Toms River: A New Classic in Epidemiology Writing
This week Larry Lewis, PhD, contributes a book review.
Dan Fagin, director of the Science, Health and Environmental Reporting Program at New York University, does a great job in “Toms River” of describing the environmental catastrophe in Toms River, NJ. The book frequently references Jonathan Harr’s, “A Civil Action,” which tells a similar story: over the course of many years, a civil suit finally found in favor of the plaintiffs against three chemical companies whose pollution of the local groundwater in Woburn, MA was linked to childhood cancer.
As a PhD industrial chemist of more than 30 years, I’m extremely impressed at how Fagin guides the reader through the complex steps in connecting chemical pollutants to disease. And as a lover of the history of science, I’m pleased that for every new concept in the narrative, Fagin delves into the backstory. A good example: the first demonstrated link to workplace chemical exposure and disease, thanks to Percivall Pott, who in 1775 linked cancer of the scrotum to men who worked as chimney sweeps since childhood. As Fagin points out in several additional examples, diseases of industrial workers are traceable to chemical exposures when doses are high and exposure constant. Woburn provided the precedent for residential exposure.
In addition to weaving the science and history through the story, Fagin adds the faces of the people who lived and died in Toms River. Linda Gillick’s story stands out. Once her son Michael was diagnosed with cancer as a baby, Ms. Gillick led the community in trying to get at the truth of what caused her son’s and other children’s cancers. Her activism is reminiscent of Lori Sames one-woman struggle to bring attention to rare diseases and to raise enough money for a clinical trial for her daughter’s rare condition, giant axonal neuropathy, the subject of last week’s DNA Science blog.
Toms River suffered at least three major environmental insults. The Ciba chemical plant opened there in the 1950s and dumped liquid waste and untreated smoke into the atmosphere for years. The only relief from their assault on the local water supply was when Ciba built a 10-mile long pipe that dumped their waste into the ocean instead of the ground or the Toms River.
Finally, Union Carbide paid the Fernicola brothers, straight from “The Sopranos,” to dispose of their chemical waste. The Fernicolas conveniently found an old egg farm in Toms River, where they dumped thousands of barrels of chemical waste. Not surprisingly, these barrels also leaked into the Toms River and the groundwater that fed the municipal water supply.
Over the years, the tainted groundwater flowed into private wells as the local water supplier delivered it to customers. Time and again, the Toms River Water Company ignored and failed to report organic pollutants in the water system. My one complaint about the book is that Mr. Fagin doesn’t resolve the water company’s knowing delivery of polluted water. Were those who ran the water company ever held accountable?
Part of the complicated tale of Toms River, and of understanding the roots of any environmental disaster, is the use of probability. The author rarely uses the word “proof,” a word frequently misused when describing a chemical mystery like Toms River. In fact, Mr. Fagin again takes us back in history to describe Poisson, who first attempted to describe a disease cluster and whether the cluster was random or non-random. And no description of disease-causation would be complete without discussion of John Snow’s discovery of London’s Broadwick Street pump in 1854 as the source of a terrible cholera outbreak. The Ghost Map, by Steven Johnson, is a riveting account of John Snow’s discovery.
In narrative nonfiction – real-life stories – endings aren’t always neat, and Toms River is no exception.
After years of company and government stalling, studies were finally initiated to see what link, if any, could tie the cancer cases to pollution. Barry Finnett attempted to use a biomarker, hypoxanthine-guanine phosphoribosyl transferase (HPRT), to connect the dots. An exhaustive search found no difference in the level of HPRT in the white blood cells of exposed children versus controls.
Jerry Fagliano’s epidemiology study was the only one that even gave a hint of an association between contaminated water and disease. Fagliano had to parse his data until a connection between drinking water and leukemia in girls emerged, albeit with high levels of uncertainty.
Another interesting story in the book follows the role of Greenpeace and the defense lawyer from a Civil Action, Jan Schlichtman, in negotiating a settlement among many of the parties.
To me, the key to this book is the crushing reality that despite evidence of direct environmental pollution from Ciba, complicity by Union Carbide, and apparent negligence on the part of the local water company, no clear link to human health effects in the community was ever established. What does this mean? Are we not so vulnerable to environmental pollution after all? More likely, the methods needed to connect pollution to human health problems are not yet sophisticated enough to establish association or causation with good statistical certainty.