Book Review: Toms River: A Story of Science and Salvation by Dan Fagin
The residents of Toms River, New Jersey didn’t mind when a CIBA chemical plant opened up in their backyard in the 1950s. It brought jobs to their small town that mostly depended upon tourism. But slowly the river started to look funny. There were plumes of funny-smelling smoke coming from the building, at first during the day, then only late at night when they were asleep. And a nurse at a hospital specializing in children’s cancer notices an awful lot of cases coming from Toms River. What follows is a multi-year public health investigation and lawsuit, only the second of its kind in the United States (the first being the Woburn, Massachusetts toxic water case).
I picked this book up for a couple of reasons. I work in an academic library that serves a Public Health program (among others), and I thought reading about a landmark case would be helpful. I also was just personally curious about how bad the pollution actually is in New Jersey. (For my non-American readers, there’s a running joke that New Jersey is the “stinky armpit” of the United States, due to the pollution).
The short version of what I got out of it is that I researched and bought the best reasonably priced water filtration pitcher for my household and will scold my husband if he drinks water directly from the sink instead of from the pitcher. The more academic version is that I learned that epidemiology is not as straight-forward as it seems, and things we can know just by looking at the situation are not easily proved. Additionally, what a woman puts into her body during pregnancy is much more important than what a young child eats or drinks.
The book is written in an investigative journalism style. If you’re comfortable reading the science section of the New York Times or something similar, you will be fine reading this book. Some of the science was new to me, but it was well-explained. On the negative end, the writing can sometimes be a bit sensationalistic. For instance, at one point the author assumes to know the reason why some people leave a meeting, jumping to the most sensational reason–that they were “repulsed” (loc 5441). (If he knows for sure why they left because he interviewed them, he does not make that clear). Most statements that are clearly factual are well-cited, however. Although the book is well-written and interesting, it simply reads as dense. I often found myself wondering if he could have maybe sped up the delivery a bit. It periodically felt like a slog, even though I was quite interested in the topic.
The book starts with introducing one of the children who was born with neuroblastoma, a particularly nasty form of childhood cancer. Then it flashes back to the arrival of CIBA in the 1950s. This clearly establishes the reader’s empathy with the children with cancer from the get-go. That’s not a bad thing, per se, but it’s not exactly unbiased.
So let’s get to what I learned. Here are the unequivocally bad things that CIBA did:
- They claimed to residents that only “the purified effluent, clear, neutral and harmless to fish life, is discharged into the Toms River” (loc 671)
- When residents complained about pollution, instead of taking pollution-minimizing measures, they just re-adjusted their schedule so that most of the discharge happened at night when residents couldn’t see it. (loc 1071)
- CIBA came to Toms River after being kicked out of Europe and the Midwest for their pollution but didn’t change their practices at all. They simply pursued the location with the least oversight. (For non-American readers, at the time, there were not the national pollution laws in place in the US that there are now. It was more overseen on a state-by-state level).
- CIBA hid the cancer rate of employees from employees
- The CIBA water fountains were too toxic for their employees to drink from–they actually stank.
- The various governmental protection agencies repeatedly found violations at CIBA, for instance, their toxic waste pits were inappropriately lined.
Here’s what I learned about cancer:
- “Cancer is not one disease but many–more than 150, by most definitions. their only common characteristic is supercharged cell division, growth run amok.” (loc 1842)
- A swollen lymph node over the left collarbone is an early warning sign of cancer. (loc 1873)
- “Between ages 5 and 69, the likelihood of getting cancer in any particular year rises with each year of life, and it does so in increasingly large intervals: from about one in nine thousand in the fifth year of life to about one in fifty-seven in the sixty-ninth year.” (loc 1882)
- “Childhood cancer incidence jumped by more than one-third between 1975 and 2005–more than twice as much as overall cancer incidence.” (loc 1889)
- The second largest cause of lung cancer in the US after cigarette smoking is radon. (loc 2343)
- Pregnant women’s consumption of polluted tap water was much more correlated with later childhood cancer than children’s consumption of it themselves (60% more likely vs 8% more likely). (loc 6757)
What I learned about Public Health epidemiology can’t be summed up easily in a bullet-pointed list. Basically, epidemiological studies are incredibly difficult, particularly when the toxic event has already passed. Study methods rely on things like patient recall of what they did day-to-day and massively complicated retroactive restructurings of how the water supply worked and which person got which well-water. The groups of people effected seem large to consumers but in the matter of actual epidemiological numbers are in fact quite small. Too small to easily prove something. As little as one extra child having cancer can be enough for the percent to appear to skyrocket but that could easily be explained as one of the normal abnormalities. A glitch, basically, that is normal when you look at a large population as a whole. Thus, even though people can look at a group and say, “Hey they seem to have a lot of cancer,” it could just be a chance cluster. Or appear like a large number but isn’t actually when you look at the charts over time. Or it could appear like a large number but actually be difficult to prove, numerically, that it is. David Ozonoff, a professor of environmental health, is quoted in the book as saying, “A good working definition of a public health catastrophe is a health effect so large even an epidemiological study can detect it.” (loc 7495) The government is reluctant to investigate these types of cases, because they take a long time, are expensive (Toms River cost over $10 million), are embarrassing, and often work out without anything being able to be proven anyway. In the United States, cancer registries may only be looked at by government agencies, due to privacy laws, so this means that if the government doesn’t look into it, no one can. The book ends on the horrifying note:
Clusters of rare cancers like the one in Toms River may actually be much more common than we can discern with the crude statistical tools of small-number epidemiology. In other words, many more pollution-induced cancer clusters may be out there, but we don’t see them and we rarely even bother to look. (loc 7535)
In the end, the book was interesting, yet a bit of a struggle to get through, as it was quite densely-written. I learned a lot about how epidemiology and public health actually work in the United States, and I was terrified of basically everything (my own tap water, weird smells in the air) the whole time I was reading it and for a few weeks afterwards. I’m still pretty freaked out by my tap water, honestly.
Overall, I would recommend this book to readers with a vested interest in better understanding epidemiology and public health, particularly in the United States, regardless of how uncomfortable knowing these facts might make them. To those who might not be up to the intensive read I would say: be vocal about environmental protection where you live, be careful what you put into your body especially if you are or will be pregnant, and seriously consider filtering your water no matter where you live or how good it tastes. Chemicals we think now are safe we may end up finding out later are not. That is certainly what the mid-20th century taught us.
4 out of 5 stars