Document pmd1zr8mEK2G6bwx11r2gMLwk

Barry Commoner A Tragedy The case history is a prime means of communication among the professions Carefully read, a medical case history tells a great deal about the [latient, tlv disease - and the physician What can we learn from the following ev.inipb ' of Errors It appeared in an article, "An Acneforni Dermatergosis," b> Drs Jack V\ i Jones and Herbert S Alden of Atlanta, Gi., in 1956 (Arch Derntainl Syphil Compounded 3,1, 1022) OD, a Negro aged 26, began work in the distillation of chlorinated dt phenyl In April 1930 and worked regularly until the latter part of the ,r,r 1933 About May of 1933, he noticed Ihe appearance of blockheads on hr. face, neck, arms and legs These areas itched alight!) In a slioil lunt Id nk heads began to appear on the chest, back and lower port of the abdomen, around the navel and on the scrotum and penis Mans of these blnrkheads swelled and became infected, discharging thick pus The areas healed n,<h difficulty and often left scars . . When seen in December 11133 die pitirni complained of lassitude, loss of appetite and loss of libido and said ih u hicutaneous condition seemed to be improving , , On examination lie seemed in good general health Itix rnmplaint of Inssttude sins netl borne .ml h, on)thing more than the usual temperament of the Negro toward work As to the patient, we learn from this case history (and from the accom panying text) that he w'as among the first workers in the first, clearl) an hygienic, plant constructed to produce a then new industrial cheniit.il now known as polychlorbiphcnyl (rt.n). rc,n has since become sen widek nsn) -and biologically notorious. We also learn that the patient was black I'lir two facts are not unrelated, for given the economic discrimination .tg.nust blacks in the U.S. they have frequently been forced to work in the most hazardous and disagreeable places A classical study of workplace-rehiUfl disease among steel workers showed that the incidence of cancer among black workers was considerably higher than among white workers because the blacks were more frequently assigned to jobs in the noxious, carcinogeiiu environment of the coke ovena. (See J. W. Lloyd et al, J Occup Med 13 53. 1971.) On the positive side, the case histoiy (and the paper as a whole) tells mthat the physicians were sensitive to the effect of the patient's work hision ii on his condition; and - as subsequent studies have confirmed - they wmi able to pinpoint pulychlorbiphenyls as the causative agent. On the urt.imi Side is their conclusion that the patient's complaint of lassitude represented only "the usual temperament of the Negro toward work," and that his di> ease was only skin-deep. As things have turned out, this statement is just ,ts scientifically incorrect as it is morally repugnant, It is now firmly established that it.b's, along with other chlorinated Indm carbons, have serious systemic effects, includtng atrophy of the liter, digrs five disturbances, hematuria, impotence - not to speak of "lassitude" II ui the original observers been less blinded by racial prejudice we might havi more quickly learned to appreciate these hazards ! In retrospect, this initial report on PC B toxicity looms as the star! i>f wh i has turned out to be a scientific tragedy of errors. Consider the follow mg First there is the long lapse in time between the discovert of toxic lu/jids in industrial experience with chlorinated hydrocarbons ( 1930 33 ) and apprt 222 Practice October 1974 MOWS 206797 [ nation of tlieir e nv ironnienta! hazards ( I960 66) In the post-World War II boom of synthetic indtislnnl chemicals main tllousinds of tons of two of the worst nffendets - mu ami i*( it s - were produced and disseminated into the pin isnnniriit At tin tune two important things were already known about snrli substances - that they are extraordinarily stable and (a number of them ) extraordinarily toxic. Twenty years later n became ey tdent that tr>T and ft it's were iKLiinHilniintc in the tissues of most living organisms, including human beings, and in a number of instances had sufficiently interfered with liver function to threaten n number of species of wildlife. These environmental hazards, which have retentiy led to the banning of n in and a sharp cur tailment tn the use of I'fit's should have been obvious from the known prop erties of the substances two decades ago Annthrr example In the early industrial experience it became evident that the toxicity of certain chlorinated hydrocarbon preparations was often due not to the main constituent but to very small amounts of impurities that yvere likely to occur hi thr relatively complex chlorination processes Yet it was not until the 1970's and the intensive studies of the toxicity of 2,4,5-T set off by the massive use of this herbicide in Vietnam, that very much atten tion was paid to the possiblt roles of such impuiities. Now it has become-clear that the toxicity of 2,4,5-T is associated with the presence of extremely small amounts of 2,3,7,8 tetrachlorodibenan-p-dioxin (l ct>l>), a substance that has just achieved dubious distinction as the most toxic known compound. A Ann! irony is that when the importance of it on was discovered, Baugh man and Meseison made an intensive effort to develop an analytic method sufficiently sensitive to detect the material at the low levels (less than 1 ppb) that are significant in environmental samples (Environ Health Perspcct, 5 27, 1973), They were interested in eyaiuating the possible teratogenic and other hazards to the Vietnamese resulting from U S herbictdal warfare and based their analyse' largely on samples of fish and crustaceans from Vietnam, They succeeded in showing that 18 to BIO parts per trillion of it nn could be unambiguously detected in these samples. 'Hie irony is this: that when thr same method was applied to a range of U.S samples -- where, in contrast to Vietnam, r (. n has been in widespread industrial use - it was found that the latter was so ubiquitously present as to interfere with the detection of i t c; i>. Because of the failure of the method with U.S. samples, the Environmental Protection Agency was recently forced to cancel hearings on the issue of banning the use of 2,4,5-T lit each of these instances what was lacking was timely communication among the relevant scientific groups* physicians, toxicologists, chemists, and ecologists. With thr introduction of new laws regarding workplace conditions and tile control of industrial chemicals - and their effective enforcement some of thr faults revealed in this account can be remedied. But this will depend on the efficiency of scientific communication. The problems thrust upon us by modem industrial technology do not readily conform to the arbi trary lines between scientific disciplines. It is useful to bridge these boundaries through tlie communication achieved by interdisciplinary research. It would be even more useful to erase them entirely through adisapltnary research -- research designed around the problem rather than the disciplines. Dr Cvmmcmcr rc of thr Center for the Btolopy of \otuwl Sytfcmi, Louts ('nurrfifj/ HoffMtll PfBCliCf October l*K4 2'2 1 HONS 206798