The spread of fear in advance of an evaluation of measuable and observable events colors health and science policy.  It shapes what we fear and how we measure risk.  In a perfect world, government agencies would provide a corrective to simply confirming the fear de jour or reinforcing a false narrative and of what causes illness.

Not so.

The article by Trevor Butterworth (see below) demonstrates how a presidential panel to evaluate cancer risks tries to re-direct research away from predicting and controlling cancer through gene-based and individualized treatment to research that reconfirms claims that all cancer flows from "toxins" in the environment include BPA.  As Butterworth shows, what we fear is a collective and political choice that can run roughshod over facts.

www.thedaily.com/page/2011/03/21/032111-opinions-column-professors-butterworth-1-2/



“When I saw this new report,” said Sir Richard Peto, “I thought, ‘Poor President Obama, he deserves better advice.’” Peto is professor of medical statistics and epidemiology at the University of Oxford, and earned his knighthood for, among other achievements, calculating the incidence of cancer. The report in question was provided last April by the President’s Cancer Panel, an advisory body of experts which had concluded that the incidence of cancer caused by exposure to chemicals in the environment had been “grossly underestimated” by none other than Sir Richard Peto.


Even with its terrifying take-home message — a “come-hither” look to journalists if ever there was one — the Cancer Panel report sank faster than the Titanic, largely because the American Cancer Society agreed with Peto and ripped the panel for treating a shopworn hypothesis as a startling new fact. For all the bluster, the president’s would-be counselors couldn’t provide any statistical data to support their claims.


None of this has stopped the current issue of the New England Journal of Medicine from weighing in with a “perspective” piece on the whole affair by David Christiani, M.D., MPH, who holds positions at both Harvard’s School of Public Health (in the environmental health department) and at its medical school. Christiani disagrees with Peto and takes the report very seriously indeed, believing it warrants an entire rethink of America’s cancer prevention strategy, which — bottom line — means we should spend more researching the environmental causes of cancer.


Every dispute about our health is now a game of “Rock ’Em Sock ’Em Professors,” so let’s rate our fighters’ form:


Back in 1971, plain old Richard Peto joined Sir Richard Doll at Britain’s Medical Research Center, one of the world’s pre-eminent independent scientific institutions, where Doll had conclusively demonstrated a link between smoking and lung cancer. Both men went on to set up Oxford University’s Clinical Trials Unit, a research colossus for epidemiology and statistical analysis. In the early 1980s, they calculated the leading causes of avoidable cancers in the United States, estimating that occupational and environmental exposures accounted for just 4 to 6 percent of all cancer cases.


How good was Doll? He contributed a staggering amount to medicine, including fundamental work in assessing the risk from asbestos, radiation, and the benefits of taking aspirin to ward off heart attack.


How good was (and is) Peto? As Doll’s obituary in The British Journal of Cancer noted, “Although recognized as a good statistician himself, he placed great importance on working with the best available in the field.” Eugene Braunwald, Hersey professor of medicine at Harvard, who is widely considered the pre-eminent cardiologist of our time, has described Peto as “the best statistician in the universe.”


The genius of Doll, plus Peto squared to the power of Braunwald, is not a guarantee of truth, of course. But it presents a powerful warrant: The probability that their calculations on environmental cancer are wrong would have to be justified by, at the very least, a comparable deployment of statistical genius.


And this is where the President’s Cancer Panel simply didn’t bother showing up. Far from being “the Mount Everest of the medical mainstream,” as New York Times columnist Nick Kristoff claimed, it appeared to rely on those who peck in the molehills of conspiracy, including Devra Davis, author of “The Secret History of the War on Cancer,” which was pilloried in The Lancet by the director of the International Agency for Cancer Research, Peter Boyle: “with so many important factual inconsistencies in dealing with areas with which I have some familiarity, I start to have concerns about the factual accuracy in the areas I do not know so well.” (The panel, by the way, did not invite anyone from the International Agency on Cancer Research to participate in its meetings.)


It’s hard not to give the two Sir Richards victory by default. 


“The particular reasons they gave for dismissing our work were ridiculously incorrect,” said Peto, after I emailed him for his thoughts. “As far as I’m concerned, the only estimates I’d change much from what we wrote 30 years ago is that instead of attributing 30% of 1978 US cancer deaths to smoking, I’d attribute 33% of 2005 US cancer deaths to smoking, I’d approximately double the risk we attributed to ionizing radiation (to reflect the improved understanding of the hazards of domestic exposure to radon … and I’d be even more definite about the importance of chronic infection than we were in 1981.”


By establishing the leading causes of cancer, Doll and Peto have, in effect, guided the world’s research priorities and spending on cancer. It is little wonder, then, that those who want more money to research environmental causes have to contend with the problem that what they do just isn’t very important in the grand scheme of disease priorities. And not being important, at a time of government cutbacks in research, means less money, not more.