environmental exposures. Control this
environment, and cancer will be prevented. Money and effort applied
to treatment are far less beneficial to society than the same
money and effort spent on prevention.
His book, The Politics of Cancer Revisited, presents
his views on why the environmental causes of cancer, the majority
man-made, are not being seriously addressed, despite adequate
scientific methodology and governmental regulation. The losing
war on cancer is the result. Epstein also questions the methods
and results of many of the well-known standard-bearers in the
battle against cancer.
The initial portion of the book is a reprint of the original
1978 version of The Politics of Cancer. That work dealt
mainly with the various known or suspected carcinogens, how they
came to be suspected and identified, and the difficulty of interpreting
industrial data and government policies at the time. Thousands
of environmental agents from the petrochemical, insecticide,
and plastics industries, to mention only a few, are in our land,
sea, air, and The Politics of Cancer explodes the threat.
How to identify a potential carcinogen as a true hazard is examined
in chapters on animal testing and workplace and consumer product
Animal testing, Epstein writes, is fraught with difficulties.
The variable sensitivity of different species to different chemicals
requires varying levels of exposure, some extremely high. This
leads to criticism of methods and results by those who are interested
in not defining a certain chemical as a carcinogen. Workplace
studies have led to identification of arsenic and aromatic amines
as carcinogens but not without years of disagreement.
In the second portion of
the book, The Politics of Cancer, 1998," results
are said to be no different than those discussed in 1978 despite
more sensitive scientific methods, improved industrial data,
and ample government regulations. Necessary political action
has not occurred, and rich and powerful forces, mainly for economic
reasons, have successfully fought change. In 1987, Representative
Henry Waxman invited Epstein to write a position paper, "War
on Cancer," which was subsequently printed in the Congressional
Record. In the paper, reprinted full in the book, Epstein
criticizes the American Cancer Society for failing to support,
and at times for being hostile to, critical legislation seeking
to reduce or eliminate exposure to environmental and occupational
carcinogens. He claims that the society's approach to cancer
prevention largely reflects the "victim philosophy," which emphasizes
faulty lifestyles rather than workplace or environmental carcinogenesis.
In addition to rounding
up the usual suspects, i.e., corporations that may have direct
monetary gain by fighting change, the author
takes aim at the National Cancer Institute (NCI) and the American
Cancer Society for misdirecting their funds toward "diagnosis,
treatment, and basic genetic research with relative indifference
to cancer prevention." Their approach is said to be neither due
to ignorance nor based on science, but rather reflects conflicts
of interest. Researchers and physicians on the society's board
sit on NCI committees and, he says, obtain funding from the society
and the NCI; society board members leave the room when funding
is discussed, but Epstein considers this measure a "token formality." He
writes, "For decades, powerful groups of interlocking financial
interest, with the highly profitable cancer drug industry at
their hub, have dominated the war on cancer. By linking their
priorities with those of major pharmaceutical companies, the
NCI has directed its own priorities away from prevention."
This book is a no-holds-barred, take-no-prisoners attack on
all who disagree with its author's thesis. As a clinician who
treats cancer patients, I feel in conflict with Epstein when
he knocks clinical trials, mammograms, and chemotherapeutical
agents. He severely criticizes respected names in academic and
administrative oncology because their emphasis is different.
The book does not disagree respectfully but rather declares political
war between a basic preventive approach and a general patient
care approach to the cancer problem. The Politics of Cancer offers
much valuable information that can be extracted without entering
the fray, while those who do appreciate a political battle, whatever
their side, will find plenty to raise the blood pressure.
Richard L. Meyer, MD