• Email
  • Single Page
  • Print

Cancer: What Do They Know?

Vivian Bearing, the main character in Margaret Edson’s Pulitzer Prize-winning play, Wit, suffers from advanced metastatic ovarian cancer. Having undergone eight full-dose treatments of an experimental chemotherapy, she muses that her doctors will no doubt write an article for a journal about her.

But I flatter myself. The article will not be about me, it will be about my ovaries. It will be about my peritoneal cavity, which, despite their best intentions, is now crawling with cancer.

What we have come to think of as me is, in fact, just the specimen jar, the dust jacket, just the white piece of paper that bears the little black marks.1

Bearing’s bitter reflections on the connection between her “me” and her disease call to mind long-running disputes about the sources of cancer. Does it originate in the self’s genes, a sentence of fate to the DNA “me”? Does it come from the behavior of the autonomous self, the “me“‘s styles of life and consumption? Or does it originate outside the self, in constituents of the environment that invade the organs of the “me”? The answers to these questions bear on how cancer might be treated or, better yet, prevented, and who should bear the costs of dealing with the disease.

At the turn of this century, physicians knew that some cancers ran in families—an indication that the disease came from some inheritable essence of the self. Yet they were also aware that the large majority of cancers occurred sporadically, independent of any prior family history. The latter evidence suggested that cancer originated in agents lurking in the environment. As early as 1775, a British physician named Percival Pott had linked scrotal cancer in former London chimney sweeps to their exposure to soot. By the early twentieth century a growing body of observations suggested linkages between cancer and the materials of modern industrial life.

German physicians and scientists, following their country’s strong tradition of social medicine, took a vigorous interest in the causes of cancer external to the natural self. After 1933, the Nazis mounted a broad-gauged “war on cancer,” to borrow from the title of Robert Proctor’s arresting and important exploration of the Hitler regime’s concern with the environmental sources of the disease. Proctor, a highly regarded historian of science whose works include the standard account in English of Nazi eugenics,2 is by no means an apologist for Nazi medical science. His purpose is partly to point out that it was complex, that along with sadism it displayed “fertile, creative faces.” He contends, indeed, that in cancer research good science did not flourish despite Nazism but because of it.

That science of high quality can arise in brutal, antidemocratic regimes should not by now be surprising, even for science under the Nazis. Proctor’s point is nevertheless worth repeating, since it remains a commonplace that science flourishes only as a ward and ally of democracy. But the value of his unblinking book lies in its revelations about why the Nazis were absorbed with the problem of cancer, what they learned about the sources of the disease, and the actions they took to prevent it.

During the 1930s, stomach cancer was the most prevalent form of the malady, which prompted Nazi scientists, like their predecessors, to put forward theories about the carcinogenic impact of alcohol and various foods. Lung cancer, coming up fast behind stomach cancer, was responsible for a quarter of all cancer deaths. Its incidence drew attention to the use of tobacco, which had risen fivefold since the turn of the century and which had been tentatively linked to lung cancer by earlier research. There was much speculation that the causes of cancers of the respiratory tract might be found elsewhere—for example, in the air pollution caused by automobile exhaust. But in the Nazi view, Proctor writes, tobacco was the chief culprit, “a genetic poison; a cause of infertility, cancer, and heart attacks; a drain on national resources and a threat to public health.”

Proctor argues that while the anti-cancer campaign drew on the German tradition of social medicine, it was far more deeply rooted in the Nazi ideology of improving the health of German society so that its men and women could better serve the Fatherland. Devotion to health could coexist with murderous cruelty—often in the same people—because the regime rationalized both as means of restoring Germany’s vitality. By identifying the environmental sources of cancer, the Nazi government would be able to control them and thus prevent disease and, ultimately, protect every racially worthy German.

The Nazi campaign against smoking and drinking, and in favor of a healthy diet, was a product partly of Nazi puritanism and prejudice and partly of the romantic right-wing idea that modern industrial civilization had polluted human beings, alienating them not only from nature but health. The dutifully healthy German was embodied by Hitler himself, a vegetarian who neither drank nor smoked, and refused to allow anyone, including Eva Braun and Martin Bormann, to smoke in his presence; he denounced tobacco as “one of man’s most dangerous poisons.”

Concern for pollution—whether environmental or the result of bad personal habits—was strengthened by the Nazi preoccupation with eugenics. Proctor rightly observes that, while suffused with a quackery all its own, eugenics was also seriously engaged with issues in genetics and health. In 1927 the American geneticist Hermann J. Muller had demonstrated that X-rays could produce genetic mutations in fruit flies. During the 1930s, a number of German scientists, extrapolating from Muller’s results, argued that they reinforced the notion that some cancers were heritable; they reasoned that cancer genes, once created, would be passed from one generation to the next. Such theorizing was mistaken as a general proposition, since a mutation in, say, a lung cell could not be transmitted to offspring. But it led German scientists to search for carcinogens in the environment that might damage the nation’s genetic heritage.

Proctor emphasizes that the intense Nazi interest in cancer produced important research into the disease. The regime established registry offices in selected cities and regions to record not only deaths from cancer but also every case of its occurrence. Coupled with an increased emphasis on autopsies that predated the Nazi regime, the registries produced abundant statistics on the incidence of the disease, a far more useful epidemiological measure than deaths caused by it. Proctor points out that during the 1930s the Nazis led all other nations in the number of publications on the general subject of occupational health. Searching for possible causes of carcinogenic mutations, investigators studied the relationship of cancer to radium and uranium, arsenic, chromium, asbestos, and aniline dyes, among other substances. They identified hazards not only in workplace toxins but also in alcohol, a variety of foods, and tobacco.

Documenting the lung cancer hazard of smoking was one of the most remarkable achievements of the Nazi era,” Proctor writes. He gives particular attention to two pioneering studies—one published in 1939 by Franz H. Müller at a hospital in Cologne, the other in 1943 by Erich Schöniger and Eberhard Schairer at a new tobacco research institute in Jena. Using questionnaires, Müller made a statistical comparison of the behavior of ninety-six lung cancer patients with that of a “healthy” control group of similar size. Nonsmokers were more common in the healthy group (16 percent) than in the lung cancer group (3.5 percent), and the lung cancer victims smoked more than twice as much tobacco each day than did members of the healthy group. Müller’s demonstration of a link between smoking and lung cancer was confirmed by Schöniger and Schairer, who used his methods but, enlarging on the scope of his inquiry, also found that smoking was not a cause of stomach cancer.3

German health activists campaigned for restrictions on the use of pesticides, asbestos, and food dyes made from coal tars. Magazines concerned with the environment regularly castigated smoking, and anti-tobacco activists called for advertising bans, tobacco taxes, and prohibitions against the sale of tobacco to youth. Eventually, the Nazis installed no-smoking cars in trains and prohibited smoking in many workplaces, public buildings, hospitals, and rest homes. They also enacted laws requiring compensation for work-related illnesses such as cancers arising from asbestos or petrochemicals. Official concern with the impact of industrial pollutants on women’s reproductive functions led to regulations prohibiting the exposure of women and children to hazardous substances or processes.

The bans, however, were enforced only selectively, and the activists made little headway against powerful industrial interests, especially after Germany went to war. The claims of war production shifted attention away from ridding the industrial environment of carcinogenic hazards. Instead the Nazis purged the workforce of its sick members, many of whom were sent to the gas chambers. “The war on disease turned into a war on the diseased,” as Proctor puts it.

Environmental carcinogenesis did not get much attention in the United States during most of the middle third of the century. The demand for war production, as in Germany, and then the pressures of the cold war discouraged attention to pollution in the workplace. During the early years of the cold war, the Atomic Energy Commission, claiming that the nation could not take the risk of slowing down development of its nuclear arsenal, suppressed research into the high frequency of cancer among uranium miners and disparaged claims that radioactive fallout could cause cancer.

Besides, claims of chemical carcinogenesis were open to question. The increasing scientific evidence that smoking could lead to lung cancer focused greater attention on the causes of carcinogenesis in individual behavior, which undermined the force of theories of its workplace origins. Then, too, the incidence of cancer increased with age, which suggested it might be caused more frequently by long-term bodily processes than by environmental insults. And the disease struck only a minority of Americans, including only a minority of even those who smoked; the medical and scientific director of the American Cancer Society took these findings to mean that the most important factor responsible for cancer was “individual susceptibility” to the disease.4

However, the doctrine of environmental carcinogenesis began to take hold after Rachel Carson called attention to it in 1962 in Silent Spring.5 By the 1970s, environmental explanations of cancer had become a major force in American politics and culture. They were given authority by the environmental movement and by numerous epidemiological studies linking specific chemicals to human cancer. Environmental explanations were reinforced by tests of the cancer-producing effects of chemicals on animals and by increasing knowledge of the impact of chemicals in causing mutations. The latter had first been demonstrated during World War II, when British researchers showed that mustard gas, like X-rays, could provoke genetic changes in fruit flies. In the 1970s, Bruce Ames, a geneticist at Berkeley, devised a method for measuring the mutagenic potency of different chemicals by using bacteria growing in petri dishes. While greatly speeding and simplifying such assessments, the Ames test also showed that many of the chemicals known to cause cancer in laboratory animals such as mice incited genetic mutations in bacteria as well, thus adding weighty evidence to theories of environmental carcinogenesis.

  1. 1

    Margaret Edson, Wit (Faber and Faber, 1999), p. 53.

  2. 2

    Robert N. Proctor, Racial Hygiene: Medicine Under the Nazis (Harvard University Press, 1988).

  3. 3

    Proctor calls Müller’s work “stunning,” not least for his emphatic claim that increasing use of tobacco was “the single most important cause of the rising incidence of lung cancer” (Müller’s emphasis) in recent decades. Very likely it was, but in both studies, while close to 97 percent of the lung cancer victims smoked, so did a whopping 84 percent of the healthy control groups. Although the data in both studies revealed with statistical significance that the cancer victims smoked more than did the smokers in the healthy control group, the evidence was not altogether reliable. It had been obtained by retrospective questionnaires, some number of which had been completed by members of a deceased cancer victim’s family. Thus, while the two studies pointed to a link between smoking and cancer, neither demonstrated it conclusively. Proctor emphasizes that the two German papers preceded two independent studies published in 1950—one in the United States by Ernst Wynder and Evarts Graham, the other in Britain by Richard Doll and A. Bradford Hill—both of which are widely celebrated as the first to demonstrate with epidemiological soundness that smoking is an important factor in lung cancer. He speculates that if the priority of the German papers has not been widely acknowledged, it is because the world is reluctant to credit the Nazis with meritorious, let alone beneficial, scientific accomplishments. Müller’s work, however, has been prominently noticed. See Richard Kluger, Ashes to Ashes: America’s Hundred-Year Cigarette War, the Public Health, and the Unabashed Triumph of Philip Morris (Knopf, 1996), pp. 109-110.

  4. 4

    James Patterson, The Dread Disease: Cancer and Modern American Culture (Harvard University Press, 1987), pp. 189-190.

  5. 5

    Carson’s discussion rested heavily on the work of Wilhelm Hueper, who had come to the United States in 1923 from his native Germany, where he had been trained as a physician and imbibed the tradition of social medicine. In 1942, he published Occupational Tumors and Allied Diseases, the first comprehensive review of workplace causes of cancer. On Hueper, see Robert N. Proctor, Cancer Wars: How Politics Shapes What We Know and Don’t Know About Cancer (Basic, 1995), pp. 36-48; Patterson, The Dread Disease, pp. 187-189; and Christopher Sellers, “Discovering Environmental Cancer: Wilhelm Hueper, Post-World War II Epidemiology, and the Vanishing Clinician’s Eye,” American Journal of Public Health, Vol. 87 (1997), pp. 1824-1835.

  • Email
  • Single Page
  • Print