By Elizabeth M. Whelan, Sc.D., M.P.H.
Posted: Monday, January 1, 1996

ARTICLES
Publication Date: January 1, 1996

Elizabeth M. Whelan, Sc.D., M.P.H., co-founder and president of ACSH, is the recipient of the 1996 Ethics Award from the American Institute of Chemists (AIC). The award is given to persons who perform "duties dictated by ethical considerations, in the face of difficulties, for the benefit of the public and/or workers in chemistry and chemical engineering"; who display "leadership in an organization's ethical relationships with the public and/or employees in the field"; and who perform "effective advocacy of organizational and/or governmental policies relating to chemistry that encourage ethical treatment of individuals." Excerpts of her acceptance speech follow:

My organization — my duty — is the American Council on Science and Health. And I accept this award not only for myself but for my colleagues at ACSH — for all those people whose own work and love and, yes, high ethical standards — have made my success possible.

Of the hundreds of people who have been involved in ACSH over the years, I must make special mention of my mentor, Dr. Fredrick J. Stare, founder of the Harvard Department of Nutrition. Dr. Stare and I have worked together for almost two decades now — and together have withstood many attacks, particularly when we have the audacity to state that the American food supply is safe. We were sued for the very act of forming ACSH by the national trade association of health food manufacturers, who accused us of conspiring to undermine their business. But Dr. Stare and I prevailed in court, albeit many years and many thousands of dollars later.

The very public criticism that has been leveled at Dr. Stare and me — remarks meant to discredit and humiliate us — has actually solidified our relationship and strengthened our work.

A second person I would like to acknowledge today is AIC President Dr. Roger Maickel. Roger is an active member of ACSH's board of directors and a tireless fighter in what is always an uphill battle in pursuit of truth. If there is a misleading health claim in the media — about food, pharmaceuticals, the environment — Roger will pursue it until the matter is rectified. Purveyors of health fraud don't stand a chance in his presence.

Our top priority at ACSH is to help Americans distinguish between real and hypothetical health risks — to separate the leading causes of disease and death from the leading causes of unnecessary anxiety. At ACSH we try to ensure that both individual health decisions and public policies are based on sound scientific evidence.

Today I will approach the issue of America's inverted health priorities from my vantage point as an epidemiologist — a public health specialist. We epidemiologists have a basic premise, and it is also a basic premise of ACSH: That those of us who protect our health daily and those of us who put our health in constant jeopardy have exactly the same mortality: 100 percent. The difference, of course, is in the timing. I believe that epidemiologists should help people learn how to die young — at a very old age. To put that another way: We in public health and epidemiology should be giving people a good shot at avoiding premature disease and death.

Epidemiologists are interested in environmental factors as they relate to premature death. But we have a somewhat different definition of the word "environment" than the average person.

For an epidemiologist, the word "environmental" refers to any and all factors in the causation of disease that are not directly linked to genetic, inherited origins. Environmental factors in disease causation — and by causation here I refer to the concept of increased risk — thus include not only industrial-, air- or foodborne chemicals such as agricultural chemicals, radiation or other products of our technological age but also lifestyle factors. We epidemiologists give high priority to lifestyle factors in the avoidance of early disease and death in the 1990s.

I believe that the purpose — the only purpose — of public health measures, whether carried out at the EPA, at the FDA, in Congress or in the private sector, should be the prevention of premature disease and death. I do not believe that public health efforts should have hidden goals — goals that might include harassing industry, alarming people about nonrisks, banning useful substances or advancing other social and political agendas. The purpose of public health measures should be, quite simply, to protect public health. So what, then, are the leading causes of premature death in 1996?

Each year:

* Two million people die.
* One million people die prematurely (in the sense that these deaths can be postponed) before age 80.
* 500,000 premature deaths each year — that is, one death in four, or one in two premature deaths — are directly and causally related to the use of tobacco. I cannot emphasize enough how remarkable this number is — and how it so dramatically influences the whole public health scene today.
* 100,000 premature deaths are due to the abuse and misuse of alcohol.

Thus, two causes, tobacco use and alcohol abuse, account for nearly 60 percent of all premature deaths. Smaller but significant numbers of other premature deaths are linked with failure to use lifesaving technology such as seat belts and smoke detectors; with failure to screen for and treat life-threatening diseases, particularly hypertension and treatable malignancies; and with reckless recreation and the abuse of addictive substances. This last category includes those HIV infections that result from IV drug use and unsafe sexual practices.

These causes represent real, documented opportunities for us to make clear progress. They are the modern-day challenges facing epidemiologists and other public health professionals. But what alleged public health risks get the attention of the media, of legislators and of regulatory bodies? Let me give you a few examples:

Each summer for the past few years I have temporarily assumed the role of an "epidemiologist from Mars" who comes to earth to find out the causes of disease and death. Each year I turn to the leading popular women's magazines as my sources of information — Ladies' Home Journal, Glamour, Redbook, Self, Woman's Day and the like.

Here's what I have learned: that food additives such as sodium nitrate, BHA and BHT cause cancer; that not eating sufficient carrots and spinach causes strokes; and that eating shark-fin soup combats cancer (sharks never get cancer, they said). Women's magazines have also warned that alarm clocks' electromagnetic fields can cause cancer and that the droppings of pet birds might play a role in the causation of lung cancer. And nearly every magazine takes as a given that pesticide residues in foods are a cancer hazard, particularly to children.

Yet these same wary, seemingly health-conscious magazines are chock full of ads for cigarettes — glamorous, fun, sexy, elegant and — oh, yes — slimming cigarettes.

I now ask you: Are these not inverted health priorities?

I could regale you with many other examples of magazine hype, but I would like to move on to legislation and policies that purport to promote public health.

* There's Superfund, which promises to reduce cancer risk by protecting us from chemical risks at toxic-waste sites, even though the science of epidemiology has never pointed to these sites as a source of risk for cancer, birth defects, miscarriage or any illness.
* There's California's Proposition 65, which requires a warning label — or a ban — on any consumer product containing even a trace level of a chemical that has caused cancer in a laboratory animal. For example, under Proposition 65, Liquid Paper — the familiar "white-out" found in every office — was designated a carcinogen (it contained trace levels of trichlorethylene as a solvent).
* There's the congressionally mandated warning label on saccharin, which says that saccharin causes cancer in animals and may pose a risk to us as well.
* And, perhaps most infamously, there was the substantial publicity given to the agricultural chemical Alar — specifically, to the claim that Alar posed an intolerable cancer risk.

These, then, are examples that underscore my dismay about the inverted health priorities in the United States today. When we at ACSH ask epidemiologists on our scientific advisory board to quantify the contribution of bird droppings, pesticide residues, exposure to chemicals at toxic-waste sites, food additives and the like to premature death, their answer is, "We don't know, but our best guess is zero."

What are the implications and the consequences of policies based on these inverted health priorities? I think they are pretty obvious:

Under a policy of inverted priorities, not only do we pursue public health goals by running rapidly in the wrong direction, but we also push purely hypothetical health issues to center stage and squander our limited public health resources — our time and our financial investment.

The mother who worries about Alar in apple sauce may well be the same mother who doesn't worry about putting a helmet on the child perched on the back of her bike or about buckling up her seat belt in the back of a taxi. The father who worries about cellular telephones and electric blankets may be a smoker who doesn't have a working smoke detector at home. The sheer distraction of constantly reading about killer apples and toxic alarm clocks (or whatever happens to be the carcinogen of the week) is at the very least leading to a lack of perspective about what is important and what is not.

But there is at least one other downside risk. As we demand that big Government require American business to protect us from risks that simply do not exist, we all end up paying more for goods and services. A mindless pursuit aimed at controlling hypothetical risks carries an enormous price tag: It not only raises the cost of doing business, but also stifles innovative activity that could dramatically improve the quality of life for all of us.

Why are the public health priorities so inverted in our country? Why are hypothetical health risks given such big play as important causes of disease when mainstream scientists do not see them playing an etiologic role at all? And what are we going to do about it?

These are complex questions. I will briefly outline five reasons why the hyperbole about environment risk prevails and describe some possible, immediate solutions. The five factors I believe are most responsible for our inverted priorities are these :

* first, the highly emotional aspects of health issues;
* second, the enormous political and economic clout of the manufacturers of the leading cause of preventable death — cigarettes;
* third, the failure of most American scientists and physicians to participate in debates about relative health risks;
* fourth, the contamination of the public health profession by an ideologically fueled form of political correctness that chills open dialogue;
* and, finally, the devastating effects of the codification into law of a scientifically baseless, uncritical extrapolation of cancer risks from animal to man.

First, issues relating to food, the environment and health are highly emotional, highly volatile issues. Psychiatrists tell us that people always fear things they cannot see — things that are unfamiliar, that they do not understand. And people have long projected their fears onto postulated, invisible, hostile agents. Food additives, pesticides and "chemical residues" are ideal targets for such projection.

Psychiatrists also point to a related theme: When it comes to the causes of ill health and other adversity, human beings reject introspection: It's better to blame an outside source — some big, bad industry — than to examine critically one's own lifestyle.

The solution? It must be long term, but we need to make a concerted effort to eliminate the scientific and technological illiteracy now rampant in the United States. We need to advance understanding of the controllable lifestyle factors that contribute to risk and promote the basic toxicological premise that "only the dose makes the poison."

Second, tobacco companies — the manufacturers of the leading cause of death — dominate the print media in this country and exert a tremendous influence on both the print and broadcast media's coverage of health issues.

The tobacco industry spends nearly six billion dollars in advertising and promotion each year. This clearly buys silence and diversion. Surely nothing could make this killer advertiser more content than seeing consumer cancer-prevention efforts focused on "cancer-causing apples" and having the word "carcinogen" used so often it loses all its meaning. Remember: When everything is dangerous, then nothing is.

Over and beyond its influence with the media, the tobacco industry's substantial economic clout — and its deep roots that run throughout corporate America — have served it well. Some day I plan to write a book about the number of times representatives from the food, chemical, pharmaceutical, paper, alcoholic-beverage and every other imaginable industry have made a concerted effort to silence the scientists of the American Council on Science and Health in our attempt to make the dangers of smoking well known.

Cigarette companies have metastasized, if you will, throughout corporate America, buying up everything from General Foods to Miller Beer and from Bulova watches to Saks Fifth Avenue. The number of American corporations that service the cigarette manufacturers — and thus owe them allegiance — is truly staggering. America's health priorities are inverted because the leading cause of death has enough clout to keep the legislative and publicity spotlights off the cigarette — and on the multitude of nonrisks around us.

The solution? We will not be able truly to realign our health priorities until Congress strips the cigarette industry of its privileged legal status and levels the playing field so that the manufacturers of the leading cause of death are forced to scrimmage on the same legal and regulatory turf as the rest of corporate America.

Third, our health priorities are inverted, and nonrisks continue to dominate, because American scientists and physicians essentially remain mute while hyperbole about risk is served up all around them. You might argue that there are few public health professionals who would want to join ranks with the likes of Jane Fonda and Meryl Streep in claiming that trace levels of environmental chemicals cause human disease — but silence is assent. Where are the professionals in toxicology, epidemiology and environmental science when the risks of dioxin, Alar, PCBs and cellular phones are exaggerated? Where are the scientists when their own profession is distorted as laws based on pseudoscience are proposed? Where are the true experts when we need to communicate the reality that we have the safest, most enviable food supply in the world?

Well, I know where they are. They are in their offices, in clinics, in classes and in laboratories. They say they don't want to get involved in what they perceive as a political process. Scientists today are highly specialized, and they feel uncomfortable in public forums. Most of all, scientists dread that four-letter word "safe." Scientists rarely talk in absolutes, yet in the everyday consumer world people need easily understandable concepts of relative risk.

The solution? Get the scientists involved! That is exactly what ACSH is doing. We now have over 250 scientists and physicians as advisors. We are encouraging them to write letters to the editor, to contribute op-ed pieces to major newspapers and to show up in television debates. Our nation's health priorities will remain inverted if the only visible spokesmen on public health issues come from the Chicken Little School of Environmental Hyperbole.

Fourth, our health priorities are inverted because the practice of preventive medicine and public health has become corrupted by a form of politically correct science that abandons the principles of epidemiology and instead advances ideological agendas and social aims. Politically correct science (PCS) is dogmatic and intolerant. Its ideology is anticapitalistic and anti-free enterprise. It sees man, industry and technology as the enemies of nature. It is an ideology that has abandoned science, reason and rationality in favor of intuition, inconsistency and a commitment to goals other than the goal of improved public health. Practitioners of PCS never address real, documented public health threats. Nature, always benign, is the new god; environmentalism and consumerism are the new religions.

The solution? A return to peer-reviewed, mainstream science and a rejection, once and for all, of what is perhaps the darkest side of PCS — the antiquated, destructive view that a growing industrial economy is the enemy of a clean environment and a healthier people. The continued march of PCS undermines our ability to achieve both economic and public health goals.

Now is the time for reason and rationality. It's the time for public health professionals to reclaim their profession — to take it back from Hollywood and the political activists.

Fifth and finally, our nation's health priorities are inverted by our dependence on animal-to-man extrapolation in predicting human cancer risk.

The mouse-is-a-little-man premise dates back to 1958, when Congressman James Delaney of New York proposed a law to ban from the food supply any food additive that caused cancer in any dose in any laboratory animal. The so-called Delaney clause promptly triggered the first major food scare — the great cranberry scare of November 1959. The Delaney clause later prompted the banning of cyclamates, the near banning of saccharin and other media extravaganzas.

The clause originally applied only to additives, but the Delaney concept of mouse to man has now spread to pesticides and to trace levels of environmental chemicals generally. Laws and regulatory definitions relying on rodent data abound at the EPA and elsewhere and are consuming billions upon billions of our limited preventive-medicine dollars — money that could be used on real public health problems.

I am not suggesting that we abandon animal testing, which is critical to biomedical research. I am, however, in favor of at least a little bit of common sense in interpreting these studies and accepting the reality that only the dose makes the poison. As far I know, this common-sense element is totally lacking in the EPA's definition of a "probable human carcinogen" based on one high-dose animal test.

I suggest that we apply the "dose makes the poison" principle to our regulation of pesticides and other environmental chemicals. Obviously, pesticides are inherently toxic: Their job is to kill bugs. We need to encourage agricultural workers to adhere meticulously to occupational protocols that limit workplace exposures. And, just to be extremely conservative about potential toxic levels of pesticides appearing in food, we need to comply with the tolerances levels now set by the EPA. But once that safety protocol is set and met, we should treat minuscule levels of synthetic chemicals in food in the same way that we do low levels of naturally occurring carcinogens and toxins.

For example, we regulate naturally occurring aflatoxin by acknowledging that it is there and monitoring it to ensure it stays within the tolerance levels. Then we stop worrying about it, because trace levels play no known role whatever in the causation of human cancer.

The aflatoxin regulatory approach makes sense. Aflatoxin causes cancer in a full spectrum of animal species and shows a distinct dose-response effect. Aflatoxin is a bad actor, and it is prudent to limit our exposure to it. Note that I said limit — not eliminate. Now contrast the common-sense approach for aflatoxin with the regulatory actions and designations made on Alar and saccharin: Consumers were led to believe that the only protection from these chemicals — which in high doses caused cancer in one species — was the exorcist approach: zero tolerable exposure.

I maintain that the fixation on rodent carcinogens — aminotriazole on cranberries in 1959, Alar on apples in 1989 and every pesticide and food additives scare in between — actually CAUSES more premature deaths, both by distracting people from real health risks and by potentially reducing the availability of and increasing the prices of the very fruits and vegetables that protect our health.

At the close of the Rio Summit in 1992, 425 members of the scientific and intellectual community formally objected to the politically correct agenda of those who dominated the conference. Those who objected rejected the theme that man was the enemy and that industry, technology and profits posed a worldwide hazard. They signed what is now known as the Heidelberg Appeal. Over 3,000 scientists have now signed this document.

The Heidelberg appeal pledges a dedication to the preservation of the earth but raises concern about the emergence of what it calls an "irrational ideology" that opposes scientific and industrial progress. The appeal notes that "many essential human activities are carried out... by manipulation of hazardous substances.... [P]rogress and development have always involved increasing control over hostile forces to the benefit of mankind. The greatest evils which stalk our Earth are ignorance and oppression, not science, technology and industry."

One of my top professional priorities is to encourage our federal and local regulatory agencies to enable the philosophy of the Heidelberg Appeal — to reaffirm the principles of good science and the principles found in worldwide peer-reviewed scientific literature. Our federal and local agencies can do this:

* first, by abandoning all regulatory policies and definitions that designate a chemical as a "probable" or "possible" human carcinogen on the basis of limited animal data;
* second, by incorporating a broad understanding of dose of exposure in determination of potential human risk, thus dismissing concerns about trace levels of chemicals;
* third, by establishing closer ties with prominent academic scientists from universities around the world and by regularly drawing upon their expertise in toxicology, epidemiology and environmental sciences;
* fourth, by obtaining the concurrence and approval of experts on cancer causation at the National Cancer Institute before designating an environmental chemical as a "cancer risk" under conditions of current exposure. Such consultation and verification would avoid baseless cancer scares.

Until we return to mainstream science, our nation's health priorities will continue to be inverted. We must defend peer-reviewed, mainstream science in the public arena. We must stand up for reason and rationality; we all must fight, as I have fought, for the truth. We must stop dogmatic and intolerant politically correct science before it's too late and must reject, once and for all, its darkest side — the view that a growing industrial economy is the enemy of a clean environment and a healthier people. We must not yield to those who would abandon facts in pursuit of the hypothetical — to those who are motivated not out of reason but out of fear and a commitment to goals other than public health.

I will leave you with the wise counsel of a great American — a man who faced and made and stood fast by a harrowing series of life-and-death ethical decisions from which a lesser man might have fled. These words are posted on the door to my office. I see them every day, and every day they give me strength to carry on:

If I were to try to read, much less answer, all the attacks made on me, this shop might as well be closed for any other business. I do the best I can, and I mean to keep doing so until the end.

If the end brings me out all right, what is said against me won't amount to anything. If the end brings me out wrong, ten angels swearing I was right would make no difference.

The words are Abraham Lincoln's. He fought and won his good fight; let us not shirk in ours.

(From Priorities Volume 8, Number 1)