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It’s been two decades since the publication of Martha Balsham’s landmark study, “Cancer in the Community: Class and Medical Authority (1993).” Balshem, a hospital-based anthropologist, documented how a Philadelphia “lay community” rejected medical advice to stop smoking, eat fruits and vegetables and schedule regular screening tests. The working class community of Tannerstown (a pseudonym) instead blamed air pollution from highway traffic and nearby chemical plants, as well as fate, for their cancers.
“Why did the dog get cancer?” a resident protested, “The dog didn’t smoke [or] eat an improper diet.”
Dr. Balshem was in a quandary. She was hired to promote the biomedical point of view in a project called “CAN-DO”. Her job was to go into the community around Fox Chase Cancer Hospital and convince the community to take self-responsibility for their cancers. The people would have none of it. They said the doctors were ignoring the elephant in the room.
Balshem didn’t know much about cancer when she began her work. But neither did her fellow anthropologists. When she presented at the AAA Meetings in 1986 about the health beliefs of Tannerstown citizens the audience “reacted by laughing” at their ignorance. And yet all those Tannerstown beliefs (e.g. there is cancer inside everybody, surgery can cause cancer to spread etc.) are essentially true.
After leaving the chains of her employment, Balshem wrote her book, juxtaposing the biomedical and the “lay community” views. She determined that both had rational bases for being labeled legitimate knowledge. Though an advance in knowledge, she failed to puncture the myth.
My father is from Tannerstown: I’m a “Natives’s Son”
My father grew up in Philly’s River Wards. He died of cancer in 1986 (about the time of Balshem’s research). So I’m a “native’s son” in this story. I remember two things about that time. I remember biking through the Tannerstown and holding my nose at the noxious fumes, wondering, “How do people live in this god-awful place? Why doesn’t somebody do something?” And I remember desperately trying to save his life, trying everything from Linus Pauling’s Vitamin C cure to massive carrot juicing. Dad said it was too late for all that and settled for a fruit salad each day after chemo at a silver lunch truck in front of Jefferson Hospital.
Dad moved away from the Tannerstown area as a young man and I don’t know exactly what caused his cancer. But today I’m a journalist/anthropologist, in part, because of that experience, and I want to know many more details than Balsham provides. Balshem did not name names and she omitted a torrent of crisp facts that might have delivered the solid counterpunch required. Why did she tell us the names of some places (like Fox Chase Cancer Hospital) but not others – like her study community? Was it Fishtown, Kensington, Port Richmond, or Bridesburg (they are the four River ward communities)? And why didn’t she name any of the local factories, like Atlantic Metals, Honeywell and Rhome and Haas? There was Toxics Release Inventory (TRI) data available then. For example, she could have checked and cited that, in 1988, for Rhome and Haas, there were 419,059 pounds of air releases from that factory, much of it carcinogenic.
Fox Chase is still guarding the Henhouse (of Knowledge)
Of course, maybe a thorough study would have had little effect. I searched the Fox Chase website and did not find even one reference to environmental etiologies to cancer in the River Wards around the hospital. Officially, they don’t exist. There is plenty of space dedicated to new screening technologies and tumor analysis. In fact, Fox released a thick Community Needs Assessment” report, in April 2013, that concluded the same advice that Balsham fought against, and I quote. “Three quarters of adults in the service area do not eat the recommended number of servings of fruits and vegetables, and one in six eats fast food twice a week or more often. In Addition, nearly half of adults do not exercise three times per week—and one in ten does not exercise at all. This may represent a need for education and programming” (PHMC 2013:41).
Programming?!
There is no change in message from 1993.
Fortunately today there are some environmental groups active in the “Tannerstown” area. One is the Port RichmondAIR whose mission is “understanding air quality in Philadelphia Riverwards neighborhoods; Port Richmond, Bridesburg, and Kensington.” They are active in the research, advocacy, and citizen science arenas. In the summer 2012 they worked with the Clean Air Council and Port Richmond residents as well academic partners at Drexel University “to collect data on the concentration of black carbon in the neighborhood. . . . [we] climbed up 12 ft. ladders in the dead heat of Philadelphia Summer, we put up monitors on homes, businesses, schools, and parks around Port Richmond and collected air quality data for four weeks.” A link to their website is below.
The Radical Cancer Toolbox in 2013
Balsham did not have today’s tool box of literature, data and theory at her disposal. Moreover, she was wedded to a hospital employer which dramatically limited her critical scope.
In 2003 I was Executive Director of a non-profit, LocalMotion (“Better health through Fewer Toxins”), in Ann Arbor and organized a conference with three of the most important cancer and environmental researchers of the day: Devra Davis, Sandra Steingraber and Ruth Etzel, MD. They haven’t stopped. Steingraber made a movie, in 2010, based on her bestselling book, “Living Downstream” (See references). In 2012 Etzel, completed the third edition of “The Handbook of Pediatric Environmental Health,” published by the American Academy of Pediatrics (Etzel 2012). It is a groundbreaking clinical guide that offers “concise summaries of the evidence that has been published in the scientific literature about environmental hazards to children, and provide guidance to pediatricians about how to diagnose, treat, and prevent childhood diseases linked to environmental exposures.”
Devra Davis’s 2007 book, The Secret History of the War on Cancer details how corporate suppression, government inaction and social amnesia have combined to cause an epidemic. Ten million cancers over the last thirty years were entirely preventable argues Davis. Her 2011 book is Disconnect The Truth About Cell Phone Radiation, What the Industry Is Doing to Hide It, and How to Protect Your Family. She shows how cell phones are implicated in brain cancer in some studies and are the subject of warnings in Great Britain and Germany, but not the U.S. Children are especially at risk.
“The War on Cancer has been stymied because we focused only on attacking the disease while ignoring what causes it,” said Davis in an interview. John McMurty names it. His newly revised Cancer Stage of Capitalism: From Crisis to Cure (April, 2013) argues that, “The connection between dominant products and processes of capitalism and the non-communicable diseases and deaths they cause in still rising global incidence has been suppressed over many decades – including by independent critical science (McMurty 2013:38)”
Unfortunately, many famous anthropologists are not making these connections. An example is he late Cecil Helman. His widely influential textbook, Culture, Health and Illness (2007), published in over 40 countries, discusses cancer and environmental health in a non-critical fashion. Helman talks about the impact of diet on cancer, recommending particular changes (such as to eat more fruit) rather than exploring cancer from a structural perspective. At one point Helman discusses environmental pollution as being associated with “lay theories of illness causation.”
Actually the advice to eat more fruits and vegetables is important but only tells a small part of the story. There is a wealth of evidence that a whole foods, plant based diet, with no dairy and no oil can help prevent most forms of cancer, heart disease and stroke, among other degenerative diseases. The film “Forks over Knives” (2011) details a mountain of evidence – epidemiological, biochemical and animal studies – by a pair of pioneering researchers, Dr. T. Colin Campbell and Dr. Caldwell Esselstyn, MD, that makes this point. They argue that it’s vital for your health to go vegan (entirely if you can) and eliminate all dairy (milk, yogurt, butter etc.) and all oil (yes that includes olive oil) from your diet. Organic is preferable, though that is more expensive. Nutritional research on anti-cancer supplements is growing and includes items like pomegranate juice and garlic capsules.
The terror of neoliberalism creates a besieged working class. Reliable knowledge about how food is medicine is hard to find. Capitalist culture saturates “Tannerstowns” across the country with diets of cheap meat, processed carbohydrates, cow’s milk, cheese, alcohol and simple sugars. Salads, when available, are a few strips of lettuce drenched with oil. The “Forks over Knives” diet will not save the working class, nor the middle class for that matter. It helps, but eliminating capitalism is the key to better health. A growing literature on the “health/wealth dialectic – how morbidity and mortality are closely associated with your place in the class-based hierarchy – is showing how the deepest part of ourselves are imprinted by capital. The film “Unnatural Causes: Is Inequality Making us Sick?” (Adelman and Smith 2008) tells important parts of this story (see below for URL on film and transcripts from the seven part series at Adelman and Smith).
Cancer, like heart disease and stroke, are forms of neoliberal violence against us. They are not natural. Neither are the cures which require massive intervention. As Peter Montague, former editor of Rachel’s Health Environmental Monthly said, “to be blunt about it, there is no money in prevention, and once you’ve got cancer you’ll pay anything to try to stay alive” (Montague 2005).
Brian McKenna is an anthropologist who teaches at the University of Michigan-Dearborn and can be reached at mckenna193@aol.com
References
Adelman, Larry and Llewellyn Smith (2008) Unnatural Causes. http://www.unnaturalcauses.org/transcripts.php
Balshem, Martha (1993) Cancer in the Community: Class and Medical Authority” Washington, DC:Smithsonian Institute Press.
Davis, Devra (2009) The Secret History of the War on Cancer. New York:Basic.
Davis, Devra (2011) Disconnect The Truth About Cell Phone Radiation, What the Industry Is Doing to Hide It, and How to Protect Your Family. New York:Dutton. See a short film on this topic: https://www.youtube.com/watch?v=Xtd-y2C9lH4
Etzel, Ruth (2012) Handbook of Pediatric Environmental Health, Elk Grove Village, American Academy of Pediatrics. http://ebooks.aap.org/product/pediatric-environmental-health-3rd-edition
Helman, Cecil (2007) Culture, Health and Illness.Oxford:Oxford university Press.
McKenna, Brian (2008) “Melanoma Whitewash: Millions at Risk of injury or Death because of Sunscreen Deceptions.” In Merrill Singer and Hans Baer (Eds.), Killer Commodities: A Critical Anthropological Examination of the Corporate Production of Harm. Lanham, MD:AltaMira Press.
McMurty, John (2013)The Cancer Stage of Capitalism: From Crisis to Cure. Halifax & Winnipeg:Pluto.
Montague, Peter (2005) “Why We Can’t Prevent Cancer” Counterpunch, November 4-6.
Phildelphia Health Management Corporation (2013) The Hospital of the Fox Chase Cancer Center, Community Health Needs Assessment. Philadelphia:PHMC.
Port RichmondAIR (2013) http://portrichmondair.org/
Steingraber, Sandra (1998) Living Downstream: A Scientist’s Personal Investigation of Cancer and the Environment . Vintage. Order the 2010 film at: http://www.livingdownstream.com/
http://www.counterpunch.org/2013/11/15/cancer-is-capitalist-violence/
From: Rachel's Democracy and Health News #829, Oct. 27, 2005
WHY WE CAN'T PREVENT CANCER
By Peter Montague
암에 대한 두 가지 상반된 treatment
In 1999, cancer surpassed heart disease as the number one killer of
people younger than 85 in the U.S.[1] Now a detailed report on the
causes of cancer tells us why: cancer has been steadily increasing in
the U.S. for 50 years as people have been exposed to more and more
cancer-causing agents, including chemicals and radiation.
Richard Clapp, Genevieve Howe, and Molly Jacobs Lefevre have just
published "Environmental and Occupational Causes of Cancer; A Review
of Recent Scientific Literature" and it is a real eye-opener.
But before we dive into this report looking for nuggets, let's set the
background.
About half of all cancer cases are fatal, and death by cancer is often
prolonged, painful, and very expensive. Those who manage to survive
cancer live out their lives molded by the after-effects of harsh
treatments popularly known as "slash and burn" -- surgery,
chemotherapy, radiation, or some combination of the three.
As more people are kept alive each year with their breasts or
testicles removed, the "cancer establishment" chalks up(기록하다) another
"victory" -- and no doubt the victims are glad to be alive -- but we
should acknowledge that there's something very wrong with calling this
"victory." Slash and burn seems more like a dreadful defeat.
The truth is, an epic struggle has been going on for 50 years between
the "slash and burn=victory" camp, versus those who think the only
real victory is prevention of disease. The struggle occurs across a
fault line(단층선) defined by money. To be blunt about it, there's no money in
prevention, and once you've got cancer you'll pay anything to try to
stay alive. Cancer treatment is therefore a booming business, and
cancer prevention is nowhere. That is the basic dynamic of the debate.
Cancer surgeons can achieve the status of rock stars among their
peers. Those who advocate prevention will most likely find themselves
without funding, ridiculed and despised by the chemical industry, the
pesticide industry, the asbestos industry, the oil industry and all
their minions -- lawyers, bankers, engineers, reporters, professors,
and politicians -- who make a fat living off those who pump out
cancer-causing products and dump out cancer-causing by-products, aka
toxic waste.
논쟁의 시작
The debate began 50 years ago when a powerful voice for prevention
spoke out from inside the National Cancer Institute (NCI). In 1948.
Wilhelm Hueper, a senior NCI scientist, wrote,
"Environmental carcinogenesis is the newest and one of the most
ominous of the end-products of our industrial environment. Though its
full scope and extent are still unknown, because it is so new and
because the facts are so extremely difficult to obtain, enough is
known to make it obvious that extrinsic [outside-the-body] carcinogens
present a very immediate and pressing problem in public and individual
health."
In 1964, Hueper and his NCI colleague, W. C. Conway, described
patterns in cancer incidence as "an epidemic in slow motion":
"Through a continued, unrestrained, needless, avoidable and, in part
reckless increasing contamination of the human environment with
chemical and physical carcinogens and with chemicals supporting and
potentiating their action, the stage is being set indeed for a future
occurrence of an acute, catastrophic epidemic, which once present
cannot effectively be checked for several decades with the means
available nor can its course appreciably be altered once it has been
set in motion," they wrote.[pg. 28]
Hueper of course was right. This is why 50% of all men and 40% of all
women in the U.S. now hear the chilling words, "You've got cancer" at
some point in their lives. That's right, 1 out of every 2 men now get
cancer in the U.S., and more than 1 out of every 3 women.
유해물질에의 노출과 암-Clapp, Howe and Lefevre의 연구가 시사하는 것
Clapp, Howe and Lefevre tell us that between 1950 and 2001 the
incidence rate for all types of cancer increased 85%, using
age-adjusted data, which means cancer isn't increasing because people
are living longer. People are getting more cancer because they're
exposed to more cancer-causing agents.
Contrary to well-funded rumors, the culprit isn't just tobacco or the
hundreds of toxic chemicals intentionally added to tobacco products.
Tobacco products remain the single most significant preventable cause
of cancer, but they have not been linked to the majority of cancers
nor to many of the cancers that have increased most rapidly in recent
decades including melanoma(피부암), lymphomas, testicular, brain, and bone
marrow(골수) cancers.[pg. 1]
No, it's more complicated than just tobacco with its toxic additives.
Most plastics, detergents, solvents, and pesticides and the
toxic-waste by-products of their manufacture came into being after
World War II. From the late 1950s to the late 1990s, we disposed of
more than 750 million tons of toxic chemical wastes.[pg. 27] Over 40
years, this represents more than two tons of toxic chemical wastes
discharged into the environment for each man, woman and child in the
U.S. No wonder some of it has come back to bite us.
Since the U.S. EPA began its Toxics Release Inventory (TRI) program in
1987, total releases have been reported as declining (though EPA does
not check the accuracy of industry's self-reporting). Despite the
reported decline, in 2002, the most recent year reported, 24,379
facilities in the U.S. reported releasing 4.79 billion pounds of over
650 different chemicals. (And TRI data do not include other enormous
discharges: toxic vehicle emissions, the majority of releases of
pesticides, volatile organic compounds, and fertilizers, or releases
from numerous other non-industrial sources.) In 2001, more than 1.2
billion pounds of pesticides were intentionally discharged into the
environment in the United States and over 5.0 billion pounds in the
whole world.[pg. 27]
While all this chemical dumping has been going on, incidence rates for
some cancer sites have increased particularly rapidly over the past
half century. From 1950-2001, melanoma of the skin increased by 690%,
female lung &bronchial cancer increased by 685%, prostate cancer by
286%, myeloma by 273%, thyroid cancer(갑상선암) by 258%, non-Hodgkin's lymphoma
by 249%, liver and intrahepatic duct cancer by 234%, male lung &
bronchial cancer by 204%, kidney and renal pelvis cancers(신우암) by 182%,
testicular cancer(고환암) by 143%, brain and other nervous system cancers by
136%, bladder cancer by 97%, female breast cancer by 90%, and cancer
in all sites by 86%.[pg. 25]
In the most recent 10-year period for which we have data (1992-2001),
liver cancer increased by 39%, thyroid cancer increased by 36%,
melanoma increased by 26%, soft tissue sarcomas (including heart) by
15%, kidney and renal pelvis cancers by 12%, and testicular cancer
increased by 4%.[pg. 25]
OK, so dumping chemicals into the environment has been a major
industrial pastime for 50 years, and cancers are increasing. But why
do we think these things are connected? What real evidence do we have
that environmental and occupational exposures contribute to cancer?
That's what the new Clapp-Howe-Lefevre report is about. It is a
review of recent scientific literature -- with emphasis on human
studies, not studies of laboratory animals. Indeed, the bulk of the
new Clapp-Howe-Lefevre report is a cancer-by-cancer compendium of what
recent human studies tell us about environmental and occupational
exposures that contribute to cancers of the bladder(방광), bone, brain,
breast, cervix(자궁경관), colon(결장), lymph nodes(임파절) (Hodgkin's disease and non-Hodgkin's lymphoma), kidney, larynx(후두), liver and bile ducts(담관), lungs,
nasal passages, ovaries(난소), pancreas(췌장), prostate, rectum(직장), soft tissues
(soft tissue sarcoma(육종)), skin, stomach, testicles, and thyroid, plus
leukemia(백혈병), mesothelioma(중피종), and multiple myeloma(골수종). (It is worth pointing out -- and Clapp-Howe-Lefevre do point it out -- that this compendium
owes a great debt to a data spreadsheet on cancer and its
environmental causes prepared by Sarah Janssen, Gina Solomon and Ted
Schettler, for which thanks are due the Collaborative on Health and
Environment.)
Many of the bad actor chemicals are well-known to us all: metals and
metallic dusts (arsenic(비소), lead, mercury, cadmium, hexavalent chromium,
nickel); solvents (benzene, carbon tet, TCE, PCE, xylene(크실렌), toluene(톨루엔),
among others); aromatic amines; petrochemicals and combustion
byproducts (polycyclic aromatic hydrocarbons, or PAHs); diesel
exhaust; ionizing radiation(전리방사선) (x-rays, for example); non-ionizing
radiation (magnetic fields, radio waves); metalworking fluids and
mineral oils; pesticides; N-nitroso compounds; hormone-disrupting
chemicals (found in many pesticides, fuels, plastics, detergents, and
prescription drugs); chlorination(염소화) byproducts in drinking water;
natural fibers (asbestos(석면), silica, wood dust); man-made fibers (fiber
glass, rock wool, ceramic fibers); reactive chemicals (such as
sulfuric acids(황산), vinyl chloride(염화비닐) monomer, and many others); petroleum
products; PCBs; dioxins; mustard gas; aromatic amines; environmental
tobacco smoke; and outdoor air pollution.
But there is additional evidence linking chemicals with cancer:
** Elevated cancer rates follow patterns -- the disease is more common
in cities, in farming states, near hazardous waste sites, downwind of
certain industrial activities, and around certain drinking-water
wells. Patterns of elevated cancer incidence and mortality have been
linked to areas of pesticide use, toxic work exposures, hazardous
waste incinerators, and other sources of pollution.[pg. 26]
** The U.S. EPA's long-delayed and heavily industry-influenced "Draft
Dioxin Reassessment" released in 2000 admitted that the weight of the
evidence from human studies suggests that, "the generally increased
risk of overall cancer is more likely than not due to exposure to TCDD
[dioxin] and its congeners [chemical relatives]." The report goes on
to conclude, "The consistency of this finding in the four major cohort(집단)
studies and the Seveso victims is corroborated by animal studies that
show TCDD to be a multisite, multisex, and multispecies carcinogen
with a mechanistic basis."[pg. 26]
** Farmers in industrialized nations die more often than the rest of
us from multiple myeloma, melanoma, prostate cancer, Hodgkin's
lymphoma(호지킨림프종), leukemia, and cancers of the lip and stomach. They have
higher rates of non-Hodgkin's lymphoma and brain cancer. Migrant
farmers experience elevated rates of multiple myeloma as well as
cancers of the stomach, prostate, and testicles.[pg. 26]
** The growing burden of cancer on children provides some of the most
convincing evidence of the role of environmental and occupational
exposures in causing cancers. Children do not smoke, drink alcohol, or
hold stressful jobs. Their lifestyles have not changed appreciably in
recent years. In proportion to their body weight, however, "children
drink 2.5 times more water, eat 3 to 4 times more food, and breathe 2
times more air" than adults." In addition, their developing bodies may
well be affected by parental exposures prior to conception, exposures
while growing in the uterus(자궁), and the contents of breast milk.
Clapp-Howe-Lefevre put it this way: "We have learned how to save more
lives, thankfully, but more children are still diagnosed with cancer
every year. The incidence of cancer in all sites combined among
children ages 0-19 increased by 22% from 13.8/100,000 in 1973 to 16.8
in 2000 and most of this increase occurred in the 1970s and 1980s.
Epidemiologic(역학적) studies have consistently linked higher risks of
childhood leukemia and childhood brain and central nervous system
cancers with parental and childhood exposure to particular toxic
chemicals including solvents, pesticides, petrochemicals, and certain
industrial by-products (namely dioxins and polycyclic aromatic
hydrocarbons [PAHs])."[pg. 26]
All in all, the Clapp-Howe-Lefevre report makes a compelling case that
many industrial chemicals contribute to many kinds of cancers. But
where this report really shines is in its clear call for
prevention. In all, there are relatively few products or substances
associated with cancer.[pgs. 10-11, 37-40] Everything doesn't cause
cancer, and many of the things that do could be shunned(avoided) and phased
out(prevented). In principle, a great deal of prevention is possible.
A lifestyle disease로서의 암-Doll-Peto연구와 미국 의료계의 주류적 시각
Thirty years into the prevention-vs-treatment debate -- in 1981 -- two
famous British scientists -- Sir Richard Doll and Sir Richard Peto
-- published an extremely influential study in which they estimated
that "only" 2 to 4% of all cancers are caused by environmental or
workplace exposures. With 1.2 million new cases of cancer each year in
the U.S., half of them fatal, 2% to 4% = 12,000 to 24,000 deaths each
year, most of them preventable. Doll and Peto said tobacco caused 30%
of all cancers and food caused another 35%. We now know that cancer
results from the interaction of our genes with exposure to several
cancer-causing agents. All the necessary exposures must occur to cause
a cancer -- if any one of them is missing, the cancer will not occur.
This is why prevention is important -- it really can work.
Because cancer requires multiple exposures to cancer-causing agents,
it is wrong and misleading to say that "Exposure to product A causes X
percent of all cancers." It simple doesn't work like that. Perhaps
Doll and Peto in 1981 did not know how such things worked, and they
boldly proceeded to estimate what percent of all cancers were
attributable to particular exposures. It was wrong, but their report
served as powerful ammunition for the prevention-is-pointless crowd.
If "only" 2 to 4% of all cancers were caused by environmental
exposures, then there was little incentive to prevent human exposure
to environmental agents, the argument went. What a welcome message
this was for the cancer-creation industries (petrochemicals, metals,
pesticides, asbestos, radiation, and others) and for the cancer
treatment industry! Damn the torpedoes -- full speed ahead!
The prevention-is-pointless crowd latched onto(cling to) the Doll and Peto study
and spread it everywhere. By the end of 2004, the original 1981
Doll-and-Peto paper had been cited in 441 subsequent scientific
papers.[pg. 4] But even more importantly, the federal National Cancer
Institute and the American Cancer Society (which, together, you could
call the "cancer establishment") adopted the Doll-Peto perspective,
that cancer is a lifestyle disease -- the victims themselves are
responsible -- and that prevention of environmental and occupational
exposures is not worth the effort. Remember this was the beginning of
the Reagan counterrevolution and the Doll-Peto paper fit right into
the new ideology -- government is bad, big corporations are good,
we're all individually responsible for whatever bad things happen to
us, and greed is good because it makes the world go 'round. In any
case, the NCI and the ACS largely adopted the Doll-Peto perspective,
and they poured the bucks into new cancer treatments, pretty much
ignoring prevention. Meanwhile, cancer incidence rates climbed
relentlessly -- making the cancer-treatment industry healthier and
wealthier, which allowed it to further erode support for prevention.
Now we are starting to shake off the stupor(인사불성) induced by the misleading
Doll-Peto arithmetic, which pretended to prove that environment and
occupational exposures are of no consequence.
포괄적 암 예방 프로그램(comprehensive cancer prevention programs) 의 중요성
Listen to this marvelously clear-eyed conclusion from the
Clapp-Howe-Lefevre report: "Comprehensive cancer prevention programs
need to reduce exposures from all avoidable sources. Cancer prevention
programs focused on tobacco use, diet, and other individual behaviors
disregard the lessons of science."[pg. 1]
And this: "Preventing carcinogenic exposures wherever possible should
be the goal and comprehensive cancer prevention programs should aim to
reduce exposures from all avoidable sources, including environmental
and occupational sources."[pg. 6]
And this: "Further research is needed, but we will never be able to
study and draw conclusions about the potential interactions of
exposure to every possible combination of the nearly 100,000 synthetic
chemicals in use today. Despite the small increased risk of developing
cancer following a single exposure to an environmental carcinogen, the
number of cancer cases that might be caused by environmental
carcinogens is likely quite large due to the ubiquity [presence
everywhere] of carcinogens. Thus, the need to limit exposures to
environmental and occupational carcinogens is urgent."[pg. 29]
And this: "The sum of the evidence regarding environmental and
occupational contributions to cancer justifies urgent acceleration of
policy efforts to prevent carcinogenic exposures. By implementing
precautionary policies, Europeans are creating a model that can be
applied in the U.S. to protect public health and the environment. To
ignore the scientific evidence is to knowingly permit tens of
thousands of unnecessary illnesses and deaths each year."[pg. 1]
What a blast of fresh air!
uncertainty에 근거한 예방조치 반대논리의 허구
The latest strategy from the cancer-creation industries is to claim
that we can't take action to prevent environmental and occupational
exposures because we don't have enough information. We're simply too
ignorant to make a move. More study is needed. [See Rachel's #824,
#825.] Clapp-Howe-Lefevre allow the eloquent writer Sandra
Steingraber to answer this argument. They say, "A main concern for
Sandra Steingraber, author of Living Downstream: An Ecologist Looks
at Cancer and the Environment, is not whether the greatest dangers
are presented by dump sites, workplace exposures, drinking water,
food, or air emissions:
"I am more concerned [writes Steingraber] that the uncertainty over
details is being used to call into doubt the fact that profound
connections do exist between human health and the environment. I am
more concerned that uncertainty is too often parlayed into an excuse
to do nothing until more research can be conducted."[pg. 29]
Clapp, Howe and Lefevre go on: "At the same time, uncertainty and
controversy are permanent players in scientific research. However,
they must not deter us from enacting regulations and policies based on
what we know and pursuing the wisdom of the precautionary principle.
This is not new thinking, as demonstrated by Sir Austin Bradford
Hill's 1965 address to the Royal Society of Medicine:
"All scientific work is incomplete [wrote Sir Austin Bradford Hill] --
whether it be observational or experimental. All scientific work is
liable to be upset or modified by advancing knowledge. That does not
confer upon us a freedom to ignore the knowledge we already have, or
to postpone action that it appears to demand at a given time."[pg. 29]
예방조치의 가이드라인 guidelines for preventive action
Clapp, Howe and Lefevre then offer some guidelines for preventive
action:
(1) The least toxic alternatives should always be used.
(2) Partial, but reliable, evidence of harm should compel us to act on
the side of caution to prevent needless sickness and death.
(3) The right of people to know what they are being exposed to must be
protected.
Clapp, Howe and Lefevre observe that "the United States has much to
learn" from the proposed European chemicals policy, known as REACH:
(1) requiring that industry be responsible for generating information
on chemicals, for eval!!!uating risks, and for assuring safety; another
way of saying this is, "No data, no market."
(2) extending responsibility for testing and management to the entire
manufacturing chain -- everyone who uses a chemical has a duty to
familiarize themselves with the consequences;
(3) using safer substitutes for chemicals of high concern; and,
(4) encouraging innovation in safer substitutes.[pg. 29]
In the words of ecologist Sandra Steingraber: "It is time to start
pursuing alternative paths. From the right to know and the duty to
inquire flows the obligation to act."[pg. 29]
발암성 유해환경 증가의 근본 원인-경제성장, 지구화 그리고 비용의 외재화
But while we're working in clear-eyed mode here, let's take our
exploration a bit further and look this problem squarely in the face.
The U.S. economy and culture are premised on endless growth. If I
loan you $100 in the expectation that you will pay me back $103 next
year, that extra 3% must come from somewhere. That "somewhere" has
physical dimensions -- something must be dug up or grown to produce
the additional 3%. That something must also be moved, processed, moved
again, packaged, promoted and sold, moved again, used, moved again,
and eventually discarded. Even if it is recycled many times,
ultimately it will be discarded into a natural ecosystem somewhere (at
which point nature begins moving it once again). The inescapable
second law of thermodynamics tells us that each of these steps will
inevitably be accompanied by waste, disorder and other disruptive
unintended consequences. Even if you create the extra 3% per year by
providing a "service" instead of a "product," you still require food,
water, shelter, energy, clothing, tools, transportation, commercial
space, medical care, municipal support services (like police, fire,
emergency services, and sewage treatment), leisure activities,
communications and information, schooling, and on and on.
An economy that is growing at 3% per year is doubling in size every 23
years -- requiring, every 23 years, a doubling in the number of
cities, food sources, mines, factories, power plants, vehicles,
highways, parking lots, schools, sewage treatment plants, hospitals,
prisons, discards, trash and dumps. For a very long time this kind of
rapid growth seemed tolerable. But now things are different -- the
earth is full of people and their artifacts. We can no longer throw
things "away" without affecting someone somewhere.
Something else is new as well. The modern, globalized financial
environment (in which money flows easily across international
borders), creates tremendous competitive pressure to attract
investment by increasing return to investors. That in turn creates
pressure to pass costs along to the general public. Economists call it
"externalizing" costs. If I dump my chemicals and make you sick, I
gain if I can get you to pay your own medical bills, and I gain again
if I can get taxpayers to clean up my mess. Firms have a natural
incentive to externalize their costs to the extent possible, but the
present "globalized" financial environment has increased that
incentive greatly, to improve return to investors.
---------
결론
In sum, let us review the pressures that prevent prevention.
(1) In general, it is difficult to make prevention pay, but
remediation can pay handsomely(come down hansome돈을 후하게 쓰다); this is certainly true for the cancer industry. In general, financial-political-legal incentives are set up to reward those who create problems and those who supply remedies.
(2) Economic growth entails the continual creation of ever-more and
ever-larger messes. Even if we managed to "green" commerce in every
way we can think of today, damage to nature would still be roughly
proportional to the size of the human economy because the second law
of thermodynamics cannot be evaded. And we now know that damage to
nature gives rise to human disease in myriad ways. (For evidence,
follow leads found here, here, here, and here.) Now that the
earth is full, a growing economy creates palpably-growing health problems,
including immune system degradation giving rise to cancers.
(3) The modern economy creates irresistible pressure to increase stock
prices, which in turn creates relentless pressure to externalize costs
by hook or by crook.
So let's not kid ourselves. Yes, cancer must be prevented
because for the most part it can't be cured -- it can only be slashed
and burned away at enormous cost, personal, social and monetary.
But saying cancer must be prevented is one thing. Expecting
that it can be prevented within the framework of the modern
economy is another. We can never stop working to prevent cancer -- and
precautionary policies will always make sense no matter what kind of
economy we have -- but until we shift to an economy that doesn't
require growth, we'll find ourselves right where we are now -- on an
accelerating rat wheel. As a result, we can expect to be living with
more and more cancer at greater and greater cost to ourselves and to
our children, accompanied by ever-increasing pain. It is not a pretty
picture. But at least we can now see it clearly.
===============
[1] Richard Clapp, Genevieve Howe, and Molly Jacobs Lefevre,
Environmental and Occupational Causes of Cancer; A Review of Recent
Scientific Literature (Lowell, Mass.: University of Massachusetts at
Lowell, The Lowell Center for Sustainable Production, September, 2005.
Available here and here and here. Unless otherwise noted,
throughout this issue of Rachel's, footnote numbers inside square
brackets refer to pages in this report.
Return to Table of Contents
[DEBATE FOCUS]
암에 대한 두 가지 상반된 treatment
유해물질에의 노출과 암-Clapp, Howe and Lefevre의 연구가 시사하는 것
A lifestyle disease로서의 암-Doll-Peto연구와 미국 의료계의 주류적 시각
포괄적 암 예방 프로그램(comprehensive cancer prevention programs) 의 중요성
uncertainty에 근거한 예방조치 반대논리의 허구
예방조치의 가이드라인 guidelines for preventive action과 그 의미
발암성 유해환경 증가의 근본 원인-경제성장, 지구화 그리고 비용의 외재화
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