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It’s been two decades since the publication of Martha Balsham’s landmark study, “Cancer in the Community: Class and Medical Authority (1993).” Balshem, a hospital-based anthropologist, documented how a Philadelphia “lay community” rejected medical advice to stop smoking, eat fruits and vegetables and schedule regular screening tests. The working class community of Tannerstown (a pseudonym) instead blamed air pollution from highway traffic and nearby chemical plants, as well as fate, for their cancers.
“Why did the dog get cancer?” a resident protested, “The dog didn’t smoke [or] eat an improper diet.”
Dr. Balshem was in a quandary. She was hired to promote the biomedical point of view in a project called “CAN-DO”. Her job was to go into the community around Fox Chase Cancer Hospital and convince the community to take self-responsibility for their cancers. The people would have none of it. They said the doctors were ignoring the elephant in the room.
Balshem didn’t know much about cancer when she began her work. But neither did her fellow anthropologists. When she presented at the AAA Meetings in 1986 about the health beliefs of Tannerstown citizens the audience “reacted by laughing” at their ignorance. And yet all those Tannerstown beliefs (e.g. there is cancer inside everybody, surgery can cause cancer to spread etc.) are essentially true.
After leaving the chains of her employment, Balshem wrote her book, juxtaposing the biomedical and the “lay community” views. She determined that both had rational bases for being labeled legitimate knowledge. Though an advance in knowledge, she failed to puncture the myth.
My father is from Tannerstown: I’m a “Natives’s Son”
My father grew up in Philly’s River Wards. He died of cancer in 1986 (about the time of Balshem’s research). So I’m a “native’s son” in this story. I remember two things about that time. I remember biking through the Tannerstown and holding my nose at the noxious fumes, wondering, “How do people live in this god-awful place? Why doesn’t somebody do something?” And I remember desperately trying to save his life, trying everything from Linus Pauling’s Vitamin C cure to massive carrot juicing. Dad said it was too late for all that and settled for a fruit salad each day after chemo at a silver lunch truck in front of Jefferson Hospital.
Dad moved away from the Tannerstown area as a young man and I don’t know exactly what caused his cancer. But today I’m a journalist/anthropologist, in part, because of that experience, and I want to know many more details than Balsham provides. Balshem did not name names and she omitted a torrent of crisp facts that might have delivered the solid counterpunch required. Why did she tell us the names of some places (like Fox Chase Cancer Hospital) but not others – like her study community? Was it Fishtown, Kensington, Port Richmond, or Bridesburg (they are the four River ward communities)? And why didn’t she name any of the local factories, like Atlantic Metals, Honeywell and Rhome and Haas? There was Toxics Release Inventory (TRI) data available then. For example, she could have checked and cited that, in 1988, for Rhome and Haas, there were 419,059 pounds of air releases from that factory, much of it carcinogenic.
Fox Chase is still guarding the Henhouse (of Knowledge)
Of course, maybe a thorough study would have had little effect. I searched the Fox Chase website and did not find even one reference to environmental etiologies to cancer in the River Wards around the hospital. Officially, they don’t exist. There is plenty of space dedicated to new screening technologies and tumor analysis. In fact, Fox released a thick Community Needs Assessment” report, in April 2013, that concluded the same advice that Balsham fought against, and I quote. “Three quarters of adults in the service area do not eat the recommended number of servings of fruits and vegetables, and one in six eats fast food twice a week or more often. In Addition, nearly half of adults do not exercise three times per week—and one in ten does not exercise at all. This may represent a need for education and programming” (PHMC 2013:41).
There is no change in message from 1993.
Fortunately today there are some environmental groups active in the “Tannerstown” area. One is the Port RichmondAIR whose mission is “understanding air quality in Philadelphia Riverwards neighborhoods; Port Richmond, Bridesburg, and Kensington.” They are active in the research, advocacy, and citizen science arenas. In the summer 2012 they worked with the Clean Air Council and Port Richmond residents as well academic partners at Drexel University “to collect data on the concentration of black carbon in the neighborhood. . . . [we] climbed up 12 ft. ladders in the dead heat of Philadelphia Summer, we put up monitors on homes, businesses, schools, and parks around Port Richmond and collected air quality data for four weeks.” A link to their website is below.
The Radical Cancer Toolbox in 2013
Balsham did not have today’s tool box of literature, data and theory at her disposal. Moreover, she was wedded to a hospital employer which dramatically limited her critical scope.
In 2003 I was Executive Director of a non-profit, LocalMotion (“Better health through Fewer Toxins”), in Ann Arbor and organized a conference with three of the most important cancer and environmental researchers of the day: Devra Davis, Sandra Steingraber and Ruth Etzel, MD. They haven’t stopped. Steingraber made a movie, in 2010, based on her bestselling book, “Living Downstream” (See references). In 2012 Etzel, completed the third edition of “The Handbook of Pediatric Environmental Health,” published by the American Academy of Pediatrics (Etzel 2012). It is a groundbreaking clinical guide that offers “concise summaries of the evidence that has been published in the scientific literature about environmental hazards to children, and provide guidance to pediatricians about how to diagnose, treat, and prevent childhood diseases linked to environmental exposures.”
Devra Davis’s 2007 book, The Secret History of the War on Cancer details how corporate suppression, government inaction and social amnesia have combined to cause an epidemic. Ten million cancers over the last thirty years were entirely preventable argues Davis. Her 2011 book is Disconnect The Truth About Cell Phone Radiation, What the Industry Is Doing to Hide It, and How to Protect Your Family. She shows how cell phones are implicated in brain cancer in some studies and are the subject of warnings in Great Britain and Germany, but not the U.S. Children are especially at risk.
“The War on Cancer has been stymied because we focused only on attacking the disease while ignoring what causes it,” said Davis in an interview. John McMurty names it. His newly revised Cancer Stage of Capitalism: From Crisis to Cure (April, 2013) argues that, “The connection between dominant products and processes of capitalism and the non-communicable diseases and deaths they cause in still rising global incidence has been suppressed over many decades – including by independent critical science (McMurty 2013:38)”
Unfortunately, many famous anthropologists are not making these connections. An example is he late Cecil Helman. His widely influential textbook, Culture, Health and Illness (2007), published in over 40 countries, discusses cancer and environmental health in a non-critical fashion. Helman talks about the impact of diet on cancer, recommending particular changes (such as to eat more fruit) rather than exploring cancer from a structural perspective. At one point Helman discusses environmental pollution as being associated with “lay theories of illness causation.”
Actually the advice to eat more fruits and vegetables is important but only tells a small part of the story. There is a wealth of evidence that a whole foods, plant based diet, with no dairy and no oil can help prevent most forms of cancer, heart disease and stroke, among other degenerative diseases. The film “Forks over Knives” (2011) details a mountain of evidence – epidemiological, biochemical and animal studies – by a pair of pioneering researchers, Dr. T. Colin Campbell and Dr. Caldwell Esselstyn, MD, that makes this point. They argue that it’s vital for your health to go vegan (entirely if you can) and eliminate all dairy (milk, yogurt, butter etc.) and all oil (yes that includes olive oil) from your diet. Organic is preferable, though that is more expensive. Nutritional research on anti-cancer supplements is growing and includes items like pomegranate juice and garlic capsules.
The terror of neoliberalism creates a besieged working class. Reliable knowledge about how food is medicine is hard to find. Capitalist culture saturates “Tannerstowns” across the country with diets of cheap meat, processed carbohydrates, cow’s milk, cheese, alcohol and simple sugars. Salads, when available, are a few strips of lettuce drenched with oil. The “Forks over Knives” diet will not save the working class, nor the middle class for that matter. It helps, but eliminating capitalism is the key to better health. A growing literature on the “health/wealth dialectic – how morbidity and mortality are closely associated with your place in the class-based hierarchy – is showing how the deepest part of ourselves are imprinted by capital. The film “Unnatural Causes: Is Inequality Making us Sick?” (Adelman and Smith 2008) tells important parts of this story (see below for URL on film and transcripts from the seven part series at Adelman and Smith).
Cancer, like heart disease and stroke, are forms of neoliberal violence against us. They are not natural. Neither are the cures which require massive intervention. As Peter Montague, former editor of Rachel’s Health Environmental Monthly said, “to be blunt about it, there is no money in prevention, and once you’ve got cancer you’ll pay anything to try to stay alive” (Montague 2005).
Brian McKenna is an anthropologist who teaches at the University of Michigan-Dearborn and can be reached at firstname.lastname@example.org
Adelman, Larry and Llewellyn Smith (2008) Unnatural Causes. http://www.unnaturalcauses.org/transcripts.php
Balshem, Martha (1993) Cancer in the Community: Class and Medical Authority” Washington, DC:Smithsonian Institute Press.
Davis, Devra (2009) The Secret History of the War on Cancer. New York:Basic.
Davis, Devra (2011) Disconnect The Truth About Cell Phone Radiation, What the Industry Is Doing to Hide It, and How to Protect Your Family. New York:Dutton. See a short film on this topic: https://www.youtube.com/watch?v=Xtd-y2C9lH4
Etzel, Ruth (2012) Handbook of Pediatric Environmental Health, Elk Grove Village, American Academy of Pediatrics. http://ebooks.aap.org/product/pediatric-environmental-health-3rd-edition
Helman, Cecil (2007) Culture, Health and Illness.Oxford:Oxford university Press.
McKenna, Brian (2008) “Melanoma Whitewash: Millions at Risk of injury or Death because of Sunscreen Deceptions.” In Merrill Singer and Hans Baer (Eds.), Killer Commodities: A Critical Anthropological Examination of the Corporate Production of Harm. Lanham, MD:AltaMira Press.
McMurty, John (2013)The Cancer Stage of Capitalism: From Crisis to Cure. Halifax & Winnipeg:Pluto.
Montague, Peter (2005) “Why We Can’t Prevent Cancer” Counterpunch, November 4-6.
Phildelphia Health Management Corporation (2013) The Hospital of the Fox Chase Cancer Center, Community Health Needs Assessment. Philadelphia:PHMC.
Port RichmondAIR (2013) http://portrichmondair.org/
Steingraber, Sandra (1998) Living Downstream: A Scientist’s Personal Investigation of Cancer and the Environment . Vintage. Order the 2010 film at: http://www.livingdownstream.com/