Living Downstream: An Ecologist’s Personal Investigation of Cancer and the Environment, Chapters 1-6

Sandra Steingraber weaves her personal story of developing bladder cancer as a young adult with a scientific review of the state of environmental causes linked with cancer in Living Downstream: An Ecologist’s Personal Investigation of Cancer and the Environment. The result is a touching story that engages audiences and reminds them of the devastating personal effects that cancer has on individuals, families, and communities as well as a review of the current state of knowledge and a charge that communities should demand limitation of exposures to contaminants even in the face of incomplete evidence that certain contaminants cause cancer.

“How much evidence do we need before we act?” This question was posed to a group of academic and governmental agency scientists about a year ago during a workshop I was taking on amphibian and reptile diseases. The speaker was a young scientist studying amphibian immune response to the deadly chytrid fungus. She was focused on the mechanism of how the pathogen leads to disease in amphibians, but she made a point that the focus on the mechanisms is not essential to put into place strategies for conservation of populations in the wild. It seems that since that time this question has come up again and again, especially during this seminar. How much evidence do we need that amphibian are declining from disease before we act? How much evidence do we need to know where to place protected marine sanctuaries? How much evidence do we need about climate change before we enact policies? How much evidence do we need about environmental causes of cancer before we limit our exposures? The answer to this question seems to becoming a bit clearer. Well, at least we know what we don’t need.  We know we do not need perfect data to move forward with action.

Steingraber convincingly makes the case that we know that our mothers, sisters, husbands, fathers, and children are suffering increased incidence of cancers that could be caused by environmental exposures of classes of contaminants that mimic hormones of the human body. And though the data are not perfect, there is enough evidence to suggest that limiting our production and release of these compounds may reduce cancer incidences. Steingraber artfully makes this argument by summarizing a massive amount of literature on documented causes of cancers. She deftly describes why it is so difficult statistically and experimentally to prove this point beyond doubt while at the same time pulling on the readers emotions as she relates her own experiences of living with cancer. While I am convinced that she is making an important point that the public needs to hear and in a way that would connect with many readers, I am anxious to see if she proposes how we become a community that demands the precautionary principle over the financial gains of industry.