Man’s unending war against cancer

I started reading The Secret History of the War on Cancer by Devra Davis on a flight to Stockholm. For light relief, I also bought the airport edition of John Grisham’s new novel, The Appeal. One book is a semi-fictional account of evil petrochemical firms poisoning the environment and causing cancer, with a political and legal conspiracy to hide the facts. And by an amazing coincidence, so was Grisham’s novel! I’ll give you two guesses as to which was the more readable.

The thesis in Devra Davis’ book runs as follows. The majority of cancers today are caused by environmental pollutants and there is a conspiracy of the biggest industrial companies in the USA, aided and abetted by government agencies and ‘hired guns’ amongst the scientific establishment, to bury these facts along with the landfills of toxic effluent.

Davis, PhD, MPH, is director of the Centre for Environmental Oncology at the University of Pittsburgh Cancer Institute in the US. To begin with I was well disposed to her, as we seemed to have much in common. She makes much of her Jewish roots and how these traditions influenced her philosophy. So do I.

I spent a seminal year in Pittsburgh working with the doyen of breast cancer research, Dr Bernie Fisher, in 1971. I was there when Dr Fisher co-signed the Nixon Cancer Act, promising to find the cure for cancer in the 1970s. President Kennedy’s goal of landing a man on the moon by the end of the decade was achieved while Nixon was in the White House; Nixon wanted to upstage him with an even grander achievement. Back then, Dr Fisher and I shared Dr Davis’ scepticism at this initiative. Nixon actually brought in engineers from the National Aeronautic and Space Administration (NASA) to design a 10-year programme of research and development, based on the lunar landing project, to lick cancer during his administration and also perhaps to deflect criticism about the US preoccupations in South-East Asia. I clearly remember sharing the joke with Dr Fisher as we gazed at a wall covered with flow charts and tick boxes that appeared to provide a road map to direct the cancer scientist to the Holy Grail.

Dr Fisher was happy to take his share of the loot to follow his own line of research that eventually led to a 30 per cent reduction in breast cancer mortality over the past 25 years. Our scepticism about Nixon’s drive was based on understanding the difference between cosmology and oncology. We knew precisely where the moon was (next door in cosmological terms); we had rockets that could reach that far, so the rest was technology and engineering. We didn’t know where cancer was in the 1970s, other than it was hiding somewhere in the vast micro cosmos of the cell. Sending off missiles at random (for example, non-specific chemotherapy) was as likely to miss the target and kill the patient as to contribute to a cure.

Davis’ scepticism is based on the fact that nowhere in this vast wall chart was there a box to tick concerning the prevention of cancer from environmental carcinogens. While I would agree immediately that this was a grave omission, she goes further in claiming that tackling environmental pollutants is the complete answer to the cancer problem. She knows this for certain and will brook no argument. At this point, she begins to lose my sympathy. She seems to have abandoned the discomfort that most scientists experience in living with uncertainty and this book ends up as an evangelical polemic written in a tiresomely hectoring tone. What’s even worse is when she pauses in lecturing us in order to introduce some folksy anecdotes. Davis suggests these tales, which she offers up as proof of her prejudices, have the same evidential value as the formal epidemiological studies she selectively cites.

Epidemiology is something of a blunt instrument, very good at demonstrating associations but rather poor at demonstrating causality. Let me illustrate this by ‘proving’ that the cathode ray tube causes breast cancer. There is a direct association between the ownership of televisions and the incidence of breast cancer. There are geographical differences in the incidence of breast cancer and the ownership of TVs. There is a dose response in that the more TVs per household, the greater the incidence of breast cancer. Finally, in the Western world, there has been a sudden increase in the incidence of breast cancer as the old cathode ray TVs have been dumped in landfills, polluting the environment, replaced by new, flat-screen monitors. Pretty convincing, you have to agree – cathode ray TVs ‘cause’ breast cancer, right?

However there is another way of looking at it. Television ownership is a surrogate measure for the prosperity of a country. Well-off areas have higher rates of TV ownership, and individual well-off households tend to have quite a few television sets in them. Prosperous women may delay their first pregnancy, become fat and indolent and drink too much wine – all of which are known to be risk factors for breast cancer. So perhaps it is not the televisions but other health factors that explain breast cancer differentials.

Flat-screen televisions were gradually introduced at the same time as programmes of mammographic screening for breast cancer were being rolled out in Europe. Perhaps the mammographic screening, not the TVs, was the problem. Screening leads to the over-diagnosis of breast cancer and a sudden apparent increase in incidence of close to 20 per cent. As I have argued previously on spiked, mammographic screening is not the unalloyed good many believe it to be; indeed, it can cause high levels of stress and even illness (see What mammography misses, by Michael Baum).

Now, after that cautionary note, let me give examples of the good, the bad and the ugly components of Davis’ seriously flawed book.

When Davis is good, she’s very, very good. The second chapter on the history of epidemiology and the discovery of industrial diseases – from scrotal cancer amongst chimney sweeps to cancers amongst the pioneers in the discovery of ionising radiation to hydrocarbon carcinogenesis amongst petroleum workers in the 1920s and 1930s – is captivating. Marie Curie died of cancer, and I’m one of the privileged few who have been allowed a short exposure to her laboratory at the Institut Curie in Paris. Her notebooks are still dangerously radioactive.

Davis’ third chapter on the work of Nazi scientists is fascinating. There is no doubt they understood the hazards of tobacco and tried to ban it in the name of hygiene for the Aryan race. There may indeed have been a blindness to their work because of its origins, and they certainly conducted some deeply unsavoury experiments. However, I think it was unlikely, as Davis suggests, that there was a formal conspiracy amongst the Allies to hide the Nazis’ data on tobacco and cancer. Her long discussion on Nazi eugenics, although truly interesting, seems out of place in this book. On principle, everything the Nazis were for – racial hygiene, organic farming, natural remedies, homeopathy and anti-vivisection – I am against. Maybe I need to look again at today’s anti-tobacco campaigns – given their origins in Nazi science, perhaps it isn’t surprising that they can be almost fascistic in their torment of the poor old guys addicted to the weed.

It is when Davis describes the history of the chemical industry, the tobacco industry and the asbestos manufacturers and their malignant fallout that she really gets into her stride. She is on safer ground here; there is little doubt that, throughout the first 60 years of the twentieth century, there was a determined effort by industry to hide the evidence supporting the malignant potential of their products. One hundred per cent of workers in the benzidine dye company IG Farben developed bladder cancer after 25 years exposure in the 1930s, but this fact only appeared in the public domain in 1946. This was a shameful period in the history of industrialisation and the development of the consumer society. A point of farce was reached when the tobacco giant Lucky Strike developed a ‘safer cigarette’ by incorporating an asbestos filter tip! Davis makes a good point when she says the tobacco industry wanted it both ways: whilst vehemently denying the carcinogenic properties of its products, the industry spent a fortune on trying to develop a ‘safe alternative’. And this work was supported by the head of the National Cancer Institute, Kenneth Endicott, who was himself a chain smoker.

Now to the bad: I could have chosen several chapters for the ‘bad section’, but the one that made me most angry is chapter 15, titled ‘Presumed Innocent’. This covers, amongst other things, Davis’ unsubstantiated conviction that mobile phones cause brain cancer. ‘Why are more children developing cancer and learning problems?’ she asks. Well, actually they’re not. ‘Why does the government of England advise that persons under 18 should not use mobile phones at all?’ she asks. Actually, it doesn’t. (I am planning to buy my 11-year-old granddaughter one when she goes to her secondary school later this year.) Davis writes about the large and impressive study carried out by the Danish Cancer Society, which concluded there was no link between mobile phones and brain tumours, only to rubbish it. The study failed to account for electromagnetic rays in coffee shops, she complains… it only looked at 10 years of usage… and her killer argument: the researchers received funding from the telecommunication industry. Describing how one’s opponents received funding from ‘corporate interests’ has become a surefire way of shooting them down in our cynical age.

Davis even claims that electromagnetic radiation causes male breast cancer by quoting relative risks that are not significant, and some of the other statistical manipulations she uses to advance her case against all the available evidence might be considered scientific misconduct if published in a peer-reviewed journal. She ends up concluding that almost every aspect of modern life is a cause of cancer until proved otherwise. And yet, and yet, we who are privileged to live in the Western industrialised nations are enjoying the longest expectation of life on record.

And finally the ugly: every study that reinforces Davis’ prejudices is described as stunning and its authors as distinguished. Every one that goes against her belief system is flawed and published by someone of no account.

She even describes RA Fisher as an obscure British statistician because she didn’t like his results. Obscure? He was one of the most famous statisticians, giving rise to the eponymous ‘Fisher’s Exact Test’. His standing was such that there is a blue plaque on the wall of his house to mark the fact that he lived there – not far from my house, as it happens.

Worst of all, though, is the way she deals with Sir Richard Doll (1912-2005), the British physiologist credited with confirming the link between smoking and lung cancer. Clearly, she does not see eye-to-eye with him on many issues, but she cannot dismiss him as ‘obscure’: along with Austin Bradford Hill and Archie Cochrane, Doll was one of the greatest medicine men in the latter half of the last century. So she sets out to assassinate his character instead. She writes: ‘We will probably never know whether Doll’s ideas about how scientists should study industrial hazards were at all coloured by the fact that he secretly served as a highly paid consultant for the asbestos, chemical and pesticide industries.’

Sadly, Sir Richard is no longer here to defend himself; he died at the age of 94 nearly two years ago. Like many in the British oncology community, I knew Sir Richard and admired him enormously. I served on a number of data monitoring and safety committees under his chairmanship. He was a man of great principle, scientific integrity, modesty and charm. More than most of his generation, along with my good friend Sir Richard Peto, he contributed to the massive fall in deaths from lung cancer over the past 30 years: the greatest success of all time in tackling the dangers of environmental pollution. He lived modestly in college at Oxford University and was the last person you could imagine taking backhanders. Davis’ character assassination reveals more about her than it does about Sir Richard.

I finished this book on a visit to Florence. After giving a lecture in the city, I went to visit the Palatine galleries of the Pitti Palace. The walls of the gallery are filled three rows high and five rows across with histrionic paintings clamouring for your attention. Yet unbidden, in each room, my attention was drawn to the sublime and peaceful paintings of the Madonna and child by Raphael. Their truth was manifest in spite of the background noise. That’s how I feel about this book. Some of the chapters are masterpieces when Davis allows the facts to speak for themselves, but the totality is seriously flawed by her shrillness and self-interested manipulation of the facts. One wonders whether the publisher ever thought to employ an editor.

If you want to read a book which is close to the truth and will fill you with righteous indignation, I recommend Grisham’s The Appeal. His subject matter is so closely linked to Davis’ book that I had to check in the acknowledgement section to see if Davis’ name appeared there; it doesn’t. Could Grisham be accused of plagiarism, or is this all another episode of synchronicity in my life?

Michael Baum worked for 30 years as a surgeon specialising in breast cancer, and is now professor emeritus of surgery at University College London.

The Secret History of the War on Cancer, by Devra Davis is published by Basic Books. (Buy this book from Amazon(UK).)