EFFECTS OF CHEMICALS 277
range from lessened health levels to death. Chronic toxicity
is of major interest here. Included under effects of chornic
toxicity are carcinogenicity, teratogenicity, and mutagenic-
ity. It has been suggested that some behavioral disorders are
seated in the effect of toxic substances. This area has not
been extensively investigated.
One or more of these types of toxicity may be induced by
pollutants in the environment. Pollutants may cause adverse
effects alone or may interact synergistically with ordinarily
harmless substances to give unexpected results. The mecha-
nism of smog formation is an excellent example, although
Man is but indirectly affected.
It has been estimated that, over the expected life span of
one malformed child, the total costs for care are in the neigh-
borhood of a million dollars. This figure, which does not
include loss of earnings, is a high price for society to pay.
Widespread, long-term genetic effects due to environ-
mental pollution cannot be accurately predicted but the cost
is certainly great. Such cost estimates have not, until recently,
been applied in matching benefits to cost in evaluation of a
potentially hazardous substance. Hazards from a particular
substance need not be accepted when another substance of
equal worth is available. Mandatory testing is usually looked
upon as an unnecessarily bothersome expense by producers
of synthetic substances. In fairness, however, it must be said
that some chemicals, in use for years, have been unexpect-
edly indicated as potential hazards and the economic loss has
been heavy. Cyclamates are a good example. It is of interest
to speculate if such a situation could have been avoided. The
basic question concerns the adequacy of existing legislation
and difficulty of implementing regulations.
It has become increasingly clear that many diseases
formerly regarded as spontaneous are caused by environmen-
tal pollutants. These diseases include cancer, birth defects,
and mutations. The problem is compounded by greatly
increased exposure of the population to new synthetic chem-
icals and their degradation products. Environmental effects
of these substances are not usually adequately evaluated.
There is now overwhelming evidence that many human
cancers are due to carcinogenic substances in the environ-
ment. These are, then, preventable. Studies of epidemio-
logical factors have indicated strongly local environmental
factors are of significance in cancer incidence.
There is a demonstrable link between cigarette smok-
ing and lung cancer and other cancers have been shown to
be related to smoking. Cigarette, pipe and cigar smoking
have become socially unacceptable. Ayers has described the
cigarette as a private air pollution source. There is strong
evidence that effects of smoking are experienced by persons
in the vicinity of the smoker. Environmental tobacco smoke
can be defined as a mixture of sidestream smoke from the
cigarette and mainstream smoke exhaled by the smoker.
Smoking in schools, public buildings and businesses is now
widely banned.
In 1604 James I described smoking as “A custom loath-
some to the eye, hateful to the nose, harmful to the brain,
dangerous to the lungs.” The first major paper suggesting
a link between smoking and lung cancer was publishedin 1939. In 1950 Wynder and Graham reported that, in a
group of 650 men with ling cancer, 95% had smoked for at
least 25 years. Doll and Bradford, in a 1951 report of inter-
views with 1357 patients with lung cancer, found that 99.5%
were smokers. There was a marked decrease of cigratte smok-
ing after the 1963 Report of the Surgeon General of the US
Public Health Service. In the same year, an internal document
of a major tobacco company stated that the company was in
the business of selling nicotine, an addictive drug effective in
release of stress mechanisms. The British government banned
television advertising of cigarettes in 1965. The first health
warnings appeared on American cigarette packs in 1966 and
on British packs in 1971. A 1984 review article in the Journal
of Epidemiology confirmed the link between smoking and
cervical cancer. A 1990 study related lung cancer in nonsmok-
ers to passive childhood smoking. A former Prime Minister
accepted a contract in 1992 with a tobacco company as an
adviser on strategy for selling cigarettes in Eastern Europe and
Developing Nations. In 1993 the US Environmental Protection
Agency classified environmental tobacco smoke as a Class A
carcinogen. The State of Texas, in a 1996 suit against a ciga-
rette maker, quotes a company executive as saying “We don’t
smoke the—, we just sell it. We reserve that for the young, the
black, the poor and the stupid.” President Clinton, the first US
President to engage in open conflict with the tobacco industry,
declared tobacco to be an addictive drug.
While Legal Aid to fund claims against tobacco com-
panies by former smokers was refused in the UK in 1996,
lawsuits against tobacco companies in the United States
have been filed by individuals and as class actions. 22 states
have sued tobacco companies to regain vast sums of public
money expended on care for smoking related maladies.
Previously confidential documents from company files
and information supplied by whisle-blowers have shown
that the companies were aware of adverse health effects of
smoking as early as the 1930s.
The tobacco industry, faced with decreasing usage at
home, resorted to a creative marketing approach. It was
decided that a new market must be developed. One large
tobacco company targeted black people and young, blue-
collar females. There was a strong public outcry when this
was reported in the news media and the company withdrew
the campaign. It was a public relations disaster.
There is increased effort to market American cigarettes
in the Third World. American tobacco products enjoy a good
reputation as to taste and are popular overseas. Officials in
some developing countries have accused the US of follow-
ing a double standard with regard to addictive drugs at home
while promoting cigarette use abroad.
Cancer of the oral cavity in Asia is linked with chewing
of tobacco leaves and betel nuts. High incidence of gastric
cancer in Chile, Iceland, and Japan has been associated epi-
demiologically with a diet high in fish. It has been suggested
that nitrosamines, formed by reaction between nitrites and
secondary amines of the fish, may be a significant factor.
Nitrites are employed as a preservative of fish. Dietary con-
tamination with aflatoxin is thought to be a causitive effect
of liver cancer in the Bantu. Aflatoxin is a fungal carcinogen.C005_004_r03.indd 277C005_004_r03.indd 277 11/18/2005 10:21:38 AM11/18/2005 10:21:38 AM