Book ReviewsHormonal Chaos: The Scientific and Social Origins of the Environmental Endocrine HypothesisSheldon Krimsky (Foreword by Lynn
R. Goldman). Generations at Risk: Reproductive Health and the Environment Ted
Schettler, MD; Gina Solomon, MD; Maria Valenti; and Annette Huddle. Reviewed by John Loretz  Environmental journalist and coauthor of Our Stolen Future Dianne Dumanoski, talking about media reception to the book during a post-publication meeting at the Massachusetts Medical Association, recounted what had been a familiar scene around editorial board conference tables. After listening for several minutes to a theoretical lecture by the book’s principal author, Theo Colborn, about the role of hormones, the intricacies of the endocrine system, and the ability of synthetic organic chemicals to mimic and interfere with hormonal function, heads would begin to nod and eyes would glaze over. “Then we would take out the photos of Florida alligators with abnormally small penises,” Dumanoski said, and the mostly male group of editors would suddenly get very attentive. This was more than just an amusing anecdote: it revealed something fundamental about the dilemma of communicating scientific information to the public in a way that characterizes research findings accurately and avoids sensationalism but, at the same time, underscores the urgency of acting to protect the public health. The environmental endocrine hypothesis asserts that exposure to synthetic organic chemicals with estrogenic or other hormonal properties has damaged the reproductive health of wildlife and may have the same effects on human beings. If the hypothesis is correct, a failure to act on the implications--reduced sperm counts, feminization of male sex organs, birth defects, and the inability to reproduce successfully, among others--could jeopardize the human future. If the hypothesis is wrong, then acting on unfounded anxiety to eliminate suspect chemicals from manufacturing processes and consumer products in which they have become endemic since the mid-20th century--in other words, essentially closing down a multibillion dollar industry--would have enormous and unnecessary economic and social repercussions. For the scientist motivated by conscience, the question is why society would not act to prevent potential harm to the public health, despite an uncertain or inconclusive scientific basis for that action, especially if the risks of not acting are grave. This, in a nutshell, is the “precautionary principle.” Those whose economic fortunes are inextricably tied to risk-producing substances ask a different question: is it sensible, or even possible, to eliminate an entire class of chemicals that have become equated with social and technological progress, without ironclad scientific proof of the harm they are alleged to be causing? The advocates of cost-benefit analysis based on “sound” (i.e., strict causal) science reject the precautionary principle as unscientific. As Tufts professor of urban and environmental policy Sheldon Krimsky makes plain in Hormonal Chaos, our ability even to engage in this far-reaching debate about the scientific, economic, environmental, and ethical values that inform public policy about toxic chemicals is hampered by a kind of social chaos. The scientific process, he suggests, is thoroughly misunderstood by the public and by policy makers and is too often hijacked by advocates on both sides of the policy divide. This only compounds the inherent difficulty of using scientific research to guide policy formation. Krimsky does not conceal his admiration and respect for Colborn who, as a public sector wildlife biologist, systematically and patiently reviewed thousands of wildlife and human health studies in order to support her radical hypothesis about endocrine disruptors, then just as systematically and patiently built a consensus for the key claims of the hypothesis among endocrinologists during a series of intensive conferences in the 1990s. Krimsky has a larger purpose in telling Colborn’s story: to instruct the reader in the nature of scientific hypotheses and the gradual, painstaking process of distinguishing causes from effects; and to offer the reader an object lesson in what he will later call “honest science.” If the public health and economic stakes were not so high, Krimsky tells us, scientific research could proceed at its own pace and according to its own methods, which, in the early stages of a new idea, often entail the floating of untested conjectures about both causes and effects. The environmental endocrine hypothesis, in particular, is an ambitious attempt to organize diverse health effects of exposure to many different kinds of chemicals under a broad explanatory arch. The evidence for such effects in wildlife and in controlled laboratory experiments is persuasive; finding clear patterns of health effects in human populations, let alone demonstrating plausible links to specific chemical exposures in a world where thousands of chemicals impinge upon our lives in unknown amounts, is fraught with uncertainty. Left to their own devices, scientists would grope their way toward the confirmation of certain effects and the refutation of others, validation of some causal claims and the rejection of others, and an evaluation of the overall hypothesis that would ultimately lead either to acceptance or abandonment. Unfortunately, the stakes-- and therefore the potential consequences of making the wrong policy decisions--are enormous, as the various stakeholders instinctively understand. In their fervor to protect the public health, Krimsky writes, some non-profit groups have presented extreme health effects to the public as though they were facts rather than open-ended research questions. Not only is this dishonest, Krimsky warns, but it needlessly undermines the credibility of the entire hypothesis when specific, but minor, conjectures are refuted in the normal course of research. Krimsky reserves his harshest criticism, however, for the powerful and well financed industrial lobbyists who have insisted upon an impossible threshold of scientific proof (which they euphemistically call “sound science”) that a specific chemical is responsible for a specific health effect, and then deride anything less as “junk science,” regardless of its methodological integrity. Recognizing that there are scientists in both camps who pursue their research with honor and integrity, that science cannot advance without skepticism, and that policy makers require scientific support but can rarely wait for scientific certainty, Krimsky proposes a new, commonsense framework that he calls “honest science.” The goal of honest science would be to ensure that scientists who are advising government agencies “disclose financial interests and other social biases that may diminish the appearance of objectivity,” in order to “raise the stakes in favor of scientific neutrality and objectivity.” Honest science, Krimsky suggests, would also give policy makers the benefit of the “consensus statement” model championed by Colborn. Rather than holding public health and safety hostage to partisan squabbles fueled by the views of competing experts, the use of consensus statements could ground legislative and judicial decisions on the following crucial scientific distinctions: undisputed conclusions based on hard evidence; claims that are likely to be valid given the preponderance and/or the suggestiveness of the available evidence, but that have not been or cannot be proven with certainty; and claims that are insufficiently tested, but are plausible enough to merit further research. A shift to honest science, as Krimsky candidly admits, would not remove all obstacles to well informed policy making, nor would it replace political dialogue and debate. What it might do, if he is right, is change the whole tenor of such debates so that they are about social values and priorities. In a functioning democracy, as Krimsky envisions it, even the imperfect results of science can help a society choose among the risks it is willing to accept and those it is determined to minimize. The book is not without its flaws. Krimsky’s writing, always dense, is occasionally opaque, and he sometimes tries too hard to be nonjudgmental about the claims of industry-aligned skeptics, even when a judgment is warranted. Minor criticisms aside, Hormonal Chaos is an important book not only for its clear and fair evaluation of the environmental endocrine hypothesis, but also for its unflinching critique of the social uses and abuses of scientific knowledge.  Generations at Risk is the book-length update of a report on the reproductive health risks of exposure to toxic chemicals originally written by a study group of Greater Boston Physicians for Social Responsibility in 1996. Intended as a handbook for practicing physicians and their patients, Generations at Risk is organized around a series of profiles of chemicals and associated health effects. Schettler and his coauthors recognize, in near complete agreement with Krimsky, that science plays a pivotal but controversial role in the formation of public policy, and that it is just as important to inform readers about incomplete or tenuous research results as it is to warn them about real and potential risks. Though they are unequivocally committed to the precautionary principle, they scrupulously discuss the nature and quality of the scientific evidence and the level of certainty (or, more often, uncertainty) regarding the human health effects of particular chemicals or classes of chemicals. The effects of lead and mercury are very well documented and beyond dispute, for example, while the risks of exposure to other toxic metals--included in the first series of profiles--and to classes of chemicals known as persistent organic pollutants (POPs) are understood with varying degrees of clarity and certainty. Organic solvents, pesticides, and endocrine disruptors are considered in turn, and for each chemical in each group the authors describe the composition, industrial and household uses, routes of exposure, and known or suspected health effects. One of the most serious impediments to establishing health effects and to evaluating risk is the sheer number of chemicals in everyday use--some 75,000 and counting. The US Environmental Protection Agency (EPA) has broad authority under a number of laws to approve and regulate the use of toxic chemicals and to set standards for exposure, but in reality only a few hundred chemicals have been tested at all for health effects--mostly for cancer. Virtually no data is available for synergistic effects of exposure to multiple chemicals, and critics of the EPA’s testing regime have questioned whether existing tests are capable of detecting subtle but important reproductive health effects. Nonetheless, EPA and other health and environmental agencies such as the Food and Drug Administration, produce annual toxics release inventories and reports on air and water contamination, and they have studied exposures to pesticides and other contaminants in fish and wildlife, farm animals, and people. Schettler et al offer concise but informative reviews of every major exposure survey conducted by the government, then analyze the exposure data and evaluate its accessibilty and usefulness to individuals and to state and local health and environment officials. Thoroughly written chapters summarizing the provisions of major US laws regulating environmental toxins (e.g., the Toxic Substances Control Act of 1976, the Food Quality Protection Act of 1996), evaluating their strengths and weaknesses, discussing “right to know” legislation, and providing what the authors call “some useful tools to help in protecting personal and community health” will be especially useful to grassroots activists. Most preventive health strategies focus on the individual and entail changes in diet and behavior in order to reduce risk. Such an approach is only a limited first step in an environment saturated with synthetic chemicals. The preventive “tools,” in addition to reading product labels and using non-toxic alternatives, are community education and organizing, vigilance in identifying and monitoring sources of local contamination, demands for increased research funding, and campaigns for stronger and more effectively enforced toxics laws. Generations at Risk avoids making exaggerated claims, and for this reason alone its case for employing the precautionary principle when dealing with persistent organic pollutants must be taken seriously. Recent Books Bread Not Bombs: A Political Agenda
for Social Justice. Douglas Roche. Edmonton, Alberta: University of Alberta
Press. 1999. 162 pp. $19.95 (paper).
The Naked Nuclear Emperor: Debunking Nuclear Deterrence. Robert Green.
Christchurch, New Zealand: Disarmament and Security Centre. 2000. 95 pp. $10 (paper). War Crimes in Kosovo: A
Population-Based Assessment of Human Rights Violations Against Kosovar Albanians.
Boston, MA: Physicians for Human Rights. 1999. 135 pp. [Order at www.phrusa.org]
Dying for Growth: Global Inequality and the Health of the Poor. J. Y. Kim,
J. V. Millen, A. Irwin, J. Gershman (eds.). Monroe, Maine: Common Courage Press.
2000. 585 pp. $29.95 (paper). |