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Samuel S. Epstein, MD, is a national treasure. A professor emeritus of Environmental and Occupational Medicine at the University of Illinois School of Public Health, he is one of the world's leading scholars on the topic of the environmental causes of cancer. The author of nearly a dozen books and over 250 scientific articles ... Since the 1970s, he has also been the public voice of a considerable movement to slow the wanton introduction of toxic chemicals into our food, air, water and workplace. Very reasonably, he and his medical and public health colleagues have demanded studies before such chemicals were introduced into general use, to make sure they were not harmful. Industry has provided little in the way of assurances that such chemicals are indeed safe.

During the Carter administration, this cautionary position did achieve a small degree of acceptance. One director of the National Cancer Institute (NCI), Arthur C. Upton, MD (1977-1979) was sympathetic to this point of view. However, since the introduction of Pres. Ronald Reagan's pro-industry policies, no administration - Republican or Democratic - has seriously taken up the challenge of controlling the long-term dangers posed by this chemical onslaught.

In 1978, Dr. Epstein published his famous book, The Politics of Cancer, which showed how the federal government had been generally corrupted by industrial polluters. His new book, Cancer-Gate, will hopefully have a similar impact on a new generation of potential activists. The book shows that, contrary to the impression fostered by our public relations-dominated media, we are in fact losing the much-vaunted "War on Cancer."

Be forewarned. Unlike most academics in the cancer field, Prof. Epstein is passionate about public health and cultivates a take-no-prisoners style. Repeatedly rebuffed by the powers that be, he does not hesitate to name names. He claims, for instance, that the National Cancer Institute (NCI) and the American Cancer Society (ACS) have both betrayed us, spending tens of billions of dollars of taxpayer and charity money "primarily targeting silver-bullet cures.while ignoring strategies for preventing cancer in the first place."

As a result, he says, cancer rates have escalated to epidemic proportions, now striking one in every two American men, and more than one in every three women. "This translates into approximately 50 percent more cancer in men," says Epstein, "and 20 percent more cancer in women over the course of just one generation." The book is worth getting simply for its discussion of whether cancer rates are going down, as NCI claims - or whether, as Epstein claims, they are in fact rising steadily.

Epstein is well aware of the influence that "Big Pharma" has on our health care system. He quotes a recent NCI director as admitting that NCI itself has become a "governmental pharmaceutical company." Similarly, the ACS also has been transformed into a cheerleader for special interests, rather than a steward of the public trust.

Epstein further claims that NCI and ACS are sitting on "mountains of information about avoidable environmental causes of cancer rather than making this available to the public in any systematic and understandable way. This silence has even extended to the frank suppression of such information, denial of the public's right to know, and violation of human rights."

Many of the facts in Prof. Epstein's indictment are simply undeniable. For instance, the failure of NCI to address issues of environmental pollution is certainly not due to a lack of funds. NCI's budget has increased 30-fold since 1971, when Pres. Nixon launched the war on cancer, and now totals $4.6 billion per year. "Paradoxically," Epstein states, "it seems that the more money we spend on cancer, the more cancer we get."

It is not that NCI, in principle, does not acknowledge the impact on the environment. If you go to the NCI website, you find the following statement: "The majority of cancers are linked to the environment." But what NCI means by "the environment" in this context is not so much the carcinogenic pollutants in our air and water as individual risk factors such as smoking and diet. In practice, most of NCI's focus is on changing lifestyles rather than confronting industrial pollution.

Historically, the NCI and ACS have mainly focused on highly publicized "cures" for cancer. But this emphasis has largely been a bust as well. Most of NCI's resources, Prof. Epstein says, are spent on promoting ineffective drugs for various kinds of terminal cancer. This is the aspect of cancer that generates the most positive publicity. NCI's directors are constantly promising that we are "turning the corner in the cancer war." The latest in a long line of such promises is the "challenge vision" of the current director to end the pain and suffering due to cancer by the year 2015.

A populist of the old school, Prof. Epstein calls for an end to the "cancer plutocracy" and a return to "public health democracy." It is a bold vision that is unlikely to find him many friends in the current administration. Nevertheless, he outlines a wide range of reforms that could save hundreds of thousands, or even millions, of lives. These include:

1) Reforming the NCI and ACS. He suggests that NCI's cancer prevention program be placed on an equal budgetary footing with all its other programs combined. It proposes the formation of a National Cancer Prevention Registry - which would be a clearinghouse freely available to the public in print and online - of all known chemical and radioactive carcinogens.

2) The right to know. Epstein insists that he public's right to know be validated by requiring NCI to disseminate information about known carcinogens in the environment and consumer products.

3) A wake-up call for Congress. Cancer-Gate carries a foreword by Congressman David Obey and an introduction by Congressman John Conyers, Jr. So Prof. Epstein's message is certainly not without its followers on Capitol Hill. But, by and large, the US Congress is asleep on issues relating to the war on cancer. With a minimum of oversight, they write NCI a blank check for its failed policies. Epstein issues a clarion call for Congress to rein in the NCI from its current independent "rogue status" and make it fully accountable to the director of the National Institutes of Health. This independence, established in 1971, was supposed to make NCI immune from the octopus-like federal bureaucracy. Instead, it has become a huge bureaucracy in its own right, and is now unresponsive to normal governmental controls.

4) Finally, Prof. Epstein calls on readers to fight back by arming themselves with the information about how to avoid carcinogens and become activists in the war against cancer.

This is an angry, impassioned and important book. But general readers should be aware that although Epstein writes well, much of this book is very technical in nature. In fact, most of the chapters first appeared as scientific articles in the International Journal of Health Services. It thus requires some effort to read and digest. For the person who is seriously interested in understanding the failure of our society to address issues of industry pollution, this book is indispensable. For those who are ready to join the fight against greed and corruption in the cancer field, it will also be an enormously rewarding experience. As with Prof. Epstein's earlier books, one comes away with an almost encyclopedic knowledge of how chemicals have polluted our environment, and how those who manufacture such chemicals have similarly polluted our political system.

Prof. Epstein's book, Cancer-Gate, is available at Amazon.

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