Medical Examiner

The New Cigarette

A new book argues that chemical waste is as much to blame for cancer as smoking.

Devra Davis wants chemical waste to become the new cigarette, an object that generates reflexive loathing from most Americans. And the pieces of the puzzle seem to be there: exposure-related cancers, decades of incriminating research, and cover-ups by the chemical industry. In her new book, The Secret History of the War on Cancer, Davis diligently and persuasively argues that we are ignoring dozens of cancer-causing chemicals. She also sounds a familiar call for toxic-producing industries to clean up their waste and figure out how to get rid of it without creating future hazards.

But along with the problems, Davis’ book reveals the barriers to changing the status quo. A strong indication of the hurdles that confront her hopes for reform is that her “secret history” is really not very secret at all—at least to anyone interested in the relationship of cancer to the environment. For almost as long as there has been a “war on cancer,” there has been what might be called a “war on the war on cancer”: a series of efforts to move beyond a sole focus on the detection and treatment of cancer (the standard war on cancer) to actual prevention of the disease. Although Davis promises to share “stories I’d never heard before and documents I could never find in libraries or government documents,” her book by and large tells well-known horror stories about supposedly cancer-inducing products long vilified by environmental activists, such as asbestos, benzene, vinyl chloride, and dioxin. Thus, it is far from clear that the public, largely quiet to this point, will now respond with outrage and alacrity to her polemic. After all, it took decades to begin to topple the cigarette. And it has a much more straightforward relationship to cancer.

Davis is truly well-situated to have written this book. She grew up in infamous Donora, Pa., a steel town where 20 people died in 1948 after a smoggy haze caused by factory emissions enveloped the city for five days. Davis’ parents both died of cancers that she believes may have been related to toxic exposures. And she has spent the last three decades at the forefront of epidemiological research exploring the environmental causes of the disease.

The Secret History starts with an almost wistful look back at the heyday of investigation into cancer causation. As Davis documents, in several countries (including Nazi Germany) in the 1930s, scientists conducted pioneering studies seemingly demonstrating that cancer could be caused by excessive exposures to, among other things, cigarettes, radiation, arsenic, benzene, and synthetic dyes. But events intervened, most notably World War II. When the war ended, the Nazi taint to this research, plus a newfound confidence that scientists could develop technologies to ferret out and destroy cancers, deflected attention from potential environmental causes. After President Richard M. Nixon formally declared war on cancer in 1971, the resulting programs contained neither funding of research into prevention of the disease nor environmental cleanup strategies.

That was in large part due to the role of the tobacco and chemical industries, according to Davis. As has now been extensively documented, most recently by historian Allan M. Brandt in The Cigarette Century, American tobacco companies spent millions of dollars over decades to deliberately deceive the public about the carcinogenic potential of cigarettes. Essentially the same process, Davis says, has occurred in the world of chemicals. There is now a substantial body of evidence, obtained through research funded outside the war on cancer, suggesting that industry has managed to obfuscate the carcinogenic dangers of chemical and other toxic waste. The Secret History provides a thorough, systematic account of these misdeeds.

For example, data have shown that residents of certain Louisiana Delta towns have three times the amount of cancer-causing dioxin in their blood than average Americans and that local children have 10 times the rate of neuoroblastoma, a rare brain tumor. Yet, Davis writes, chemical companies in the region have consistently “undermine[d] reports on the dangers of vinyl chloride, benzene, asbestos and other petrochemical residues for workers, their families and communities.” Similarly, those who worked at or lived near the Clairton Coke Works of Western Pennsylvania after World War II had alarmingly high rates of lung cancer. Once again, industry—in this case the coke manufacturers— made sure that the news wouldn’t get out. Davis describes her own secret meetings with a former monitor of the coke plants, who documented toxic levels of chemicals in the local drinking water and air—findings that were later squelched by the state’s Department of Environmental Protection.   

Davis ultimately argues that in their doubt-sowing public-relations efforts, the chemical industry and others have cleverly manipulated the science of epidemiology, the study of health and disease among populations. Epidemiologists would be the first to admit that it is truly difficult to establish definitive proof that a given hazard causes a given cancer. But scientists and spokespeople for the chemical industries have gone further, using epidemiology’s penchant for caveat to attempt to nullify a lot of very convincing data. Those who have accepted money from industry to weigh in have even included the heroes of epidemiology, such as Richard Doll, who had earlier been one of the first investigators to prove the connection between cigarette smoking and lung cancer. Doll, Davis writes, was a “highly paid consultant” for Monsanto and Dow Chemical and the Chemical Manufacturers Association. She believes he wrote reports that, among other things, minimized the connection of vinyl chloride to certain brain and liver cancers.

But the subterfuge of industry isn’t the only barrier to shifting the war on cancer from simply treatment to prevention and treatment. Also powerful is the way in which most Americans respond to a diagnosis of cancer. As Davis remarks about cancer patients, “Nothing can match the singular devotion that comes to those who are fighting for their own lives or those of family members.” My experience as a clinician caring for cancer patients corroborates this point as well as its corollary: Most cancer patients are not especially concerned about why they developed cancer. While many of them become activists, participating in walkathons and races to raise money, relatively few see their cancer as a reason to man the barricades against toxic waste. They look forward, to a cure, not backward, to what might have prevented them from getting sick in the first place. If only a small percentage of Americans are environmental activists, why should cancer patients be any different?

There is one additional barrier to consider. Once the perfidy of the cigarette industry was revealed, the danger of smoking became indisputable: Cigarettes cause lung cancer. But in the case of chemical hazards, there are many hazards, many different industries, and many different cancers that can result. In one of her chapters, aptly titled “No Safe Place,” Davis lists a variety of hazards and related health complications, including contaminated water, poisoned fish, toxic fumes, miscarriages, and congenital malformations. The litany is frankly overwhelming. And when one adds in routine X-rays, cell phones, aspartame, and hot dogs as conceivable causes of cancer, just where does one begin? Is everything toxic?

And yet Davis may be catching the right wave at the right time. Despite all the obstacles, growing numbers of cancer activists and interested citizens seem to be grasping her main point: By creating doubt about cancer causation, industry perpetually prevents reform and thus allows more cancer to emerge. Scientists and funding agencies are finally beginning to focus on preventing cancer—not just blasting it away with better and better medications. For example, according to its Web site, the National Cancer Institute now “supports a large research portfolio which identifies environmental risk factors for breast cancer.”

Davis herself imagines some version of South Africa’s Truth and Reconciliation Commission, where activists, scientists, and industry can come together, admit past mistakes, and then launch a mass cleanup. This is a nice thought.  But again, the cigarette example is instructive. True change did not occur until incriminating documents surfaced, which the plaintiffs’ lawyers used to make the tobacco industry admit past wrongdoings and pay substantial penalties. Davis’ book is a good start, but it does not provide nearly enough of a punch to bring the chemical industry to its knees.