The Fight Against Hidden Diseases (France)

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http://www.truthout.org/docs_2006/042606H.shtml

 

 

 

 

 

The Fight Against Hidden Diseases

By Henri Pézerat

Le Monde (France)

 

Wednesday 26 April 2006

 

For several decades, government and medical actors in the field of

prevention have essentially targeted tobacco-use among the causative

factors for a certain number of cancers. Yet that is only one of the

carcinogenic factors we must attack.

 

But it is easier to make individuals feel guilty than to condemn

those economic actors that don't hesitate to put products or

technologies on the market capable of generating an increase in the

incidence of cancers. We've seen it with asbestos exposures that will

bring still another 50,000 to100,000 new deaths in their wake between

now and 2025. This result could have been foreseen from the medical

and scientific data as of the beginning of the 1960s. But the public

health dignitaries didn't want to know about it, not in 1960, nor even

in 1975 when other actors sounded the alarm. And we had to wait until

1997, following highly publicized social movements, to obtain a

prohibition on the material. Which goes to show that cancer prevention

has not only a medical, but also a social dimension.

 

Beyond asbestos, we know of about 500 products or physical or

technological agents considered as potentially cancer-producing in

people, of which 100 with a strong degree of certainty. But prevention

against these agents is only in its first steps. There have been only

very few efforts to explain why the annual incidence of breast cancer

has gone from 21,200 cases in 1980 to 41,800 cases in 2000. For those

types of tumors, the research should bear principally on the

relationship between cancers and endocrine-disruptors, a class of

products, which, in addition to synthetic hormones, includes

quantities of chemical products found in plastics, detergents,

pesticides, etc. But that's an area in which all research - in both

public and private institutions - is under the international chemical

lobby's tight surveillance!

 

Certainly, some epidemiological investigations here or there

confirm knowledge gained through clinical work and toxicology. But to

go beyond that, epidemiology must base itself on trans-disciplinary

projects that include clinical work, toxicology, biology, sociology,

expologie (which explores means of exposure). Yet, at present, it's

parceling out and compartmentalization that rule, and epidemiology,

which aspires to being a sovereign discipline, can only conform to

pre-established, standardized models that lose sight of the ill and

their environment. Research can only progress if it opens itself to

all disciplines.

 

In the research field of cancer etiology, the initial observation,

the one that can generate an innovative project, is often that of

cancer " clusters, " possibly affecting the same organ, limited in time

and space. Most often, these clusters go unnoticed, or, when they are

reported by isolated individuals, unions, or associations, they are

rejected by institutions as due to chance, to what they call

" statistical hazards, " an a priori rejection, with no in-depth

investigation into the different possible hypotheses.

 

And yet, in the area of work-related cancers, history teaches us

that most products classified as carcinogens have been so classified

from the starting point of cluster observation!

 

Twenty years ago, [French] Social Security only recognized about a

hundred cases of cancer provoked by workplace exposures; now it

acknowledges over 1,500, 83% of which are imputed to asbestos

exposure, but epidemiologists estimate that the real number of new

cases annually is more on the order of 20,000! The understatement is

consequently considerable, with strong responsibility on the part of a

medical corps that is, certainly, poorly informed, but also, in

general, little inclined to oppose the institutions and persons in

power at the moment.

 

The vast majority of carcinogens other than asbestos met with in

the workplace give rise to only isolated observations, even though it

is certain that there exist unidentified clusters in the absence of

observers likely to sound the alarm. To impose public risk

reconnaissance is, in fact, a difficult task, full of pitfalls to

which few doctors or scientists would agree to harness themselves.

 

I speak from experience, since, independently of the fight against

asbestos conducted since 1975, I participate - alongside unions and/or

associations - in this struggle to make carcinogenic factors visible

in different companies. The main lesson we draw from these struggles

is that the primary trump card that allows the existence of cancer

clusters to be revealed is an alliance between a lucid, strong, and

determined union movement inside a company and one or more scientific

or medical actors.

 

The discovery of clusters and their most likely origin is not - at

first - the fruit of scientific and medical research as it is

currently understood. That research, in its multiple dimensions, with

in vitro and in vivo tests, mechanism studies, epidemiological

investigations, exposure investigations, etc. only comes downstream of

a preliminary fight, a fight which is, above all, social.

 

Environmental cancers are more difficult to identify than

work-related cancers, the dispersion of pollutants covering a far more

vast geographic area and leading to much weaker concentrations of

carcinogenic agents in the air than those met with in industrial

surroundings. Overall, cancer clusters of children - with short

latency periods - are undoubtedly the easiest to identify, since there

does exist a privileged observation vantage point that gathers

children from a given geographic area together: that is, school.

 

My personal experience led me to become aware of two clusters of

cases, in Vincennes and in Mortagne-au-Perche, both in the age range

(0 to 5-7 years old) where the incidence of childhood cancers is

highest. In general, if the feedback is adequate, there's a DDASS

investigation, then one by the Institute for Sanitary Monitoring

(InVS) and its regional relay stations. The conclusion of the

investigations in the two examples of clusters that I know about were

proclaimed even before the investigations took place. It could only be

a " statistical hazard, " that is, a result of chance!

 

A single example in Perche, with four cases of cancer in less than

two years in a little school close to a meat-processing plant: the

InVS closed the affair without any investigation of the factory. We

demanded that the investigation be reopened, but the InVs answered

that " no exposure to a known risk factor has been discovered, " and

even that no such exposure could be discovered because, " the

investigation of a cluster does not present conditions susceptible to

the performance of etiological undertakings. "

 

So then what's the point of the InVS? It remains indispensable in

such a case to explore the hypothesis of a pollution of the village,

in particular during a period of BSE epidemic when various attempts to

destroy the pathogenic prion in animal meal by heat and pressure took

place in the factory. Pollutants could then have been carcinogens

formed when meat was heated above 100°C, known pollutants belonging to

the amine heterocyclic family, all capable of inducing cancers in

multiple organs. We note that such research would undoubtedly not be

without consequences with regard to the understanding and prevention

of cancers linked to diet!

 

In fact, it seems that the first concern of governmental

authorities is to avoid making any waves, to avoid implicating

heavyweight economic actors or flawed administrations in any way. As

far as research institutions are concerned, they appear, in this

domain, incapable of initiative, without imagination: some directly

influenced by representatives from industry, others paralyzed by the

fear of displeasing or of bringing ripostes down on themselves that

might hurt their image and research careers.

 

Consequently, there will be no progress towards better cancer

prevention unless the level of society's demands as a whole changes.

Demands that imply collective and sustained action, not the blind

trust so frequently demanded by medical and scientific institutions.

 

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Henri Pézerat is honorary research director at the CNRS. (National

Center for Scientific Research)

 

Translation: t r u t h o u t French language correspondent Leslie

Thatcher.

 

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