The Daily Item, Sunbury, PA


March 20, 2013

Slate: In Toms River, N.J., Cancer Cluster or Chance?


So what are we to make of this? As epidemiologists parsed the numbers this way and that — including one age group in their calculations and excluding another, or making different assumptions about when contamination reached the water taps — were they closing in on a deeply hidden truth or picking and choosing among the data? There was no biological explanation for why male and female fetuses would respond differently to the carcinogens. If limiting the analysis to girls hadn't uncovered an association, would the next step have been to distinguish between those with brown hair and blond?

The study ultimately concluded with "considerable uncertainty" that water and air pollution might have been risk factors for leukemia in prenatally exposed girls. As with Woburn, the evidence was ambiguous and the litigation was settled out of court. The polluters paid off the plaintiffs while denying blame, and the families were left feeling robbed of vindication.

Given those kinds of subtleties and an anticlimactic ending, it takes a good writer to tell a compelling tale. With a talent for describing courtroom drama, Jonathan Harr turned the Woburn case into a best-selling book, "A Civil Action." Where Fagin excels is in vividly recounting the science of carcinogenicity and the remarkable history of how the international chemical and pharmaceutical industry arose from a few Swiss dye makers — along with the problem of pollution and the ever inexact science of epidemiology. He brings the complexities of Toms River to life. The result is an honest, thoroughly researched, intelligently written book. It closes with the warning that there may be more to Toms River than what could be confidently concluded from the data — and other towns where industrial pollution is causing a barely noticeable but deadly rise in cancer.

That may be, but no matter how hard I squinted at the numbers, I found it hard to be convinced that there had been a cancer problem in Toms River. The tools of statistics, so powerful when applied to large populations, break down with small numbers. As so often in life, we're left wondering how to distinguish between randomness and patterns too subtle to see.

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