Reversing the Cancer Epidemic
Samuel Epstein

Dr. Samuel Epstein has bravely exposed one of the greatest scandals of the twentieth century: the tragic failure of the war on cancer and the concerted effort by the cancer establishment to prevent prevention. He was among the first to break this news, which he did in 1978 with his landmark book The Politics of Cancer.

After beginning his career as a laboratory chief documenting the metabolic origins of cancer, he impeccably documented the direct effects of industrial chemicals as causes of cancer. He wrote the original proposal for what became the Toxic Substances Control Act of 1976. He charged that industrial interests had conspired to deflect, distort, or even destroy evidence of the carcinogenicity of specific compounds, especially when profitable products were at stake. His straightforward conclusion: "While much is known about the science of cancer, its prevention depends largely, if not exclusively, on political action."

Today a professor of occupational and environmental medicine at the University of Illinois at Chicago, Sam Epstein is a direct heir to Rachel Carson, whose chilling exposé The Silent Spring first alerted the nation and the world to the health horrors of DDT and industrial pollution. As with Rachel Carson, his courageous public warning has drawn fierce fire. It landed him on a White House hit list during the Reagan era, and efforts were made to keep him off any government committees studying cancer prevention. An actual smoking-gun memo read, "Get him out. Horrible."

Conversely, in 1998 he was honored with the Right Livelihood Award, known as the "alternative Nobel Prize." He has written innumerable scientific articles and several compelling books, including The Safe Shopper's Bible, which details avoidable carcinogens in consumer products. He is the chairman of the Cancer Prevention Coalition - a global network of scientists, public servants, and activists.

THERE ARE TWO VERY IMPORTANT REASONS why you should take an interest in cancer prevention and the present cancer epidemic: One in every two men and one in every three women will get cancer in your lifetime, and most of these cancers are avoidable. We are failing to avoid them because of a complex of scientific, political, financial, and public policy considerations.

But there is an even more important reason to pay attention to this crisis. Many people share passionate concerns about issues such as human rights, social justice, and corporate globalization. However, these are not issues around which you can readily organize grassroots national campaigns. You're simply not going to fire up 250 million Americans or every single family in this country about such issues, however important they are. The only way to succeed is on the basis of an appeal to self-interest. You can go out into the community and the whole nation and say to all citizens, "You or some of your family members are going to get cancer, and a substantial number will die from cancers, most of which could be avoided." You then stand a realistic chance of creating a powerful grassroots national campaign.

In the latter part of the twentieth century, we've seen the emergence of three runaway industrial technologies that have threatened not only our country but the totality of the environment. The first are the petrochemical and agrichemical industries. These started in the 1940s, when industry first learned how to synthesize new chemicals, which had never existed before, by fractional distillation of petroleum and by molecular splicing. The second is nuclear technology, and the third and most recent is genetic engineering. In this connection, I should mention that most of the public, and many scientists, are under the impression that genetic engineering products are just appearing on the market. In fact, we've been exposed to genetically engineered milk since 1985, when milk from unpublicized large-scale national production trials conducted by Monsanto, working with captive land grant universities, was sold to an unsuspecting and uninformed public. Since then, the sale of rBGH milk has become widespread in this country. About 10 percent of cows are injected with genetically modified bovine growth hormone, and this milk is bulked with nonhormonal milk, thus contaminating all the nation's milk, with the exception of that of a few socially responsible dairy companies.

Cancer is the only disease for which we have absolute trend data on incidence and mortality for the last few decades. Certainly we are concerned about a wide range of other problems-reproductive, immunological, neurological, and respiratory-but we don't have as solid incidence and mortality data for them as we do for cancer. Most carcinogens-chemicals and agents that produce cancer-also produce a very wide range of these other effects. In that sense, cancer is a paradigm or broad indicator of the adverse impacts of toxic chemicals in our environment. Moreover, cancer is the only major adverse impact for which we can clearly relate a direct causal relationship between avoidable carcinogenic exposures and escalating trends. Cancer is thus a quantifiable manifestation of runaway industrial technologies that affect all of us.

Cancer is also an expression of corporate crime and regulatory complicity, social injustice, the denial of the right to know, and a massive failure of the democratic decision-making process.

What are the facts of the cancer epidemic? The incidence and mortality rates have escalated dramatically since the 1940s. Since 1950, there's been about a 55 percent overall increase in all cancer rates. When broken down to particular cancers, excluding lung cancer (which is largely related to smoking), the majority of the increases since 1950 have been nonsmoking cancers.

This doesn't mean that smoking isn't the single most important cause of all cancers, which it certainly is. But the non-smoking related cancers are largely an expression of involuntary and avoidable exposures to carcinogens in our air, water, food and other consumer products, soil, and the workplace.

For example, testicular cancer is up 100 percent; for men between 28 and 35, the incidence has gone up by 300 percent. Adult brain cancer: 80 percent. Breast cancer and male colon cancer: 60 percent. Childhood cancers: 20 percent. Brain and nervous system cancers in children: 40 percent.

What are the causes of the epidemic? Contrary to what industry and the cancer establishment-the National Cancer Institute (NCI) and American Cancer Society (ACS)-tell us, it's not the fact that people are living longer. The incidence figures are age standardized, or adjusted to reoect the increasing longevity of the population. What we've seen in children is a perfect example.

The very high increase in childhood cancer makes it clear we're not dealing with problems of longevity.

Smoking is responsible for about a quarter of the increase in all cancer rates, but we also have clear evidence there are other important causes of lung cancer, particularly air pollution, radon, and a wide range of occupational exposures. In addition, while vast amounts of money are being spent on genetic research, genetics has virtually nothing at all to do with the escalating cancer incidence. Genetics is responsible for perhaps 5 to 6 percent of breast cancers, and about 1 percent of all colon cancers. In no way could the genetics of the human population have changed in the last few decades; that takes millennia.

Dietary fat, often named as a key factor in cancer, is not in itself necessarily a cause, though high-fat diets are clearly bad from the point of view of heart disease. It's what's in the fat that matters, the contamination by pesticides and industrial chemicals that concentrate in fatty tissues in animals fed in feedlots in the highly industrialized countries and that rise up the food chain. In southern Mediterranean countries, where olive oil is in constant use and the diet consists of as much as 40 to 45 percent fat, there are very low cancer rates.

There's overwhelming evidence that the increase in cancer rates results from avoidable exposures to carcinogens in the workplace, in consumer products, and in air, water, and soil. First, there's a vast body of analytical or body burden chemical data. If you examine the fat in your own body or in fish and wildlife, you'll find some two or three hundred industrial chemicals and carcinogens. Even in the Arctic, where there is no industry to speak of, we find PCBs and other carcinogenic and toxic chemicals.

Animal studies are most important. There's substantial evidence from tests in mice and rats that clearly shows that many of these chemicals induce cancers, in many cases in the same sites as in humans. One example is DES, diethylstilbestrol. From 1938 to 1950, there were about twenty different animal studies that clearly demonstrated that this synthetic estrogenic chemical was a major cause of reproductive cancers, even at the lowest levels tested. Yet in the mid-1950s, obstetricians and gynecologists were giving it to women in unsubstantiated attempts to reduce complications of pregnancy and telling them it was perfectly safe. The animal evidence didn't faze them. "We don't have any human data," they protested. You know the rest of the story: DES caused cancers and birth deformities.

However, I must caution those who share my concerns about animal rights. Animal testing of chemicals, in the view of the independent scientific community, is the most reliable and only way of creating the strongest index of suspicion that the same chemicals will induce cancer in humans. We have a very strong body of human epidemiological data that has confirmed the significance of the animal data. However, I recognize that this is an unpopular and painful dilemma.

We also have epidemiological studies in fish and wildlife, called epizootics. We find fish in certain parts of the world with a very high incidence of tumors that we can relate to contaminated waters. Then there are the human studies: the occupational studies, the cancer clusters in certain communities, and the overall trends in industrialized nations versus nonindustrialized nations.

What has been happening to our ability to treat and cure cancers over all this time? In the 1960s, there was about a 49 percent five-year survival rate. Forty-nine percent of people survived five years after diagnosis in the 1960s, when virtually no money was being spent in these areas. Now, after billions of dollars have been poured into cancer treatment, the length of survival is about six years. It has barely increased over the last forty years for the great majority of common cancers in the overall population.

When it comes to the nonwhite population, the survival rate was 38 percent four decades ago and remains 38 percent today. So, although you read about alleged miracle cures, the great advances we're supposed to be making in treatment, if you look at the actual figures, the improvement over decades has been minimal, if any.

How does all this square up with what we are constantly hearing about these miracle cancer drugs? The answer lies in a deceptive statistical ploy. The efficacy of cancer drugs is determined on the basis of what we call tumor response. If a patient with cancer takes a drug and at the end of six months the tumor has shrunk in size, that's a tumor response. That's supposedly fine. We're doing very well indeed. Let's go out and market this miracle drug. Let's go out and make millions and billions out of it. However, if you follow up with these patients who have had a tumor response at six months after diagnosis and treatment, in twelve to eighteen months you generally find that the original tumor has recurred and often grown larger. Sometimes, the treated patient will die sooner than the untreated patient-and this is quite apart from the fact that the treated patient's quality of life is often devastated by highly toxic chemotherapy and radiation.

For the majority of cancer chemotherapeutic agents, there is questionable evidence of e‹cacy. There are some relatively rare cancers for which there is strong evidence of efficacy for childhood cancer, where treatment is successful, the incidence of long-term recurrences are very high. Delayed toxic complications such as neurological, behavioral, and reproductive problems are also common, and the incidence of secondary cancers caused by the treatment itself is very high.

So much for the claimed advances in our ability to treat and cure cancer. Who is responsible for this public policy travesty? In 1971, President Nixon declared the war on cancer. He was persuaded by the leaders of the cancer establishment that if we could put a man on the moon, we could cure cancer in our lifetime. The budget of the National Cancer Institute in 1971 was about $200 million. It's now about $2 billion. The ACS, the largest private charity in the world, has an annual budget of well over $500 million. These budgets have escalated from relatively small amounts twenty or thirty years ago as the public has been assured that we will have the ability to treat and cure cancer if given more funding, when in fact the statistics say otherwise.

The cancer establishment consists of the NCI, ACS, and a national network of comprehensive cancer centers in major universities and hospitals all over the country. Their assets and resources are overwhelming. Apart from massive financial resources, they have major influence on the media through well-financed public relations campaigns that blanket the country.

The cancer establishment is fixated overwhelmingly on damage control: screening, diagnosis, and treatment, and also genetic research. It displays virtual indifference, if not hostility, to cancer prevention. At the National Cancer Institute, for instance, occupational cancer, the single most important avoidable cancer, which we estimate is responsible for nearly 20 percent of all cancer deaths in this country, receives about 1 percent of the budget. Cancer among people of color, for which the rates are high, receives 1 percent of the budget.

The ACS has a long track record of actual hostility to cancer prevention. It fought against the Delaney Amendment, which says, "Thou shalt not add any level of carcinogens to food." It issued joint statements of support with the Chlorine Institute saying there's no evidence that organochlorine pesticides represent any hazard whatsoever. A few years ago, just before PBS was getting ready to air a program called Pesticides in Our Children's Food, a script was somehow leaked. Actually, it was stolen from the desk of Marty Coughan, the program director, and found its way to a PR operation with close ties to the ACS. Immediately, memoranda were sent out to all regional ACS divisions calling on them to contact the media and trivialize concerns about the risks of infant and childhood foods being laced with carcinogenic pesticides.

The cancer establishment has further failed to inform Congress, regulatory agencies, and the public about the wide range of avoidable cancer risks. Most cancers are largely avoidable, and we have very specific information on the causes of a wide range of these cancers, such as breast, ovarian, and childhood cancers, as well as non-Hodgkins lymphoma.

What are the reasons for these distorted policies of the cancer establishment? They're twofold. They're an expression of a professional mind-set that is fixated on damage control: diagnosis, treatment, and genetic research. This arena is where the leaders come from and what they are interested in. But there are also deep, interlocking conflicts of interest between the cancer establishment and the cancer drug, mammography, and other industries. This is most obvious in relation to the ACS, but even a previous director of the National Cancer Institute admitted in an unusually candid moment that the NCI has become a "governmental pharmaceutical company."

One example is Taxol, a drug used in the treatment of ovarian and certain other cancers. The basic research on it was done at the NCI with taxpayers' money, your money. The moment it looked profitable, the NCI turned it over to Bristol-Myers Squibb, which manufactures the drug for about twenty cents for each five-milligram capsule, which it then sells for $5. So, the public has to pay twice? First, we pay for the research by funding the NCI to the tune of $4.6 billion annually. Then, we pay exorbitantly again for the same drug once it becomes marketable.

There used to be a fair pricing clause, a law that said that when drugs and useful products are developed by government, if they are turned over to industry, there have to be restrictions on industry's profits. However, the previous director of the National Institutes of Health, Harold Varmus, who has been the recipient of millions of dollars of funds from industry and the cancer establishment, said the fair pricing clause was a blow against industrial innovation, and he struck it down. So now industry can charge whatever it likes for drugs that you and I as taxpayers have funded.

The ties between the NCI and the mammography industry are even closer. Apart from these sorts of highly questionable arrangements, the ACS is the only charity in this country that funds political parties, which is supposedly illegal. According to the Chronicle of Philanthropy, the leading national watchdog of charities, "The American Cancer Society is more interested in accumulating wealth than saving lives."

In addition, both the ACS and NCI have maintained a policy over the last few decades of harassing practitioners of alternative and complementary medicine on the grounds that there's no evidence of efficacy or effectiveness. The overriding irony is that for the majority of the uses of toxic chemotherapy, there isn't significant evidence of increased survival rates. However, different standards are used for conventional versus alternative or complementary therapies. At the same time, the cancer establishment has, until very recently, denied public funds for development of trials for alternative or complementary therapy.

Running deep through all of this chicanery is a pattern of corporate and white-collar crime that is well documented. It is inextricably linked with decision making at the regulatory agency level, and it is linked with the policies and priorities of the ACS and NCI. In 1978, I had the privilege of drafting legislation for Congress on white-collar crime in the area of public health, which I defined as "crimes of economic motivation with public health consequences." Congressman John Conyers, Jr., who was chairman of the Judiciary Committee, advocated criminal penalties for CEOs and other executives, managers, and scientists in industries that knowingly manufactured and sold products for which there was clear evidence of adverse public health or environmental impact. However, Congress wasn't ready for the concept that people who went to church and came from Yale or Harvard could possibly be criminals. The legislation did not get a warm reception on Capitol Hill.

Today, I believe the time has come for a public health crimes tribunal, like the war crimes tribunal. Bulletproof documentation exists detailing acts of manipulation, suppression, distortion, and destruction of data by a wide range of corporations, resulting in disease and death.

What can we conclude from all of this? We know how to avoid the majority of cancers. From the point of view of self-interest, it's important for everybody to have this information and to spread it nationally. It's also incumbent on us to draw attention to the adverse impacts of runaway technologies and to get citizens nationwide concerned about them, using cancer as the most powerful paradigm, symbol, and metaphor of their dangers, and a metaphor for failed public policy. All this must be clearly recognized if we are to win the losing war against cancer.

Excerpted with permission from Ecological Medicine: Healing the Earth, Healing Ourselves (A Bioneers Book), edited by Kenny Ausubel, published by Sierra Club Books and distributed by The University of California Press.

© 2004 Collective Heritage Institute.

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