Nothing to See Here
Ever since I was in school, I have heard the words that America is a great country, and the reason why is we have a great economic system which provides the greatest standard of living in the world, and I think that is true. Well, given that kind of statement…it puzzled me in these hearings to hear that in or do protect that great economic system we had to put up with 3,000, 10,000, 50,000 cancer deaths a year from occupational causes in order to protect this great standard of living. Now, it seems to me there is a real contradiction there.
Mike Wright, Industrial Hygienist, Testimony, Washington, DC, July 11, 1978
“How did I get this? What caused it?” In my experience, those are the most common questions I get from myeloma patients. It’s one of those rare times I feel free to give something remotely close to medical advice: “Don’t obsess about it, put it out of your mind if you can, knowing only becomes important if it matters to your treatment. It doesn’t. And you probably won’t find an answer.”
As a member of the myeloma community, however, it matters a great deal. The knowledge that certain toxins are linked with specific types of cancers is now common. Since most myeloma patients know this, the story told by Jim Morris in The Cancer Factory: Industrial Chemicals, Corporate Deception, and the Hidden Deaths of American Workers has a familiar ring to it.
In this case, Morris focuses mostly on the effects of the chemical ortho-toluidine, “a colorless to pale yellow liquid…used to make textile dyes, rubber chemicals, pharmaceuticals, and pesticides.” Workers at a Goodyear chemical plant in Niagara Falls, New York – and their families, after they got home from a day of work – were consistently exposed to the chemical with little-to-no training, protective equipment or cleaning facilities. On the other hand, ortho-toluidine was essential in making rubber and plastic tubing more durable. It was very profitable.
I had planned to write about Morris’s survey of examples around the nation linking specific chemical exposures to certain cancers. In the case of the Goodyear plant, Morris tells the personal stories of some of the workers and their families, many of whom were diagnosed with bladder cancer years and decades after their exposure – once was enough for some. The plant had four times the incidence of bladder cancer as compared to the general population, the average period of latency was twenty-three years.
Lastly, I wanted to convey Morris’s understanding and description of the politics and public policy issues faced by those workers and families when they learned they were at significant risk of being diagnosed with bladder cancer.
Everything changed as soon as I learned about the Supreme Court’s decision in Loper Bright Enterprises v. Raimondo. Few, it seems to me, are aware how much public policy can have to do with the genesis of disease and its treatment. In more than a few cases, their consequences are as important as knowledge of individual genetics.
This will be the first of two articles; next up will be about the potential implications of the Loper decision to cancer research and treatment. Morris’s book is a great place to understand occupational linkages to cancer. It explains the history of regulatory hurdles, both in enforcement and nonenforcement. Often, they can be higher than those science itself builds into each cancer case. But first, a quick refresher on myeloma.
Myeloma’s history is inextricably hitched to those of industrialization and modernization. Although evidence of the disease has been found in Egyptian mummies, it wasn’t until the latter 19th century that the disease was classified as multiple myeloma.
Sarah Newbury and Alexander McBean died decades before their disease was assumed to be myeloma. It seems significant, however, that both lived in the most industrialized city in the world at the time, London, England. It was unsanitary, filled with sewage, subject to mass disease, and urban “progress” meant new chemicals were being discovered, used, and disposed haphazardly, exposing countless people to risks none could yet imagine.
Although impossible to prove if toxic exposures had anything at all to do with Newbury’s or McBean’s myeloma, the suspicion lingers through today. By the next century, however, the connections would become recurring themes in cancer. Even when scientists and activists would make great personal sacrifice when more powerful interests wanted to keep them quiet.
Morris peppers his story with brief descriptions of scientists who proved various linkages of toxic exposures in the workplace to cancer. One, Wilhelm C. Hueper, was a German-born pathologist who emigrated to the United States after World War I. By the early 1930s, while working at a DuPont-funded toxicology lab, he found certain dyes and chemicals were responsible for causing significantly higher incidences of bladder cancer among DuPont’s factory employees.
Hueper soon experienced the same treatment many other scientists who made uncomfortable findings like this. He was fired, ostracized while DuPont’s legal and public relations teams did their best to minimize the news and keep it quiet. DuPont commissioned studies that found no bladder cancer cases over a three-year span. Hueper knew why: it was due to latency, a delay of years, even decades, that it would take for toxic exposure to cause detectable disease. He “came to conclude that commercial interests could not be trusted to protect the health of their employees or their customers.” Profits were too good, and doubt was easily cast to avoid responsibility.
Time often becomes the enemy, translating into the legal stumbling block of latency. It could take years or decades for exposures to be expressed as disease; at the Goodyear plant, bladder cancer was most common. Latency was the corporate lawyer’s best friend. Defense arguments centered on creating doubt, willful amnesia, and time to contrive confusion and justify uncertainty. A cynical pattern began repeating many times over.
Corporate interests often knew the health impact – or at the very least, that it had some significant effect – decades before the news became public. The two most well-known cases are of Philip Morris knowing about the dangers of smoking as Exxon (then Esso) did with data about climate change decades before becoming common knowledge and after fighting countless cases in courts to deny what they knew to be true.
History would prove Hueper’s fundamental ideas to be correct, but only after more cancer cases were found years later. Coincidentally, “Hueper mentioned [ortho-toluidine] in a 1934 review paper; six years later researchers in Japan reported ortho-toluidine caused tumors in the bladders of rabbits that had been injected with it and rats whose skin had been painted with it.” It would take decades before this would make its way into the daily news.
By the 1960s, growing public awareness of environmental issues led to a reassessment of how public health was being protected, if at all. Bipartisan legislation granting authority to existing and newly established federal agencies to address both environmental and occupational sources of disease led to numerous laws signed by Presidents Lyndon Johnson and Richard Nixon.
Ohio’s burning Cuyahoga River and southern Californian smog were just two of countless examples of political consensus which, oddly, occurred at the same time the turmoil of Vietnam and Watergate were creating deep national, regional, social and political divisions. Americans wanted a cleaner environment; they were becoming more aware of connections between pollution and chemicals to diseases. Not since the turn of the century, when muckraking reports exposed dangerous, unsanitary conditions throughout American business and communities was public support so high.
At the federal level, the Environmental Protection Agency (EPA), the National Science Foundation (NSF), the Centers for Disease Control and Prevention (CDC), and the National Institutes of Health (NIH) were beefed up. To broaden protections for workers, agencies like the Occupational Health & Safety Administration (OSHA), the National Institute for Occupational Safety and Health (NIOSH), and National Labor Relations Board (NLRB) were created.
A report by President Nixon’s Council of Environmental Quality explained this newly found sense of urgency: “Our awareness of environmental threats, our ability to screen and test substances for adverse effects, and our capability to monitor and predict, although inadequate, are sufficiently developed so that we need no longer remain in a purely reactive posture with respect to toxic substances. We should no longer be limited to repairing the damage after it has been done; nor should we continue to allow the entire population or the entire environment to be used as a laboratory.” [Emphasis added.]
Appearances, as Morris explains in what I consider to be the most revealing parts of his book, could be deceiving. He shows how these agencies were consistently undermined by the same interests that created them. Hidden in the legal language ostensibly designed to protect the public, rules were written to limit reach and effective action.
Congress would, for example, mandate agencies to conduct workplace inspections, but approve too few resources to do the job. This was consistent with most administrations, excepting that of Jimmy Carter, from the 1960s through today, reaching its nadir during the Trump Administration:
OSHA suffered mightily at the hands of Donald Trump. By the end of his administration, the number of inspectors had plunged to nearly its lowest levels since the agency was created. There were only 1,719 – 755 federal, 964 state – to cover 10.4 million workplaces for fiscal year 2021, according to the AFL-CIO. This translated to one inspector for every 81,427 workers. OHSA’s puny budget meant the nation was spending $4.37 to protect each worker – a little less than the cost of a venti latte at Starbuck’s.
What few inspections that took place were often inadequate for the job required. Active opposition from corporate interests would be distilled into an anti-regulation talking point that live on today: excessive regulation will eat into profits and therefore jobs and economic prosperity because the costs would ultimately be borne by consumers.
Congressional obstruction to its own creations seemingly followed the template: overpromise, underfund, understaff, and create an appearance of actually doing something substantive while doing little-to-nothing of the sort. Agencies created to address worker safety were undermined by corporate political donations and stonewalling to deny staff and funding to implement rules. Science-based evidence would be diluted and hindered by bureaucratic stalling. The few times workers prevailed was mostly due to union representation and a few committed individuals whose lives were devoted to science and justice.
Despite these obstacles, most of the few that were hired were extremely competent and committed, much like we saw with Frances Oldham Kelsey and the approval of thalidomide. Virtually all of them were apolitical and devoted to the science that inspired them to make it a career. Taken together, they created a meritocracy based on expertise that was unmatched in prior history. Unfortunately for them, science arguments did not have much legal standing.
Raising doubt became a reliable, tried-and-true legal strategy for corporations’ defense in court. Latency was a powerful deflecting argument. Doubt caused by time and memory was as well. A 1989 deposition of a fifty-five-year-old former Goodyear worker, Richard Sullivan, diagnosed with bladder cancer who sued the company illustrates the ordeal:
Sullivan was asked to describe, in excruciating detail, the jobs he did at Goodyear and estimate how many times, and in what ways, he might have been exposed to ortho-toluidine. DuPont’s lawyer…quizzed Sullivan on his personal habits, fishing for anything other than the suspect chemical that might have set off the plaintiff’s cancer. Did Sullivan smoke? (Yes, a pack or half-pack of unfiltered Chesterfields a day; he’d quit “off and on.”) Drink alcohol? (Not anymore; used to when “socializing.”) Drink coffee? (Four or five cup a day.) Consume sugar or artificial sweeteners? (Yes; no.) Eat red meat? (Not often.) Did his home have formaldehyde insulation? (No.) City water? (Yes.) And on it went.
Morris recounts numerous similar instances. Just as long as “anything but the defendant’s product caused the plaintiff’s illness or death. Smoking, drinking, genetics, atrocious luck – but not the product over which you’re suing.” It became the “anything but my product” defense.
Workers were kept in the dark. Whatever complaints they had were dismissed. One Goodyear medical director, speaking to workers in the 1980s, “tried to convince the men they had a better chance of getting bladder cancer from grilled meat than from any chemical in the plant.” Workers’ private behavior and lifestyles became the culprit, not the chemicals to which they were exposed, not the lack of safety protection or training provided by Goodyear.
Ridicule became a defense tactic. In one trial, a corporate attorney opined, “Hadn’t Joe’s mother and father died of cancer? They had.” He pointed out that “none of them worked” at the plants the defendant claimed caused his cancer. The attorney replied with snark, “they all got cancer. Isn’t that amazing?” The implication? It could have been hereditary.
Perversely, one defense tactic admitted linkages, but not to the chemicals or behaviors being tried in court. It wasn’t the chemical on trial that caused the cancer, it was one of many others. Logically, it was like arguing: “The actual death of a murder was not caused by the gunshot. The knife sticking in the body, the bruises to the head, and the poison in the bloodstream had nothing to do with it.” But laws and trials sometimes have a logic of their own.
Legal rules use scientific doubt as a cudgel, scientists see it as motivation. Legalities consider cost-benefit-analysis equations and other non-scientific business data to make decisions. Science doesn’t. Which calls into question if the legal system is even capable of making decisions about the ever-increasing complexity and ethical issues of medical science.
Compare this situation with how car maintenance and repair has changed in the past few decades. Backyard mechanics flourished for decades, some still do, with older cars. Even those not mechanically inclined could do simple things like change oil. Those days are gone. Intricate computer systems in cars mean we usually have to leave it to professionals; oil changes are not for amateurs anymore.
Sometimes public outrage, sympathy, or some combination of both creates politically defined exceptions. As I noted about Don Thomas and bone marrow transplantation (BMT), if you were unlucky enough to be diagnosed with an immune-compromising cancer or disease but had the “luck” of having a healthy identical twin, BMT was potentially curative. And if one diagnosed was in the wrong place at the “right” time, politics could trump science and the legal system.
The best examples being Vietnam Veterans exposed to Agent Orange and September 11 first responders and those who were at Ground Zero. Even though the scientific linkages between their cancers and other diseases related to these toxins, no categorical, unequivocal links exist, at least find reasonable, legally valid excuses to bypass scientific certainty could be found. In both cases, just proving one was exposed and had been diagnosed with one of the covered diseases satisfies the political assumption to qualify for full medical benefits.
But for the most part, cancer patients are pretty much on their own. Especially in the United States, wealthy and well-insured persons will have advantages of timeliness and access that many won’t. Those exposed to harmful, cancer-causing risks through their employment are “ambushed by a preventable, chronically induced illness that could not be blamed on lifestyle, genetics, or rotten luck.” They are, by definition, victims.
Profit motives fed by consumer demand leads to quantifiable indifference and human costs. Cold calculations such as the percentages of “allowable, safe” levels of exposure to chemicals known to have carcinogenic effects on humans are used to justify immoral outcomes. Legalisms based on cynical, contrived fictions create weak—or more often than not, non-existing—standards and practices to keep affected employees ignorant of the hazardous nature of their jobs.
This fed the "myth…that ‘safe’ levels of carcinogens could be determined” when in reality “there were no safe levels.” Medical evidence, research known to employers, was routinely, intentionally hidden or manipulated or appear of inconclusive, resulting in workers being hit by “an adversary they couldn't see, one that weakened untold numbers of them over time and lopped years off their lives.”
In playing down the risks of handling ortho-tuluidine, by carelessly exposed workers and their families and neighbors, Goodyear was responsible for setting off the genetic trigger of bladder cancer. And while Morris devotes more space to explain this episode, he buttresses it with relevant examples from around the nation and history to strengthen his arguments.
The Cancer Factory is a parable that will only become more relevant in the coming years because cancer is a disease of modern life. We cannot avoid the air we breathe, the foods we eat, the jobs we have. And we don’t yet know how, for example, microplastics, forever chemicals, or the consequences of climate change might damage our genes or those of future generations to set off the chain reactions to create new cancers, diseases, or disabilities. In some cases, it might not even be genetic.
Given the shameful record of corporations distancing themselves from health issues their businesses cause and the mixed, overwhelmingly timid record of governmental attention, it’s hard to be optimistic. But doing something positive about environmental and occupational cancers — even preventing them is not impossible — if it happens at all, will be in very small increments.
Even that might be too much to hope for in the future should even some of the predicted implications of the Loper decision come true. Especially for newly diagnosed patients who will ask, “How did I get ths?”
I’ll explain why I feel this way in my next article.