ArticlePDF Available

Cancer, Global, Pandemic, Health, Ethics, and Social Justice: A Meditation on Some Five-Letter Words That Are Pervasive Accelerants

Authors:

Abstract

In reflecting on cancers, this chapter stresses the serious social harms caused by inadequate prevention and, within the social fabric, he examines what he calls the “cancer accelerants:” water, power, money, and greed. They are four specific factors that require ethical attention. Water powerfully influences past and future health and well-being, for human beings and for the planet. Water conflicts are ethically troubling. Powers at play within the medical/industrial complex lead to further power imbalances in the social fabric, which are increased and worsened by structural racism and systemic impoverishment. Money further complicates any attempt to promote greater social justice whether one considers, on the one hand, financial interests and, on the other hand, lack of financial resources and poverty. Finally, greed poisons human and social interactions by inhibiting virtuous behaviors and choices, both at the personal and social level.
62
Chapter 5: Cancer, Global, Pandemic, Health, Ethics,
and Social Justice: A Meditation on Some Five-Letter
Words that Are Pervasive Accelerants
Richard J. Jackson
In reflecting on cancers, Richard Jackson stresses the serious
social harms caused by inadequate prevention and, within the
social fabric, he examines what he calls the “cancer
accelerants:” water, power, money, and greed. They are four
specific factors that require ethical attention. Water powerfully
influences past and future health and well-being, for human
beings and for the planet. Water conflicts are ethically
troubling. Powers at play within the medical/industrial
complex lead to further power imbalances in the social fabric,
which are increased and worsened by structural racism and
systemic impoverishment. Money further complicates any
attempt to promote greater social justice whether one
considers, on the one hand, financial interests and, on the other
hand, lack of financial resources and poverty. Finally, greed
poisons human and social interactions by inhibiting virtuous
behaviors and choices, both at the personal and social level.
Billions of dollars have been spent investigating the genetic and
biological causes of cancer. The National Cancer Institute alone has
funded $27 billion over the last five years, and far more is spent on
treatment.1 These expenditures are understandable. Cancer kills 600,000
Americans a year and brings immense suffering as well as social and
economic costs.2 At the same time, the narrow focus on, and support
of, the model of “the brilliant researcher in a well- funded laboratory
working to save lives” is an overly narrow and badly diversified
1 See National Cancer Institute, “NCI Funding Trends,” January 12, 2021,
www.cancer.gov/about-nci/budget/fact-book/historical-trends/funding#funding.
2 See Center for Disease Control and Prevention, “Leading Causes of Death,” National Center
for Health Statistics, October 19, 2021, www.cdc.gov/nchs/fastats/leading-causes-of-
death.htm. See also Christian Cintron’s chapter in this volume.
A Meditation on Some Five-Letter Words that are Pervasive Accelerants
63
investment. Reflecting on the broad agenda of the global cancer
pandemic, with its many strands of causation and approaches, I propose
there are some five-letter words that weave these strands and approaches
together.
I affirm this as a physician with a long public health career
committed to reducing risks to health from the environment,
including tracking and reducing exposure to carcinogens. As my
admired colleague Dr. Kenneth Olden, former Director of the National
Institute of Environmental Health Sciences, observed: “The genes load
the gun, but the environment pulls the trigger.” I worked hard in
establishing childhood cancer and birth defect registries, on reducing
health risks from pesticides, and in reducing chemical exposures by
measuring the levels of chemicals in the bodies of a large sample of
Americans.
More
recently,
I
have
focused
on
the
ways
the
built
environment—how we build our homes, neighborhoods, and
transportation systems—influences our health, often in ways we barely
perceive.
It may seem that to improve the health of all we need more and better
science. This is only partially true. Quadrupling health expenditures from
one to nearly four trillion dollars a year has failed both for those who need
care and those who provide care. More harmful are the science deniers,
the disease- and vaccine-deniers and political and internet manipulators,
who have harmed us and our neighbors. This was clearly the case with
COVID-19. Look at the death rates in refuser communities. The
serious harm from inadequate prevention is also true for cancer. I
suggest that the triggers common to and accelerating both of these failures
can be explained in a few five letter words.
Water
The first of the five letter words is water. This is a reflection on my living
in the western United States where water powerfully influences past and
future health and well-being. While the Northeast and the Gulf Coast
of the U.S. are coping with too much water, we in the Southwest must
A Meditation on Some Five-Letter Words that are Pervasive Accelerants
64
confront too little drinking water, not enough for bathing, irrigating fields,
and raising livestock. Los Angeles, the immense, second-largest city in
the U.S., was founded in part because of its location on the Los Angeles
River. As with all other great cities, early civic leaders realized that the
city would languish without vast supplies of water from distant places,
in this case, the Colorado River, the Owens Valley, and the western
slope of the Sierra. California spent billions in capturing freshwater
runoff and delivering it to Los Angeles and to the state’s farms.
California now directs 20 percent of its electrical power merely to pump
water. Diminished West Coast precipitation and a reduced snowpack are
making fresh water far more precious. Now, as you drive the major north-
south freeway in California, you see newly desertified fields and dead
orchards.
Water challenges foreshadow planetary collapse. At the time of the first
moon walk in 1969, there were 3.5 billion people on the planet. Today
there are 7.6 billion.3 The planet’s level of CO2 in the atmosphere has
gone from about 324 to 414 ppm,4 causing the earth to become hotter
with droughts. Wildfires and storms are becoming increasingly more
lethal with “once in a century storms” becoming nearly annual events.
When I speak about this, I try not to use the word warming. It does not
capture the malignant power of a 2-degree C° increase in average global
temperature. This increase is just the beginning. Water access will become
a powerful trigger worldwide for political conflicts, often because of too
little water, as from the melting of glaciers on the planet’s “third pole,”
namely the Himalayan Hindu Kush that supplies water to 1.3 billion
people.5 As great a threat that drought is, too much water will be life
3 See United Nations Department of Economic and Social Affairs and Population Division,
“World Population Prospects 2019: Online Edition. Rev. 1,” 2019, population.un.org/wpp/
Download/Standard/Population/.
4 See CO2-Earth, “Latest Daily Co2,” 2021, www.co2.earth/daily-co2.
5 See Arnico K. Panday, “Melting Glaciers, Threatened Livelihoods: Confronting Climate
Change to Save the Third Pole,” United Nations Development Programme, Regional Bureau
for Asia and the Pacific: Strategy, Policy and Partnerships, June 3, 2021, www.asia-
A Meditation on Some Five-Letter Words that are Pervasive Accelerants
65
destroying, with seawater inundation and submersion of productive
agricultural areas, for example in Bangladesh and other areas in Southeast
Asia. The United States Intelligence Report asserts that drought and
flooding resulting from climate heating are threat multipliers and
anticipates that they will lead to political conflicts and immense
population migrations.6
Power
I believe the second five letter word is power. I have often thought about
how water and power in California are nearly synonymous. Power,
especially the lack of it, relates to cancer. The continued use of
carcinogenic chemicals over the years and in many geographic areas is the
product of the political power of the manufacturers and distributors and
the agriculture industry.
While considering powerful industries in the United States, I must
include the medical/industrial complex, which accounts for 18 percent the
U.S. Domestic Product and employs about 9 percent of its workforce. It also
produces about 8 percent of the U.S. climate-forcing greenhouse gases. A
different form of power shapes cancer mortality, and the rates are higher in
areas with limited economic power, which are often marginalized because
of race. Those with less power and resources have higher smoking levels and
poorer quality food and are more likely to work in hazardous settings and to
have earlier disabilities. Medicine has known for two hundred years that
exposure to coal tars raises the risk of cancer, and yet as we speak, there are
increasing political efforts globally to return to high rates of mining of
cancer-causing agents like asbestos.
Power imbalance by using more advanced weapons facilitated
colonialist expansion and was enabled by racist tropes to deny humanity
pacific.undp.org/content/rbap/en/home/library/human_development/policy-brief-
confronting-climate-change-to-save-the-third-pole.html.
6 See Office of the Director of National Intelligence, “2021 Annual Threat Assessment of the
U.S. Intelligence Community,” April 9, 2021, www.dni.gov/files/ODNI/documents/
assessments/ATA-2021-Unclassified-Report.pdf.
A Meditation on Some Five-Letter Words that are Pervasive Accelerants
66
to those seen as “the other.” When working conditions were
intolerable—for example in sugarcane and cotton harvesting in the
tropicscolonial power created a demand for economic and legislative
human exploitation in the form of slavery. The cancer rates of those with
low power are always higher than those of the plantation or factory owner.
A leading destroyer of our health, and of capital and happiness, is
structural racism and structural impoverishment. Think of the massacre
and fires in 1921 of the “Black Wall Street” in Tulsa,7 and of
generationally impoverished families deprived of access to decent homes,
neighborhoods, jobs, and family farms. Since 1980, the United States
there has seen an acceleration in the assets of the very wealthy,8 but no
adjusted improvement of wages for the middle class, and a near flat line
for the poor. Poverty remains pervasive and the condition of nearly 1 in 7
of our children.9 In 1970, health care costs were about 7 percent of the
Gross Domestic Product (GDP) and today they exceed 17.7 percent.10 And
while we have made scientific progress, I and many of my clinical colleagues
are more concerned today than in the past about loved ones who must enter
the “health system” than we were 40 years ago. It breaks my heart to see
primary care physicians pushed to care for more than five patients an hour
and dedicated nurses who need their unions to bargain for properly
apportioned patient loads. The local hospital near where I live was taken
7 See Yuliya Parshina-Kottas, Anjali Singhvi, Audra D.S. Burch, Troy Griggs, Mika Grondahl,
Lingdong Huang, Tim Wallace, Jeremy White, and Josh Williams, “What the Tulsa Race
Massacre Destroyed,” New York Times, May 24, 2021, www.nytimes.com/interactive/
2021/05/24/us/tulsa-race-massacre.html.
8 See Thomas Piketty, Emmanuel Saez, and Gabriel Zucman, “Distributional National
Accounts: Methods and Estimates for the United States,” November 2016, gabriel-
zucman.eu/files/PSZ2018Slides.pdf.
9 See Children’s Defense Fund: Leave No Children Behind, “The State of America’s Children
2021,” 2021, www.childrensdefense.org/wpcontent/ uploads/2021/04/The-State-of-
Americas-Children-2021.pdf.
10 See Rabah Kamal, Daniel McDermott, Giorlando Ramirez, and Cynthia Cox, “How Has
U.S. Spending on Healthcare Changed over Time?,” Peterson-KFF Health System Tracker,
December 23, 2020, www.healthsystemtracker.org/chart-collection/u-s-spending-healthcare-
changedtime/#item-usspendingovertime_2.
A Meditation on Some Five-Letter Words that are Pervasive Accelerants
67
over by a large chain that reduced nurse staffing while increasing patient-
loads even for the sickest patients. Even early in the pandemic the hospital
business leaders were cost-cutting personal protective equipment and
paying the healthcare system’s CEO $18 million per year.
Money
The third five letter word is money. During my fourth year at Jesuit-run
St. Peter’s College in Jersey City, I traveled for medical school
application interviews. At least three times during my interviews, I was
asked, “Do you want to go to medical school to make a lot of money?”
The first time I was asked I mumbled that I wanted to have a meaningful
life, but it forced me to think about what I did not want. I did not want
to be poor. I grew up that way, and I did not want constant worry about
food, heating, and rent and have a desperate fear about medical bills. Frank
McCourt’s 1996 memoir, Angela’s Ashes, reflected on the pain of being
marginalized and ridiculed because he was poor.11 I think of one in seven
children in my country growing up in poverty, the pain of those fears,
and the erosion of self-confidence. Having too little money meant too
little power over one’s life.
Greed
The last five letter word is greed. The saying “Behind every great fortune
there is a crime” is ascribed to many writers. Lawrence James’s history, The
Rise and Fall of the British Empire, outlines the degree to which
colonialist military incursions were the political partner to immense trade
operations such as the East India Company and the Hudson’s Bay
Company.12 The British Navy, along with sometimes surprisingly small
armies, were the operating arms of these corporations. Early on, Portugal
and Spain extracted enormous amounts of gold and other wealth from
South America, but feeding addictions and human trafficking was an
even greater moneymaker.
11 See Frank McCourt, Angela’s Ashes: A Memoir (New York: Scribner, 1996).
12 See Lawrence James, The Rise and Fall of the British Empire (London: Little, Brown, 1994).
A Meditation on Some Five-Letter Words that are Pervasive Accelerants
68
Harvesting sugarcane throughout the Caribbean basinto make
lucrative, easily transported, rum—required disease-resistant heat-
tolerant populations and fueled the transatlantic slave trade from Africa.
The tobacco trade, the opium wars, and the drug wars follow this
pattern. The more profitable an industryfor example, easy extraction of
a ready resource and sale at premium prices—the more those who profit
aggressively guard their positions in legal, legislative, and physical battles.
While water, money, and power affect the mind, greed erodes moral
boundaries. Self-interest is at the core of capitalism, but greed has become
a global malignancy with omnipresent metastases, and the medical
industrial complex is not greed-free.
The overselling
of
alcohol,
tobacco,
and
unhealthy
foodalong
with dangerous workplaces and vehicles—is a byproduct of greed.
At these moments, we need the best of medicine with caring clinicians in
organizations where health is a core value rather than a billboard slogan. I
grew up in New Jersey,
a
state
profoundly
impacted
by
the
petroleum,
chemical,
and pharmaceutical industries, which has affected
the lives of family and friends. A few times each year, a friend or family
member calls me about a recent diagnosis of cancer and looking for advice.
I almost always give same advice (and this is the right advice for all
“curbside consults”): “find the best possible physician and care setting you
possibly can.”
The Lown Institute, named after renowned medical leader Dr. Bernard
Lown, offers its Lown awards to role-model physicians like Don Berwick
and Mona Hanna-Attisha.13 The Institute’s other efforts include the
Shkreli Awards for individuals and organizations who disgrace the title
“caregiver.”14 The Shkreli Award is named after the “Pharma-Bro” who
cranked up the price of a long- standing essential anti-parasitic medication
for children by fifty-six-fold. He eventually was sentenced to seven years
in prison. I worry that we suffer a prison deficiency for powerful crooks.
13 See Lown Institute, “About,” 2021, lowninstitute.org/about/.
14 See Lown Institute, “Shkreli Awards,” 2021, lowninstitute.org/projects/shkreli-awards/.
A Meditation on Some Five-Letter Words that are Pervasive Accelerants
69
Few if any tobacco industry CEOs have faced prison. I predict no prison
for the CEOs of the Texas electric power companies who reaped great
profits while exploiting a vulnerable power grid that failed in 2021
February’s ice storm and led to over two hundred deaths.15 Some hospital
system CEOs are similarly self-serving. Even at the most prestigious
healthcare institutions in Boston and New York City, published stories
report the failure of their leaders to disclose outside corporate board
memberships and extraordinarily lucrative retainers.16 When I was a child,
I thought that greed was personified by a villainous old man exulting in
his diamonds and gold. Greed has become a systemic disease not merely in
individuals but a blood cancer of the modern world reaching across
societies and right to the top of all world governments. When you first
looked at the table of contents of this volume, it might have seemed to
have many disparate strands, but they weave together in a fabric that
suffocates public health progress and covers many avoidable and, yes, moral
threats.
The U.S. has been at “War with Cancer” for over fifty years, but cancer
threats will always reside in living cells. I would suggest that the cancer
accelerants of water, power, money, and greed must be brought to justice
so that humanity can prevent and control this cursed disease rather than
merely continue to amplify it.
Richard J. Jackson, MD, MPH, is Professor emeritus at the Fielding
School of Public Health at the University of California, Los Angeles. A
pediatrician, he served in many leadership positions with the California
Health Department, including the highest as the State Health Officer. For
15 See Jeremy Schwartz, Kiah Collier, and Vianna Davila, “‘Power Companies Get Exactly
What They Want’: How Texas Repeatedly Failed to Protect Its Power Grid against Extreme
Weather,” The Texas Tribune, February 22, 2021, www.texastribune.org/2021/02/22/texas-
power-gridextreme-weather/.
16 See Charles Ornstein and Katie Thomas, “Memorial Sloan Kettering Leaders Violated
Conflict-of-Interest Rules, Report Finds, New York Times, April 4, 2019,
www.nytimes.com/2019/04/04/health/memorial-sloan-kettering-conflicts-.html.
A Meditation on Some Five-Letter Words that are Pervasive Accelerants
70
nine years he was Director of the National Center for Environmental
Health at the Center for Disease Control and Prevention (CDC), and he
received the Presidential Distinguished Service award. He was also elected
to the Institute of Medicine of the National Academy of Sciences.
ResearchGate has not been able to resolve any citations for this publication.
How Has U.S. Spending on Healthcare Changed over Time?
  • See Rabah Kamal
  • Daniel Mcdermott
  • Giorlando Ramirez
  • Cynthia Cox
See Rabah Kamal, Daniel McDermott, Giorlando Ramirez, and Cynthia Cox, "How Has U.S. Spending on Healthcare Changed over Time?," Peterson-KFF Health System Tracker, December 23, 2020, www.healthsystemtracker.org/chart-collection/u-s-spending-healthcarechangedtime/#item-usspendingovertime_2.
Power Companies Get Exactly What They Want': How Texas Repeatedly Failed to Protect Its Power Grid against Extreme Weather
  • See Jeremy Schwartz
  • Kiah Collier
  • Vianna Davila
See Jeremy Schwartz, Kiah Collier, and Vianna Davila, "'Power Companies Get Exactly What They Want': How Texas Repeatedly Failed to Protect Its Power Grid against Extreme Weather," The Texas Tribune, February 22, 2021, www.texastribune.org/2021/02/22/texaspower-gridextreme-weather/.
Memorial Sloan Kettering Leaders Violated Conflict-of-Interest Rules
  • See Charles Ornstein
  • Katie Thomas
See Charles Ornstein and Katie Thomas, "Memorial Sloan Kettering Leaders Violated Conflict-of-Interest Rules, Report Finds," New York Times, April 4, 2019, www.nytimes.com/2019/04/04/health/memorial-sloan-kettering-conflicts-.html.