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Review of The Politics of Cancer Revisited

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 case studies.

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

Cincinnati, Ohio

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