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Book Review: The Politics of Cancer
by Bob Ginsburg
By Samuel S. Epstein, Anchor Press/Doubleday, 1979 ($6.95)
Bob Ginsburg is presently the staff chemist/toxicologist at Citizens for a Better Environment (CBE), which is based in Chicago. He is also active in the Chicago Area Committee on Occupational Safety and Health (CACOSH) and has been active in a number of unions in Wisconsin and Illinois.
The impact of the physical and social environment on our health and on the incidence of disease has been recognized, if not accepted, for over 100 years. By the end of the 19th century, TB, cholera, and the plague were firmly linked to the overcrowding and unsanitary living conditions associated with urban pollution and poverty. Already in the 18th century scrotal cancer (in chimney sweeps) was linked with soot. Yet in many ways such knowledge has had little effect. Among patients in hospitals serving big city ghettoes, TB is still rampant. Machinists show high levels of scrotal cancer. Infant mortality levels are directly related to socioeconomic levels. Our environment must still be affecting our health.
We constantly hear about the deterioration of our environment caused by modern pollution, but some people would like us to believe that such “modern pollution” is not as harmful as the 19th century variety. A recent article in Chemical and Engineering News went so far as to suggest that the problems of pollution, toxic chemicals, and cancer had reached crisis proportions primarily because of biased reporting and exaggeration by the news media.
Many researchers blame the increase in heart disease and cancer, the two leading causes of death in the last 40 years, primarily on changes in lifestyle and personal habits, such as increased cigarette smoking and poorer diets. Those same people also minimize the contributions of industrial pollution and exposure to occupational or environmental hazards.
However, this viewpoint has not gone unchallenged. We have witnessed in the last 10 years a heated public debate concerning the effects of pollution; nowhere has this contest been as fierce as over the significance of environmental causes of cancer.
The Wrong War?
No one disputes that cancer is the second leading cause of death in the U.S. or that 1000 people die of cancer every day. At issue are what causes it and what should be done about it. The first official attempt at a resolution was a declaration of war in 1971. The goal was to treat the symptoms and find a cure, a time-honored strategy in medicine. President Nixon said he wanted to cure cancer in our lifetime. As in other wars, vast quantities of money were spent, this time on chemicals and equipment. Nine years later we have still not met the enemy. We are neither closer to a cure nor better at treating the symptoms. The chemical companies, the pharmaceutical houses, and the big research institutions have gained — but those thousand people still die every day, and the toll is increasing.
There were some who argued all along that we were fighting the wrong war. They urged control and prevention, and pushed the facts to support such claims. By 1964 it was generally established that over 70 percent of cancer is environmental and therefore possibly preventable. By 1973 the National Cancer Institute had published maps of the geographical distribution of cancer which implied a strong correlation with pollution. Finally, estimates in the mid-to-late ’70s put percentage of cancer due to industrial pollution at 30 to 40 percent, and the percentage due to occupational exposure was at least 20 to 40 percent. It should have been clear that the poor, who could not move, and working people, who generally can’t change jobs, were bearing the brunt of the disease just as they had done with TB. The sides were drawn over these issues.
Environmental groups, labor unions and some scientists fought to bring these issues out of the industrial closet and into the public domain. The movement, such as it was, grew in the struggle to establish a safe and healthy environment as a right, not a luxury. It attained some successes, such as passage of the Occupational Safety and Health Act, but has not consolidated any of its gains. The contest enters the ’80s in a state of uncertainty. For many years Samuel S. Epstein has been part of the fight — through research, through books, in testimony to Congress, and as a labor consultant. The Politics of Cancer is his contribution to the debate over the future of the environmental health movement. In it he has pulled together a monumental amount of information on specific carcinogens, on the scientific background to cancer, and on the “scientific” and “non-scientific” opposition to regulation. He directly confronts corruption and distortions on the part of scientists, and industry and government officials who argue against control of various chemicals. By laying out their connections and biases he clearly destroys the myth of objective science and scientists. This is one of the first books that treats cancer as a disease with social origins, which must be treated in a political and economic context. This makes it an important resource for understanding the problems of health and disease in capitalist America.
The Politics of Cancer is overflowing with facts and is designed to convince the reader (and move the reader to convince others) that cancer can and should be prevented. The principal point is that cancer is due to carcinogenic compounds that are dangerous at any level, so that control of these substances can control cancer. The book begins by discussing the scientific basis for cancer research, testing and statistics. Included is up-to-date information on the incidence and distribution of cancer, on correlations of cancers with levels of chemicals in the workplace and the environment, and on the cure rate for cancer (which hasn’t significantly changed in the last 20 to 30 years). The sections on cancer epidemiology, which is the only valid approach to proving human carcinogenicity, and on animal testing (bioassays) are clear, concise, and easy to read. They may be the best general descriptions available.
Following this background section are 13 case studies on the regulation of carcinogens which are divided into workplace hazards, consumer products, and general environmental hazards. Like the first part of the book, the case studies are on the whole readable, understandable and entertaining. The most striking feature of the case studies is the similar scenario of each one: A compound is introduced into the workplace or the environment. Medical people find it to be hazardous. Industry denies or minimizes the hazard by covering up the problem or hiring consultants (supposedly independent scientists) to contradict the claims. Finally the government comes in with too little, too late.
Epstein has not hesitated to expose the connections of these “independent” scientists, many of whom don’t reveal any possible source of bias when giving their opinions. In any event, industry has little trouble finding experts who will deny the carcinogenicity of almost anything from asbestos to cigarette smoke. The extent and implications of this medical-industrial conspiracy are staggering.
The most frightening aspect of this alliance is its low regard for the lives of workers. Industrialists evidently think nothing of withholding information on hazards while thousands or tens of thousands of workers die. Asbestos provides the most blatant example. (See box.) In 1935-37 executives of Johns-Manville, the world’s largest supplier of asbestos, suppressed the publication of scientific data on the dangers of asbestos. Their stated reason was to avoid the “promotion of lawsuits” by their employees. This was not the last time the asbestos industry hid data. In the late ’50s they withheld information on the links between asbestos and lung cancer. The asbestos industry is not alone. Rohm and Haas covered up the cancer hazard from BCME for most of the ’60s. The Manufacturing Chemists Association delayed release of information on vinyl chloride for nearly two years in the early ’70s. Dow withheld data from the National Institute for Occupational Safety and Health (NIOSH) and the EPA for nearly a year on the induction of chromosomal abnormalities by benzene. The list could go on for pages.
Given such priorities on the part of industry and its medical allies (and their immense influence on government policy), it is clear how the crisis of industrial pollution reached its present state and why the war on cancer could not and did not succeed. Simply stated, an emphasis on control and prevention would require industries’ investing in existing plants significant amounts of money for modifications that would not increase profitability. The “preferable” search for a cure could be financed by tax dollars, would subsidize the manufacturers of complex research equipment, and would produce significant and profitable spinoffs (especially for pharmaceutical houses). Furthermore, should a cure be found, industry could only benefit from its production and use (remember the swine flu panic?).
The presentation of 13 different cases would be unnecessary if it didn’t serve to emphasize and, by implication, to prove the basic similarity of the cases. The consistent positions of different industries against control or regulation of chemicals, whether on scientific or economic grounds, reflects a basic commonality of analysis and purpose which goes beyond the personal morals of specific individuals, no matter how important the offices they occupy. Personal morals cannot satisfactorily explain such consistencies; economics can. Top-level managements are responsible for the position their companies take on health and safety questions. Such decisions are dictated by the drive for profits. The fight does not become one of people versus people, as individuals, but one between different ideas and bases of economic power.
This leads quite naturally into the book’s final section and the main topic, the “politics of cancer.” But instead of real political discussion and analysis, we are treated to a laundry list of the laws, agencies (governmental and otherwise), and individuals associated with the federal regulatory and research structure as well as with private interest groups.
Villians or Cogs
Focusing on agency chiefs, Epstein loses sight of how agencies fit into larger governmental policy. Administrators, while important to the general attitude and performance of an agency, are still cogs in a much larger policy-making machine. Epstein believes that individuals, by themselves, have the ability to make the system work. His solution to the problem of poorly run bioassays is to establish “neutral third parties” to insure quality. Federal regulatory agencies can be made to work if the right people head them.
The problem with this approach is that it is at best a short-term tactic aimed at the symptoms and not the sources of regulatory failure. Scientists are no more objective than anyone else in evaluating scientific problems that have economic and political ramifications. Isolated individuals in positions of power are subject to immense political and social pressures forcing them to support the status quo. The book is littered with examples of scientists who turn against regulation and controls as soon as they leave the government and go to work for industry. The only way to counter that kind of pressure is to build a broad-based movement independent of both industry and federal agencies instead of developing “various legal and other safeguards… to avoid or minimize potential abuses and conflicts of interest” as Epstein has proposed.
The contradictions in Epstein’s analysis of people and governmental agencies lead to problems in his understanding of other areas. Comparatively little space is devoted to labor unions and their role in the fight, even though unions are the only existing vehicle for organizing workers. Further, workers in organized industries hold a significant weapon — the ability to withhold their labor. He also criticizes industry for “failing to understand the magnitude of health and safety problems entailed in the manufacture and handling of hazardous, particularly toxic or carcinogenic, chemicals” and management for failing “to be aware of the shortcomings in its own modes of developing health and safety information… ” and making “all-but-irreversible economic commitments… on the basis of information that subsequently proves to be defective or based solely on short-term marketing considerations.” (Emphasis added.) Epstein’s liberal belief in the power of individuals blinds him to the realities of capitalism. Given the present economic system, industry has no choice but to base investment and production schedules on profit margins. Whatever good intentions individuals in industry might have are outweighed by larger economic concerns.
Epstein evidently denies that the basic problem is the nature and priorities of capitalism. He underestimates the amount of pressure necessary to force the system to move because he does not explain why the system behaves the say ti does. He apparently believes that a hierarchy of organizations and personalities in responsible positions, i.e. good vureaucrats instead of bad, can make the government deal effectively with the problem of cancer prevention and carcinogen control. Nowhere does Epstein vive us a clue as to how he believes that method of organization can hope to gather enough political and economic power to change the situation on other than a minor and temporary basis.
Despite such political failings, The Politics of Cancer is an impressive book. It contains all the necessary information — sufficient for scientists, political activists, or working people — to make an independent analysis. It has opened the door to political solutions of what many would like us to think are purely medical or scientific problems. Finally, it points out the need for reliable information which can be used to convince people of the problems. Only when people start seeing envrionmental problems linked to health linked to industry linked to economic problems will they begin to look behind the facade and see the true face of the enemy.
The Asbestos Papers
Epstein’s chronology of the asbestos tragedy illustrates how he works his facts into cornerstones of a corrupt structure — what the British medical journal Lancet calls the” Medical-Industrial Complex.”
The following information emerged only as recently as October 1978 at hearings of the Subcommittee on Compensation, Health and· Safety of the House Committee on Education and Welfare in San Francisco. Dubbed the Asbestos “Pentagon Papers,” industry documents dating from 1933-1945 include correspondence similar to the following examples among senior executives, lawyers, doctors, consultants, and insurance companies of asbestos companies. These companies allege that they were not aware of the hazards of asbestos until1964.
Epstein’s documentation of the asbestos story begins in 1929, when Anthony Lanza, a scientific researcher, began a study of 126 workers with 3 or more years’ experience working with asbestos. In 1931 Lanza completed his study, which was sponsored by two asbestos companies and Metropolitan Life Insurance, carrier for both companies.
On September 25, 1935, the editor of the trade journal Asbestos requested permission of the president of an asbestos company to publish a British article on the hazards of asbestos, saying discussion of it “‘along the right lines” might combat undesirable publicity given it in the newspapers. On October 1, 1935, the president wrote to Vandiver Brown of Johns-Manville, still the world’s largest asbestos producer, praising Asbestos for not reprinting the English articles, saying “the less said about asbestos the better off we are.” He added that it would be better to publish an American study, i.e. Lanza’s, which could be made more favorable to asbestos manufacture.
In 1935 Lanza’s study results were published, after being edited by its sponsors (and censors), the asbestos and insurance companies. The published version portrays asbestosis as a disease milder than silicosis, in view of pending workmen’s compensation legislation in New Jersey. The plant owners and medical insurers did not want asbestosis included as a compensable disease.
Prior to Lanza’s manipulated study being published, Brown forwarded suggestions that “all favorable aspects of the study be included and that none of the unfavorable be unintentionally pictured in darker tones than the comments justify.” Lanza, concluding in his published report that asbestosis was milder than silicosis, neglected to mention his findings that 67 of the 126 workers (53%) he examined suffered from asbestosis, which is in fact at least as debilitating as silicosis.
Kenneth W. Smith, medical director of a Johns-Manville plant in Canada, found seven workers with asbestosis but decided not to tell them. He advised to wait until the workers were totally disabled and then to make the diagnosis and submit a claim by the company. Smith admitted that “the fibrosis of this disease is irreversible and permanent.”’
Where has government been during all this suppression and distortion of asbestos dangers? On April 26, 1978, then Health, Education and Welfare Secretary Joseph Califano said that as many as half of all workers exposed to asbestos since the beginning of World War II — between eight and eleven million workers — could develop serious diseases such as lung cancer, mesotheliomas and asbestosis. He urged these workers to get chest x-rays. He sent a letter regarding asbestos dangers to the country’s 400,000 doctors. What Califano did not tell the workers about was their right to sue the government, nor were plans announced for a surveillance program, nor was any mention made of the National Institute for Occupational Safety and Health (NIOSH) recommendation that a 100,000 fiber standard was the only meaningful way to protect against asbestosis and other asbestos-induced cancers and diseases. Also, no mention was made of dangers of the public-at-large living close to asbestos plants, or of public exposure due to asbestos-containing consumer products. Epstein concludes that Califano’s statement, though seriously lacking in some aspects, “opens the door of national health care policies to preventive medicine” because the high cost of surveillance of groups at high risk of cancer will encourage the “discovery” that prevention is cheaper than cure.
Where has the scientific community been through all this? One example is the current Occupational Safety and Health Administration (OSHA) standard for asbestos-workers’ exposure — an average of two million fibers per cubic meter of air over an eight-hour working day. There is a definite problem with this standard. Current optical microscopic techniques for counting fibers in the workplace can only detect fibers longer than 5 microns. Smaller fibers can only be counted by electron microscopy and they may outnumber the longer ones by as much as 100:1. Also, the shorter fibers are believed to be more carcinogenic than the longer fibers. Epstein urges development of a practical, sensitive method for monitoring total asbestos fibers in air breathed by exposed workers. The OSHA standard, inadequate as it is, was fought by industry, though it only addressed asbestosis and not cancer. This standard was later shown by U.S. investigators (Epstein doesn’t say who) to be inadequate even for asbestosis, not to mention lung and other cancers.
The asbestos industry threatened employee lay-offs and cried severe economic dislocation. Despite this, organized labor fought for the OSHA standard, noting that asbestos is a major health hazard not only for asbestos workers but for workers in many other chemical and manufacturing industries where asbestos is used in many forms. Over the past decade, the asbestos industry has fought work health and safety regulation with lies and scientific manipulation. They have, over the last decade, funded major scientific studies, all of which minimized asbestos dangers. One of the studies, done by J. Corbett McDonald, then in the Department of Epidemiology/Public Health at McGill University in Montreal, was presented in testimony at an OSHA hearing. McDonald introduced himself as a fulltime employee of McGill, and as an independent researcher. However, at the end of the text McDonald read from, in small print, was the acknowledgement: “This work was undertaken with the assistance of a grant from the Institute of Occupational and Environmental Health of the Quebec Asbestos Mining Association.” In the face of mounting criticism, McDonald resigned his position at McGill, taking his asbestos-cancer research funds with him (including continuing support from the National Cancer Institute in this country). He went back to England, where he was appointed to the Trade Union Congress Chair of Occupational Medicine by the London School of Hygiene and Tropical Medicine.
Another example of the duplicity of key figures in the medical-scientific-industrial complex is Dr. Paul Kotin who, in 1942, was medical director and senior vice-president of Johns-Manville, the world’s largest asbestos manufacturer. As such, be wasa strong supporter of minimizing asbestos hazards. Contrarily, in 1970, as director of the national Institute of Environmental Health Sciences at Research Triangle Park in North Carolina, Kotin supported the opposite view on the dangers of asbestos. This is an example of what Epstein calls the “revolving door” policy between government agencies and private industry’s leadership positions, where loyalty seems to supercede consistency and honesty.
As of now, OSHA’s two million fibers per cubic meter of air standard still stands, 20 times in excess of NIOSH recommendations. And industry continues to fight to loosen OSHA standards: in 1972, the R.T. Vanderbilt Co., which owns talc mines in upstate New York and Vermont, put pressure on key congressmen for help. (Vanderbilt’s talc has a high asbestos content.) The politicians obliged by pressuring then OSHA chief John Stender, who in turn pressured OSHA standards director Gerald Scannell. Scannell, over the objections of his own health standards chief, encouraged Vanderbilt to do its own sampling to determine if their talc contained asbestos, and advise Vanderbilt customers of their results. Vanderbilt rose to the opportunity by redefining their product so as to exclude its classification as asbestos, though it is clearly defined as such in the legal standards. Vanderbilt then notified their customers that “our talc products used in your manufacturing processes are not subject to the OSHA asbestos standard.”
On July 4, 1974, an OSHA inspector cited a Vanderbilt customer, Borg-Warner, for violating the OSHA asbestos standard. The case went to the highest arbiter of OSHA cases, the OSHA Review Commission. On June 28, 1976, Judge Jerry W. Mitchell ruled against the company. Since then, a NIOSH epidemiological investigation of workers at Vanderbilt mines found “both respiratory diseases and lung cancers which appear to be significantly above those expected.”’ Incredibly, rather than divert some profit into research and development for worker health and safety, industry continues to use more and more convoluted tactics to avoid responsibility. They say it’s smoking and not asbestos that gives workers lung cancer, in spite of a 1977 NIOSH study that proves that non-smoking asbestos workers also have excessive risks of lung cancer. — Beth Powers