Families Against Cancer & Toxics

New York Review of Books Volume 55, Number 11 · June 26, 2008

'Malignant Maneuvers'
By Gayle Greene

In response to Cancer: Malignant Maneuvers (March 6, 2008)

To the Editors:

There was a strange turnaround in Richard Horton's review of Devra Davis's
The Secret History of the War on Cancer [NYR, March 6]: after several
paragraphs describing her arguments, making them sound cogent and strong,
Horton comes to Sir Richard Doll, revered for his work on cigarette smoking
and lung cancer, and seems to slip on a banana peel, landing in a surprising
position, concluding that Davis's book is a tissue of "vague exhortations"
and that she "has chosen the wrong targets." Horton has granted that Davis
has a point, that the inexplicably high incidences of cancer in some parts
of the world suggest environmental influences. He seems convinced by her
analysis of the "misplaced emphasis on treatment over prevention,"
mentioning the strategy of "doubt promotion," the casting of aspersions on
scientists who don't toe the party line. Yet he concludes that the real
reason cancer is on the rise is that people smoke and eat too much. It's a
familiar ploy, this reduction of a politically charged issue to a matter of
individual self-control‹it is "doubt promotion" at work. What surprised me
was that his review had seemed so favorable, until he came to Doll.

If Horton is shocked by the "vitriol and innuendo" about Doll he hears in
Davis's book, he should hear the things I learned about Doll while writing
The Woman Who Knew Too Much: Alice Stewart and the Secrets of Radiation. I
interviewed Doll while writing about Stewart, the physician and
epidemiologist who discovered that the practice of X-raying pregnant women,
which was common in the Forties and Fifties, doubled the chance of a
childhood cancer. Doll and Stewart moved in the same Oxbridge circles, sat
on the same committees and editorial boards. Both started out as physicians,
then moved into epidemiology after the war, each making major discoveries in
the Fifties that helped shape epidemiology so it came to include cancer as
well as infectious diseases. But after Stewart went public with the dangers
of radiation, she plummeted to obscurity, while Doll, credited with
discovering the link between lung cancer and smoking, rocketed to fame and a
knighthood.

Immediately after Stewart published her findings, Doll launched a study to
prove her wrong. For nearly two decades, he succeeded in keeping her
findings from being accepted, thereby allowing fetal X-raying to continue
(one doesn't like to think how many cancers that may have caused). This was
the decade when the arms race was at its height and the US and UK
governments were reassuring us we could survive all-out nuclear war; nobody
wanted to hear that radiation was as dangerous as Stewart claimed. But she
dug in her heels and built an extensive database, the Oxford Survey of
Childhood Cancer, that established beyond a doubt that she was right. Yet
when Doll came to Oxford as Regius Professor, in 1969, he announced
(publicly) that "there was little there in the way of epidemiology
research," and made her so unwelcome that she took a position at another

university. Science in those days was men talking to men. Stewart was
several years older than Doll, she'd been raising children and grandchildren
and doing her research, too busy to be jockeying for position in a
competitive male world; a genial granny-like presence, she was easily
brushed aside.

The contrast between the prosperous path of Sir Richard and the
hand-to-mouth career of Alice Stewart could hardly be more poignant. It's a
cautionary tale to any scientist who's considering taking an unpopular
stand. Doll spent his final years at the prestigious Imperial Cancer
Research Center, where he had the best researchers working under him.
Stewart moved north to Birmingham, getting her research done by sheer
energy, charisma, and the capacity to inspire the enthusiasm and loyalty of
those working for her‹managing to publish more than four hundred studies in
refereed journals.

In the end, her findings prevailed, and doctors ceased the practice of fetal
X-rays. But so long a shadow did the esteemed Sir Richard cast that my book
was never published in England. A left-wing British press turned it down
because it was sent to a reader who had the same apoplectic reaction to it
that Horton had to Davis: How dare she say such things about this man?
Another British publishing house accepted it but withdrew the offer on the
advice of their legal department.

After his death it came out that Doll was receiving payment from Monsanto
(quite a lot) all the while he was doing the studies that cleared vinyl
chloride of an association with liver cancer. I'd have thought that would
have laid to rest this overblown veneration. But no, Horton defends him,
suggesting that he may simply have been "naive." I can tell you, whatever
else he was, he was not naive. He was charming, canny, and political to the
bone; it was Alice who lacked guile. He saw to it that he had the last word,
writing the entry on Alice Stewart, after her death, in the Oxford
Dictionary of National Biography, using this venue to say she was
"embittered" and that her "reputation as a serious scientist was...greatly
harmed" by her research on the Hanford workers, the studies that won US
nuclear workers government compensation for radiation-related cancers.

He came to her funeral. At a country church outside Oxford, a small group of
family and close friends assembled, and in tottered a frail, old man
unrecognized by most of those present. Whatever for? Some said it was
conscience, most saw it as a political show. But who knows? I could tell he
was keen, in the interview, to convince me he'd behaved honorably toward
her: "I've done nothing but try to help her," he said. Perhaps he needed to
persuade himself. I have no idea what story he told himself, where is the
line between the lies a man tells himself and the lies he tells others, nor
do I know what fueled his animosity toward her. Differences in their view of
radiation risk played a part, no doubt. Sexism, too. And rivalry, I'd bet. I
sensed when I interviewed him that she, in her early nineties, was a lot
sharper than he, in his late eighties. I told her so.

"Well, I always was!" she snapped.

It appalls me that this carefully crafted public persona continues to
determine the way cancer is thought of, that this ghost is conjured to
discredit Davis's excellent book.

Gayle Greene
Professor of English
Scripps College
Claremont, California