Politics and Disease

The Apocalyptics: Cancer and the Big Lie.
by Edith Efron.
Simon & Schuster. 589 pp. $19.95.

Among the many remarkable qualities of this book about cancer science is the back of the dust jacket. It is not unusual to find in this space highly favorable comments by distinguished readers who have seen a book before its publication, and Miss Efron’s book is no exception: “A sensation . . . displays a dazzling technical mastery of the field that I would not expect of anyone but a professional cancer scientist. . . .” “A masterful work. It is difficult to believe that anyone (layperson or professional) could organize and interpret the literature on this subject so logically and present it so thoughtfully. . . .” And so forth. Yet in my experience it is without precedent that such comments should be made, as they are here, anonymously. Miss Efron’s pre-publication reviewers are identified on the jacket not by name but only by professional specialty.

When we turn to her preface we learn the reason for this, and it is an extraordinary one. Although a number of scientific reviewers were willing to speak publicly and favorably about Miss Efron’s survey of the basic science behind the cancer problem, none who reviewed her devastating conclusions about the way this science has been applied was willing to have his name attached to his opinion. To do so, they said, would turn them into professional pariahs and damage or perhaps even destroy their careers. So Miss Efron has been led to a remarkable expedient: she has deposited copies of their signed reviews both with her publisher and with several academics serving, so to speak, as men of honor; for her readers she contents herself with describing their professional qualifications. This prologue to the tale she tells in her book proper is, in its own way, further evidence of the collapse of the scientific method in the United States.

Proceeding to treat her main theme—the politicizing of cancer prevention—Miss Efron traces two interrelated chains of development. The first is the growth of the now widespread belief that nature is benevolent, human artifice malevolent. This notion, given its original currency by Rachel Carson, was sped along by Barry Commoner and taken up by dozens of emulators; in its present received version, it contends that human artifice is at its most vicious when embodied in the work of large corporations.

The second chain is itself made up of two strands: one is the process by which scientists have been striving to learn the causes of cancer; the other is the process by which the federal government has used the findings of these scientists to control the activities of business and industry. Miss Efron calls the first process basic science, the second regulatory science, a term she invests with more than a touch of the oxymoronic.

In demolishing the idea that nature is a benign system into which wicked humans have pumped a great many evil chemicals that can cause cancer, Miss Efron lists hundreds of substances and processes in nature that give rise to carcinogens. These go back nearly to the Creation—it has been discovered that dinosaurs suffered from bone cancer—and are everywhere: radiation in the atmosphere, carcinogenic metals in the earth’s crust, carcinogenic elements in the air and sea. Oxygen itself is a suspected carcinogen and a proved mutagen. Eight other elements required for life have been reported to be carcinogenic. Moreover, nearly a fifth of the elements in the universe are suspected carcinogens.

Wherever we turn, Miss Efron writes, there are reported carcinogens: all plants and trees contain them. Many of our foods, both vegetable and animal, are said to be carcinogenic. The human body itself produces several carcinogens from non-carcinogenic materials. Insulin—yes, insulin—has been reported to be carcinogenic. Blood contains a number of naturally radioactive substances which in their sum guarantee that the average body experiences some 500,000 radioactive disintegrations a minute. Far from being the invention of a chemical industry introducing manifold poisons into a naturally healthful biosphere, carcinogens appear to be even more natural than apple pie.

Miss Efron takes us next through an account of contemporary research into the mechanism of carcinogenesis. Much of the packed detail need not concern us here; the bottom line is that the area is still in a state of flux and that we do not know what causes cancer. For one thing, carcinogenesis appears to be highly specific to species: what causes cancer in mice does not necessarily cause cancer in rats. For another thing, although scientists have reported hundreds upon hundreds of chemicals to be carcinogenic in animals, only a handful have been identified through epidemiological studies to be carcinogenic in man. And some of those that have been shown to be carcinogenic in man have not been shown to be carcinogenic in any other animal. Actually, the notion that substances which in large doses can cause genetic mutations in bacteria are probably also carcinogenic in man depends on three untested levels of extrapolation: from small doses to large doses, from bacteria to animals, and from animals to man.



Miss Efron’s rigorous survey of the state of basic cancer research thus shows a field in ferment, riddled with uncertainty and controversy. Yet the regulatory scientists—those responsible for the enforcement of the Toxic Substances Control Act—behave as if science had provided a firm substratum of knowledge for the close and constant regulation of human behavior. In doing so they rely on a whole series of dogmatic assumptions that have themselves never been proved and for which there is substantial contradictory evidence.

One of these is the notion that there is no safe dose of a dangerous chemical. This idea is confuted by such obvious data as medicines which are life-saving in small doses but fatal in large ones. It is also confuted by more recondite data. Regulatory science in its extreme form believes in the “single-hit” theory, i.e., that a single radioactive particle striking a single molecule in the body can initiate cancer. While there is no way to prove or disprove this, the fact that all people experience trillions of radioactive disintegrations within their bodies but most people never contract cancer suggests that a successful “single hit” must be an extremely rare occurrence.

Another notion beloved of regulatory scientists is that we are experiencing an epidemic of cancer. Yet no such thing has happened. When cancer rates are corrected for age (the population is getting older, and cancer is predominantly a disease of maturity and age), all cancers but respiratory ones are seen to be stable or declining slightly in incidence.

But the master dubious assumption, and the one with the most devastating impact, has been the belief that, since cancer is supposedly caused largely by industrial chemicals, most cancer can be prevented by identifying industrial carcinogens and excluding them from the environment. Billions of dollars and thousands of minds that might better have been spent on the treatment of cancer have been wasted on the pursuit of this chimerical theory of prevention.

Miss Efron’s final conclusion is harsh:

Were a physician to treat a patient for ten years by terrorizing him incessantly with hypothetical or false warnings of threats to his life, while failing to inform him of, and to treat, the known diseases from which the patient actually suffers, that physician would be recognized as a sadistic incompetent.

The reader who absorbs Miss Efron’s thickly textured and minutely documented argument is not likely to find this description of the federal cancer-prevention establishment a hyperbolic one.



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