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NEWS & VIEWS A BIMONTHLY PUBLICATION OF THE AMERICAN COUNCIL ON SCIENCE AND HEALTH VOL 2 NO. 3 MAY/JUNE 1981 PRICE: $1.00 AMERICAN COUNCIL ON SCIENCE AND HEALTH 1995 Broadway. NewYork, New York 10023 (212)362-7044 A nonprofit tax exempt Mucaitonal association promoting scientifically balanced evaluations of chemicals, the environment and human Health THE DDT DEBATE: THE BEGINNING OF THE BIG BAN ERA URL 05185 by Helen E. Kelly It has been incon trovertibiy shown to prevent human illness on a scale hitherto achieved by no otherpublic health measure entailing the use of a chemical. --British Medical Journal editorial Chemicals used as sprays are like devils that create chains of poison and death. --Justice William O. Douglas Both of these allegations refer to the same substance. A paradox? Perhaps. A prototype for conflict? Absolutely. The substance is DDT, and the statements above epitomize the heart of the battleover the banning ol DDT, a battle that gave birth to and nurtured the environmental movement that is now in full bloom. The DDT controversy may seem like ancient environmental history today, but its form can be traced in virtually every environmental conflict since then. It is this role as prototype that makes the DDT debate so fascinating and so worthy of study. Now, almost two decades after the appear ance of Silent Spring, environmental contests take the form of ritual drama, the script of which was written during the fight over an ordinary-looking white powder--dichloro diphenyl trichloroethane. DDT was first synthesized in 1874, but 65 years passed before it was tested as an insec ticide in 1939 in Switzerland. The following year, in 1940, it was patented as a contact insecticide by Dr. Paul Muller, who received the Nobel Prize in medicine in 1946 for his discovery. DDT began its life of use as a public health insecticide during World War It. In 1943 the U.S. began manufacturing the chemical for military use in the fight against two devastat ing insect-bornediseases; typhusand malaria General worldwide use of DDT began after 1945- At first the emphasis was still on the medical benefits of the Insecticide, primarily in termsofmaJariacontrol, but alsoagainst the vectors of yellow fever, sleeping sickness, plague, typhus, dengue, and encephalitis, ail of which are transmitted by insects. However, the low cost and wide effectiveness of DDT guaranteed that its use would be extended to pest control in agriculture and forestry, (n many cases, the use of ODT greatly increased crop yields, as in the case of rice production in the Philippines, Thailand, and Venezuela, in the U.S., the greatest but by no means sole use of DDT was in the South, to combat the insect destroyers of cotton, peanuts, and soybeans. OOT was also found to be an effective agent against the spruce budworm, pine weevil, tussock moth, and gypsy moth, which have the capacity to devastate woodlands. Since DOT was not the only insecticide availableby the earty 1950s, one might wonder why it continued to dominate the soene, especially for use in public health programs. There were three reasons why ODT remained the preferred insecticide for many uses, not the least of which was its extraordinarily low cost. In 1968 one pound of DOT cost 17Vt cents. Since, for many purposes, the recom mended application level of DOT was one pound per acre, enormous areas of land could be treated at a minimal expense. At the height of the DDT controversy it was generally ac knowledged, even by opponents of DDT, that no available alternative could be obtained as cheaply. The second reason for the overwhelming success of DDT was, ironically, the very propertywhichwastobecomeammunitionfor those who sought to Dan Its use in the late 1660s, namely, the exceptional stability and persistence of DDT in the area sprayed. This ability of DDTto remain active formany months after application eliminated the need for fre quent respraying. While this made ODT use efficient for both forestry and agriculture, it was in the area of malaria eradication that the persistence of the insecticide was most vital, in many cases,theareastobe sprayedwere far removed from civilization and difficult to reach, and the need for constant respraying would have crippled anti-malaria programs. The long-term residual effect of DDT made it possible for long intervals to elapse between sprayings of dwellings. Without the advent of DDT or some other equally effective and per sistent insecticide, it is dubious whether largescale malaria eradication programs would ever have been attempted. As it stands now, DDT has been credited with saving 100 million lives as a result of its use against insect-bome diseases. Some idea (continued on page 13) DR. JOHN HIGGINSON TALKS WITH ACSH URL 05186 ACSH NEWS & VIEWS ' A bimonthly publication of the American Council on Science and Health 1995 Broadway New York, New York 10023 212 -- 362-7044 EDITORIAL STAFF Dr. Elizabeth M. Whelan J| Executive Editor Betsy Ritz [ I Editor i 1 Terrence Smith Associate Editor j Helen E. Kelly, Robert V. Kline, iBetsy McPherrin, Kathleen A. Meister, i Robert E- Olson, David B. Roll Contributors j j 1 ; The comments and editorial opinions i expressed in this newsletter do not j necessarily represent the views of all I ACSH Directors and Advisors, i Yearly subscription (atso includes other l publications and membership): $35 for individuals; $175 for institutions. American Council on Science and Health 1981 IN THIS ISSUE: "The DOT debate: The begin ning of the big ban era" Or. John Higginson talks with ACSH "The food industry and nutrition" ACSH Reviews: Three Mile Island Brain Allergies: The Psy chonutrient Connection Atomic Energy Health Watch Editorial: The science and politics of nutrition "Misleading megadoses" Profile: Thomas H. Jukes, Ph.D. Environmental Update 2 John HlQQinson is the founding director ol the World Health Organization's international Agency for Research onCancer(IARC). Bom in Belfast, Northern Ireland, in 1922, Or. Higgin son received his Medical Degree from Trinity College, Oublin, in 1946. Prior to joining IARC, Dr. Higginson was a research pathologist at the University of Glasgow and the South Afri can Institute for Medical Research, Johannes burg, and later, American Cancer Society pro fessor at the University of Kansas. He is widely recognized as one of the originators of the environmental theory of cancer causation. ACSH: WHAT ARE THE GOALS OF IARC? HIQGINSON: The IARC was established as a research institute by a group of governments to try to develop and execute a coordinated interna tional program in cancerresearch with special emphasis on epidemiology, causation, and prevention. ACSH: HOW DO lARC'S RESEARCH AND PUBLIC EDUCATION PROJECTS DIFFER FROM THOSE OF OUR NATIONAL CANCER INSTI TUTE OR THE AMERICAN CANCER SOCIETY? HIGGINSON: Although the budgets are very different (the Agency being a somewhat "peanut" opera tion), all nonetheless have the same goals In the field of environmental carcinogenesis. Be cause of our limited budget, however, the Agency has no clinical program and does not treat patients. The Agency is essentially a scientific research body, publishing In the scientific literature. The practical value to the general community comes from public health measures for prevention. These can be ap plied, as a result of that research, either through government action or through educa tional programs. Forexample, wecan educate people about the carcinogenic dangers of ex cessive drinking. ACSH: IS CANCER A SERIOUS HEALTH PROBLEM WORLDWIDE? HIGGINSON: Well, the relative importance of cancer as a health problem keeps changing in different countries. Thus in the United States, about one In four persons will develop cancer today. These figures are similar to those in Western Europe and the Soviet Union. In contrast, In the developing .world, changes can take piece extremely rapidly, as illustrated in the case of Singapore. Cancer was e relatively unimportant cause of death in Singapore in I960. By 1965 It had become the most important cause of death on the Island. Later, It was overtaken by heart disease, which had previously been of less Importance. This was possibly due to changing lifestyle condi tions associated with increased prosperity. In Indian the number of cancers is increasing markedly due to improved life expectancy. However, the relative importance of this in crease is diminished by the large number of children and young people In that country. The importance of cancer will become more obvious as the population pyramid stabilizes as a result of birth control. ACSH: HOW DO YOU REACT TO THE SEEMINGLY ALARMIST REPORTS THAT THE UNITED STATES IS CURRENTLY EXPERIENCING A "CANCER EPIDEMIC"? HIGGINSON: I have discussed these reports with numer ous epidemiologists. We are all agreed that there has been an epidemic of lung cancer related to cigarette smoking over the last two to three decades. This is partly offset by a marked decline in stomach cancer. For most other cancers, there are only slight trends up and down,which aredlfficuittoevaluatedueto registry artifacts, etc. As a generality, it could be stated that in the U.S. in whites, tobaccorelated cancers are still increasing. In black males, there are marked increases in lung and esophageal cancers and some increases in prostaticcancer. In black females, lung cancer is increasing but others are decreasing. Borne of these letter changes may be due to lifestyle factors. I do not believe that there is an epi demic, as is often implied, apart from lung. ACSH: THE AMERICAN ATTITUDE TOWARD CAN CER IS CALLED BY SOME A "CANCERPHOBIA"--IS IT UNIQUE TO THE UNITED STATES? HIGGINSON: I don't think it's unique to the United States. However, when you have a population where over 20-25 percent of the people get cancer, practically everyone has had personal contact with the disease. Thus, fear of cancer has largely replaced fearof tuberculosis(the white death, as It was known in the pest). Naturally, people are very worried about adisease whose nature they do not understand. I think that vocal cencarphobia Is probably more extreme in the U.S. than in othercountries in the sense that people feei that few Improvements have taken piece In treatment and understanding of the disease. This attitude is partly mediaengendered, and partly due to over-expecta tions as to the immediate results of modem research. ACSH: DO YOU THINK IT IS BECAUSE A "CURE" HAS NOT BEEN FOUND? HIGGINSON: I think that there have been definite over- expectations as to the possibilities of an im mediate cure, although many people believe that if enough money is spent, cancer can be prevented, controlled, and cured very soon. Unfortunately, people don't recognize how much in fact has been done, and how much could be done by applying available know ledge. Forexample. in theUnited States, if skin cancer is included, we probably could prevent nearly 40 percent of all cancers in males with certain changes in cultural habits and life styles. The proportion theoretically prevent able in females is much smaller, say 20 per cent. Unhappily, such changes often involve individual action which people don't want to carry out. This indicates the discrepancy which exists between a vague fear of an event intheiong-term future, andapresent pleasure, such as smoking. People's fears and their willingness todo something about those fears do not always operate rationally. So. cancer prevention should be considered in addition to gradual improvements in therapy. Certain skin cancers are deemed virtually 100 percent curable today. ACSH: IN ONE OF YOUR MANY ARTICLES YOU TALK ABOUT THE GENERAL UNWILLING NESS OF GOVERNMENT TO APPLY CURRENT KNOWLEDGE OF CANCER RISKS WHERE IT OFTEN AFFECTS PERSONAL PLEASURES OR MATERIAL WELL-BEING. YET YOU ALSO STATE THAT IN SUCH CASES IT IS THEGOVERNMENrS RESPONSIBILITY TO TAKE THE NECESSARY DRACONIAN MEASURES. (S THIS A SOLUTION OR A PARADOX? HIGGINSON: It's a paradox and not easy to resolve, and I am not optimistic that it can be resolved in the short term. I do suspect, however, that it can be gradually resolved in the long term with improved education and positive modification in certain lifestyles. It is informative to look at the consumption of cigarettes in the United Kingdom over the last 15 years. In the popula tion group with the highest education, e.g., professionals and college graduates, ciga rette smoking has fallen to approximately one half of that in the early sixties..In contrast, in the group with the least education, there has been practically no change. This indicates that with education, people will listen. I believe it is the responsibility of the government to pro vide a total educational plan regarding health hazards. Thus, children should not be per mitted to smoke at school. In my time, you could get expelled for smoking. Oraconian efforts to control smoking among children are being tried in France. Teachers are not allowed to smoke in class, but only in a special room. All of us have seen the marked changes that are taking place in airline travel, and it is inter esting to note that many smokers prefer the non-smoking seats for short trips. Unfortu nately. the group on which education has had the least effect is the young female. AC8H: IS IT LIKELY THAT THERE IS YET SOME UN DISCOVERED FACTOR THAT IS RESPONSI BLE FOR A LARGE NUMBER OF CANCERS? HIGGINSON: Certainty, but you have to consider each site individually, and separate possible causative factors from an understanding of mech anisms. Wedon't understand the mechanisms of breast cancer, a very important female cancer, nor the external factors involved. We suspect the involvement of hormones, which may be altered by sexual and behavioral pat terns such as number of children, age at first pregnancy, and so on, and also diet. But our knowledge does not at present permit defini tive recommendations as to prevention. Similarly, forcancersof the stomach and large intestine. Again, there are many hypotheses, but few of them are supported by adequate data, especially in relation to lifestyle. ACSH: CAN YOU COMMENT ON THE RECENT REPORT BY THE FEDERATION OF AMERI CAN SOCIETIES FOR EXPERIMENTAL BIOLOGY ON COLON CANCER AND THE LOW FIBER DIET? HIGGINSON: In all studies on colon cancer, the only risk factor that seems consistent is low fiber; high fiber seems to have a protective effect. How ever, there are many different types of fiber. There are tots of hypotheses regarding the action of fiber besides regularity. 1 am suffi ciently convinced of the possibility that 1 now take All Bran at breakfast, which I didn't do before. That is the sum total of the dietary changes that I have made, apart from not over eating, in the last 30 years, and the only ones for which I would say that the evidence is suffi ciently satisfactory. Further, the action is certainly not going to do any harm, and may do some good. Forty years ago I was told that roughage was a good thing, and as a kid I was made to have roughage for breakfast. I was taught in medical school that it prevented all sortsof diseases of the large intestine. Then it dropped out as old-fashioned medicine, granny stuff. Now it's back in again. ACSH* YOU HAVE PREVIOUSLY MADE THE STATE MENT, "IN OTHER WORDS, I BELIEVE THAT OVEREMPHASIS ON CHEMICALS HAS DIS TORTED OUR APPROACH TO THE ENVIRON MENTAL THEORY FOR MANY CANCERS." HIGGINSON: This statement obviously excluded discus sion of point-sourceexposure such asoccupation and medical drugs, which represent a different problem. However, the belief that the great burden of cancer of so far unknown cause is largely due to diffuse chemical pollu tion of food, water, and air, and can be con trol led through identification and avoidance of one synthetic carcinogen only, has little Support. Thus, studies of the vast number of compounds that are present in the general environment do not suggest that any individ ual compound is a predominant factor for most sites. The possibilities of guaranteeing prevention through such action are extra ordinarily low. About 1500 compounds have been identified in alcoholic beverages and more than that in average municipal water. These include many animal carcinogens. It is impossible to evaluate the impact of each of these compounds on an individual basis. However, it may be possible to evaluate their impacton the total burden in man. When this is done, you will find that there is no real difference in terms of cancer between people served by polluted and non-polluted water, as in the case of arsenic in Taiwanese water. In Utah there is no difference in overall cancer incidence in Mormons in urban and rural areas, in contrast to national differences in nonMormons. Even where there is obvious evidence of pollution, e.g., as in the air of Los Angeles, evidence of a major impact on lung cancer in non-smokers remains to be proven. On the other hand, this does not imply that unnecessary pollution should betolerated. No one wishes to drink unnecessarily dirty water or breathe sooty air. People have forgotten, however, that things have gotten a lot better. There have been vast improvements in London, and also in some U.S- cities. But if such pollution is not the cause of 70-80 percent of cancers in women and 40-50 percent of cancers in men, those of unknown origin, then what are the causes? At this point, the problem becomes completely different. Thus, while recognizing the difficulties of identifying specific factors which may have initiated a specific cancer, we now accept the possibility of modulating factors associated with diet and lifestyle, and their role on cancer mechanisms. The effect of diet on fetal lite, infancy, and childhood, is only just beginning to be recognized. We know people vary widely in theirability to metabolizeand modify certain foodstuffs, and further that the latter have a marked effect on the metabolism of cancerproducing agents. While the role of lifestyle does not represent a chemical or industrial carcinogen in the classical sense, as represented by occupational exposures or cigarette smoking, it does reflect a biochemi cal background. These comments don't mean that you shouldn't control pollution and waste disposal, etc. That's another question. But the point is. that concentration only on polluting factors is unlikely to permit control of a great portion of the cancer burden, and that a whole new field of research is opening up. 3 URL 05187 A^H THE FOOD INDUSTRY AND NUTRITION URL 051 Be by Kathleen A. Meister Many people who are interested in nutrition think that the food industry doesn't share this interest, and that food manufac turers are unresponsive to consumer needs in this area. This impression is false. The industry is very aware of the in creasing public interest in nutrition, and virtually every company has made systematic efforts to provide consumers with nutrition information about its prod ucts. Many have gone far beyond this basic responsibility and have undertaken substantial nutrition-related activities that benefit the consumer. These include establishment of corporate nutrition policies and nutrition advisory boards, in volvement in basic nutrition research, and publication of educational materials. However, the food industry's involve ment in nutrition also has a negative side. A company's main goal, ofcourse, is to sell its products at a reasonable profit. As public interest in nutrition has become in creasingly intense, it has provided oppor tunities for exploitation of this interest for marketing purposes. This has led todistortions of nutrition facts that can mislead and confuse consumers. Nutrition Activities of Food Companies Increasing numbers of packaged foods carry nutrition labelling, but even if aproduct doesn't have this kind of label, nutri tion information is almost always avail able from the manufacturer. Most com panies take consumer complaints, re quests for information, and other inquiries seriously. For instance, Best Foods has a stated policy of responding to all con sumer correspondence within 48 hours of receipt. Most large food companies have developed corporate policy statements on nutrition, dealing with such topics as ac curacy of nutrition information in advertis ing, support for nutrition research, and provision of nutrition information to con sumers. These policies tend to be general and innocuous. Few deal with specific nutrition topics or take stands on con troversial issues.The primary significance of these statements is that they indicate that the company realizes nutrition is im portant enough to demand an official cor porate policy. 4 Today, nutrition commands this kind of attention even in firms that produce relatively limited lines of food products. For instance, a nutrition policy statement is currently being developed at FritoLay. Procterand Gamble, which sellsonlyatew grocery products, has an informal (unpub lished) nutrition policy, and maintains an active program of basic nutrition research. In addition to forming a committee within the company to determine nutrition policy and guide research and develop ment, some food manufacturers, such as Universal Foods and Kraft, have estab lished advisory boards of outside experts to provide additional scientific input in nutrition matters. Best Foodsestablished such a board more than forty years ago. Food processors have worked closely with government agencies in nutrition research efforts ranging from the design of enrichment programs inthe1940s tothe developmentof uniform nutrition labelling in the 1970s. Today, the larger food com panies have extensive nutrition research programs. Many research efforts are directly aimed at meeting consumer needs. For instance, at Oscar Mayer, the corporate nutrition task force is in vestigating ways to reduce or replace sodium in processed meats, while retain ing acceptable product quality. This pro ject was undertaken in response to ex pressed health professional and con sumer concerns about sodium and hyper tension. Some segmentsof the food industry are involved in nutrition activities that go beyond the promotion or development of specific products. Numerous companies support and participate in the activities of professional organizations such as the National Nutrition Consortium and the In stitute of Food Technologists. Trade organizations, such as the National Dairy Council, theSugarAssociation, the Cereal Institute, and Grocery Manufacturers of America, publish nutrition information for professionals and consumers. Some in dividual companies have similar pro grams, of which the following are only a few examples. Foremost Foods produces a highquality quarterly publication entitled The Professional Nutritionist. Kraft publishes an extensive line of booklets for consumers on topics such as food and nutrition terms, food selection, storage and preparation, and guidel ines to good health. General Mills publishes a monthly newsletter called Contemporary Nutri tion. It is designed for health profes sionals and each article iswritten by an ex pert on the specific subject. Nabisco has recorded a set of radio spots on nutrition, distributed them to sta tions throughout the country, and pub lished them in a consumer brochure. As part of a continuing public affairs program on food issues, General Foods recently took out a series of full-page ads in major newspapers, reprinting and ex plaining the federal government's Dietary Guidelines. Federal health officials praised these ads as "intellectually honest." Nutrition Exploitation Some manufacturers have capitalized on popular ideas about nutrition that don't coincide with scientific facts. For in stance, popular wisdom condemns sugar, but scientific evidence implicates it in only one health problem, tooth decay, and even then only when consumed in a sticky form in between meals, not when consumed as part of a meal. Nevertheless, some com panies exploit the lack of sugar in their products asa major selling point. A recent television commercial for Aunt Millie's spaghetti sauce based its entire pitch around the rather irrelevant fact that this brand of sauce contains no sugar, while a major competitor's product does. Consumerattitudes may also influence product formulation. Oneyogurt manufac turer complained that the mention of sugar on the labels of his fruit-flavored yogurts was damaging tothe products' im age. He considered substituting honey, because it has a better image, even though he acknowledged that honey is merely sugar in another form. Another form of exploitation has become so common that this entire news letter could easily be devoted to listing ex amples. This, of course, is the extensive use of such terms as "all-natural," "organic," "no additives," and "no ar tificial anything" in food advertising and labelling. Many consumers believe that such products are of better quality and more nutritious than other products. In fact, there is little difference. Sometimes a ``natural" product may even be of inferior quality if apreservative which would other wise have lengthened its shelf life has been omitted. However, many people think that "natural" products are always better, and food manufacturers and adver tisers reinforce this misconception. Although the nutrition information presented in food company publications is almost invariably accurate, each manu facturer tends to emphasize the nutrition al advantages of its products and ignores the disadvantages. Different companies may also present nutrition information in different ways, to favor their own prod ucts. Unfortunately, this mayconfusecon sumers. For example, informational booklets published by Oscar Mayer (producers of meat products) and Best Foods (manufac turers of peanut butter and many other packaged foods) both include tables listing the fat contents of a variety of foods. However, the Oscar Maver table lists the percentage of fat in each food (bologna 30 percent, peanut butter 52 per cent) while the Best Foods table lists the percentage of calories from fat (bologna 82 percent, peanut butter74percent). Both sets of figures are correct, and nutrition experts do not agree about which system more effectively conveys information about the fat content of foods. Although there is no overt deception here, most peo ple would be very confused about the relative "fattiness" of bologna, peanut butter, and the other foods listed after reading both tables. Addition of nutrients to specific food products has been an effective way of cor recting some forms of malnutrition. However, indiscriminate fortification of food products, for the purpose of generating impressive figures to put on nutrition labels, does little to improve public health. Overfortification can en courage careless eating habits and, since some nutrients are toxic in excess amounts, it may even be directly harmful to health. Fortunately, many food manufacturers realize this. The nutrition policies of Kraft, Oscar Mayer, Kellogg, General Mills, and many other companies include statementsthat nutrient additions will be made only when appropriate. However, it should also be noted that Kellogg and General Mills each produce one breakfast cereal (Most and Total, respectively) so highly fortified that it must be labelled as a supplement rather than a food. The suitability of these prod ucts is subject to question. Sailing Nutrition in the 1980s It has been said many times in the past that "you can't sell nutrition." There is in creasing evidence that this is no longer true. The Second (1980) Woman's Day Survey indicated that one out of two con sumers uses nutrition labelling to com pare food brands. According to a General Mills study, over 40 percent of consumers check the nutrient content of a product before buying it for the first time. A recent study by Arthur D. Little, Inc., concluded that public interest in the nutritional value and healthfulness of food is genuine and here to stay and predicted that products with a healthful image will sell well in the 1980s. Many recently introduced nutrition- oriented products and advertising cam paigns have been successful. The New York Times has reported that increasingly large sums of money are being invested in the research, development, and advertis ing of nutrition by food companies in response to the growing recognition that nutrition sells. An editorial column in the November 1980 issue of the trade journal, Cereal Foods World, pointed out that food manufacturers would have much to gain in terms of sales, credibility, and relations with government agencies if they regard ed themselves as members of the "health care team." If food companies adopt this attitude toward the marketing of nutrition, both producers and consumers will benefit. However, if food manufacturers regard nutrition as merely the latest food fad to be exploited in product develop ment and advertising, without regard to the real nutritional needs of the public, they will be failing to meet their respon sibilities to their customers. Kathleen Meister, M.S., is a research asso ciate with ACSH. 5 .... a- : BOOK REVIEWS TITLE: Three Mite Island: The Hour-byHour Account of What Realty Happened AUTHOR: Mark Stephens PUBLISHER: Random House, New York, 1980 COST: S11.95 (hardcover) REVIEWER: Helen E. Kelly, M.P.H. It was inevitable that the March 1979 inci dent at the Three Mile Island nuclear power plant would spawn a book such as Mark Stephens' Three Mile Island. There Is no need to append a subtitle to insure that the reader will know the book's content. The title alone is testimony to the extent to which the incident at Three Mile island is considered common knowledge. Perhaps predictably. Three Mile Island pur ports to tell "what really happened during the accident at Three Mile Island." Disclaiming any particular bias, Mark Stephens presents his book as an anatomy of the Three Mile Island (TMI) incident, considering the actions of the utility officials, the government, and the press. Such an impartial dissection of the con tributions of the press, government, and in dustry to theTMl incident and its Impactonthe American public is greatly needed. Public understanding of what occurred at TMI, both technically and politically, is limited. Much of the confusion has resulted from the con tradictory versions of the incident issued by each of the primary players: press, utility, and government. If this book had given an honest critical appraisal of all three groups, it would have provided a great service to truth-seekers everywhere. As it is, Stephens subjects both utility and government to illuminating micro scopic examination but leaves the media vir tually untouched, rather like a well-feathered fowl beside two uncomfortably plucked com rades. The first inkling that the press will emerge unscathed appears in the prologue of the book where we learn that we will see "how the press tried to do its job." Tbe phrasing of this fragment automatically exonerates the press from any unsavory role in the proceed ings. Afterail, they were only nobly trying todo their job. However, rather than harp on Stephens' failure to unflinchingly examine those who are, afterall, his colleagues(Stephens isajour nalist and professor of public affairs com munication), it is worthwhile to consider his successes. Forabook which must necessarily deal with innumerable complicated technical pro cesses and even more complicated political processes, Three MileIsland Is quite readable. At its best, it is as compelling as any popular thriller. Stephens relies heavily on the per sonalities of the individuals involved in the TMI drama toadd interest to theaspectsof the inci dent which might otherwise be less than fascinating to the lay reader. While the tech nique is effective, Stephens overdoes it. Two hundred and forty namesare listed in the index of Three Mile island, among them Attila the Hun, Groucho Marx, Teddy Roosevelt and, of course, Jane Fonda. The greatest difficulty of the reader is keeping track of this enormous cast of characters. While Stephens' technical descriptions of what he always refers to as "the accident" are well and simply written, it will probably still be difficult for many readers to visualize the se quence of events in the Unit 2 reactor at Three Mile Island. Illustrations would have been helpful, especially if they-Included a simple step-by-step flow diagram. WhereStephensreahyexcels, however, is in his penetrating look at theactions and interac tions of the technicians, scientists, and politi cians who both dealt with and exacerbated the problems at Three Mile Island. Three Mile Island details the incredible lack of coordina tion between the local and federal govern ments, the Metropolitan Edison Utility Com pany, the Nuclear Regulatory Commission (NRC), and a plethora of other agencies which 6 became involved with TMI. It rapidly becomes evident that much of the blame for the need less psychological damage done to the residents of the TMI area must be laid at the feet of the NRC, an agency which the book por trays as suffering from a sort of organizational St. Vitus' dance. Stephens says in hi$ prologue that "the story of TMI is generally one of informa tion--its presence, absence, and evasive nature." In a sense, thesame may be said of his own book. The absence of a critical review of the vital role the press played in disseminating ~ information and misinformation, and the failure to address the question of the media's responsibility In such events as TMI, prevent the unqualified recommendation of ThreeMile Islandasafair and complete look at "what real ly happened." With this reservation, however, the book can be recommended for its thor ough examination of the behavior of the utility and the government. After all, two out of three isn't bad. 105190 TITLE: Atomic Energy: A New Start AUTHOR; David E. Ulienthal PUBLISHER: Harper & Row, New York, 1980 COST: $8.95 (hardcover) REVIEWER: Robert V. Kline, Ph.D. TITLE: Brain Allergies: The Psychonutri ent Connection AUTHORS; William H. Philpott, M.D. and Dwight K. Kalita, Ph.D. PUBLISHER: Keats Publishing, Inc., New Canaan, Connecticut, 1980 COST: $15.00 (hardcover) REVIEWER: Betsy McPherrin, M.S. URL 05191 At founding director and chairman of the Tennessee Valley Authority (TVA) from 1933to 1947 and the first chairman of the Atomic Energy Commission (AEC), David E. Ulienthal had a long and successful career in adminis tration. In particular, he witnessed and nur tured the development of both the civilian and military nuclear energy programs. In doing so he had to cope with many technical and human difficulties generated by the wide spectrum of uses to which nuclear energy would be put. Civilian versus military control and govern ment versus private development of nuclear energy are two of the thorny issues that had to be dealt with along the way. it is this wide per spective that Lilienthal shares with us in this book. The TVA is cited as an organization that works well, being run by conscientious, re sponsive people who are trained on the }ob. The AEC on the other hand is seen as an organization traditionally devoted to pro moting nuclear energy whatever the cost: Our main objective in the past was to pro duce electricity with a cheap atom, the cheapest possible, one that would be economically and environmentally com petitive with other forms of energy at a time when foreign oil was absurdly cheap and plentiful. This simple formula was shortsighted and dangerously wrong, as wa have teamed to our cost. The author contends that, in the rush to Im plement nuclear energy, safety issues were given short shrift, and cites the Three Mile Island incident as one consequence of this. The anecdotal material brought to bear in sup port of thiscontentiondraws from theauthor's long experience and is the most, interesting aspect of thebook. After quitting the AEC, Ulienthal became a vociferous critic of the agency. In about 1963 he attacked the agency's conflicting rote as both promoter and regulator of nuclear energy. Partly as a result of this conflict of in terests, the U. S. Congress eventuallydisband ed theAECand formed the NuclearRegulatory Commission. The theme of the book, and presumably the reason why it was written, is contained in the following: Our new objective must be to find a safer, "healthier" method of producing peaceful energy from the atom by a method that also minimizes or eliminates the present risk of furthering the spread of nuclaar weapons. If it is also cheap, or relatively cheap, fine; but first it must be safe. At this point nuclear energy, as an energy source, becomes a thing unto itself: "ordinary standards are not good enough for nuclear power." Apparently because of the potential connection with nuclear waapons, the con cern for safety becomes both an obsession and a conceptual trap. In at least ten other places in the book an appeal is made for some one to develop afundamentaiiy newmethod of obtaining energy from nuclear material, one that is inherently safe. Just how is not even a matter of speculation. The author's desire to piace nuclear energy in a category by itself is, however, aconceptual trap. No method of producing energy is without risk. The magnitude of the risk can only be reasonably determined by looking at an energy system in its entirety. Total risks in curred by each system must be compared. Coal-fired power plants incur risksassociated with mining, transportation, pollution, waste and ash disposal, etc. Viewed in this way, nuclear energy may be inherently no more dangerous than any other, the problems are simply different. The importance of energy in our society is not minimized. In a short summary of the energy options available today, the author acknowledges the necessary role that nuctear energy will have to play in the foreseeable future: "We cannot reject out of hand any possibility, including nuclear power. But it must be safe." The importance of affordable energy is waved away, however, when it is said: "If it is cheap, or relatively cheap, fine." To beaccept able, any energy system must be both safe and produce energy that is economically competi tive with other methods of production. A safe system producing expensive energy is of limited interest. Parts of the book are entertaining, but over all the hindsights are more interestingthan the foresights. The author fails to recognize that existing nuclear power plants can be made saferfora relatively small increase in cost. The author's vagus calling, in the book's title, for a fundamentally newapproach tonuclearpower production Is, realistically, little more than wishful forecasting. Robert Kline, Ph.D., is a Fellow of the Inter disciplinary Program on Health at Harvard University. The authors of Brain Allergies seek "to ac quaint the lay reader, as well as the concerned physician, with the concepts of orthomolecu lar medicine and human ecology." The book does, indeed, "acquaint," but the thoughtful readerwill wish forgreaterdocumentation and less side-stepping of vital questions. Human ecology, according to Philpott and Kalita, is the scientific examination of man's environment in order to discover sources of environmentally produced illness. They believe that up to 60 percent of the symptoms attributed to such mental illnesses ss schizo- ,, phrenia are actually "allergic" reactions to various environmental stimuli such as foods, inhalants, animals, etc. (The term "maladap tive reaction" is used, since the reactions are not necessarily allergies in the classical sense, wherein a specific "allergen" such as pollen elicits antibody production.) Philpott claims that of 250 consecutive patients, most had "maladaptive reactions,"including 92per cent of the schizophrenics. Onethird of his pa tients reportedly react to common environ mental chemicals (insecticides, preserv atives, additives, chlorine in water, etc.). Philpott, Kalita,andothershypothesize that maladaptive reactions result from "addic tion" to certain foods or chemicals. When the addictive substance is used frequently, all is well. Maladaptive reactions occur In response to "chronic stress" such as an overload of the "allergen," harbored infection, or other physical and emotional strees. Abnormalities in blood sugarievelfdlabetes and hypoglycemia), are said to be allergic responses to specific foods, which are not necessarily carbohydrates. Philpott teats for such maladaptive substances by fasting patients for four days, then exposing them to the substance, where upon susceptible individuals show an "Im mediate reaction wlthanallergic-likequality." For example, one patient responded to wheat with sneezing, laughing, and pacing, to black olives with a two-hour headache, and to dates with a running nose and "hard-to-please" at titude. (Classic allergists apparently refer to this as "presumptive evidence" of a causeand-effect relationship, since the patients are aware they are being challenged with suspect foods.) The "cure" for such addiction is what the authors call the "diversified rotation diet." Foods or food families that evoke responses are avoided for three months or more. After that, if a food is eaten infrequently, say once every four days, no symptoms are evoked. The testing and therapy appear similar to those used by conventional allergists. (continued on pege 10) 53># H HEALTH WATCH EDITORIAL: URL 05192 Contempt of Court An ACSH member from Ohio sent us an arti cle from the Cleveland Hsin Dealer about some extraordinary goings-on in the Juvenile courts of Licking County, Ohio. One of the Judgestherebellevesthat hostility andaggres sion in children can be attributed to their con sumption of certain foods, including milk, flour, chocolate, sugar, and gelatin, and ap pliesthese scientifically unfounded beliefs on the Job. Juvenile offenders who come Into his court ere required to fill out a diet question naire, and if the results indicate that food "might bea factor in behavior,*' theyare put on a restricted diet. According to the judge, "It's got to be cold turkey all the way." We're getting accustomed to health hogwash, but it's disturbing to find out that in some pieces, it has the forces of lew behind It. Phyatetsf* Rx for Hsrpee A News & V/ewa reader from Washington, O.C. providedanotherexceltentadditiontoour hogweah file: an article from the magazine Sexology Today entitled "Controlling Herpes with Food." Herpes type li is a virus that can cause pain ful, recurring outbreaks of blisters, mostly in the genital region. No cure for this sexually transmitted disease has been found, end the symptoms tend to come and go. These characteristics end the personal nature of the problem make it a perfect target for home remedies, folk "cures,'' and the kind of nutri tional nonsense found inthe magazinearticle. According to the magazine, herpes sufferers should avoid sugar, vitamin E, and fat, and in crease their intake of vitamin C to levels of questionablesafety. Oneshouidalsoeat more of the amino acid lysine and lees of theamino acid arginine. What this means, in practical terms, is to avoid chocolate-covered peanuts, which apparently have an unfavorable lysinafarginineratio, andcansupposedly "pre cipitate recurrence of active herpes the next day." Scientific evidence to support these menu suggestions is lacking. However, the article gives the Impression that this information has a scientific basis because it it drawn from a public presentation by a university physicist. Of courss, training in medicine or nutrition is not required for a degree in physics, and e lec ture at an "alternate lifestylesconvention" iss far cry from e publication in e peer-reviewed scientific journal. Unfortunately, it is uniikeiy that most readers of this magazine article ap preciated these distinctions. USDA Boss on Food Safety In an interview published in the February issue of the Washington newsletter. Nutrition Intelligence, John Block, the new Secretary of Agriculture, was asked hisopinion on the sub ject of using risk-benefit analysis tomakefood safety decisions. Secretary Block replied, "I think we almost have to move to something a like that, because there's risk in almost any thing ws do or eat... .Still, a lot of these things we have to have. Vitamin D is an ex ample. If you eat too much vitamin D, it's a car cinogen. But we have to have it." Mr. Block's commentsars an exampleof the new, more realistic approach to food safety issues that we've been hoping to see. Rare Courage We have noted before (see "Conspiracy of Silence?",ACSH NewsS Views, Volumel.No. 2) that most magazines devote tittle attention to the hazards of cigarette smoking, it's a pleasure to be ableto pointout an exception to this ruts. Ths December 1960 issue of the per sonality magazine Modem People featured e hard-hitting cover story on the dangers of cigarettes, entitled "How the Tobacco Com panies Are Sending You to an Early Grave." in addition to presenting the medical evidence against smoking, thearticle captured readers' attention with pictures of celebrities, In cluding JohnWayne, Humphrey Bogart, Betty Grabie, end Nat King Cole, who died of smok ing-related diseases. Ths striking cover showed pictures of eight convicted murderers and a cigarette pack, with the caption "Ail of These Kilters Are Deed or in Prison Except One." Modem People also ran a follow-up story In its next issue on how to quH smoking. Many readers ofthefirst article were undoubt edly receptive to that kind of information. doerVision at FDA Some people fear that the new administra tion will threaten public health with Its efforts tocutdown ongovernment regulation-Wediaagree. There are some truly necessary regula tions which must be kept in effect, and we think that the administration realizes this. However, there Is s reel need to stop the over whelming flow of unnecessary regulations, whichcreate problems ratherthan solve them. A goodexampleof the latteroccurred when an administrator si the Food and Drug Ad ministration (FDA) had salt tablets used in the cere of soft contact lenses taken off the market. The FDA decided that peoplecouldn't be trusted to prepare their own solution for storing and cleaning their lenses. By taking away the tablets, FDA forced contact lens wearers to buy prepared salt solutions. Unfor tunately, these solutions cost six limes as much as the tablets, and they contain a pre servative that can causa bothersome allergic reactions in soma people. On the other hand, doctors have reported no problems with the sett tabletsas longas theywereusad properly. After receiving many complaints from the public, a House subcommittee conducted an investigation of this incident and concluded, quite reasonably, that there was no basis for withdrawing the salt tablets from the market. We certainly need regulatory agencies to pro- (continued on pegs 11) At thepresent timethere is unprecedented interest In the subject of nutrition in thiscountry. Our people, consumer advocate groups, health food devotees, voluntary health agen cies, theUnited States government through Its various departments and Institutes, congres sional committees, and the National Academy of Sciences are concerned about nutrition practicesand policy. Why hasthis comeabout in the last decade? Possibly because Americans, sines Vietnam, have become dis illusioned with the conventional institutions ofgovernment, industry, medicine, and educa tion, andhaveincreasingly devotedtheiratten tion to self end self-entitlement. Since ade quate food is clearly required for personal health, much attention has been centered on the value of foods. Mythology of food is an ancient and recog nized phenomenon and postulates that food; have powers of heating beyond their nutri tional values. Because of the emotional and cultural values of foods, nutrition is subject to more political action than many other branch es of natural science. Politics deals with the defense of the party (institution, political group, cult,orposition)whersassciencedeals with the investigation of truth. Why Is nutritional science so susceptible to the intervention of politics? There are several reasons. First, nutrition is big business not only fortheproductionof foods butalsohealth foods. Second, food mythology fostersbeliefs rather then understanding and leads to emo tional investments in given nutritional con cepts, l.e. cultism, whether the concept is scientifically valid or not. Third, the press plays a big role In nutrition education and in dividual food writerswield significantpowerin determining nutrition policy. Somejournalists believe that becausetheywriteabout nutrition theyare.de/acro, experts In thescience. Many are consumeractlvlstsand naturopaths. Final ly, nutrition programs get votes. A prime example of politics in nutrition is ths reception given to the recent report of the 15-member Food and Nutrition Board of the National Academy of Sciences on the relation ship of diet to disease. "Toward Healthful Diets," released on May 28.1960, summarized a critical scientific review of over 400 medical papers to determine what advice should be given to the American public about diet aimed at prevention of the chronic degenerative diseases. Using as its principal criterion that proof of benefit should be demonstrated for a public health measure before it is generally recommendedtothepublic, the Board advised healthy Americans to: (1) eat a variety of foods to obtain each day's nutritional requirements, (2) eat moderately to maintain desired weight, The Science and Politics ofNutrition p URL 05193 (3) avoid alcohol, sugar, fats, and oils if one needs to lose weight or has a very sedentary occupation, (4) increase physical activity fitness, and (5) use salt in moderation. Although these modest recommendations were supported by the American Medical Association and by a segment of the food in dustry, the report elicited a storm of criticism from the American Heart Association, con sumer advocates, the government Depart ments of Agriculture and Health, and many journalists. In its June 3,1980 editorial entitled "A Con fusing Diet of Fact," The New York Times stated. "The National Academy of Sciences is supposed to be an authoritative. Impartial source of scientific advice to both the public and the government, the supreme court of science. But its latest report on healthful diets is soone-sidedthat it makesadubiousguldein national nutrition policies." Dr. Made Hegsted, administrator, Human Nutrition Center of the USDA, said on July 31 that "the Foodand Nutri tion Board Is irresponsible in not making a recommendation on dietary cholesterol." Although the American Heart Association ad mitted in a news conference on August 8 that "the scientific evidence is lacking that choles terol-lowering will reduce or prevent heart at tacks," it nonetheless endorsed Its previous position, urging Americans to reduca total fat, saturated tat, and dietary cholesterol In the hope of preventing coronary heart disease. Representative Fred Richmond of the House Subcommittee on Domestic Marketing, Con sumer Relations, and Nutrition stated on June 18 that he felt that the Food and Nutrition Board had overstepped itscharterandviolated its authority by putting forward a public policy advising the American people about whet kind of diet to follow. Several consumer advocates madeadhominem attackson Board members, alleging that their consultantshlps with segments of the food Industry proved Industry bias. All these were political arguments that did not deal with the scientific content of the report. This furor illustrated the extent to which the field of nutrition is dominated by politics rather than by science. Vested Interests took precedence over scientific criticism and the report was attacked in order to advance those interests. Most scientists would argue in general that If data are incomplete or uncon vincing, as are the data relating diet modifica tion to prevention of heart disease, then It is better to withhold final conclusions and par ticularly advica to the public until there ia tangible proof of benefit. Intervention in susceptible populations with both diet and drugs to alter overall mortality rates from a variety of chronic diseases by changing serum cholesterol levels has uniformly failed. The data linking dietary cholesterol to car diovascular disease are very weak. The Intake of dietary cholesterol in the United States has not changed appreciably in 70 years and does not correlate with the rise in the incidence of coronary heart disease that occurred in this country between 1920and 1963 nor with its fall from 1963 to the present time. Furthermore, in the U.S. no correlation has been made be tween any component of diet, including satu rated fat and cholesterol Intake, and the risk of coronary heart disease. In free-living popula tions it has been shown that wide-range alter ing of dietary cholesterol has little, if any, ef fect on serum cholesterol. Although LDL- cholesterol in plasma is a risk factor for cor onary heart disease, the Board decided, in company with five other national expert com mittees from Canada, England, Australia, New Zealand, and Norway, that dietary cholesterol is not a risk factor for coronary heart disease. It is my view that science wilt eventually triumph over politics in scientific disputes, although in the case of Galileo It took cen turies. The Food end Nutrition Board report has stimulated considerable debate and dis sent in professional circles in the past several months. Dr. Thomas James, in hls 1960 presi dential address to the American Heart Association (AHA)entitlad "SureCures,Quick Fixes, and Easy Answers: A Cautionary Tale About Coronary Disease," said, "Today I want to share with you my growing concern about overpromise in coronary disease. My remarks center around the credibility of the AHA and medical science generally." He continued by making four main points in hls address: (1) we should be more explicit, l.e. make full dis closures ol the basis for public recommenda tions; (2) we should distinguish between risk reduction and true prevention for individuals; (3)we should be awareof thecoercive powerof publicadvice, i.e. in generating regulation, and (4) weshouldadmit thatwadonot knowthefuil effects of dietary restriction in childhood. Atherosclerosis and Its principal clinical ex pression, coronary heart disease, is a disease of unknown cause and is contributed to by many factors in addition to diet. Coronary heart disease is not a nutritional disease like rickets or pellagra. Only SO percent of the risk of suffering a heart attack is accounted for by all the risk factors, which include family history of heart disease, obesity, diabetes, hypercholesterolemia (high plasma LDLcholesterol), high blood pressure, cigarette smoking, and inactivity. Platelets, little cellular particles in the blood, play an Im portant part inthe initiation of thedisease. The public must understand that the solution to the medical riddle of atherosclerosis Is not for politicians but tor scientiststo solveby careful Investigations of true cause-and-effect rela tionships in the body. An entirely new strategy of prevention may be needed! One hopeful development is that the mor tality rate from coronary heart disease has been decreasing in our country over the past twenty yearsat the rate of 1 -2 percent per year. The National institutes of Health has conclud ed this positive result is not due to any single factor. Even when the slight changes in diet, serum cholesterol, smoking, blood pressure, and physical activity are summed, the result exceeds expectations. Further scientific re search is needed to understand even the good things that are happening to the U.S. popula tion. Robert E. Olson, M.D., Ph.D. , St. Louis University School of Medicine WE NEED YOUR HELP) You con ensure ACSH's growth by --tolling others about ACSH and encour aging them to Join --sanding us lists of potential msmbsrs --helping us soHolt grants from founds- obtaining ACSH membership for your company or organization - providing informationon ACSH's mem bership drive In your institutional publi cations or newsletter MISLEADING MEGADOSES Book Review /continued from page 7) URL 05194 by David B. Roll, Ph.D. Although one expects to find the advocacy of megadoses of vitamins in the health cult literatures, it is disappointing to discover un critical endorsement of this practice in literature directed at health professionals. Yet, such an article recently appeared in American Pharmacy (Vol. NS 19, No. 9, p.498. 1979), a publication of the American Pharmaceutical Association (APhA). One would hope that the editors of such a prestigious publication, aimed at health professionals having a minimum of five years of college education, would show more sophistication in theirselection of articles or at the very least submit them for peer review prior to publication. The fallacy of megadosage is well covered by Ron Deutsch in his excellent book ReatitiesofNutritioni&uH PublishingCo.,Palo Alto, CA, 1976) In which he points out that, since mankind was successful in evolving on the food readily available, we would not expect tofind largenatural barrierspreventing access to foods needed forhealth.The following table shows some of the recommendations made in the paper cited inAmerican Pharmacy- Also in cluded is the amount of food(inall casesan ex cellent source of the vitamins was used in the calculations) that would be required to obtain the quantity recommended. Or. Pollis Professor of Medicinal Chemistryat the College of Pharmacy, University of Utah. Vitamin Quantity Recommended Food Needed to Obtain Quantity Recommended E 8401U 15.2 Ib.ofwheatgerm C 5280 mg 18.9 lb. of oranges Bi 52 mg 19.8 lb. of roast pork 62 52 mg 68.01b. of whole milk Niacinamide 32 mg 3.7 lb-of peanuts Keeping in mind that the energy require ment for a 23-year-old male is 2700 calories (2000 calories for a female), it is interesting to note the approximate number of calories that would be found in these quantities of food, namely, wheat germ(25,000 calories); oranges (4600 calories); pork <12,400 calories); milk (20,400 calories); peanuts (9500 calories). Such quantities of food are not compatible with life, and make the advocacy of such high quantifies of vitamins suspect at best. Is it not reasonable to ask why, after our reasonably successful evolution, it is now necessary to rely on megadoses of nutrients that we have not required in the past? Among the alleged benefits cited in the arti cle for such a regimen are "better" health and metabolism and more energy, with the evi dencefor suchclaimsbeing largely anecdotal. When the quantities of food noted are con sidered, one might add to the list massive obesity. Obviously this would not lead to bet ter health even if we could tolerate such tremendous quantities of food. It is our hope that APhA will reevaluate its editorial policies with the aim of insuring that scientific inquiry and not just personal opinions and anecdotes is retained as the foundation upon which all legitimate health professions are based. Philpott believes that "super'' nutrition, via intravenous and oral megadoses of individual nutrients, reduces the incidence and severity of maladaptive reactions. This is the "ortho molecular" part of the treatment. Forexample, a woman who was maladaptive to wheat reportedly had no symptoms when wheat was eaten after receiving intravenously 7.5 grams of Vitamin C (125 times the Recommended Dietary Allowance) and one gram each of pyridoxine and niacin (500 and 77 times the ROA, respectively). Book chapters describe "the healing powers of Vitamin C," "the perils of toximolec- ular medicine." and a theory of "the disease process." The authors' observations (bizarre case histories appear throughout the book) are fascinating, but they are merely observations. Philpott and Kalita recognize "the need for long-term, intense--and necessarily expen sive-scientific evaluations of clinical ortho- molecular-ecologic medicine as applied to chronic degenerative diseases." They are less credible when they state that "without double blind studies, we have believable evidence of a cause-and-effect relationship." and when they recommend the rotation diet to everyone because"Americansareeating.. .foodswith a frequency that is beyond our biological capability to handle in a healthy way." If there are controlled studies which support the latter statement, they are not mentioned in the text. Philpott delves little into mechanisms which might explain his observations, stating that "even when there is a demonstrated evi dence of symptom production on exposure to a food or chemical, we still do not know why," and postulating the causes as "immunolog ical, metabolic errors, enzyme deficiencies, nutrient deficiencies, toxins, infections, or something else." They say you can't arguewith success, but it is not clear that the orthomolecular-ecoiogic approach has been successful. All of the case histories have happy endings, but there is no mention of failures or long-term follow-up, and the authors claim no specific rate of success. The rotation diets are potentially safe and nutritious, but many of the specific foods allowed each day are seasonal, prohibitively expensive, or otherwise unavailable in most parts of the United States. Different cooking oils, herbs and spices, and sweeteners must be used on each day of a four- or seven-day cy cle. Most prepared foods, even those as basic as bread and cereals, are unacceptable. The al ternative is "cooking from scratch" (using special recipes) or doing without. How many patients could adhere to such a stringent and time-consuming diet? The book aroused this reader's interest in allergy and the brain-nutrient connection. However, l would not recommend it to people who don't know the difference between a study and a story. Befsy McPherrin, M.S-, is a nutritionist and free-lance miter. 1 URL 05195 Health Watch (continued from page 8) PROFILE tect us from hazards that are beyond our con trol. But we don't need them to protect us from ourselves, on the insulting assumption that we are incapable of reading and following directions. TV Touts Feingold We were deeply disturbed by a recent seg ment of the syndicated TV show PM Magazine entitled "Diet for Problem Kids." The program consisted of interviews with children who were on the Feingold diet and with their parents (members of a New England area Feingold Association), who were very en thusiastic about the diet's effects on their children. The show not only lacked scientific balance, it lacked science, period. No physi cian or other professional with expertise in hyperactivity was interviewed. Viewers were never even told that the diet had been tested scientifically, let alone that It had been found to be ineffective. The controversial nature of the Feingold regimen was never mentioned. This kind of careless approach to a serious problem that deeply troubles many families can only be described as irresponsible jour nalism. Caffeine Confusion ACSH found itself in the midst of confusion last month when our report on caffeine, which concluded that this food and drug component is not a threat to human health, was released just after the publication of a Harvard School of Public Health study suggestingastatistical link between coffee consumption and pan creatic cancer. Actually, there is no contradiction between thetwo studies. Our report focused specifleallyon caffeine, a compound found Intea, cocoa, some soft drinks, and some medications as well as in coffee. The Harvard study focused specifically on coffee, a complex mixture of more than three hundred substances, one of which is caffeine. The Harvard study was preliminary, as Its authors pointed out. It raised a hypothesisthat is worthy of further study, but it certainly did not establish a definite link between any cof fee component and pancreatic cancer. How ever, if such alink isestablished inthefuture.it is highly unlikely that caffeinewill bethe impli cated substance. In the Harvard study, pan creatic cancer risk was not elevated in tea drinkers, and tea contains substantial amounts of caffeine. --E.M.W. HOMASH. JUKES, Ph.D. ofessor in Residence, Biophysics and Med al Physics, Lecturer in Nutritional Sciences, Diversity of California, Berkeley Irector, National Council for Environmental alance; Editorial Board: Biochemical enetica. Journal of Molecular Evolution Jucation.. .Ph.D., B.S.A., University of >ronto; D.Sc., University of Guelph "V'----1'. : -A-' ACSH's scientific Directors and Advisors re "doers," action people involved in many spects of their fields. Varied in ackground. interests, professional affflia* one, and geography, they are bound to other by their desire to see a new conumer group grow. We think the ACSH scientists are a nique and interesting group of people that ou, our readers, would enjoy getting to now. To h*p you become acquainted, ach issue of NEWS AND VIEWS will feajre a biographical PROFILE of one ACSH >irector or Advisor. Recent Publications. - ."Silent nucleotide substitutions and the molecular evolu tionary clock," Science, 1980; "Silent nu cleotide substitutions during evolution," Naturwissenschaften, i960. Research.. .``Molecular evolution and the sequences of DNA molecules." Turning Point..."The most recent turning point took place in December 1961 at a meeting of the Enzyme Club at Rockefeller University when Dr. Severo Ochoa gave a talk on `Synthetic polynucleotides and the aminoacid code,' I promptly decided to stop what I was doing and enter this new field. For the same reason, I resigned from my job, about ayear later to organize a new research group at the University of California, Berk eley. It led me into molecular evolution." Personal Health Code.. ."I stopped all use of tobacco In 1953 which was easy because I smoked only one cigarette a day. I gave up coffee about ten years ago, not because of any particular health concern, but because it was a nuisance that `did nothing for me.' I have no special dietary fads. My food list for heavy exercise on high mountain backpack ing trips includes one half pound of sugar per day, starting In 1938.1 have no tendency to overeat, apparently, because my weight is approximately normal without 'dieting.' I don't regularly consume either alcohol or vitamin pills. I have a very active family life with my wife, three children, and five grand children." Major public health concerns Americans face ... "Cigarette smoking, overeating, quack ery, misinformation, and alcoholism." What do you think will be the most important public health accomplishments in the com ing years? "In the coming years, new dis coveries in Immunology have great poten tial and so has the development of recombi nant DNAtechnology--not for'changlng in dividuals,' but for more general applica tions." Why did you join the American Council? "I helped start the Council because of the great need forauthentic informationon mat ters involving public health,especially nutri tion. The need arose from the tremendous amount of misinformation by 'special in terest groups,' such as consumerlsts and environmentalists who start scare stories as a way of life." i ENVIRONMENTAL UPDATE Drugs: The controversy over the benefits and risks of estrogen therapy In preventing osteo porosis In postmenopausal women continued unabated with a report In the February Issue of the American Journal of Public Health. From their study of women enrolled In the KaiserPermanents Medical Care Program in Portland, Oregon, authors Johnson and Specht concluded that estrogen replacement therapy reduces the risk of hip fractures. They acknowledged, however, that the email number of study cases limits the strength of their conclusion and that the protective effect among hysterectomized women was smaller than that for the entire study group. Hysterec tomized women generally receive greater ex posure to exogenous estrogen and would presumably benefit the most from Its protec tive action. Hip fractures due to osteoporosis, a pro cess of bone thinning resulting from calcium loss, are ten times more frequent in females than males. Although osteoporosis occurs in both males and females beginning aroundage 35, the rate of bone loss Increases significant ly in some females after menopause. This ac celeration is presumed to be a function of the decrease in natural estrogen that accom panies menopause. However, the exact pro cess by which estrogen influences bone den sity is not known. To further complicate mat ters, there are numerous other factors, in cluding insufficient dietary intake of calcium and vitamin D, cigarettesmoking,and inactivi ty which accelerate bone loss in postmeno pausal women. The real controversy, though, lies in the tradeoff between estrogen therapy's preven tive benefits and its risks of causing en dometrial cancer. Epidemiological studies conducted since 1975 have shown an associa tion between long-term (more than 2 years) estrogen use and this form of-utertne cancer. Yet amongelderlywomen,endometrial cancer resuIts in farfewerdeaths (2700)than thoseat tributed to hip fractures (15,000). Many clini cians advocate prophylactic long-term estrogen therapy lor most women who have reached menopause. Even the Food and Drug Administration, through its EndocrineMetabolic Advisory Committee, has ruled that "estrogens are effective in preventing post menopausal bone loss and the risks are acceptable." Many questions about estrogen use to pre vent bone fractures remain unanswered. While It is clear that estrogen therapy Is an aid in reducing bone loss, it has not been con clusively established that this treatment prevents fractures. The lowest effective dose, minimum duration of treatment, and perhaps most important, a well-defined population at risk are still unknown. Thus, as with the cholesterol-heart disease controversy, it may be premature to advocate long-term estrogen therapy for most women without more evidence of benefit. Lifestyle: With the publication of an epidemiological study in the New England Journal of Medicine (304<13):745, March 26, 1961), another of life's simple pleasures joins the growing list of cancer hazards. This time It's snuff, a finely ground or powdered tobacco used by many to get "that real tobacco taste." In acomparison of drinking, cigarette smok ing, and snuff dipping habits between a group of North Carolina women with oral and pharyn geal cancer and a control group, researchers found a 4-fold increase in cancer risk associated with snuff dipping in white nonsmokers. Among women using snuff for more than 50 years, the risk for cancer of the gums and oral mucous membranes increased almost 50-fold. A dose-related increase in oral cancer risk was also noted for those who smoked but did not use snuff, and for those who smoked and drank only. White women hadaoreater increase in cancer riskthan black women, apparently becausethey used snuff in greater amounts over a longer period of years. Theauthors identified N-nitrosonomicotine (NNN) as the prime suspect responsible for oral cancer. NNN has tumor initiating proper ties in laboratory animals and is found in to bacco smoke condensate, chewing tobacco, and snuff. It is formed by bacterial or enzyme action on tobacco during curing and from the mixing of snuff with salivary nitrites. The original hypothesis linking snuff dip ping with ora) cancer stems from the geo graphical distribution of oral cancer deaths generated by the National Cancer institute's Cancer Atlas. Male deaths from this type of cancer are concentrated in the Northeast and are generally thought to result from the com bination ofcigarette smoking and alcohol use. In contrast, female oral cancer deaths are con centrated in the South, particularly North Carolina, Georgia, and Alabama. This new study suggests that as much as 31 percent of oral cancer in North Carolina is attributable to snuff dipping alone. The researchers noted that total production of smokeless tobacco products in the U.S. rose from 98 million pounds In 1971 to an estimated 134 million pounds In 1960, with a 3-fold increase In finely cut tobaccos. They ex pressed concern about the heavy advertising campaigns by the tobacco industry and reports in the medical literature recommend ing these tobacco products as substitutes for cigarettes. We wholeheartedly concur with the authors' recommendations to educate the public about this hazard. The only safe tobac co product is the one that is not consumed. Pesticides: Spring is here and with it comes the annual plague of gypsy moths in the North east. The voracious larvae of this insect pest defoliated more than 400,000acresof park and woodlands in New Jersey alone last year and are expected to cause record damage again thisyear. Butdespitetheavallabilityofan inex pensive and safe pesticide, carbaryl (more popularly known by Union Carbide's trade name, Sevin), many communities are ap parently opting for the moths. Last year we reported that aerial spraying of Sevin was discontinued In many areas because of an alleged relationship with birth defects. Based on this public concern, the En vironmental Protection Agency reevaluated the literature on carbaryl and human health. It concluded that there is no evidence that useof^ this pesticide poses any health risks to" humans. Unfortunately, this decision and others by various state environmental agen cies did not satisfy carbaryl's critics, and the debate continues. In our own community of Summit, New Jersey, Sevin has been accused of "a litany of horrors" including Reye's syndrome, birth defects, miscarriages, lowered sperm counts, liver disorders, and "a personal testimony of Sevin-induced blindness." The city council, which approved the uee of Sevin, also stands accused of disregarding the rights and health of pregnant women and opting fora"quiekfix" becauae of Sevin's undisputed costeffectiveness. If the pragmatic consequencesof this fervid emotionalism were not so serious, there would beagreat tendency to shakeone'shead in disbelief. But there is a disturbing schizo phrenia towards science that is clearly ob vious in this debate. On the one hand, anti pesticide activists are more than willing to quote vague, allegedly scientific sources which support their contentions. However, more reasoned scientific opinions not in ac cord with their own are regarded as profitmotivated or "inconclusive." As has been stated many times, Americans today seem wlllingtoaccept anyopinionofourtechnoioglcai society, as long as it is bad. --T.S. 12 URL 05196 i The DDT Debate (continued from page 1) of the incredible effectiveness of DDT in reducing the incidence of malaria can be seen in India, where ten years of insecticide use reduced the malariadeath rate from 750,000 to only 1500. Even more dramatic was the case of Ceylon. With the useof DDT. malarkaincidence declined from 2.8 million cases in 1946 to 110 cases in 1961, when the battle was considered won and spraying was abandoned. Seven years later, malaria incidence in Ceylon was beck up to 2.5 million, and DDT spraying had to be reinstated. The final reason that DDT enjoyed such popularity as a pesticide was the fact that it combined high toxicity for insects with low toxicity for other organisms, including man, a fact which may well seem amazing in light of the infamous rsputation which this chemical was ultimately to have with the lay public. Thousands of individuals, military and civilian, had their clothing dusted with 10 percent DDT powder while they wore it, without ill effect. More pertinent to the safety Issue was the absence of any DDT-releted fatality or chronic disease among individuals employed as DDT sprayers in anti-malaria programs, a group estimated at one time as consisting of 130,000 men annually. Nor was any toxic effect noted in the 600 million to one billion people who lived In repeatedly sprayed dwellings. Poison ing with DDT was a rarity, and the only docu mented instances were the result of massive accidental (and sometimes suicidal) ingestion of the insecticide. However, despite this generally clean bill of health, DDT use was not completely problem free. For one thing, certain insect strains began to develop resistance to DDT. By 1969, insect resistance to DDT necessitated the use of alternative insecticides in 1 percent of the areas where DDT had originally been used for disease eradication. Of course. It should be remembered that the problem of resistance was not peculiar to DDT, and has been shown to occur with repeated use of any chemical. The occurrence of resistance in some insect species, though disturbing, cannot be con sidered arationale forbanning achemical, just as few would suggest discontinuing the general use of penicillin due to the emergence of several penicillin-resistant strains of bacteria. The greatest problem associated with DDT, however, was that, in a few instances, enthusiastic use became enthusiastic over use, primarily in the area of agriculture. "If some isgood, moreisbetter1'was therationale of some farmers. In addition, whether by accident or carelessness, a tew incidents occurred in which concentrated pesticides found their way into lakes and streams. While DDT was not specifically involved in all of these mishaps. Its reputation with the public nevertheless suffered from guilt by association. Proper and responsible application and dis posal of DDT were the rule rather than the exception. Even the increased applications of DDT to cropland, considered damning evi dence by those opposed to the pesticide, were sometimes a legitimate, and accepted, response to the development of insect resis tance. However, the incidentsof carelessness and misuse, both real and exaggerated, inevi tably provided ammunition for individuals opposed to DDT use, and were often luridly portrayed to the lay public. It was this perceived pesticide abuse which helped Rachel Carson's Silent Spring to gain acceptance. Considering how effectively this book aided the environmental movement, perhaps a more accurate title would have been "Silent Springboard." The infant environmen tal movement saw its opportunity when Silent Spring was published in 1962, and, by riding the wave of interest and concern generated by Carson's book, gained a position of consider able prominence end power in a relatively abort period. It is unknown whether Carson herself would have supported the call for a total ban on DDT around which the environ mentalists rallied in the late 1960s; Rachel Carson died In 1964. WhileSilent Spring Is cer tainly hard on DOT, often Inaccurately so, it is even harder on certain other pesticideswhich, it states, make DDT "seem by comparison almost harmless." ironically, though Silent Spring never specifically advocates a ban on OQT or any other pesticide, the Audubon Society's Rachel Carson Memorial Fund was used to support one of the first legal suits for a ban on DDT use. By the late 1960s, the DDT ban crusade was in full swing, led primarily by the fledgling Environmental Defense Fund (EOF). The popularity of the antl-DDT movement led a 1970 Nature editorial to quip, "In the last few months resistance to insecticides has been growing almost faster among people than insects." In 1969, Michigan was the first state to actually ban the chemical, followed by Wisconsin, Arizona, and California. It was in 1969, loo, that the EDF, Sierra Club, National Audubon Society, and a Michigan environ mental group petitioned then Secretary of Agriculture Clifford Hardin to ban DDT, alleg ing it to be a carcinogen. A Commission on Pesticides and Their Relationship to Environ mental Health, called the Mrak Commission, was appointed by the Secretary of Health, Education, and Welfare In the same year. On the basisof therecommendations of thatcommission, theAgrtcultureSecretaryannounced a plan for phasing out the use of DOT by December31,1970, wlththeexceptlonof uses essential to protection of public health and welfare. Under this ban, the use of DOT in health-relatedmosqultocontrolprogramsand on certain crops, such as cotton, continued to be permitted. It might be helpful to pause here and briefly describe the basis for opposition to continued use of DDT. The previously mentioned per sistence of the Insecticide became a thread of fear woven through many other concerns about DDT. While DOT'S lengthy residual Ilfs was In Itself harmless, it was the idea of this persistence linked to the claims of harm to the environment and human beings that generat ed the real hysteria. It was generally acknow ledged that DDT was present throughout the world environment, although this is true for other compounds as well. Small concentra tions of DDT were found to be present in the U.S. population, but, according to the Mrak Commission's report, "no reliable study has revealed a causal association between these residues and human disease." At first, the main concern about DDT re volved around some studies suggesting that it was responsible tor causing thin eggshells and, therefore, declining populations of cer tain bird species such as the brown pelican. Even now there is no scientific consensus as to the validity of this claimed effect; opinions vary on the adequacy of the studies cited as evidence. (Other environmental pollutants, such as PCBs and mercury, may have been re sponsible for many of the effects.) However, (continued on next page) 13 ^ 0 <-n ^ -_j 3/K H The DDT Debate (continued from preceding page) this point was probably not the majorsourceof conflict. Nor was the fact that, at some concentrations, ODT is toxic to many crusta ceans and fish. Had the environmentalists concentrated only on these dangers to wild life, there probably would have been far fewer fireworks. But as the movement against DDT gained momentum, other more controversial and frightening hazardouseffects wereadded to the list of DDTs alleged sins. Foremost among these was theassertion that DDT was a carcinogen and posed a substantial threat to human health. DDT does cause liver tumors in mice fed large quantities, but there was and is no evidence that DDT causes cancer in humans, even among those individuals occu pationally exposed to very high doses over long periods. The ban on DDT that was recommended by the Mrak Commission was baaed, as was stated in the Commission report, more on "suspicion of danger" than on proof. In ex empting certain essential uses of ODT from the ben, the commission was careful to note that "the current evidence is not sufficient to justifyunqualified banningofthe insecticide." The partial ban of DDT, extensive though It was, did not satisfy the environmental groups, who subsequently pressed the newly formed Environmental Protection Agency (EPA) to cancel the remaining registered uses of ODT. Such an action would amount to atotal ban on the use and sale of DDT, and would effectively eliminate DDT use worldwide. It is worth noting that, though the incidents of pesticide overuse which motivated theantiDOT crusade occurred solely in developed nations such as tha U.S., the reel hardship ofa total DDT ban would fall on poor and starving Third World countrieswherehuman existence aaas? is more fragile than thin pelican eggshell. The same economic considerations that made DDT so appealing, and essential. for use in developing nations tended to militate against the wasteful overuse of the chemical by those poorer countries, whether in agriculture or mosquito control campaigns. In fact, the use of DOT for malaria control entails almost no environmental contamination, as spraying Is restricted to the inner surfacesofdwellings, in pushing for a total OOT ban then, American environmental elitists were essentially pur suing a course which would punish develop ing nationsfortheoccasional pesticideexces ses of the United States. Time and again the World Health Organization stated that a total ban on DDT would mean the demise of programs against Insect-borne disease in Third World nations, and the death of millions of people. It was this push fora total ban that created the real controversy. In 1971 a hearing was scheduled so that each side could present Its case, it is revealing that, while EPA was meant to decide the question of the ban on the basis of the recommendations of the hearing exam iner, EPA ultimately pertlcipated in the hearings on the antl-DOT side, along with the EOF and conservation groups. In April of 1972 the hearing examiner, Edmund Sweeney, recommended to EPA that no more extensive ban of ODT was necessary or desirable, based on the evidence presented at the hearings. Yet less than twomonths later, on dune 14, 1972, then Administrator of the EPA William Ruckelshaue banned all of the remaining usee of DDT with the exception of uses related to essentiai public health pur poses. This ben did not effect the sale of DOT to developing nations. 14 All rights reserved. 5-4 7*M 1 Why Ruckelshaus ignored Sweeney's recommendations is not clear, but his action may have stemmed from a desire to establish the authority of the infant EPA through some muscle flexing. Ruckelshaus' motive was especially perplexing to those who remem bered his stated position on DDT two years previous: DDT is not endangering the public health and hasan amazing and exemplary record of safe use. DDT, when properly used at recommended concentrations, does not cause a toxic response in man or other mammals and is not harmful. Thecarcino genic claims regarding DDT are unproved speculation. By making an example of DOT, Ruckelshaus may have hoped to give warning to various environmental bad boys that the new agenqy meant business, while simultaneously garner ing brownie points from environmentalists. Regardless of the intent of the move, it set a precedent for caprice at the EPA which has cropped up in later actions of the agency. By now, DDT and the furor that surrounded the ban have been largely forgotten, but the reputation of DDTas pariah of the insecticides seems as persistent as the chemical itself. As recently as last August, a magazine article accused U.S. chemical companies of export- ing cancer in the form of DOT, thus giving new life to that tired old sophistry. At the time of the DDT ben, much was made of the need for more reliable research, particu larly on the human health effects of DDT exposure. However, in a classic example of what happens when cautionary bans are insti tuted pending more data, studies on DDT waned following the ban. Ex post facto re search rarely excites much interest or re search grant funding. In retrospect, it is difficult to say whether the ben on DDT was harmful. Other pesticides wereavailable, end relativelyaffordable, in this country, end the continued availability of DOT for export insured the maintenance of vital food and public health programs Indeveloplng nations. On the other hand, misconceptions about the alleged hazards of DDT were also effectively exported to Third World countries, and may havedlscouraged truly essential uses of the pesticide. But howeveruncertain theeffects oftheban itself, the process of the debate was disas trous. The DDT conflict set a pattern for environmental decisions based less on scien tific evaluation of risk than on hystrionlcs, mud-slinglng, and hyperbole. The rigid di chotomizing of issues and the enshrinement of The Cause are by now honored traditions, stemming from the format of that prototype contest, the DDT debate. Helen Kelly, with ACSH. is a research associate URL 05198 ii i t