Book Review:

Every movement has its history, its unsung heroes and its lessons for the present. The environmental health movement is no exception. In When Smoke Ran Like Water, Devra Davis takes the reader from killer smogs and leaded gasoline to the critical issues of the present including breast cancer, male sterility and climate change. Davis writes with the accuracy of a scientist, and the warmth and compassion of a storyteller. For such heavy material, the book is amazingly readable. 

A cutting edge epidemiologist and researcher, Davis has been in the thick of environmental health research and policy making for decades. She has worked for the EPA, the National Chemical Safety and Hazard Investigation Board, the World Health Organization and the US National Academy of Sciences. Davis is passionately committed to decreasing illness and loss of life from environmental pollution. She is determined not to let statistics hide the real people whose lives are at stake. 

When Smoke Ran Like Water provides rare insights into the science and politics of public health. It documents the developing science, efforts at regulation, as well as the sophisticated and all to often successful efforts to sidetrack, discredit and stall effective action. It provides a context through which we can better understand questions  like "Why does it take so long to get action to make our environment healthier? Why are products still being sold which, to our minds, are clearly unhealthy? Why are governments so slow to protect us from harm?"  The answers evolve through the histories of past public health issues. 

The struggle to remove lead from gasoline is considered one of the major triumphs of public heath. One of its unknown heroes was psychiatrist and toxicologist, Herbert Needleman. Needleman studied the residue of lead in baby teeth, documenting lead levels which had accumulated over time. In 1979, he published a study documenting the impacts of lead exposure on the IQ of children.  The International Lead Zinc Research Organization (ILZR), an industry trade group, hired dozens of scientists in an effort to discredit his work. In 1991, a formal charge of scientific misconduct was laid against him.  

But Needleman’s work was solid. Follow up studies showed that effects of lead persisted into adolescence and included higher rates of criminal and delinquent behaviour. In 1996, Needleman was awarded the prestigious Heinz Foundation Award for his refusal to buckle under pressures and for being “the unsung hero behind one of the greatest environmental health gains of modern times.” 

In an editorial in the medical journal Pediatrics in 1992, Needleman wrote, “If my case illuminates anything, it shows that the federal investigative process can be rather easily exploited by commercial interests to cloud the consensus about a toxicant’s danger, can slow the regulatory pace, can damage an investigator’s credibility, and can keep him tied up almost to the exclusion of any scientific output for long stretches of time while defending himself.”

It’s a chilling account. Even more chilling are these facts: in the year 2000, leaded gasoline was still being used in more than 100 countries, and in 2002, US President George W. Bush appointed a representative of the lead industry to a key regulatory body responsible for determining acceptable standards for lead exposure.

Outdoor air pollution has been an ongoing public health issue since the 1600s.  Surprisingly, as late as 1967 no one had yet evaluated the long-term effect of growing up and living in a polluted atmosphere. Lester Lave and Eugene Siskine analyzed statistics on air pollution and public health. They asked the question, “Is air pollution more of a public good or a public bad?” and answered it by costing the economic impact of controlling or not controlling air pollution. This was the first example of “green accounting.”  The results were so startling that in 1970 they led the US Congress, under the Clean Air Act, to order a 90% reduction in car emission rates in 5 years. The automobile companies predicted disaster, bankruptcy, job loss, unreliable vehicles and a “complete shutdown of the industry.” They called the standards “impossible” (even though they were already being met in Japan) and begged for more time and more leniency.

When the EPA stood firm, granting only one extra year, the industry met the standards and improved fuel efficiency, in less than the time allotted, and with no noticeable ill effects. Yet present day accounting seldom includes the intangibles of human health and environmental degradation when calculating the cost of action or inaction, and cries of “it will ruin us” are still frequently heard from vested interests.

When Smoke Ran like Water is not only about the past. Chapter by chapter, Davis examines the major environmental health threats of the present, air pollution, still causing chronic illnesses, increased disease and death, breast cancer, now at rates of one in eight women, and the almost taboo subject of reproductive damage and sterility in men and baby boys. Although the first federal reports of hazards to male reproductive health came out two decades ago, there has been little advance in knowledge since then. Davis argues that in part this is because of the “skillful ways in which some in the corporate world have effectively blocked research, canceled studies, pulled funding and employed sophisticated public relations campaigns to cast doubt on these questions.”

In 1977, 35 men working with the pesticide DBCP in an agricultural chemical division of Occidental Chemicals in California discovered they were all unable to father children. When the company refused to investigate, the union did. Tests showed all the men were sterile. Further investigation showed that the companies manufacturing the chemical and the EPA all had information that DBCP was a proven reproductive toxin at very low doses in all species tested. The toxicologist who studied the substance had warned that it should be considered extremely hazardous, and that workers should wear full protective gear. But MSDS sheets did not indicate this, and workers were not properly protected. When the California case hit the news, the pesticide was quickly banned for use in the US. However, the manufacturers, Dow and Shell, continued to sell large quantities in third world countries, where workers again were not warned of the risks. Later lawsuits against the two companies won damages for 20,000 Costa Rican men and 13,000 men in Guatemala, Nicaragua, Dominica and seven other countries who became sterile working with the pesticide. 

While acknowledging the difficulty of public health research, which requires many years, often generations, and massive studies in order to be conclusive, Davis argues convincingly that it isn’t necessary, or wise, to wait for conclusive proof before taking action.  She’s certainly not the first to say so. Sir Austin Bradford Hill, a prominent British environmental health pioneer, wrote in 1994,  “... All scientific work is incomplete -- whether it be observational or experimental. All scientific work is liable to be upset or modified by advancing knowledge. That does not confer upon us a freedom to ignore the knowledge we already have, or to postpone the action that it appears to demand at a given time.”
  
When Smoke Ran Like Water is not all gloom and doom. Davis provides examples to show that effective regulatory action can result in measurable public health improvements.  Davis’s book has been compared to Rachel Carson’s Silent Spring, published in 1962, the first major wake up call to the dangers of pesticides. The comparison is a good one. Both books are compelling examinations of many facets of environmental health. Both issue a call to act before it is too late. What is at stake in the issues Davis covers is nothing less than human health in its broadest sense, including our ability to reproduce, our intellectual abilities, and the survival of our planet.   About climate change, the ultimate environmental health issue, Davis argues, “...The risks of irrevocable damage to the earth’s climate are so great that waiting for clear proof constitutes a doomsday experiment.”

For anyone interested in the future of human health, When Smoke Ran Like Water provides a fascinating and valuable basis for understanding and action. MD Mitchell Gaynor of Weill-Cornell Medical College writes in the introduction, “The battles against environmental degradation have often been waged by lonely figures, far from the public eye, against those with a multi-million-dollar stake in having us believe that there was no crisis -- that smog and soot do not induce heart and lung disease, that lead in the air does not diminish children’s IQ’s. All the tales of environmental deception relayed in this book remain sadly relevant today... .” 

When Smoke Ran Like Water, Tales of Environmental Deception and the Battle Against Pollution, by Devra Davis, Basic Books, 2002, 316 pages, $39.50 Canada.