Sandra Steingraber © Benjamin Gervais/The PPC
Sandra Steingraber: There's a taboo about telling industry and agriculture that practices must change to prevent cancer
30th November, 2010
Having survived cancer, biologist Sandra Steingraber wrote a book to expose its link to the environment. As the film version premieres in Europe, she tells the Ecologist why we must all take a stand on air, food and water pollution
The environment and cancer seems like an overwhelming and depressing problem, but its root causes are the same as those that are killing the planet
Matilda Lee: Can you briefly explain the idea behind your book and film Living Downstream?
Sandra Steingraber: It represents my best attempts as a biologist to summarise the state of the evidence for the link between cancer and the environment. At the same time, as a cancer patient myself, it tells my own story of my diagnosis, aged 20, with bladder cancer, which has known links to the environment.
It's a personal memoir, and interwoven between the scientific analysis is a story about my return home as a woman in my 30s, a biologist investigating the environmental toxins in her home town. You see the story of my family, who still farm in Illinois and still use some toxic pesticides; the story of the industrial chemicals that leaked into the drinking water wells there. I really went in search of my own ecological roots and became an environmental detective.
I discover that there is a cancer cluster where I grew up and I'm one data point in that cluster. But I also care for the other people who live there, and I care for the river and the farm fields. It's a kind of love story between me and this place, but at the same time it's a scientific analysis.
ML: How strong are the links between chemicals and cancer?
SS: The evidence is quite compelling. It's my impression as a cancer patient that there is a disconnect between what we in the scientific community know about the evidence for the link, which is quite a lot, and what cancer patients are told when they talk to their doctors about it, which is very little. This discontinuity was my motivating force for writing the book. I decided that I wanted to bring the evidence that I knew as a biologist to other cancer patients and have my own life serve as a kind of bridge.
ML: Why aren't we told about all the evidence for the link between cancer and the environment?
SS: For one, there is a double standard: the evidence for the link between, say, hereditary factors and cancer is actually not that strong, and we freely talk about the importance of family history to cancer patients.
We know there is a link between lifestyle factors, such as diet, and cancers such as colon cancer. But for breast cancer, the data are contradictory, yet we feel free to tell women to change their diet as a way of preventing breast cancer, even though the evidence is not very good. At the same time, we have equally good if not better evidence for a link between air pollution and breast cancer.
To talk about that, the ‘cease and desist’ order would have to be directed at industry, or our energy sector, rather than individuals. Cancer is a disease that makes you feel helpless. I think there is an intent to make people feel that they have control over their future, so they give them all kinds of tips about what to do in their individual lives. The idea that air pollution and breast cancer are related doesn't really offer an individual cancer patient advice on what to do – we leave it out.
Maybe that is rightfully so. Who needs to be told that the air they breathe is contributing to the disease that they are now trying to fight with chemotherapy and radiation? Maybe that would make cancer patients feel helpless, when we want them to have a fighting spirit. But then comes the silence. Then we don't turn around and tell industry that we have evidence that combustion byproducts such as polycyclic aromatic hydrocarbons are contributing to breast cancer, so we need to stop and get off fossil fuels. That message never gets played out.
I think there is a cultural willingness to tell individual cancer patients what to do, and a cultural taboo about telling industry and agriculture that their practices need to change to prevent cancer.
Another reason is the medical education of physicians. Having taught in the medical and pre-medical programmes at universities myself, I would say that the doctors that are training are not getting a good background in environmental health. It's not part of their curriculum.
The evidence has become much more rigorous in the past decade, and there have been many breakthroughs. Epigenetics shows how environmental signals alter the expression of genes in a way that can place cells on the path way to tumour-formation. If a physician, like an oncologist or cancer doctor, has not graduated recently, they may not have had that information.
ML: Why is there so little money given to researching prevention (rather than cure) in the major cancer charities?
SS: I don't know. It's a mystery to me as well. In the US, the latest report by the president's cancer panel, part of the National Cancer Institute, was about the link between cancer and the environment. The panel that reviewed the literature, in the same way that I did, and came to many of the same conclusions that I did, also heard testimony from some 40 experts on the issue of cancer and the environment.
The panel became so persuaded of the strength of the evidence, and so alarmed at how little attention has been given to this, that they took the unusual step of accompanying their report with a letter to the president that said the ‘burden of environmental cancer has been grievously underappreciated’ and urged the president to use the power of his office to remove carcinogens from the air, food and water.
Yet we did not see our cancer charities rally around this report. In fact, the American Cancer Society immediately moved to downplay the report. I find it mysterious and distressing. The data are there, and we have the opportunity to prevent all kinds of suffering and save lives before cancer even gets started. Our treatments aren't that good. Half of all cancer patients go on to die from it; this hasn't changed very much. I can only speculate about why more money is directed to look at new treatments rather than to prevention.
ML: What has been the response of the chemicals industry to your book?
SS: I haven't heard from them, so I don't know.
ML: What do you want people to do after becoming aware of the link between cancer and the environment?
SS: The bulk of the chemicals that cause cancer are derived from fossil fuels, petrochemicals. Moving our economy away from fossil fuels is already something we need to do because of climate change. Even though the environment and cancer seems like this big, overwhelming and depressing problem, in fact its root causes are the same as the causes that are killing the planet.
I often use a metaphor: we are all musicians in this great human orchestra. It really is time now to play the ‘save the world’ symphony. None of us has to play solo, but we do have to know which instrument we hold and play it as well as we can. Everyone has some expertise to bring to this huge human-rights issue: people who are chefs can source from local, organic farmers. I work with young girls who are trying to promote non-toxic makeup and nail varnish. Architects can design more energy-efficient buildings and find substitutes to materials such as polyvinyl chloride, which causes cancer in workers. Athletes can promote organic playing fields and golf courses; fashion designers can take on the dry-cleaning industry and source organic fabrics. We all have a role to play. Cancer patients have a role to play, too: we don't give up easily; we fight – I want us to bring that same fighting spirit to cancer-prevention.
ML: The US premiere of Living Downstream took place in your home town. Have things there changed for the better?
SS: I have been delighted to learn that now there is a thriving, organic farm culture instead of endless fields of soy and corn, which were very intensively farmed and used for ethanol production, animal feed or snack food. Now there are famers' markets.
At the same time, in the area where the cancer rates are high, there is a plan to build a mega-hog-farm operation. There are so many chemicals used to raise animals in that way, my concern will be drinking-water contamination. It's the last thing that community needs.
The second edition of Sandra Steingraber's book Living Downstream: An ecologist's personal investigation of cancer and the environment (Da Capo press, March 2010) is available in North America.
The European premiere of Living Downstream takes place tonight in Brussels. Sandra Steingraber will be speaking at the European Parliament on behalf of HEAL, a non-profit that advocates greater protection from exposure to environmental chemicals, including carcinogens.
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Re: Sandra Steingraber: There's a taboo about telling industry and agriculture that practices must change to prevent cancerwell done
Re: Sandra Steingraber: There's a taboo about telling industry and agriculture that practices must change to prevent cancerActivists like Sandra are the only hope in an otherwise dark tunnel. Her views are to the point and practical. As a teacher she is able to know how even medical practitioners are also ignorant or not bothered about pollution and its effects on humans
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ugxAs the American Psychiatric Association unveils the latest edition of what is considered the "bible" of modern psychiatry this weekend, the uproar over its many changes continues.
"This is unprecedented, the amount of commentary and debate and criticism," said Dr. Jeffrey Lieberman, president-elect of the American Psychiatric Association (APA). "It's been an interesting phenomenon, but the evidence is what it is. You have to evaluate it and then make your own determination of how compelling it is, and what would be best clinical practice."
The APA believes that changes made in this fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) will allow for more precise diagnoses of mental illnesses in patients, because this edition better characterizes and categorizes disorders.
But it has drawn fire from critics who are concerned that the revised version will lead to the diagnosis of mental illness in people who are simply being challenged by life.
More than 1,500 experts from 39 countries representing a wide variety of medical fields contributed to the new DSM-5, which was more than a decade in the making. Drafts of the manual were made available online as part of three open-comment periods that drew more than 13,000 responses.
One of the most notable naysayers has been Dr. Allen Frances, chairman of the task force that created the DSM-4, the previous version of the guide that has been in use since 1994.
In a commentary released the day of the DSM-5's release, Frances wrote that this latest revision introduces "several high-prevalence diagnoses at the fuzzy boundary with normality," and predicted that the changes "will probably lead to substantial false-positive rates and unnecessary treatment."
"In DSM-5, normal grief becomes a major depressive disorder, temper tantrums become disruptive mood dysregulation disorder, worrying about medical illness becomes somatic symptom disorder, gluttony becomes binge eating disorder and almost everyone will soon qualify for attention-deficit disorder," Frances said in an interview.
The main points of contention regarding the DSM-5 include:
The combination of a number of autism-related disorders into a single category called autism spectrum disorder. Although some clinicians believe that placing autism on a continuum from mild to severe will allow for more accurate diagnoses, others are concerned that high-functioning people with autism will find themselves unable to receive services or treatment. This is particularly true of people with Asperger's Syndrome, a diagnosis that has been eliminated from the DSM-5, critics of the new version contend.
"We're concerned that people who have Asperger's -- who have high-functioning autism -- are going to be dismissed as just being different when the majority of adults with Asperger's will need people to assist them in parts of their lives," said Karen Rodman, president and founder of Families of Adults Affected With Asperger's Syndrome.
"We are very concerned that medicine is going to drop the ball again, and the children who need services won't get them," Rodman said. "Fortunately, clinicians and physicians and the public around the world are still going to refer to Asperger's as Asperger's. It's like saying people don't have a right arm anymore.
"Many people with Asperger's are [also] concerned there will be a stigma -- that everyone will be considered autistic -- and when people think of that they think of a child sitting in a corner and spinning," Rodman added.
Changes made to the diagnostic criteria for attention-deficit/hyperactivity disorder (ADHD). Critics are concerned that changes made to better diagnose ADHD will instead lead to over-diagnosis. In the previous version of the DSM, a person needed to show the onset of symptoms before age 7 to be diagnosed with ADHD. The new version now says 12 is the latest age at which ADHD symptoms can manifest themselves. The DSM-5 also reduces the number of criteria needed to arrive at a diagnoses of adult ADHD from six to five.
A new diagnostic category for children who are hostile or acting out. The DSM-5 includes a new category called disruptive mood dysregulation disorder, which would apply to children who have extreme irritability but fall short of the standards for bipolar disorder or depression. The category was created to deal with the upswing in bipolar diagnoses among children, but there is concern that some clinicians will label a simple childhood temper tantrum as a treatable mental illness.
Breaking out obsessive-compulsive disorders into their own category. Obsessions such as hoarding, hair-pulling and skin-picking had been considered anxiety disorders, but in the DSM-5 they will have their own category. Critics are concerned that this change has more to do with reality television's recent focus on hoarders than with the need for a new category of mental illness.
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