Toms River (33 page)

Hueper was completely wrong to minimize tobacco’s importance as a health risk. Cigarettes turned out to be at least as damaging as Doll and Hill had asserted in the early 1950s. Their work helped save millions of lives, including many of Hueper’s beloved blue-collar laborers who gave up the destructive habit of smoking. Doll eventually became so convinced of the importance of cigarettes as carcinogens that he would argue that smoking caused 30 percent of all cancer deaths. Workplace chemical exposures, he boldly asserted, were responsible for only 4 percent and pollution just 2 percent.
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Doll’s critics attacked this claim, questioning his data and his motives: In the years just before his 2005 death, Doll, a former socialist, served as a paid consultant and expert witness for manufacturers of pesticides, industrial chemicals, and asbestos.

Despite his errors about tobacco, Hueper was right about the chilling effect that “lifestyle factor” research would have on the identification and mitigation of chemical hazards in the workplace and in neighborhoods like Toms River as well. Beginning in the mid-1950s, medical journals began publishing fewer case reports and more case-control studies. Instead of physicians reporting on their examinations of a few dozen patients and describing perceived patterns of illness, the authors of these new studies were often biostatisticians who had never actually examined a patient but instead relied on paper records from thousands of cases.
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Hands-on physicians, who had dominated the search for cancer’s causes since the days of Paracelsus and Bernardino Ramazzini, were rapidly losing influence. Young doctors increasingly looked to large epidemiological studies for information about what was making their patients sick, instead of emulating
Ramazzini and drawing their own conclusions based on what they saw and heard from patients.

In Toms River, this attitudinal shift ensured that people like George Woolley and Linda Gillick would be met with skepticism, and even condescension, when they started asking questions about all of the cancer cases they noticed. Richard Doll’s smoking studies were more reliable than the old case series studies because their use of matched control groups made it easier to exclude alternative potential causes. But there was an important caveat: To reduce the confounding role of chance, the study populations needed to be large—much larger than a single factory or town, ideally. That was especially true if the disease being studied was rare. Otherwise, no one could be sure whether a detected association between a risk factor and a disease was real or merely coincidental.

Researchers responded predictably to Doll’s triumphs. They gravitated toward very large studies involving thousands of people and relatively common diseases. That was very bad news indeed for proponents of factory-based health studies. Even at a huge plant such as DuPont’s Chambers Works, only a few hundred workers were likely to be directly exposed to a particular suspect chemical, and that chemical might be used in only a few other places anywhere in the world. With such a small population to study, a difference of just one or two cases of a rare disease could drastically alter the results—and could easily be dismissed as nothing more than luck. For industrial workers, who had long benefited from case series reports, the rise of the new epidemiology was unwelcome in two ways: Those old case reports were now dismissed as unsubstantiated, and the new, more credible case-control and cohort studies were rarely attempted in factories—or in small residential communities like Toms River.

Wilhelm Hueper recognized the trend and railed against it, but as the years passed, fewer people listened. It was at least partly his own fault. He was as combative as ever at the National Cancer Institute—his boss once said Hueper was “usually right about what he said and what he did, but the way he was right was wrong. He had an uncanny facility for abrasiveness.”
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His past clashes with DuPont continued to plague him; he would later assert that DuPont officials had accused
him, at various times, of being a secret Nazi and of having “communistic tendencies”—an interesting juxtaposition of ideological extremes.
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Hueper eventually made so many enemies that his supervisors at the cancer institute told him that he could no longer do factory studies. He responded by speaking out more than ever. At the request of Rachel Carson, Hueper vetted portions of
Silent Spring
before her profoundly influential book was published in 1962; Carson cited his research approvingly in the text. He retired five years later and died in 1979, at age eighty-five, after venting his spleen in an intricately detailed autobiography few people have ever read. He called it
Adventures of a Physician in Occupational Cancer: A Medical Cassandra’s Tale
. It was never published, and it exists in manuscript form only at the National Library of Medicine in Bethesda, Maryland, not far from the cancer institute.

Like Cassandra, the mythological prophetess who foretold the fall of Troy but was ignored by her father the king, Wilhelm Hueper lived to see his own unhappy prophecies fulfilled, including his prediction that research into cancer’s causes would come to be dominated by studies of lifestyle choices like smoking and nutrition, with relatively little attention paid to involuntary chemical exposures like the ones in Toms River. Just like dismal Cassandra, Hueper was powerless to stop it.

Case series reports were already falling out of fashion when a forty-five-year-old man walked into Dr. Arthur Wendel’s Cincinnati office in January of 1958 complaining of blood in his urine. The man worked on the factory floor of the Swiss-owned Cincinnati Chemical Works, and no one—doctor, patient, or employer—was surprised that he had ended up in the care of one of the city’s busiest urologists. The men who worked at the Cincinnati Chemical Works often complained of trouble urinating, and if their symptoms persisted the company sent them to Wendel for a more thorough examination.
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Wendel met his new patient and took his history, learning that the man had worked at the factory for eight years and that one of his principal jobs was shoveling benzidine into kettles. Wendel then did what he always did in such cases: He performed a cystoscopy, an uncomfortable
procedure in which a thin tube equipped with lenses is inserted into the urethra. Looking through the lens, Wendel discovered a cancerous tumor in the man’s bladder. It was the fourth case of bladder cancer Wendel had diagnosed in a Cincinnati Chemical Works employee over the previous twelve months, and he was sure it was not a coincidence. “He was seeing a disproportionate number of patients from the chemical industry, and he picked up on that,” recalled his son Richard, who was also a urologist and later joined his father’s medical practice. The four affected workers not only worked for the same company, they also worked in the same building and performed similar jobs, handling benzidine.
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This was, of course, a very old story. Bladder tumors had been linked to dye manufacturing ever since Ludwig Rehn reported on three cases in Frankfurt dye workers in 1895. By 1925, so many cases had accumulated that the Swiss government officially recognized bladder cancer as an occupational disease in the dye industry, making the stricken workers eligible for special compensation. British dye workers (though not their American counterparts) received similar benefits starting in 1938 after a cluster of bladder cancer cases appeared at a Ciba-owned dye factory in Manchester.
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The cause was almost certainly exposure to benzidine and beta-naphthylamine, or BNA. Thanks to Wilhelm Hueper’s dog studies, the case against BNA was so strong that by the 1950s DuPont and the Swiss had stopped using it at all of their plants, including in the United States. The discovery of cheaper substitutes made the decision to abandon BNA a relatively easy one. Benzidine, however, was a very different case; there were no similarly inexpensive alternatives. It was used in much greater volumes than BNA ever was, yet when dye workers at the Chambers Works kept getting bladder cancer in the 1940s and 1950s, DuPont scientists blamed past exposure to BNA, not the ongoing inhalation of benzidine dust.
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DuPont stuck to its position even after researchers at a Ciba plant in England reported in 1951 that twenty-one of the sixty-six workers who had developed bladder cancer there worked only with benzidine, not BNA.
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Dye makers also benefited from growing skepticism about the relevance of animal experiments. In a study published in 1950, for example, researchers at
Allied Chemical and Dye Corporation acknowledged benzidine was carcinogenic in rats but noted that the tumors occurred in other organs, not the bladder. They also pointed out that rabbits and monkeys exposed to benzidine did not develop bladder tumors and that only one of seven dogs did.
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The Cincinnati Chemical Works had been a national center of benzidine production since 1929, producing about three thousand pounds per day. There were large, uncovered piles of benzidine powder at the company’s St. Bernard factory, and the dust was everywhere. Workers shoveled benzidine by hand, often with no protection other than gloves and sometimes masks. In the late 1940s, there was a flurry of urinary tract tumors among workers there; the company blamed BNA and instituted stricter rules for handling it. But the Swiss owners, despite the evidence from their own factories in Europe, did not mandate similar controls on the much more important benzidine. In fact, benzidine production increased in Cincinnati after 1952, after vat dye production shifted to Toms River and freed up more space in the overcrowded St. Bernard plant to make benzidine-based azo dyes. As a result, workers at the aging St. Bernard factory throughout the 1950s continued to shovel piles of benzidine powder by hand and also used their hands to clean the powder off filter presses in the open air.
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So when Arthur Wendel diagnosed a fourth case of bladder cancer among workers at the St. Bernard plant in January of 1958, alarms went off in the executive offices of the Cincinnati Chemical Works and its parent companies in Basel. They looked for help from the department of environmental health at the University of Cincinnati, which was housed in the independent Kettering Laboratory, a unique arrangement. Named for a longtime director of research at General Motors, the Kettering Lab was heavily funded by manufacturers and had a reputation for research that tended not to challenge industry interests. Mitchell Zavon, a Kettering physician who headed the team summoned to assist, arranged for Wendel to examine all twenty-five men who handled benzidine at St. Bernard. Despite all of the evidence from Europe about bladder cancer and dye chemicals, the Cincinnati Chemical Works had never encouraged its workers to get yearly bladder exams (a standard practice in Europe), and its medical record
keeping was poor. Now Wendel and his cystoscope would begin filling in the record.

By the summer of 1958, Wendel had completed his examinations of the twenty-five men. They were as young as thirty and as old as fifty-nine and had spent anywhere from three to twenty-eight years working on the factory floor in St. Bernard. Nine of them—36 percent—had bladder cancer, including five previously undiscovered cases. It was a staggeringly high percentage. Among the nineteen men who had handled benzidine for at least seven years, the rate was even higher: 47 percent.

“It was just unbelievable how much cancer there was in that plant,” remembered Eula Bingham, a young biologist at the University of Cincinnati who was part of the research team summoned by the company to assess the situation. Bingham would go on to a distinguished fifty-year career as an environmental cancer researcher, including a stint as the director of the Occupational Safety and Health Administration in the late 1970s, but the extremely high case count at the Cincinnati Chemical Works made an indelible impression on her. Years later, she even invited a retired worker from the plant to visit an industrial hygiene class she taught at the University of Cincinnati to demonstrate how he used to shovel benzidine by hand. “In my entire career, I never saw anything else like that again,” Bingham recalled. “I never saw so many people get cancer in one place. Even back in 1958, there were enough cases to know that something terrible was going on.”

Later in 1958, a protégé of Wilhelm Hueper’s named Thomas Mancuso, who worked for the Ohio State Health Department, confirmed Wendel’s findings in a more sophisticated study that included a control group. He found that plant workers were fourteen times more likely to die of bladder cancer, six times more likely to die of kidney cancer, and four times more likely to die of pancreatic cancer than typical Ohio men. The overall cancer death rate was 23 percent higher than the statewide rate.
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The evidence was irrefutable: The Cincinnati Chemical Works had a major cancer problem. This time, the company could not ignore it. In 1958, soon after Arthur Wendel finished his examinations, the
company halted manufacturing of benzidine in Cincinnati and belatedly instituted improved protections for workers handling the chemical. But the plant’s Swiss owners, who had already stopped using benzidine in many of their European plants, did not stop using it in Cincinnati. It was too economically important to abandon. Instead, they began shipping in benzidine via railcar from Allied Chemical’s huge factory in Buffalo, New York, where it had been made for more than forty years.

Soon after, in 1959, the Cincinnati Chemical Works closed down, and azo dye production moved to Toms River. A few of the benzidine workers, including two with bladder cancer, transferred to New Jersey. Most, however, stayed in Ohio. Benzidine itself made the transfer, of course. The powder-laden railcars from Buffalo were re-routed to Toms River, where a new generation of employees began working with the carcinogenic chemical. Most knew nothing about what had happened in Cincinnati. Medical researchers around the world did not know either, because Mitchell Zavon, the consultant hired by the Cincinnati Chemical Works, did not publish the stunning results of Wendel’s examinations. After all, those embarrassing findings were mere case reports, not a massive, Richard Doll–style case-control study.
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