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ABSTRACT
Today, our understanding of and approach to the exogenous causes of cancer are dominated by epidemiological practices that came into widespread use after World War II. This paper examines the forces, considerations, and controversies that shaped postwar risk factor epidemiology in the United States. It is argued that, for all of the new capabilities it brought, this risk factor epidemiology has left us with less of a clinical eye for unrecognized cancer hazards, especially from limited and localized exposures in the workplace.
The focus here is on Wilhelm Hueper, author of the first textbook on occupational cancer (1942). Hueper became the foremost spokesman for earlier identification practices centering on occupational exposures. The new epidemiological methods and associated institutions that arose in the 1940s and 1950s bore an unsettled relation to earlier claims and methods that some, Hueper among them, interpreted as a challenge. Hueper's critique of the new epidemiology identified some of its limitations and potentially debilitating consequences that remain with us today. (Am J Public Health.1997;87:1824-1835)
Introduction
Although people have come in contact with the chemical ortho-toluidine for nearly a century (in this country, for half that time), the first firm scientific evidence of the substance's carcinogenicity to humans came only in 1991 at a Goodyear plant in Buffalo, NY. Two decades after the federal government had committed to workplace health protection through the Occupational Safety and Health Administration and the National Institute for Occupational Safety and Health (NIOSH), NIOSH-sponsored epidemiologists found dramatically elevated rates of bladder cancer that were, in one small group of workers, 27 times higher than expected.' Beyond the questions this discovery raised about how healthy a workplace federally directed surveillance and protection has secured, it also posed a historical puzzle. Why was recognition of ortho-toluidine's carcinogenicity so long in coming?
Any explanation leads directly into the origins of the post-World War II epidemiology grounding federal regulatory laws and the interlocking epistemological and sociopolitical struggles that constituted this epidemiology. The reason for this discovery's belatedness stemmed from diffculties that repeated epidemiological study finally helped to penetrate. Among these difficulties, exposed workers were relatively few in number and had contact with many chemicals other than ortho-toluidine, and they developed the disease only after many years of exposure.2...