Ellen Leopold's excellent book traces aspects of cold war ideology through to the present day via two related processes: the history of atomic science and the expanding use of radiation therapy. In doing this she uncovers a widespread campaign of scientific disinformation against the US public and systematic abuse of human rights among cancer patients and others who were exposed to radiation during tests for military and medical uses.
The book opens in 1955 with the story of Irma Natanson, the first women to be treated for breast cancer with what was paradoxically known as the 'cobalt bomb'. Her personal story is then interwoven with an analysis of the experimentation with atomic energy that was a major focus for the US government in the years after the second world war.
At the heart of these activities lay a growing determination to use atomic science for both destructive and therapeutic purposes. Not only could it be used to blow up millions of people, as the devastation in Hiroshima had shown, but it could also be presented as a cure for the cancers that were growing in incidence in the post-war years. In order to exploit these apparently contradictory potentials, a complex set of relationships developed between the military, the atomic industry and the medical profession. It is these relationships that form the heart of this book.
The main challenge in promoting the benefits of therapeutic radiation was that its harmful effects were already well known: pioneers of x-rays had paid a heavy price for their work. But it was atomic fallout from military uses that really brought the hazards into public view. The government, and those scientists who were 'on side', therefore had to work very hard to present a positive view of this new technology. 'The coverage of fallout and the coverage of cancer were not to connect. They were to remain parallel but never intersecting perils,' as Ellen Leopold puts it.
Communism and cancer
As the dangers of nuclear fallout became ever clearer it became increasingly urgent to conceal them. One strategy adopted to achieve this was to highlight the importance of nuclear weapons in protecting the US from the Russians.
This was expressed within a cold war rhetoric where the 'cancer of communism' was held up as a 'ravenous terror stalking the American landscape'. The few scientists who spoke out were condemned as communist and sometimes even prosecuted.
Paradoxically, it was over the same period that the medical uses of radiation were being developed. Though there was little evidence of its effectiveness, it was heavily promoted to patients suffering with what was seen as a 'dread' disease. Leopold highlights the fact that the new technologies offered great advantages to doctors, especially the new specialty of radiologists.
Most doctors, therefore, kept very quiet about the risks. Indeed, cold war ideology proved to be very useful to them. 'Under cover of militant anti-communism the American Medical Association was able to defeat the last attempt to legislate for a compulsory health insurance programme,' Leopold writes.
In the meantime, many patients suffered very badly on the borderline between experimentation and treatment. And it is here that Irma Natanson returns to the story. As Leopold describes it, she was instrumental in setting in place the emerging doctrine of 'informed consent'.
Despite her terrible suffering, which continued for some 30 years after the treatment, she eventually decided to fight back. 'We know about her only because she had the grit to step out of the script of housewife and mother and against all the odds recast herself as litigant, thereby ensuring that her ordeal would be inscribed into the public record,' says Leopold.
The continuing use of radiotherapy also helped to cover up many of the environmental causes of cancer, since the emphasis remained on treatment rather than prevention. In spring 1986, the New England Journal of Medicine published a controversial article arguing that the 'war on cancer' had been a failure, with the number of deaths still increasing. This led to a switch towards clinical trials of therapeutic drugs.
But Leopold shows that here again there were many interests at stake beyond those of the patients, many of whom were still faced with unenviable choices that could lead to considerable suffering for little chance of a positive outcome.
The mortality rates from cancer remain high today and little has been done to control what Leopold calls 'a veritable tsunami of potentially carcinogenic substances added to the stream of goods and services in the post-war period'. As she concludes, 'We are all, in a sense, Irma Natansons now.'