2003/11/25 by Michael Gochfeld · 1 citation
Environmental Science · #American Environmental and Regional History
paper · doi:10.1097/01.cot.0000290754.63910.1b
openalex publication_date 2003/11/25 · openalex created_date 2025/10/10 · openalex updated_date 2026/07/30
by Devra Davis, Basic Books, New York City, Hardcover, 316 pages. 26; Paperback edition renamed with the subtitle of “Sex, Death, & Environmental Deception,” Perseus Press, 256 pages, 16.95FigureIt is fortunate that one of the most thought-provoking books on health and the environment has appeared so early in the 21st century. The last century had to wait nearly 50 years for its seminal books on the subject: Road to Survival by William Vogt was published in 1948, and Rachel Carson's Silent Spring didn't appear until 1952. Silent Spring is unequivocally the most important book on the environment—the one that reached the most people, engendered the most excitement and criticism, and withstood the scientific test of time. Devra Davis' When Smoke Ran Like Water captures similar attention. Rachel Carson had the advantage of bursting on the scene with a shocker for an audience imbued with enthusiasm for technology. How could something as wonderful as DDT, then hailed as our salvation from many insect-borne diseases, be so harmful? Devra Davis, PhD, MPH, speaks to a much more environmentally savvy audience. I share some of her history, at least vicariously. As a high school student seeking a career, I read science writer Berton Roueche's essay on the “killer fog” that killed 20 people in Donora, Pennsylvania in 1948. It was still a fresh story when I read about it less than a decade later, and it played a major role in channeling my energy into environmental health. Donora, fog and all, was Davis' hometown. The flames from the zinc plant lit the sky. My college town, Oberlin, Ohio, had the same phenomena emanating from the steel plants of nearby Lorain on the Lake Erie shore. They were our aurora borealis. Like the Lorain steel plants, Donora's zinc plant is now silent, part of our industrial rust belt. But, like Minamata in Japan and Love Canal in New York, Donora, PA, is living history for advocates of environmental health. Davis explores its significance in depth from several angles. Linking Exposure to Health She begins with the premise that environmental exposures profoundly affect human health, and proceeds to demonstrate how environmental epidemiology incontrovertibly supports that premise. The book is a series of carefully interwoven stories about pollution and health, the challenges of environmental epidemiology, and the forces arrayed against those who identify environmental hazards. Dr. Davis, an epidemiologist, weaves questions, approaches, solutions, and uncertainties throughout her stories. Like Roueche and Carson before her, she is passionate about her subject and writes in prose that is clear but not condescending. The first unifying theme is the ways in which we rely on epidemiology to learn how the environment affects health and how difficult and uncertain this essential quest remains. The second theme is the ways in which the lessons learned from environmental epidemiology have been the target of a variety of assaults launched by the industries whose oxen may be gored by tightening environmental regulations. These themes are woven throughout several important stories of air pollution—-Donora, the London Fog, lead in gasoline, and fine particulate matter. Other chapters cover anthropogenic climate change and endocrine active substances in the environment. Endocrine Active Substances Among current controversies, the issue of endocrine active substances in the environment looms large. Sex apparently sells, for few environmental issues have captured as much public attention. Davis explores an extensive literature documenting changes in male reproductive development, particularly abnormal genitalia, which are clearly linked to exposure to organic compounds. Whether human sperm counts are truly an indicator of endocrine disruption is less important an issue than whether natural populations of animals are subjected to disruptive hormone influences. The increase in breast cancer may well be part of the same story. Historic Perspective As a senior citizen, what I like most is her scrupulous attention to the historic underpinnings of current environmental regulation (where they exist) or the lack thereof. While some of my colleagues consider five-year-old journals to be outdated, she unabashedly examines the history of air pollution studies as lessons learned, tracing them back to studies too early to be picked up by current computerized searches. Davis obviously believes that history is instructive, a refreshing view as academia relies increasingly on electronic retrieval extending back only two or three decades. As a professional in the field for more than 30 years, I found it personally gratifying to have heard something about each of the stories. But, it was also humbling that I had so much to learn from the details that are skillfully woven into the fabric of the book. What emerges is a complex tapestry of health interlaced through the warps of environment, genetics, politics, and money. She carefully examines epidemiologic research. Ironically, both the champions and opponents of environmental regulation agree that more research is needed. As an academic, this is my mantra as well. More research is always needed—that is the inexorable human quest for dominion. But Devra Davis shows that opponents of environmental regulation believe that if we wait for research, the problem will go away. On the other hand, they also believe that research might actually exonerate them. Industry's Grand Strategy The book is not a page-after-page condemnation of the universal opposition by industry to regulation. Rather it reveals the ways in which opponents of better regulations and protective standards operate by invoking the “more science is needed” argument when it affords the opportunity to delay action. Industry is only doing its job when it seeks its own scientific experts to attest that a substance is not as harmful as government scientists claim. But, as Davis argues, it engages in serious chicanery when it hires critics to harass scientists who provide unfavorable evidence. Childhood Lead The harassment of Herb Needleman, the hero of the childhood-lead story, is illuminating, although not unique—the lead industry went after researchers in the 1940s as well. A systematic effort was made to discredit his work, impugn his integrity, prevent his funding, and remove his work as an underpinning of regulation. Although fraudulent and mischievous, this created a cloud of apparent controversy and inflicted great costs on the researcher, his institution, the federal agency, and ultimately society as a whole. It slowed, but could not halt, the inexorable progress toward reducing the lead burden that society needlessly imposed on children. Such mischief lies at the heart of the book. I learned many details about stories that I only knew peripherally. The history of air pollution in the Los Angeles basin and the consequent increase in both acute and chronic respiratory disease, is also the story of the deliberate dismantling of its light rail commuter system by a consortium of oil, auto, and tire companies. This was not just a local conspiracy. Many other cities experienced the conversion from streetcars to buses, with a consequent increase in air pollution and traffic. Implicit throughout the book is the remarkable asymmetry that exists between those who lobby for weakening environmental laws versus those who would strengthen them. Corporations can invest huge amounts of tax-deductible dollars in lobbying, while nonprofit environmental groups jeopardize their tax-exempt status if they engage in similar activities. The Myth of the Perfect Study One ploy for rejecting epidemiologic evidence is to insist that only perfect studies be utilized. Those of us who teach epidemiology begin with the premise that there are no flawless epidemiologic studies. Environmental epidemiology is fundamentally different from clinical trials or laboratory research where subjects are randomized, exposures carefully controlled, and outcomes followed prospectively. If we could experiment on humans in that fashion, we would not need epidemiology. If, as the cigarette companies used to claim, there is no absolute proof that cigarette smoking causes lung cancer, neither is there any doubt. Scientific studies are not about proof; they are about erasing doubt. But, as the book repeatedly demonstrates, environmental epidemiology is not for sissies. It is extremely hard work to mount large-scale studies. It is also costly and time consuming. There are many obstacles. No study can be completely free of bias, and any results must be carefully examined for confounders. Nonetheless, when study after study points in the direction of an association between environmental exposures and a variety of health effects, only a nihilist could continue in good conscience to doubt the relationships. Davis also poses a challenge to epidemiologists themselves. It is easy to be seduced by the complexity of the problems and the elegance of their analyses. Epidemiologists have already created a very high bar by setting the arbitrary level for statistical significance at 0.05, meaning that one must be 95% confident that an observed association has not arisen by chance. In real life, we seldom require such a high degree of confidence for making important decisions. Fighting Disinformation “The real scientific difficulties of the field have been complicated by a stream of disinformation fueled by the short-term economic interest of those who stand to profit from keeping matters unresolved,” Davis states. She takes certain industry interests to task for criticizing anything they don't like as “junk science.” In fact, “junk science” comes from the mouths of hired experts, such as those who obfuscate issues on global climate change. The real junk science equates no evidence of harm as evidence of no harm. Davis points out that industry groups also hide behind seductive and misleading names such as the Air Quality Standards Coalition, which represents 600 companies and trade associations. These points explain why Davis is wary of the EPA's position that companies producing toxic chemicals should be entrusted with providing the agency with the results of toxicology testing—a “fox in the hen house” analogy. After reading these chapters any rational person would question the wisdom of such an approach. Worldwide Problem The book is not an indictment of US policies alone. As Davis learned, China didn't ignore environmental pollution; it categorically denied its reality. Hence, it was unprepared to deal with its most serious air pollution problems when the opportunity for new economic ventures resulted in unbridled, unplanned, and uncontrolled growth of small, polluting industries. Complexities & Omissions I was disappointed that Davis did not mention what I view as the underlying and primary environmental health problem: Unbridled human population growth around the world in the face of limited resources and the unwillingness of people to barely survive at subsistence levels, assures that the pressure on the global environment will increase. Every story in the book is multidimensional. For example, lead is about cars vs trains, about gasoline vs children, and about gross toxicity to adult workers vs subtle cognitive impairment of infants. Moreover, Davis personalizes the book by relating chapters to her personal experiences and those of close family members. The book is not a litany of complaints. Davis believes that there are realistic solutions to environmental problems. For example, governments can offer subsidies for clean energy and tax dirty sources. Problems will be more costly to fix in the future (if they can still be fixed) than now. The book contains many examples of ways in which policies can utilize science to reverse environmental degradation. Environmental quality has been improved in places where resources have been spent. We must find ways to pay the full costs of environmental damage today. Davis supports the precautionary use of environmental epidemiology by citing arguments that rectifying problems a generation from now, when they have become intolerable, will be much more costly than preventing them today. An ounce of prevention is worth a pound of cure. How many lives might have been saved if we had listened sooner?