By Barron H. Lerner,
the author of "When Illness Goes Public: Celebrity Patients and How We Look at Medicine"
Wednesday, August 22, 2007

THE BLUE DEATH

Disease, Disaster, and the Water We Drink

By Robert D. Morris

HarperCollins. 310 pp. $24.95

POISONED NATION

Pollution, Greed, and the Rise of Deadly Epidemics

By Loretta Schwartz-Nobel

St. Martin's. 216 pp. $24.95

With all the recent talk about childhood obesity and juvenile diabetes, it is hard to remember that the modern public health movement began with the Great Sanitary Awakening of the mid-19th century. Reformers in England and elsewhere convincingly argued that the environment served as a major source of disease and needed to be cleaned up. Now two new books remind us that toxins and other waste products are producing new and frightening threats to public health. Like Al Gore's arguments about oil dependence and the ozone layer, these concerns are surely inconvenient. But are they also true?

The hero of Robert D. Morris's "The Blue Death" is John Snow, the British epidemiologist who proved in the 1850s that epidemic cholera was spread by waste products in drinking water. Snow reached his conclusions, which initially were mocked, decades before the discovery of the cholera bacillus. His work eventually led to the modern system of purifying tap water, which involves both filtering and treatment with chlorine.

But success has bred complacency, according to Morris. His book is full of examples of recent health problems traceable to inadequate supervision of our water supply. For instance, the majority of pipes that supply major urban centers -- including Washington -- are close to 100 years old and full of leaks that allow contamination. Morris puts into this broader context the now-familiar story of what happened in the District in 2004, when officials added phosphoric acid to the city's water system in an attempt to reduce lead levels and instead created a new headache by loosening a layer of slime and microorganisms, known as the biofilm, and flooding the system with bacteria. He also describes how a 1993 outbreak of diarrhea in Milwaukee was caused by cryptosporidium, an organism experts insisted could not be present.

Morris is no impartial observer. An epidemiologist who specializes in drinking water, he is the author of a controversial paper suggesting that chlorine might increase the rates of several cancers. Indeed, some of his narrative describes his David-like efforts to challenge the Goliaths of water, ranging from the Environmental Protection Agency to the drinking-water industry, which he suggests are cutting corners on water purification to save money.

Still, it is hard not to be sympathetic to Morris's claims, which rely in part on the same crack epidemiological detective work used by Snow 150 years ago. Indeed, I switched from tap to bottled water while reading his book (although Morris also warns that bottled water "is less closely regulated than tap water and is not required to meet stricter standards for purity").

Loretta Schwartz-Nobel is a journalist, not a scientist, but if anything her outrage is even greater than Morris's. In "Poisoned Nation," she describes a series of diseases, ranging from asthma to cancer, that she believes are on the rise due to pollution. Her book has a much more conspiratorial tone. She is largely uninterested in presenting both sides of the issues in question, even when defenders of the status quo are respected scientists and government agencies.

For example, she tells the now familiar story of how childhood vaccines containing the mercury additive thimerosal supposedly led to an enormous rise in cases of autism. Similarly, she charges that companies in the forefront of breast cancer awareness campaigns produce the very environmental toxins that cause the disease.

To be sure, Schwartz-Nobel is right when she points out how profits and politics led industry to conceal the potential dangers of mercury in tuna and other foods. Similarly, the breast cancer movement only recently has turned from a focus on mammography and chemotherapy to investigating the connection between toxic waste and cancer rates. And she tells compelling stories about individuals with autism and breast cancer whose diseases seem to have emerged just after a toxic exposure. One such person was Chris, a bright 2-year-old who, after a reaction to a vaccine, "could no longer concentrate on his books or anything else for more than a few seconds." Eventually, he was diagnosed as having severe learning disabilities.

But what does one do with this information when organizations such as the esteemed Institute of Medicine, one of the four U.S. National Academies, have found no association between thimerosal and autism? Or when the Long Island Breast Cancer Study did not find evidence that toxins were responsible for high rates of the disease? It is hard to accept, as Schwartz-Nobel apparently does, that the scientists involved in these studies make decisions based mostly on industrial connections and political pressure.

A big part of the problem, both books acknowledge, is the difficulty of achieving definitive scientific proof when trying to determine causes of disease outbreaks. Such studies, which rely on retrospective data and participants' recollections, are notoriously difficult to carry out.

So it is disappointing that neither book mentions the so-called precautionary principle, a moral and political argument often invoked by activists when there is no scientific consensus about potential harms. In this case, the principle would argue that society should err on the side of cleaning up possibly toxic environmental waste.

Rather than characterizing industry as villains, it is time for critics such as Morris and Schwartz-Nobel to enlist activists, government and business in constructive partnerships. But this effort will require engaging the public, which can then put pressure on politicians. In making this point, Schwartz-Nobel quotes longtime breast cancer activist Barbara Brenner: "We figured that if people really knew what was happening with the Cancer Industry, they would be furious."

Unfortunately, such anger has not yet materialized over breast cancer or other diseases with possible environmental causes. If, despite their limitations, these books alert the public to such environmental connections, they are doing a great service.