Toms River (32 page)

The uproar over the leaking pipeline, and the torrent of bad publicity that followed, had brought labor and management closer together, united by a shared sense of persecution. Now that the company was notorious, Ciba-Geigy
needed
the support of its workers in a way it never had before, and the workers—fearful of losing the best blue-collar jobs in the county—were eager to be drafted. The union represented 650 workers, and even though they were a much smaller percentage of the town’s total population than in earlier years, they were still a formidable political force when mobilized. Now they showed up by the hundreds at public hearings, wearing company jackets and union baseball caps; some even drove out to the beach communities and organized counterdemonstrations near Greenpeace rallies. When Ocean County Citizens for Clean Water started getting publicity, Ciba-Geigy workers tried to take it over, demanding to see its bylaws, calling for elections, and showing up uninvited at meetings. The union president at the time, Jim McManus, was particularly bellicose. “Swim somewhere else!” he would shout, if someone complained about the ocean outfall.

Even before the public criticism began, the chemical plant was in
decline. At just under one thousand people, its workforce had fallen by one-third since its 1968 peak. The Swiss had lost patent protection for their most important dyes, allowing competing factories in Asia and Eastern Europe (some of which they owned) to use the same relatively simple manufacturing processes to make dyes much more cheaply. The new plants in places like India and Poland saved money by dumping barely treated waste into open pits or rivers, just as Toms River Chemical had done a generation earlier. An even more important economic advantage for overseas manufacturers was the cost of labor. Hourly wages at the Toms River plant were more than eight times higher than those at most foreign factories. A similarly huge disparity in wages had already devastated the American textile industry, creating yet another incentive for dye manufacturers to move overseas. Fabric was usually dyed before it was cut and made into clothing, so it made sense for dye manufacturers to be located near the booming textile factories of East Asia.

By the mid-1980s, it was obvious that high-wage, low-tech chemical plants like the one in Toms River did not have a long-term future in the United States, and the workers at the plant knew it. But that realization only strengthened their determination to hold on to their jobs for as long as they could. Besides, Ciba-Geigy had given them reason for hope by announcing plans to make Toms River the new home of its American pharmaceutical manufacturing operations, which were not as labor-intensive and therefore less vulnerable to foreign competition than dyes. If Ciba-Geigy’s executives told them that the ocean pipeline was necessary to keep the factory running, then the unionized workers would fight for it.

And yet, for all their aggressiveness in challenging Ocean County Citizens for Clean Water and Greenpeace, the unionized workers of Ciba-Geigy had more in common with the plant’s critics than either side acknowledged publicly. The more the environmentalists talked about the dangerous chemicals the company was dumping, the more worried the workers became about their own safety, especially after Don Bennett began listing many of the chemicals in his stories in the
Ocean County Observer
. “There was all this talk about cancer on the
outside, so we said, ‘What about the people who worked in the plant?’ We were much more exposed than they were,” remembered John Talty, an officer in the union starting in the mid-1980s.

Practically every long-term employee knew someone who had died of cancer. “It would just be people you knew from around the plant. There were a lot of them, and not all of them were listed as dying from cancer,” Talty explained. Everyone had his or her own theory about where the clusters were: George Woolley was convinced that there were an unusual number of cancer cases in Building 108, where epichlorohydrin and another carcinogen, ethylene oxide, were used. Talty worried about North Dyes, where benzidine derivatives were used to make azo dyes, which were now the most important products made in Toms River. And everyone had heard about young Randy Lynnworth, the teenager who lived just outside the factory fence on Cardinal Drive and was still struggling with brain cancer in 1985. Company officials continued to deny that chemical exposures at the plant were causing cancer, but relatives of several dead workers had won large workers’ compensation awards on the grounds that the cancers were work-related.
¹

The factory was a maelstrom of conflicting anxieties, and as the head of the union safety committee, George Woolley was caught in the middle. Many Ciba-Geigy workers were very worried that they were risking their health yet were terrified that the negative publicity over the company’s pollution problems could cost them their jobs by forcing the closure of the waste pipeline and the factory. “Everyone was under so much stress because of everything that was going on,” Woolley recalled. “We were being put through the wringer, and it was a terrible, terrible experience. We were doing everything we could to fight to keep the plant open despite all of the bad press, but we also knew there were too many cancers at the plant and that no one had studied that.” Now the union had to choose. Should it push the company to conduct a cancer study, even at the risk of further spooking the workforce and providing more grist for damaging news stories? Or should it downplay the health risks and focus on trying to keep the plant open? For self-taught environmental health enthusiast George
Woolley, a hometown guy who loved his job but did not fully trust his employer, it was a difficult choice.

Indecision was not one of Wilhelm Hueper’s problems. His 1937 dismissal from the DuPont Corporation—the second time in five years that DuPont had fired him for insubordination—might have been cause for introspection. Perhaps the world of industrial health research, increasingly dominated as it was by scientists in the pay of manufacturers, was not a natural fit for someone so bullheaded. But Hueper was not one for self-analysis. He had been trained in a very different tradition, one epitomized by legendarily cantankerous Teutonic physicians such as Rudolf Virchow and even the ancient Paracelsus. These very confident men were clinicians first: Their emphatically expressed conclusions about the causes of illness were based on the firm bedrock of their own hands-on examinations of sick patients. In the parlance of epidemiology, they were “case series” investigators. Hueper’s experimental triumph in inducing bladder tumors in BNA-exposed dogs merely confirmed what he already believed from examining workers, touring factories, and reading old case reports from factory physicians in Europe. Hueper had already been sure that dye chemicals caused bladder cancer; now he had proof.

But science was changing, and Hueper’s forceful views about what constituted proof were becoming increasingly unfashionable among cancer researchers.
²
With the coming of World War II, manufacturers like DuPont were seen as crucial national security assets. Inevitably, health concerns took a backseat in the drive to ramp up wartime production of plastics, steel, and insecticides. There were scientific reasons, too, why Hueper’s ideas were increasingly out of the mainstream. The “numerical medicine” pioneered by Pierre Louis and Siméon Poisson a century earlier had come into full flower with the development of biostatistics as a legitimate academic discipline. The new biostatisticians were not only interested in tracking infectious disease, they also took the first steps to measure the extent of chronic diseases—especially various forms of cancer—across broad populations. What they learned was that cancer was increasing and seemed to be everywhere, including in many people who had never set foot in
a factory or a mine. The official statistics for England and Wales showed a quadrupling of the cancer rate among men over age forty-five between 1860 and 1939 and a near doubling among women.
³

Especially disturbing was the huge increase in lung cancer. Predictably, it was noticed first by the Germans, with their long history of effective public health surveillance. In the late 1930s, research at the University of Jena implicated tobacco use as the overwhelming cause of lung tumors. The strongest evidence came via one of the first true case-control studies, in which a German researcher named Franz Müller compared the smoking habits of lung cancer victims to those of healthy people or those with other kinds of cancer.
⁴
It sounds bizarre in retrospect, in light of the participation of many German physicians in Nazi atrocities during the war, but their counterparts in Britain and the United States made pilgrimages to Jena and other German cities in the years before World War II to learn about the Third Reich’s vigorous efforts to curb smoking and promote public health among ethnic Germans—campaigns that had no analogue in the tobacco-loving democracies.
⁵

One of those visitors from abroad was a young English medical student who would go on to have a towering influence on scientific attitudes toward pollution and cancer in Toms River and throughout the world. Richard Doll ended his week’s stay in Frankfurt in 1936 impressed with the quality of German science but disturbed by the anti-Semitism he encountered in professors and students alike.
⁶
Doll had a good head for numbers; he was in medical school only because he had drunk three pints of ale on the night before an entrance exam and had thus failed to qualify for a scholarship to study mathematics at Cambridge. Despite his fascination with statistics, Doll wanted to be a brain surgeon, though his plans changed with the outbreak of World War II. He spent most of the war working in army hospitals and aboard ships. By the time the fighting ended, Doll had no interest in going back to school for seven years to become a surgeon.

What interested Doll instead was the growing movement, spurred in England by the creation of the National Health Service, to take chronic-disease epidemiology out of the factories and mines—Wilhelm Hueper’s domains—and apply it to the whole of society. In Britain,
the first target of this new effort was the mysterious leap in lung cancer cases. In 1947, the country’s leading statistical epidemiologist, Austin Bradford Hill, was asked by a government committee to devise an epidemiological study on an unprecedented scale, involving many hundreds of hospital patients. Hill chose Richard Doll as his collaborator. Doll knew of the work Müller had done in Nazi Germany before the war identifying smoking as the key cause of lung cancer but thought that the studies were too small to be convincing. He hoped to reach a much more definitive conclusion.

The series of studies that Doll and Hill undertook would become the most celebrated pieces of research in the history of epidemiology, rivaled only by John Snow’s work on cholera almost a century earlier. They would also marginalize the workplace-centered research of rivals like Hueper and cast serious doubt on the usefulness of investigating cancer clusters like the one in Toms River. Doll’s studies, first with Hill and later with Richard Peto, not only established that smoking and other “lifestyle” habits were major risks for lung cancer and heart disease, they also enshrined two relatively new forms of research—the case-control study and the prospective cohort—as the new gold standard for epidemiology. Everything else, including the “case series” studies and animal tests that had been important for so long, were now seen as suspect.

By virtue of their design, the smoking studies could withstand skeptical analysis in ways that Hueper’s case-by-case reports on his examinations of DuPont dye workers, as well as his experiments on dogs, could not. Doll and Hill’s first major lung cancer study, published in 1950, adopted the case-control format that had been employed only sparingly in the past, and never on such a large scale. Seven hundred and nine confirmed lung cancer patients from twenty London hospitals were included, and their habits were compared to an equal number of patients hospitalized for other reasons. The non-cancer control group was selected to match the cases in age, wealth, male-to-female ratio, and area of residence. Most of the participants smoked, but Doll and Hill discovered that those with lung cancer were twice as likely to smoke more than twenty-five cigarettes a day. The cancer/smoking connection was especially strong among men:
Just
two
of the 647 male lung cancer patients did not smoke, compared to twenty-seven of an equal number of cancer-free men.
⁷

It was a convincing result, bolstered by a similar study published four months earlier in America.
⁸
(Doll was chagrined—he wanted to be first.) But the research was not entirely bulletproof because it depended on the patients’ uncertain recollections of their smoking history. Moreover, there was a possibility that Doll and Hill had overlooked some other possible cause. So they planned a second study, a prospective cohort, in which they would follow a very large population over many years, periodically quizzing them about their habits and waiting to see how many got lung cancer. Because they wanted to find a group they could count on to stick with such a long-running study, Doll and Hill chose physicians—forty thousand of them. Doll would ultimately follow the group for decades, obtaining results that were similar to the earlier case-control study but less vulnerable to challenge by the tobacco industry. Unlike the case-control study, the cohort results did not depend on participants remembering their past smoking habits, and with such a large group it was easier to be confident that smoking really was the most important factor determining a person’s lifetime risk of developing lung cancer.

Wilhelm Hueper watched with alarm as Doll’s “risk factor” studies soaked up acclaim that his own work had never received. In 1942, soon after his second firing from DuPont, he had committed his vast knowledge to paper, producing a massive tome—its 896 pages included citations to almost four thousand studies. Called
Occupational Tumors and Allied Diseases
, it is still considered a classic in the field. The book was so highly regarded that in 1948 the National Cancer Institute hired Hueper as the director of its new environmental cancer section. Even from this exalted perch, however, he had little influence, especially after the worldwide sensation of Doll’s smoking studies. Hueper was an outspoken skeptic of what he dismissively called “the cigarette theory,” questioning how an “ill-documented, simple, unitarian theory” could be a major cause of conditions as pervasive and diverse as lung cancer and heart disease.
⁹
His objections ran much deeper than a mere scientific dispute over the strength of the evidence. Ever since Rudolf Virchow had manned the Berlin barricades
in the failed revolution of 1848, German public health investigators had identified strongly with the laboring classes. They saw themselves as fighting for safer conditions and fair recompense for the human casualties of industrial production. Many of those workers smoked, drank, and ate poorly, so the new emphasis on “lifestyle factors” as causes of chronic disease would not only draw scarce research dollars away from workplace studies, it would also, Hueper feared, allow companies to avoid taking responsibility for conditions in their factories by shifting blame to the bad habits of their employees.