Higginson Responds

trols" his environment at work or at home. How much control, for instance, does anyone have over what Higginson calls the "chemical environment"? What does the public know or have to say about the addition of DES to cattle feed or its prescription for spotting in pregnancy? What control does an individual have over the transport of radioactive materials or the unnecessary use of X-rays in defensive medicine? How many smokers knew that reconstituted tobacco leaf had been substituted for the original tobacco (or what effect this had on their health hazards)? How many workers "control" the environment in the factory where they work? Clearly it is impossible in our modem world to isolate oneself or family from hazardous environment. The "punishment for sin" theme echoes in Higginson's statement "it behooves each individual to examine his own conscience as to what he is prepared to do through personal action." This "personal action" becomes a substitute for the effective public action that is needed to deal with the hazards that have resulted from the mindless use of technology. The public is increasingly concerned with the carcinogens that are constantly being added to the environment and they want something done right away to protect their health. This frightens the present generation of top administrators who have shirked any public health action that might antagonize the economic interests responsible for this stupid and dangerous use of technology. So the chorus that "disease is punishment for life style" is orchestrated by the administrators who have failed to live up to their public health responsibilities. But this reversion to the Dark Ages isn't preventive medicine. It isn't science. And it isn't going to fool a public which is getting sick and tired of health professionals who have failed to do their job. There is one bright spot in this dismal picture: All those who join this fashionable "life style" chorus will automatically mark themselves as the kind of professionals that the public can do without. Irwin D. J. Bross, PhD 109 Maynard Drive Eggertsville, NY 14226 Higginson Responds Dr. Bross failed to appreciate the main thrust of my lecture, namely that of the etiological factors identified in human cancer the most important by far to date are largely related to cultural habits, e.g. cigarette smoking, excessive ingestion of alcoholic beverages, and over exposure to sunlight. I believe it was made adequately clear in my presentation that some cancers result from exposure to other stimuli in the chemical environment, factors over which the individual himself has no control and which clearly are the responsibility of the government and the community. Certain occupations have been shown to carry a cancer hazard or other health risks, e.g. injury, toxic poisonings, etc. In most modern states various legislative measures have been introduced to control these risks. Unfortunately, for many cancers in developed countries whose incidence has not changed markedly over the last several decades the cause is unknown, but circumstantial evidence indicates that they are related in some way to our modern "life style" which includes dietary patterns, etc. Certainly, the concept of "life style" is scientifically unsatisfactory and it is obviously necessary to define its meaning in more objective biological, physical and chemical parameters, but to equate it, as Bross does, only with the chemical environment of the post-industrial society is contrary to the available data. If Bross can show that there is evidence that other risks are of greater significance than those cultural habits mentioned, he should supply this information in the appropriate manner. At present, lung cancer is responsible for approximately onethird of male deaths in the United States, and for 40 per cent of those in the United Kingdom. Dr. Bross and others with similar views bear a heavy responsibility to society in trying to divert limited resources and public attention from the most important cancer producing stimuli. All epidemiologists know that cigarette smoking is followed by damage to health-if Dr. Bross chooses to regard this opinion as implying "punishment for original sin" it does not distress me in view ofmy Calvinistic upbringing. Naturally, the knowledge of these important stimuli does not absolve those who have responsibility for community health from ensuring that all possible efforts are made to control these and other identifiable hazards, as I stated in my lecture. John Higginson, MD Director International Agencyfor Research on Cancer Lyon, France