After being diagnosed with bladder cancer as a sophomore in college, Dr. Sandra Steingraber discovered an apparent cancer cluster in her hometown in Illinois. Armed with the belief that it was caused by industries lining the region’s river valley and the widespread use of pesticides on farms in the area, Dr. Steingraber dedicated her career to shedding light on the links between cancer and environmental contamination.

She is also the author of Living Downstream: An Ecologist’s Personal Investigation of Cancer and the Environment, Having Faith: An Ecologist’s Journey to Motherhood, and her most recent book, Raising Elijah: Protecting Our Children in an Age of Environmental Crisis. Released in a second edition in 2010, Living Downstream is now the subject of an award-winning documentary film produced by the People’s Picture Company ofToronto.

Dr. Steingraber is a scholar in residence at Ithaca College, a columnist and contributing editor at Orion magazine, and a lecturer. She has lectured at universities and medical schools throughout the country. She has testified in front of the European Parliament and before the U.S. President’s Cancer Panel, and served on the U.S. Department of Health and Human Services’ National Action Plan on Breast Cancer.

Over the course of her career as an ecologist and author, Dr. Steingraber has received numerous honors and awards. Just last week, she was awarded the prestigious Heinz Award for her work linking toxic chemical exposure to disease. How does she plan to spend this $100,000 prize? In the battle against hydrofrackin in upstate New York, where she lives with her husband and two children. To those who might question this decision, she says, “Some might look at my small house (with its mismatched furniture) or my small bank accounts (with their absence of a college fund or a retirement plan) and question my priorities. But the bodies of my children are the rearranged molecules of the air, water, and food streaming through them. As their mother, there is no more important investment that I could make right now than to support the fight for the integrity of the ecological system that makes their lives possible.”

How has your background as an ecologist affected your ability to research your own cancer and environmental health in general?

My background as an ecologist was actually prompted by my experience with cancer. I was diagnosed at age 20 with bladder cancer. At the time, I was an undergraduate biology major with plans for medical school. Waking up in the hospital and experiencing cancer at that young age, I realized that I didn’t want a hospital to be my workplace. I wanted to have as little to do with the IV drips, grey partition curtains, and medical data as possible.

I was prompted by my diagnosing physician to look into the environmental contributions to my cancer. He asked if I had ever vulcanized tires, smelted aluminum, or had anything to do with textile dyes. While the answers to all of those questions was no, I was aware that there was an aluminum smelter in my hometown, that I lived downwind from two coal burning power plants, and that there was a lot of pesticide infested agriculture in my community. So the question about how environmental health and human health are related to each other came immediately and very urgently to my attention as a young biologist. Once I realized that bladder cancer is a quintessential environmental cancer, and that my aunt died of the same kind of bladder cancer I had even though I’m adopted, I became very interested in understanding cancer clusters and what else families had in common: air, food and water.

At the same time, I also felt like I wanted to get away from toxic stuff in laboratories, so I became a field biologist. My graduate research took on a straightforward question in the field of community ecology. I did my dissertation near the headwaters of the Mississippi River in northernMinnesota, in what I thought was a very pristine habitat. The idea of doing science outside, away from labs and chemicals, was very attractive to me. I came to find out, however, that my study site-a beautiful red pine forest-had actually been sprayed with Agent Orange a decade earlier. That fact was hidden, and I actually uncovered it in some secret memoranda that had gone back and forth between the Minnesota Department of Natural Resources and the state park managers. With that, I realized that I had likely been exposed to dioxin, as had Vietnamveterans who dealt with Agent Orange. Even though it wasn’t being sprayed while I was there, dioxin can last up to fifty years in human tissue and in soil. I realized then that there really was no “away.” As a cancer patient and now an environmental scientist, I knew I couldn’t keep searching for pristine places and escape toxic chemicals.

I realized that I needed to take my experience as a cancer patient and what I know as a PhD biologist and make this my career. It was those two experiences-my own cancer diagnosis and the discovery of Agent Orange in my field site-that led me down this path.

Based on your knowledge as an ecologist and as someone who has researched and written about environmental health, which human influence on the landscape has been (or is likely to be) the most damaging to both ecological and human health?

I would say it is fracking. If you had asked me that question five years ago, before fracking really sank its teeth into our bedrock, I wouldn’t have had an answer. I would have said it depends on where you live. It might be pesticides if you live in a very agriculturally intensive region likeCalifornia’s central valley. If you live inPatterson,New Jersey, it might be toxic waste sites, and so forth. But now, I would unequivocally say fracking.

By “fracking,” I am referring to the hydraulic fracturing technique for extracting natural gas from shale. It is a technology that is dependent on inherently toxic chemicals, it is happening all over the nation and therefore exposing huge numbers of people to those chemicals, and those exposures are happening through what we call multiple environmental media. By that I mean that fracking contributes to air pollution and water contamination, and it threatens to contaminate the food supply. It is possible to be exposed through at least three different routes, and those contaminants include not just chemical contaminants but radioactivity as well. Because natural gas is a fossil fuel, it contributes to global warming, which itself is probably the biggest human health threat to the world’s children. Not future generations, but children living now.

At this point, what do we know about the long-term impacts of fracking to the environment and to human health?

Some things we know, some things we expect, and some things we simply worry about. The dangers fall all along the spectrum of certainty and uncertainty. We have never done anything like this before. There are a lot of things that are very new about fracking, so let me talk about some of those unprecedented things first.

One of the things fracking does is shatter large amounts of bedrock a mile or so below our feet. It does so by pumping the bedrock full of toxic chemicals and large amounts of water. What fracking does that humans have never done before is make water exit the water cycle. You take four to six million gallons of water per well (inTexas, fracking requires more like 13 million gallons of water per well) and you use that as a sledgehammer to smash the bedrock. Some of that water comes flying back up with the bubbles of gas that are liberated in that detonation, but most of that is trapped and entombed in deep geological strata, miles below the water table. That water, wherever it comes from (it may have been groundwater itself, or it may have been taken from surface water) will never be seen again.

At a time of climate crisis, when we know that we’re facing a shortage of fresh water (already a tiny percent of all available water on Earth), we’re taking huge amounts of water and making it disappear entirely. That water will never again flow from a tap. It will never be sap from a tree, juice of an orange, or blood plasma. Since Earth was created, water has flowed from groundwater to rain, from streams to oceans, and along the way it becomes tears, blood plasma and urine. It’s a big wheel of water. Fracking, for the first time in the history of the planet, makes water vanish. That’s one thing we know will have consequences for future generations.

There are also threats to groundwater. In New York state, there are thousands of unmapped and abandoned wells from vertical drilling operations that have gone on for more than 100 years. Those are like little cocktail straws that go from the surface of the earth down into the bedrock, and can serve as portals of contamination. The concern is that by injecting very toxic fluid at high pressure, it could come squirting up through one of these openings. We know they’re out there, but we don’t know where they are because no one ever bothered to map them.

All of this requires burning tremendous amounts of diesel fuel in order to generate that kind of pressure (10,000 pounds per square inch), to carry the chemicals and all that water to the site, and to carry  away the toxins that come back up.

We know with certainty that fracking contaminates the air. We have very good data from places in the gas field. Formerly pristine air in places like Wyoming and eastern Utah now has ozone levels that approach or exceed those in downtownLos Angeles. We know with certainty that there are health effects from ozone. Ozone is a powerful poison, and it has the power to stunt lung development when exposure happens early in life. Infants and children exposed to smog will grow a smaller set of lungs than unexposed children. That means less respiratory surface area, which raises the risk of asthma and other problems later in life like chronic pulmonary obstructive disorders.

In older people-whose lungs have already stopped growing-ozone has the power to punch holes into the alveoli (the gas exchange surface of the lungs) and cause inflammation in ways that can raise the risk of heart attack and stroke. Breathing in smog or ozone shortens lives and is disabling to the respiratory systems of children. We know that fracking operations contribute to ozone creation, and we know that this has health effects.

There are other concerns, such as earthquakes. We see these swarms of earthquakes, associated not so much with actual fracking, but with the subsequent injection of fracking fluids into deep wells.

These are uncertainties that need to be researched, but the question is, who gets the benefit of the doubt? Should it go to future generations and children, or should it go to the drilling operation? There is no way of testing this on some other planet. We don’t have a laboratory in which to try these things out. If we shatter the bedrock of our nation, there’s no way to put it back together. With the Deepwater Horizon, which was a problem that was difficult to solve, at least they were eventually able to plug the hole. We won’t be able to go back and repair the damage we create through fracking. If we discover that it’s a terrible idea and that it’s releasing radiation and contamination into groundwater, there’s no remediating it. That’s also why I’d identify it as the most serious of all of the polluting activities that we’re doing. The possibility of creating a pipeline of unstoppable consequences is very great.

Have non-discloser agreements that property owners sign with companies doing the drilling affected the ability to research the impacts of fracking on ecosystem and human health?

The secrecy that surrounds fracking makes it very difficult for those of us in the research community when we are approached by communities that want to know, for example, if the health effects they’re seeing in their farm animals or pets might be related to chemicals that appear to be in their ponds, streams and perhaps drinking water. Because of the information that is held as proprietary secrets, it’s hard to give information to people. It blinds those of us in the scientific community from being able to answer questions.

That being said, I don’t think the answer is simply to compel the fracking industry to reveal what it is using. I don’t think it’s sufficient to simply tell people what they’re being poisoned with; I think we just need to stop poisoning people.

The larger issue is our energy economy. The best science shows us that continuing on the pathway of turning on the lights with fossil fuels is killing people and killing the planet. The capital investment in new forms of energy should not be directed toward natural gas. “Natural gas” is a euphemism for methane. Natural gas simply refers to a vaporous form of petroleum. Unburned methane is one of the most powerful greenhouse gases we know of. It is 23 times more powerful at trapping heat than carbon dioxide. Inevitably, when you blast bubbles of methane-a vapor-out of the ground, some of it will leak and enter the atmosphere.

Fracking is a tremendously expensive operation that requires industrializing rural landscapes, which involves building a whole infrastructure of pipelines, road, condensers and compressors. All of that effort and job creation could be directed down other pathways, such as solar and wind, which is what I’m in favor of. So while I’m certainly in favor of the fracking companies being public about the chemicals they’re putting into the commons (the earth, air and water we all share), I don’t think that is sufficient. I think they should just stop.

Some communities have been able to ban it. Some say the key factor is an educated populace. Do you agree? If so, what’s the best (and fastest) way to do that?

Certainly, there are many community-wide bans here in upstate New York. Those occurred because our previous governor had personal reservations about fracking and what it could do to communities. As one of his last acts of office, he declared a one-year moratorium on fracking until research was done to understand the environmental and human health effects of this operation. So, unlike the rest of the nation,New Yorkwas given a year to study it.

What then happened was that small communities who live on top of the shale (and I live in one of those communities) became aware not only of the dangers of fracking, but of what they could lose. They weren’t just concerned about fracking threatening their health, but also with the industrialization of a rural landscape; on top of which are cows and vineyards that provide a lot of jobs and are part of the beauty of the landscape which makes this an area for a lot of recreation and tourism. People began to look at the economic issues of what would be lost, and to realize that if there’s a gas boom, there will eventually be a bust. The gas will run out sooner or later and we’ll be left with a ruined land–no thriving dairies, no artisanal cheese, no wine, and no water.

So many communities, including my own, have decided “no.” We have passed referendums and resolutions, not banning this specific industry, but declaring that heavy industry is not part of the vision we have for our community. The gas industry claims that it will sue all of these communities and win because we do not have the right to regulate their industry. That can’t be done at a local level; only a state level. The response has been, “We’re not trying to regulate you. We’re trying to ban you. We don’t want you here.” What will happen remains to be seen because the court hasn’t ruled whether or not these bans will hold up.

We need a nationwide moratorium on fracking. This cannot be done town by town. First of all, there is an unfairness factor. The towns that don’t have the time, education and money to look into it are going to be fracked, and those will be places where poorer children live. It can’t be that the ability to keep fracking out rests with all of these little town boards.

We need national leadership. When the industry was developing fracking techniques, they were clever to succeed during the Bush administration. They received federal exemptions from many of our environmental laws. That is why the EPA has little jurisdiction over this kind of energy extraction. In fact,Washingtoninsiders refer to those exemptions as the “Halliburton Loophole.” Halliburton was one of the companies that pioneered fracking. The Clean Air Act, the Clean Water Act, the Safe Drinking Water Act, the Right to Know laws don’t fully apply to fracking.  That has left the states to regulate it. States likePennsylvaniahave opened the floodgates to the gas boom and see it an economic engine. Here inNew York, because of this serendipitous act of our former governor, we had time to think about it. The more time communities have to think about it, the more appalling it seems. There’s an unfairness in that. Given that fracking relies on chemicals that are known to cause cancer and birth defects, and are linked to asthma, miscarriage, preterm labor, and learning disabilities, and given that these are very expensive problems, there needs to be a nationwide debate about this. It seems very likely that when we quantify the full costs, the benefits of fracking would look very different. The costs that we already spend on things like asthma and preterm birth are billions of dollars a year. That’s part of why we have out of control medical costs. Twenty-two percent of all taxpayer dollars that fund our public school system goes toward special education services now. Putting more brain sabotaging chemicals into communities is only going to exacerbate those kinds of problems.

Have there been nationwide moratoriums on fracking in other parts of the world?

France has banned fracking nationwide. I went to France in November of 2010, when the news of plans to frack in beautiful parts of southern France was first hitting the press. People were just beginning to become outraged. Having just come from the U.S., fresh from the fracking battles here, I was eager to share what I knew. I went from there to the European Parliament, where I gave a talk in Brussels about cancer and the environment and talked a lot about fracking. At that time, fracking was a new idea to a lot of the French public. I met with leaders of some of the European environmental organizations, and it was also very new to them. But they went from just learning about it in December to a decision this summer to ban fracking in France. I was very impressed with the ability of French political leaders to look at the dangers fracking would create for the country’s wonderful agricultural system, as well as air, water, and public health. They decided that harming people in order to get gas out of the ground was not an acceptable tradeoff.

As a biologist, it’s interesting to me to see one society take a look at the same data and very swiftly say, “This is not worth the risk.” We have the same data available to us here, but it’s being played out very differently.

Is France a place where the Precautionary Principle effectively guides policy? In France, does the burden of proof rest with the industries that stand to gain from operations, rather than on the public?

I think that’s true of European nations in general. The precautionary principle is actually enshrined into the constitution of the European Union.

This is my opinion: Where you have national healthcare systems, governments pay attention to the healthcare costs. Because healthcare is being paid for with taxpayer dollars, everyone is in it together. Activities that private industries want to do that might threaten public health and increase healthcare costs down the road, immediately become part of the above ground conversation. Here, there are metrics for, say, the number of jobs an industry might provide, but the amount of money we would spend on all the cancers and additional asthmas and learning disabilities-those costs are not on the front pages of our newspapers here. They tend to be more hidden. That being said, fracking has not been banned across the European Union. The debate still goes on. Poland, for example, would like very much not to rely on Russia for national gas. There are a lot of big, geostrategic energy things happening in Europe and I don’t pretend to know all of the issues in every nation.

World War II dramatically changed the rate of production of synthetic chemicals, many of which are still circulating, untested. What about chemicals or other substances developed more recently?

There is a lot of secrecy around chemicals invented for wartime purposes, so we may not even know what those are. Because World War II truly was a world war, it involved a lot of blockades. It became impossible, for example, to get Japanese silk, so nylon was invented for parachutes. Germany lost its ability to get Chilean saltpeter for fertilizer so they invented synthetic fertilizers that could also be used as explosives. The overlap of those two things became obvious when someone who had access to fertilizers used them to blow up the Federal building inOklahoma City.

Since then, we haven’t had a war that filled up the whole world all at once. But certainly, in the 1940s, that was the catalyst for substituting synthetic chemicals for what had previously been a lot of botanicals. We relied on carbohydrates and animals for things we do not get from oil and natural gas.

This is why I’m so focused on fracking now. Natural gas is the starting point for a lot of the chemicals that I, along with others, have been very concerned about. One of them is PVC (polyvinyl chloride), which is one of the main sources of dioxin in North America. Burning PVC plastic is a leading creator of dioxin. For workers, PVC is very toxic because it relies on a chemical-vinyl chloride-that is not only very explosive, but is a known carcinogen. A PVC factory near my hometown in Illinoisblew up in 2004, contaminating a large area with dioxin and killing a lot of workers. My investigation of that terrible chemical accident, one of the worst ever in Illinois, is in my most recent book, Raising Elijah. It’s important to realize that the starting point for PVC is natural gas.

Natural gas is also the starting point for anhydrous ammonia, a synthetic fertilizer which is basically what the whole industrial food system runs on.

Whether we live in an area that’s being fracked or not, all of us who live in the U.S. are invested in whether or not we go down the road of fracking. By lowering the cost of natural gas, we lower the cost of everything natural gas makes, which is not just heating our home. It is used as a feedstock, the starting point for a lot of dangerous chemicals. If we’re interested, for example, in divorcing agriculture from chemicals (synthetic fertilizers) which are contaminating our groundwater, putting a dead zone in theGulf of Mexico, and allowing cheap commodities like corn and beans to form the basis of our cheap, junk food system, the starting point is natural gas. If we want local food, and we want kids to eat healthier, and we want carrots to be cheaper than Twinkies, then fracking is part of the story.

Fracking is the root of not only our energy system, but part of our materials economy. It’s hard to imagine that something that is an invisible vapor (methane) may be the starting point for the credit card in your wallet which is made of PVC. The vinyl siding on your house, the garden hose, the Barbie doll…all of these things are petrochemicals. Helping people see that chain of material is part of what I see as my task as a writer in this moment in history.

I was going to ask you which, of all of the known toxic chemicals present in our environment, you consider to be “enemy number one” but it sounds like you’d give this label to natural gas? Am I right?

I would label natural gas as enemy number one right now. In a previous time, it would’ve been something else.

Here in Ithaca, for example, we have a toxic site downtown. It creates a terrible problem because it’s part of a historic neighborhood and there are all kinds of beautiful buildings above this site, but it is the site where a factory used to exist that turned gasified coal into a gas that was used to light streetlamps. I was born in 1959, a full century after the Ithaca Gas Light Company opened for business. I have no idea what gas streetlamps look like. Yet the generation that turned coal into streetlamp light left behind this toxic legacy that everyone in my generation and my kids’ generation has to pay to clean up. I felt compelled to pull my daughter out of ballet lessons because the ballet studio was located near this site, and we now understand the soil is contaminated and there are toxic and carcinogenic vapors that emerge from there. So now we’re using natural gas as the starting point for carbon, and we’re making stuff that, in another hundred years, may be entirely obsolete to people who come after us. But their kids are going to be paying the price for all the shattered bedrock, the contaminated water they won’t be able to drink, the fragmented landscape that won’t have the abiding life support system that we need to live there. Living in a place requires pollinators. It requires organisms like frogs and bats to keep the mosquitoes down. Fracking is throwing a barrage of poisons at all of those ecosystem services. We’re damaging the life support system, not just for ourselves but for generations to follow.

It’s hard enough to go into a historic neighborhood and get rid of these toxic chemicals that are vaporizing through the soil from 100 years ago. How are we going to do it if it’s coming up from the bedrock a mile below our feet? How would we ever fix that? We don’t have a solution for that.

To me, one of the most fundamental obscenities of fracking (and there are many of them) is what it does to water. There are two crimes here. First, fracking entombs large amounts of precious fresh water deep into geological strata and removes it from the water cycle forever. Second, the water that does come back up the borehole is permanently damaged in a way we don’t know how to fix. We don’t know how to turn frack backflow into drinkable water again. To me, fracking is not a revolutionary technology. It’s regressive. It’s creating poison in order to turn on the lights. It’s a 100 year old experiment that has failed every time.

Happily, green chemistry and green engineering show us that a whole other world is possible that is revolutionarily different. It relies on wind, solar, and things that don’t destroy the functioning of the biosphere. The best science shows us that we could entirely run the economy on renewable energy, creating jobs along the way and getting ourselves off of fossil fuels entirely within a 30-year period if we are willing to cut our energy consumption by half. Europeans already consume  half the energy per capita than Americans do; therefore, it’s a doable goal and it won’t change our so-called lifestyle.

How do we get there? Is policy change the answer? If so, how do we conquer the perceived conflict between new regulation and job creation? First of all, there is no conflict. Every time we have pursued federal regulations, jobs have been created, not destroyed. Every time we close down dirty industry, there are opportunities for green collar jobs. I think it’s a false debate.

As a biologist, I’m really interested in getting lawyers, economists, accountants, and all kinds of folks together to figure it out. As I often tell my audiences, at this moment in history, we have a really complicated problem. Our economy has become ruinously dependent on fossil fuels, both to run our materials economy and to run our energy systems. That has a distorting effect on our foreign policy, it is adding to our healthcare costs, and it is destabilizing the climate to the point where we won’t be able to grow enough food to feed a growing population on Earth. This is a very complicated problem, but it’s solvable. It’s an all hands on deck moment, and it can’t be solved by each individual trying to green our own household. But there are historical precedents for our current situation. When our economy was ruinously dependent on slave labor, we required a national policy change, a whole new economic arrangement, not just each individual pledging that they won’t own or buy a slave.

I take a lot of inspiration from the abolitionist movement. The early abolitionists, especially In the 1830s, who were speaking out against slavery at a time when investing in slaves was like investing in real estate in the 1990s.  A lot of people in slave owning states invested much of their personal wealth in slaves. Millions of dollars in personal wealth was held up in slaves. To say that all slaves will be free tomorrow meant you were going to wipe out all of this wealth. It meant that all of these slaves would suddenly be free and would need jobs and housing, and who knows what would mean in terms of social unrest? It was thought to be an idea that was beyond the bounds of thinkable thought.

The abolitionist for whom I named my son, Elijah Lovejoy, made the argument that in spite of the way slavery allowed all of us to buy goods at lower prices and made us competitive on the world market, and [despite the fact that] people had their wealth bound up in slavery, it was a homicidal abomination that had to stop. For that, he was pumped full of five bullets in the free stateof Illinoisby a pro-slavery mob. Nonetheless, his words lived on. They influenced the young Abraham Lincoln, who was beginning to practice law; they influenced Harriet Tubman, John Brown, and Harriet Beecher Stowe, who went on to write Uncle Tom’s Cabin, which changed a lot of hearts and minds.

At this moment in history, those of us who believe it’s time for us to divorce our economy from fossil fuel in the way, previously, we had to divorce it from slavery, are looked at in the same way – with great derision, as though we were living in a fantasy world. Yet the science is on our side. Future generations may look back on those now working for emancipation from fossil fuels in the same way we look at the heroic abolitionists of the 19th century.   I want to be judged as that kind of person. To use another analogy, I don’t want to be thought of as “a good German” who refuses to see the signs of atrocity around me. I want to be thought of as a member of the French Resistance.

Your analogies are very effective, especially in your writing. Let’s talk about the power of words-both said and unsaid.  In Living Downstream, you wrote:

“Amid a flood of information, an absence of knowledge. Amid a thousand computer-generated words, a silence spreads out.”

The theme of silence-in various forms- is woven throughout that book, beginning with your reference to Rachel Carson’s Silent Spring. You even named one of your chapters “Silence.” Talk about the role of silence in the link between ecological and human health. It is certainly present in the relationship between doctor and patient. In 1979, at the time of my own cancer diagnosis, I was asked by my young urologist questions about my possible environmental exposures. It turns out that this is an unusual experience. Most cancer patients don’t talk with their doctors about the environment in which they grew up.

Instead, doctors tend to ask about family history. That’s the conversation I’m more likely to have with my physicians. It’s always fun for me to talk about my family medical history. Doctors are usually very interested in the facts that my aunt also had bladder cancer, that I went on to get colon lesions in my 30s, that I have family members who have colon cancer, that my mom had breast cancer the same time I had bladder cancer, and that I have another cousin who just died of breast cancer, and on and on. Then, when I reveal that I’m adopted, there’s lot of blinking that goes on, as though “that does not compute.”

There’s a presumption that what runs in families runs in genes and that cancer is a result of hereditary predisposition. In fact, when you look closely at that presumption, it begins to disappear.  Most of the data show us that shared environmental experience, rather than shared genes, is a contributing factor. Even when you look at the body of evidence, which is fairly slim, on cancer among adoptees, you see that the chance of an adoptee dying of cancer is for more related to whether or not his or her adoptive parents met that same fate than it is to deaths of a biological parent. In addition, we know from twin studies that gene expression changes with time, and twins become less and less identical over their lifetime, especially if they live in different environments. The environment alters the way the genes behave.

The new thinking in science takes us away from the old, Cold War-era image of the DNA as the master molecule in the cell, flipping all the switches. We now see our genes as keys of a piano, with the environment as the hands of the pianist. You can play jazz or you can play Bach. That depends on the musical score and the musician. Our genes are really responding to environmental cues. They’re two partners in a dance. We can’t change our ancestors, but we can   change the chemicals that we put into the environment. That’s why I think that environmental reform is a meaningful place to begin cancer prevention.

There is a lot of scientific research on the role of environmental carcinogenesis, so there’s not a lot of silence about that in the world of science. But there is silence in the experience of a cancer patient. It’s hard to be part of that conversation because it hasn’t entered the world of the doctor-patient relationship. To an unfortunate degree, it also hasn’t entered the world of cancer patient advocacy. The American Cancer Society, for example, is largely silent on the issue of the environment. So if a cancer patient newly diagnosed should turn to any of the fairly well-written pamphlets produced by the American Cancer Society, the word “environment” rarely appears there. I’ve been a cancer patient for 32 years, and I’ve logged a lot of hours in hospital waiting rooms and doctors’ offices and I’m always surrounded by American Cancer Society literature. For years, I challenged myself to find the words “carcinogen” and “environment” in any of their literature. For many years, I couldn’t. Now, it’s beginning to show up, but in a fairly dismissive way. I don’t think the popular public educational literature on cancer adequately and accurately represents the state of the science on what we know about cancer and the environment.

That is really what prompted me to write Living Downstream. As a writer, I wanted to describe the state of the evidence for my readers, and for that book, I defined them as cancer patients or the people who love them. I wrote out of my identity as a cancer patient and told the story of my own diagnosis and the fact that I was only one data point in a larger cluster of cancer in the toxic hometown where I grew up. I wanted to use that narrative to hang a very accurate and plainspoken description of what we know about cancer and the environment. It was published in 1997 and thenupdated in 2010. It’s a much thicker book now, as the evidence has gotten a lot stronger.

In Raising Elijah, you discuss the term “well-informed futility.” In Living Downstream, you say that as a cancer patient, you know how to “stop dithering in uncertainty” and “unparalyze” yourself and take action. How can we, as designers, engineers and restoration ecologists, unparalyze ourselves?

I’m thrilled to talk to this audience because I don’t see you as paralyzed! Essentially, what we have is a design problem. We have designed a food system, an energy system, a materials economy that is toxic and has human rights consequences. We are using people’s bodies as the final repository for all these toxic byproducts in order to bring food to the table, in order to bring consumer goods to market, and in order to turn on the lights. So we have a design problem. Designers who are providing solutions are the antidote to despair.

There’s nothing better for me as a writer than to say, “here’s the evidence for harm, but this is all needless, because these green engineers, organic farmers, designers know how to make carbon-neutral housing; they know how to make wind turbines that don’t kill bats; through biomimicry, they can create systems of synthetic chemistry that don’t require the generation of toxic byproducts that have to be shoveled into a hole in someone’s backyard, only to leech into their groundwater or waft up as vapors in their basement.

Designers are my heroes, along with organic farmers and everybody else who is figuring out how to do it better. Showing people that there are solutions. Right now, these solutions may occupy the margins, but they could, with a little capital investment, become the normal way of doing things is very exciting. For my readers and people in my audiences, no strategy works better to get them unparalyzed than to realize that there are solutions out there that we just need to insist upon.

Earlier, you said that we are in an “all hands on deck” moment and you mentioned the need for cross-disciplinary collaboration. To what degree do you see the medical community (both professional and academic institutions) collaborating with environmental scientists (and vice versa) to influence policy?

I’d say it’s a patchwork. I’d like to see more collaboration. Certainly, there are physicians who are on the front lines. In fact, I am confident that we were able to prevent the expansion of a toxic waste site overtop of a drinking water aquifer in Peoria [IL] when area doctors showed up at the public hearing. All they really needed to say was, as one did, “I don’t need any more patients with cancer in my office. I have enough already.”  That really tipped the discussion. Up until that point, it almost seemed inevitable that this toxic waste site was going to be able to expand.

When doctors write letters to the editor, and when they raise questions like, “Why is it that so many of my pediatric cancer patients seem to come from this same community? Why are there so many birth defects of this type in this farm community?” they can serve as sentries and bring problems to the attention of the epidemiologists and toxicologists, who then should follow up. Unfortunately, our system of public health doesn’t have that kind of rapid response mechanism in place. A lot of the doctors I talk to feel frustrated because they see these things and they raise these questions and bring them to the county or state health department and nothing is done. There is nothing in the system that means that doctors’ observations will be pursued with vigorous research. So that means that doctors can become cynical about the system. I’d like to see that change.

I’d also like to see a lot more environmental health taught in the medical schools. I think it’s tough for doctors to even ask the right questions if they aren’t familiar with the whole body of knowledge of molecular epidemiology (which shows how certain chemical actors play a role in human cancer). The medical schools could do a much better job at making the connection between health and the environment.

It really all starts at the top. There was a wonderful report that the President’s Cancer Panel released in May 2010 (2008-2009 Annual Report, President’s Cancer Panel. Reducing Environmental Cancer Risk: What we can do now.) I was able to testify before the Panel as they took up the question of cancer and the environment. They wrote a very strong report, which is a summary of the evidence. They came to much the same conclusions that I came to in Living Downstream, which is that the burden of human cancers attributed to the environment has been grossly underestimated. The Panel even took the unusual step of submitting the report to President Obama along with a letter urging him to use the power of his office to remove carcinogens from air, food and water because environmental cancers were adding to spiraling health care costs, undermining the productivity ofU.S. workers, and creating suffering and death. That report was entirely ignored by the administration-no response at all. In fact, when I had the opportunity to meet with White House staff, along with a couple of other epidemiologists and a physician who also provided testimony, we were basically told that there would be no response to the report. I thought that was really stunning. The response from the Obama White House was very different from the response the three of us received when we did a Congressional briefing. There was a packed room on Capital Hill and a lot of interest among legislators and their aids about policies that could be created that would save lives and reduce health care costs based on what we now know from this very good report. But I have seen absolutely no action.

It is often very difficult for scientists to communicate with a broader audience. Your writing, particularly in Raising Elijah, was laced with surprising bits of humor. Have you found humor to be an effective tool in the communication of very serious environmental health information?

I really have, and I’m glad you asked that. Of the three books I wrote on environmental health, Living Downstream is the most serious and earnest of them all. I tried out a little comedy in my next book on environmental threats to pregnancy, Having Faith (named after my daughter, Faith). That came out of a struggle as a writer to write about something that felt even more taboo than writing about cancer and the environment, and that was chemicals that may sabotage pregnancy. My audience would be new and pregnant mothers, and scaring a pregnant woman is not something you’re supposed to do. Yet keeping the field of fetal toxicology a secret seemed wrong. We don’t want to infantilize pregnant women and think they can’t handle bad news. They need to know these things to protect themselves.

So how do we talk about the evidence linking pesticides to birth defects, or certain solvents to miscarriage rates? I decided if I could be funny, that might be the vehicle I could use. Of course nothing is worse than trying to be funny and not succeeding, but it worked so well with Having Faith that I decided to keep on with it in Raising Elijah.

The challenge for me in Raising Elijah was that among all three of my books, it covers the longest time span, and so needed an exciting narrative arc. The story begins with the birth of my son and continues until his ninth birthday. But the day-to-day life of parenting young children is not that dramatic. With Having Faith, at least I had a good plot- the story of a cancer patient who then became pregnant, and laid down on the same ultrasound table in Boston where she had once been scanned for signs of tumors, and has her first prenatal ultrasound. The events of pregnancy are exciting. The opera of embryonic development created some great opportunities for fun, descriptive writing, and of course, there’s the big climax with the birth. By contrast, Raising Elijah is about raising two young children, and it’s not that exciting. Most of your days are spent doing small, interior, domestic things. I felt like humor was necessary to generate some plot excitement and because I needed to be able to reveal what seemed counterintuitive. When you’re living with small children and you feel very interior and isolated, actually you are bound to some of the biggest policy issues of our time. All of our policies about air, food and water are enacted in a new mother’s house every single day, and they affect what she’s going to do with her hours because our kids are, more so than us, ecological creatures. Their bodies are made up of the rearranged molecules of air, food and water that flow through our households and we cannot put our own bodies between all those chemicals and the bodies of our kids. Humor is also sometimes counterintuitive, so I thought it would help me reveal those links between the domestic and the public.

Do you have any final words of wisdom to share with Leaf Litter readers?

Environmental contamination is the human rights issue of our time. The answer is to radically redesign our economy in ways that make it not dependent on fossil fuels. Thinking of our current situation as a design problem makes it feel like it’s fixable. I really do believe in the power of human ingenuity to come up with previously unimaginable and elegant solutions to really complicated solutions.

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