THE POLITICS OF CANCER REVISITED*
NOHA Professional Advisory Board Member Samuel S. Epstein, MD, received the Right Livelihood Award, the Alternate Nobel Prize, on December 8, 1998 in Sweden, for his courageous and unrelenting work exposing the environmental causes of cancer and other diseases. He has just completed an excellent volume, The Politics of Cancer Revisited, which reiterates in many forms his powerful contention that we are losing the "War Against Cancer" because we are failing to control (or even more importantly to eliminate) the vast number of carcinogens that we are spewing into our environment.
"Cancer is the plague of the twentieth century." In 1900 cancer caused "less than 4 percent of all deaths" in the United States. "By 1976, cancer had become the second leading cause of death after heart disease, accounting for about 20 percent of all deaths. Especially following World War II, industry has produced a vast array of new products from the "cracking" of petrochemicals, which requires huge outlays for plant and equipment but relatively tiny outlays for the original petroleum. Consequently, creating a market for the new products becomes essential, first to break even and then for profit. Production rates of synthetic petrochemicals has increased from one billion pounds in 1940 to over 400 billion pounds per year in the 1980s. Many of these chemicals accumulate in the human body and some have been shown to cause cancer.
As Professor of Occupational and Environmental Medicine at the School of Public Health, University of Illinois Medical Center at Chicago, Dr. Epstein is an international authority on the toxins in our air, water, food, homes, and work places. For many years, he has studied and written about carcinogens (cancer causing substances). Cancer is a disease that develops slowly, so, studying the effects of any substance in animals, and especially in people, can take time and must be carefully monitored. Cancer can take two years to develop in rodents and up to thirty years in people. In order to show that a substance is a carcinogen, studies in mammals (usually mice and rats) must be long enough for cancers to develop and there must be a sufficient number of animals so that if a few more cancers develop in the exposed animals compared to the control unexposed group, the increase in cancers will be "statistically significant." In other words, all the studies of cancer effects depend on probability and statistics. Consequently, no one can say scientifically that a particular cancer in one particular person was caused by a single "carcinogen." In actuality, the cancer was probably caused by many factors acting together synergistically.
Dr. Epstein worked on a team for the United States Environmental Protection Agency (EPA) that developed nine cancer principles defining carcinogenicity. "These cancer principles have broad general applicability. They summarize the overall conclusions of many national and international committees on environmental cancinogenesis. " The principles include:
Dr. Epstein gives dramatic examples of substances that showed strong cancer effects in numerous animal studies and the implicated industries refused to take any action to reduce exposure. We are all familiar with the case of the tobacco industry and their many years of denial and support in Congress. In addition to tobacco, Dr. Epstein gives us exceedingly disturbing details about another dozen industries and their governmental supporters When an industry is objecting to any controls on the carcinogens in its workplace and/or products, its spokespersons will often say that animal studies are meaningless in regard to human cancer. However, very often they do not have or will not release health data on their employees, which would be essential for human studies. The "Asbestos Pentagon Papers" came to light in court hearings in 1978. The industry documents show "a pattern of denial and disease and attempts to suppress information . . . for fear of promotion of lawsuits," beginning in the 1930s.
Dr. Epstein’s new volume includes his earlier volume,The Politics of Cancer, first published in 1978 by the Sierra Club, plus an extensive and extremely useful update: The Politics of Cancer, 1998. He points out that we are "Losing the War Against Cancer" because the focus of industry, government, and the media is on cancer diagnosis and treatment instead of on prevention. He has exceedingly revealing chapters on The National Cancer Institute (NCI) and on the American Cancer Society, which together he calls "the Cancer Establishment." Both bureaucracies have named persons in authority, who have close associations with the producers of cancer treatment drugs and with the industries that spew out carcinogens in their factories, in their products, and usually also into the surrounding environment. He refers to fascinating maps of cancer "hot spots" in the United States. The "hot spots" are close to industrialized areas and hazardous waste dumps.
In January 1984 Dr. Epstein spoke for NOHA on "Hazardous Waste: Source and Solution," in which he pointed out that all dumps, no matter how carefully contained, eventually leak, contaminating our ground water and, of course, our air and that the solution is for industry to completely contain and recycle any toxic materials used in their processes, thus completely eliminating economic "externalities," which are the health costs and the clean-up costs that are borne by society when toxic and often very persistent materials are spewed out into our environment. Dr. Epstein mentioned other countries that have made more progress in this direction of containing and reusing hazardous contaminants. Of course, the ultimate solution is to turn to products and processes that are truly nontoxic.
A dramatic story is told in "1992-1993 Challenge to the Cancer Establishment." Dr. Epstein, with four former directors of federal agencies and the endorsement of 64 other leading cancer prevention experts, holds a press conference condemning the Cancer Establishment for its gross neglect of cancer prevention. Then in "The 700-to-1 Debate," he responds valiantly to questions and personal attacks. The confrontation was called "Medical McCarthyism." We can be thankful that Professor Epstein is a full professor, has tenure at the University of Illinois, and was not dismissed. In his acknowledgments Dr. Epstein states, "Thanks are also due to the University of Illinois, Chicago, for their staunch support of my academic freedom, and to the School of Public Health and its scholarly and activist Dean Susan Scrimshaw, for providing me with a hospitable academic base for scientific research and public policy initiatives." This situation contrasts vividly with the dismissal during the actual McCarthy era of the Berkeley "non-signers," those who refused for the sake of academic freedom to sign a vaguely worded "loyalty oath." Professor Tolman, a leader of the non-signers, sued the regents of the University of California and won, but years later.
A report on Dr. Epstein’s ordeal in the prestigious English medical journal, The Lancet, begins, "‘The first time we got your attention is when you were, with due respect, hit over the head with a two-by-four,’ said Prof. Samuel Epstein, resolute antagonist of the reigning priorities in the disheartening war on cancer. His audience, the high command of the Government’s $2-billion-a-year cancer research program, listened intently, as though confronted by an apparition." After all the hot exchange he received a perfunctory letter of thanks for his presentation but not much has changed within NCI. Change must come from public pressure.
The National Cancer Institute has been called a "pharmaceutical industry" and we, the taxpayers, have paid for the development of a number of cancer drugs, which are then given to private companies to be sold to the public at high prices. Included in Epstein’s book is the February 1998 testimony of NOHA Speaker Ralph W. Moss, PhD,
before the House Committee on Government Reform and Oversight on "Clinical Trials and Alternative Treatments." Dr. Moss points out that the trials can be very dangerous for the patients. "The drugs approved by the FDA for cancer treatment are all toxic." [emphasis added] In one study of three drugs, the scientists in charge reported "acceptable" side effects when 8 percent "died after contracting raging bacterial infections, capillary leak syndrome, bleeding inside the brain, and irreversible kidney failure—all caused by these drugs. . . . This is the ‘scientific‘ approach of the NCI." Patients are looking desperately for alternative nontoxic treatments. Dr. Moss describes vividly the vendetta of the FDA against alternative therapists and the successful efforts of the NCI, using its Cancer Information Service, to attack and destroy confidence in alternative and complementary treatments. Dr. Moss asks for evaluation of alternative practices. There was a conference to set up such a system, enthusiastically attended by the members of the Office of Alternative Medicine. So far nothing has happened.
Other countries are far ahead of us in utilizing alternative, nontoxic cancer therapies. Dr. Moss states, "On a recent trip to Germany I was astonished to see the scope and freedom with which many progressive oncologists treat cancer. They use a combination of conventional approaches with such things as tumor vaccines; mistletoe therapy; local, regional, and whole-body hyperthermia; thymus and other organ extracts; fever therapy; orthomolecular and antioxidant therapies;. . . and many, many others. Their government not only allows such approaches, but encourages and pays for them as well."
Dr. Moss writes, "The FDA has approved approximately 40 drugs for the treatment of cancer. But it has never approved a nontoxic agent or one that was not patented by a major pharmaceutical company." [emphasis in the original] "The approach of the NCI and FDA is overwhelmingly in support of toxic chemotherapy. They have abrogated their duties as the defenders and protectors of the cancer patients. . . . They are the drug testing and law enforcement arms of a vast $100 billion a year business, the cancer industry." Interestingly, of the fifty most used drugs in the United States, cancer risk has been shown in 16, including four hormonal drugs, such as the Pill, Mevacor®, Dilantin®, Prilosec®, and Ritalin®.
In many detailed cases, Dr. Epstein points out that when a polluting industry immediately objects to reducing or eliminating a particular carcinogen, it is usually a short-sighted, thoughtless reaction, whereas when they consider their long-run profitability, they can do much better by changing to nontoxic production methods and products. Interestingly, he points out that because of the risks of its own operations petrochemical industry insurance premium renewals are "sometimes fifty times the old rates."
When these various polluting industries, including nuclear, want to block control measures they employ professors, who sign contracts promising not to release their research results without permission. Thus, many people in academia are beholden to their industry sponsors. One world renowned example is Sir Richard Doll of Green College (set up by industry) at Oxford. There are many interesting references to him in Epstein’s book. Doll supplies statistics indicating that we are doing well in our "War on Cancer."
Years ago your editor read the statistical appendix to The Causes of Cancer by Doll and Peto. The optimistic results on cancer trends were obtained by eliminating figures for blacks, whom we know often work in the dirtiest industries and live in the most polluted areas, and for people over 65. The excuse was that these figures were hard to obtain. When you look at a statistical study, be sure to look carefully at the population of people or animals that the researchers are actually talking about. Dr. Epstein criticizes the statements of Doll and Peto because, of course, they have left out the very people whose cancer rates are highest.
"Cancer now strikes one in three and kills one in four Americans." Dr. Epstein carefully uses figures that are "age-adjusted," so that any change in the age distribution of the population is taken into account. When the "War on Cancer" was initiated by President Nixon in 1971, one in fourteen women contracted breast cancer, now the rate is one in eight. Women are told that the causes of breast cancer are unknown and that they must have frequent mammograms and breast exams in order to have early diagnosis. Actually, Dr. Epstein points out that mammograms, especially for pre-menopausal women, can increase the incidence of cancer; that there are other effective diagnostic methods; and that the causes of cancer are far from unknown. He includes extracts from the recent book he co-authored, The Breast Cancer Prevention Program. and lists twelve important risks, which are also listed in the review of their book under "Preventing Breast Cancer," NOHA NEWS, XXIII(1):6-8. Certain organochlorine pesticides, including DDT, are carcinogenic and concentrate in the fatty tissue of the human breast. Interestingly, "breast cancer mortality in premenopausal Israeli women declined by 30 percent following regulations reducing levels of DDT and other carcinogenic pesticides in dietary fat, in spite of increasing fat consumption and decreasing parity." [number of children] Meanwhile in the rest of the world the breast cancer rates are increasing.
Based on the huge increases in cancer incidence in this century and especially since World War II, Dr. Epstein feels strongly that cancer is basically a preventable disease. What should we do? He advocates two approaches:
POLITICAL: Carcinogens are worldwide. The first and most fundamental principle is to work on the RIGHT-TO-KNOW. This is a powerful approach because no politician in a democracy wants to be caught in favor of hiding deadly substances. We have a long way to go on this track. For example, there are pesticides that are carcinogens. Many of these and others are also neurotoxic and hormone disruptors. Dr. Epstein would begin by having posting for ALL exposures to pesticides, including food. He states, "Food is the most important single source of exposure to a very wide range of synthetic chemicals, either as direct additives or as accidental contaminants such as pesticides and industrial chemicals." Dr. Epstein would have all pesticides and other contaminants listed on foods. Remember, there is NO safe dose of a carcinogen, so, any excuse about the levels being low is unacceptable. Can you imagine a supermarket with all the herbicides, insecticides, and fungicides, used on the produce, listed on labels right beside the prices? Then we can imagine people flocking to the food that has not been directly contaminated.
We need to have "right-to-know" warnings about many products. For example, there is no warning on the labels of cosmetics about the carcinogens that they contain. We can work on all this politically and Dr. Epstein has worked here for years as well as in Britain on right-to-know both for workers and for the public. We also need action internationally because, when a polluting industry is exposed in the United States, it often moves to another country, where there are no regulations and where the workers will be injured and also everyone worldwide, because the product and its effluents are toxic.
PERSONAL: There are many ways we can influence our exposures to carcinogens. If we have choice where we live and work, we can avoid areas of heavy motor traffic, industrial areas, and areas near toxic land fills. We can choose nontoxic building materials, which are often comparable in price with the toxic ones. For our purchases we can use Steinman and Epstein, Safe Shopper’s Bible. Actually, when many people choose safe products and boycott the dangerous ones, our action will have a tremendous impact on the marketplace and will have a wonderful influence on reducing the toxic exposures of everyone worldwide.
Mr. Jimmy Margulies has granted NOHA permission
to make unlimited use of his editorial cartoon on pesticides on fruit
Meanwhile we are urged, often by ignorant salesmen, to buy toxic products. One example: "The role of pesticide salesmen in the proliferation of pesticides has been questioned by many, including the late Robert Van den Bosch, the world’s leading expert on integrated pest control: ‘The greatest absurdity in contemporary pest control is the dominant role of the pesticide salesman who simultaneously acts as diagnostician, therapist, nostrum prescriber, and pill peddler. It is difficult to imagine any situation where society entrusts so great a responsibility to such poorly qualified persons. (This characterization also seems generally apt for drug salesmen.) Pesticides rank with the most dangerous and ecologically disruptive materials known to science, yet under the prevailing system these biocides are scattered like dust in the environment by persons often utterly unqualified to prescribe and supervise their use.’"
Dr. Epstein’s book is a tremendous compilation of material of urgent and vital importance. The above summary only gives an inkling of the contents.
*East Ridge Press, USA, 1998, 770 pages, soft cover, $21.95.
Article from NOHA NEWS, Vol. XXIV, No. 1, Winter 1999, pages 1-4.