Panel: Public Health Control of Environmental Asbestos Disease: Multiple Responsibilities
PUBLIC HEALTH CONTROL OF ENVIRONMENTAL ASBESTOS DISEASE: CONSUMER PRODUCTS Barbara Hackman Franklin
U S . Consumer Product Safety Commission Washington, D.C. 20207
The mission of the agency I represent, the Consumer Product Safety Commission (CPSC), is to protect the public from risks of injury, illness, and death associated with consumer products. A very broad mandate, it includes more than 10,000 items, ranging from toys and wearing apparel to home insulation and electrical wiring, and excludes some, too; automobiles, food, drugs, and cosmetics, for example. The bulk of our work over the first five years has been targeted at acute hazards, such as poisonings, burn injuries, fractures, lacerations, and electric shock. In directing the commission to look at illnesses and injuries, however, Congress thrust the commission into the area of chronic health hazards and the full range of challenges associated with this kind of public policymaking. What I will emphasize in my remarks is the commission’s experience with asbestos. But, as the title of my remarks suggests, asbestos is only the tip of the iceberg, not only for my agency but many, many others as well. Finally, I will conclude with some thoughts about how we can deal with carcinogens more effectively. For over 25 years, epidemiologic studies of the workplace have shown that exposure to high levels of free-form asbestos fibers, even for short periods of time, vastly increases a worker’s chances of developing cancer. The concern about exposure to consumer products in everyday use is much more recent. In 1973, our agency first opened its doors. By then, research suggested that families of workers and persons living near asbestos plants were more likely than the general population to get cancer. This information, coupled with similar studies on the effects of vinyl chloride outside the workplace, threw open the possibility that exposure to even low levels of free-form asbestos fibers could be dangerous, even fatal, to consumers. In 1975, the commission’s attention was called to free-form asbestos in artificial ashes and embers by environmental writer Rachel Scott. A year later, the Natural Resources Defense Council (NRDC), an environmental group, petitioned the commission to ban asbestos from patching compounds, which are widely used in home repair and remodeling. Even “brief exposures to asbestos such as those experienced by consumers [with] patching compounds have been shown to substantially increase the risk of cancer,” NRDC said. From then on, there was no doubt. The commission was actively involved. In 1977 and 1978, our efforts increased substantially. Last year, the commission placed a priority on developing mandatory safety rules for consumer products that contain respirable free-form asbestos. We directed the staff to undertake a systematic search for other consumer products that contain asbestos and that could be harmful to consumers. In addition, we began a survey of schools and homes in Puerto Rico, after concern arose that asbestos/cement construction materials may create higher than normal levels of asbestos fibers in the air. During the past six months, the commission has finalized rules that ban intention-
497 0077-8923/79/0330-0497
$1.75/0 0 1979. N Y A S
498
Annals New York Academy of Sciences
ally added asbestos in patching compounds and artificial embers and ashes. The rules now are in force. The agency also, has received preliminary results from a study on consumer products that contain asbestos. Fundamentally, it documents, to no one’s great surprise, that asbestos is used in a host of consumer products under our jurisdiction. Our best guess at this point is several thousand items, and at the moment, our staff is trying to identify which ones are likely to merit the closest attention of the commission in the immediate future. By the end of June 1978, I expect the commission will declare this work one of our highest priorities. In April, Dr. William J. Nicholson of the Environmental Sciences Laboratory, Mount Sinai School of Medicine forwarded his findings in the Puerto Rican study. Based on an analysis of 22 samples of chrysotile asbestos in schools and homes, he reports some higher than normal asbestos readings, especially in some of the schools. As a result, the commission immediately asked Dr. Nicholson to conduct another study to determine whether the higher concentrations are, in fact, linked to the use of asbestos/cement building materials. Already, I understand the Puerto Rican government has taken steps to cover the floors with sealants to contain the fibers at schools where the major concerns arose. Based on this and the report released in Washington on June 26, 1978 by the National Institute on Environmental Health Sciences (NIEHS) concerning the effects of sprayed asbestos in several New Jersey schools, we may have a bigger problem on our hands. It is quite possible that buildings, especially schools, that have sprayed-on asbestos finishes and asbestos/cement paneling and floors will become an urgent matter for action by the commission and other federal and state agencies in the days and months ahead. Now, I shall discuss briefly some of the questions and difficulties the commission must resolve as it regulates in this area. First, there is the practical difficulty of identifying the large universe of consumer products that contain free-form asbestos. We know enough from the preliminary results of the recent survey to know we need to know more, and we are making every effort to do this now. The report lists a wide variety of consumer products that contain asbestos, for example, textiles, paper products, floor and roofing materials, paint coatings, sealants, and reinforced plastics. The problem for the commission is to determine which ones have free-form asbestos readily available for human uptake and a high potential for consumer exposure. A complicating factor is that with few exceptions, products are not labeled to indicate whether they contain asbestos. To those who say the commission should ban asbestos from every consumer product, I can only reply that this is an impossible task. Until we have a better understanding of the items that contain free-form asbestos and how they are used, the commission could not do it, even if we wanted to. Second, asbestos is a ubiquitous fiber that can contaminate products a t any point during the manufacturing process. As we know, asbestos is found in our environment, both as a natural element and as a result of environmental emissions that occur after use of the material in many ways. As a result, even if a manufacturer intends to make an asbestos-free product, contamination may occur at the plant or even earlier, in other raw materials. A prime example of such contamination is patching compounds. The commission banned the “intentional addition” of respirable free-form asbestos to these compounds and included within the ban “knowing” additions of contaminants. The main idea was to stop the use of one component, talc contaminated with asbestiform tremolite. The
Franklin: Consumer Product Safety
499
big unanswered question, however, is how the manufacturer (or, for that matter, the commission) will know if contamination occurs and, if so, in what quantities. Third, science has so far not been able to develop an inexpensive or entirely reliable test method to count the tiny asbestos fibers. Reportedly, the best method currently in use is electron microscopy. However, the microscopes are costly, from $1 00.000 to $200,000 apiece, and not all laboratories can afford them. Even if the device were in the hands of all who could use it. there remains the complex problem of preparing samples for analysis so that an accurate fiber count is obtained. The current technique involves “rubbing” a sample onto a slide. But I am aware there is disagreement over the use of this methodology. Thus, what a scientist sees through the microscope may give a distorted picture. Fourth, another issue-how to enforce our patching compound ban with respect to contaminant levels of asbestos. The major thrust of our enforcement effort is, as I believe it should be, on removing from the marketplace those items that contain substantial amounts of asbestos. We now need to map a strategy to deal with the tougher issue of minor contaminant levels. I n my opinion, one partial answer might be to require suppliers to provide, in a uniform way, assurance to manufacturers on contaminants. Perhaps the commission should consider rulemaking to require manufacturers to state on the label that their products do not contain asbestos. Beyond this, I believe that manufacturers of other products that contain asbestos also might be required to label-this time, affirmatively-to indicate how much asbestos is present. At this point, I want to turn to some of the broader public policy questions we face, not only with asbestos, but with many, many other potential carcinogens in consumer products. At the top of my list is the question of threshold levels. For all regulators, the fact of life at the moment is that science has not determined if levels of exposure exist below which a potential carcinogen will not cause cancer. As a result, regulatory agencies, including the commission, are forced to assume that no safe level exists and that any amount of a carcinogen might be dangerous. So far, the commission has followed this assumption with its asbestos bans. But we must also recognize that the level of the public’s exposure to harmful substances in consumer products can be very different, and generally less predictable, than is the case with workplace exposure. A consumer might use a patching compound, for example, no more than ten times during his or her lifetime. The duration of use may vary from an hour to a day. The question is how much risk this poses. Because many workers are exposed daily to asbestos, it may make sense for the Occupational Safety and Health Administration (OSHA) to try to limit their exposure to one-half fiber of asbestos per cubic centimeter of air. Certainly, the commission must work very closely with OSHA. But at the same time, we should not, and did not, delay in regulating major amounts of the substance in consumer products until OSHA completes its debate on the finite details of its regulations. Does it make sense to regulate trace amounts of carcinogens in consumer products? Perhaps so or perhaps not, but scientific advances on threshold levels are desperately needed to tell us whether we are on the right track, or the wrong one. Other kinds of scientific agreement and advances in the state of the art also are needed.
SO0
Annals New York Academy of Sciences
For example, what tests should be run to determine the potential carcinogenicity of a substance? In the case of asbestos, the commission, at least, has had the results of epidemiologic studies. But for other carcinogens, we must rely on short-term screening tests in concert with animal testing as indicators. More reliable, more reproducible tests are essential now. Risk assessment is another example. The state of this art is improving, but even greater progress cannot come too soon if regulators are to make decisions that are fair, equitable, and lasting. Another major policy issue is what substitutes will be available if we ban. The basic question is this: Are the substitutes safe? When we banned certain products that contain asbestos, the truth of the matter is that we lacked information to evaluate the safety of the substitute materials. One of the likely replacements, attapulgate, also consists of small mineral fibers that might be respirable, although research on its effects is still very incomplete. There are other questions. How will the substitute affect the availability and utility of the product and the likelihood that consumers will still want it? If a substitute is used and there are costs to reformulate the product or change production methods, will the consumer want to pay the increased price? Stated another way, we are charged with making decisions that are in the public interest. This means weighing the need for adequate consumer safety against the possibility of greatly increased costs and burdens for industry and, ultimately, for the consumer. We have said in the commission’s carcinogens policy that the public health is our paramount concern. I believe this is the right approach. However, my agency also has a statutory obligation to analyze the economic impact of each regulation we issue and to determine that each is reasonably necessary to protect consumers. 1 do not take this responsibility lightly. This balancing process is perhaps most difficult when the carcinogenic substance is a minor contaminant and the costs of eliminating it are very high. How we allocate our resources is another question the commission faces. Our resources are far from unlimited, and as a practical matter, we must set priorities. In the immediate future, we will have to find better ways to rank the carcinogenic risks in consumer products to assure that we are dealing with the most important ones and not giving other vital product safety concerns the short shrift. The commission also greatly needs a boost in resources from Congress and the President, so that we can do the job that they expect and that the public deserves. The situation probably will be compounded, in light of the veritable flood of reports on suspected carcinogens that are expected to be released in the near future by the National Cancer Institute and other federal agencies. Under the commission’s new carcinogen policy alone, our staff estimates that over each of the next three years, we may screen 150 substances, classify 50, and possibly regulate five. Finally, let me stress the importance of your work. It is fundamental to our regulatory efforts. Without a solid scientific basis, our efforts to protect the public in a responsible way will fail. As one regulator who does not have an extensive scientific background, I sometimes find it difficult to understand complex scientific principles. But I know that I must when it is a critical part of any regulatory decision. However, you have a responsibility, too. Scientists, like anyone else, I have learned, often disagree, but the nuances of your disagreements are not always in a form that regulators or the general public can understand. The challenge is to find ways we all can communicate better about complex technical issues.
Franklin: Consumer Product Safety
50 I
Another Franklin at another time said we must hang together or hang separately. This Franklin thinks we must get together first, the scientific community, business, government, consumers, indeed all of us. Let’s face it: the same public policy issues in this area apply in others and are of concern to us all. This is why I have repeatedly urged President Carter over the last year to take the lead in developing a single national cancer policy. As 1 see it, the White House, as the highest level of our government, must take the lead responsibility, but the policy must be developed in concert with the public, industry, scientists, and many, many others. So far, it has not happened. But, in my view, the need for such a policy is more imperative than ever, if we are to have a strong, sustained, and coordinated commitment to control cancer. As I see it, a national policy should articulate-clearly, so that there is no misunderstanding-the posture and program of the federal government as a whole. At a minimum, I believe the issues to be addressed include the following: a uniform definition of carcinogens and agreement on the short-term and long-term tests that should be run, how they should be conducted, and how the test results should be interpreted. Consideration of factors other than public health also must be dealt with. Simply banning a substance may be one immediate way out. Indeed, it may be the proper approach. But the consequences of whatever we do must be anticipated, and alternative courses of action must be considered, so that we do not cause unnecessary economic upheaval. The policy must recognize the need for flexibility, so that developing scientific knowledge can be applied, so that the individual agencies can perform the jobs that the President and Congress expect, and so that industry can deliver. Most of all, a national policy on cancer must spell out the magnitude of the problem before us, the need to protect consumers, workers, and our environment, and a timetable for intelligent and informed action to achieve it. Let me close with this scenario: At the moment, products whose benefits consumers have enjoyed, sometimes for years, are headlined as hazards that may be garrotes around their throats. At the same time, there is a barrage of conflicting news reports that tell them there is absolutely no cause for concern. Is nothing safe any more, they ask? Are we victims of overdramatization by the media? Regulatory overkill or underkill? Industrial conspiracies? Is this the price we must pay for living in a highly industrialized society? The questions are good ones, and they are directed a t all of us. With cancer, there are no easy solutions, but I believe there are solutions. Unless we approach them together and with the very best of our efforts, however, we could face not merely a public health crisis, but a calamity. So, I say to you that we all have a job to do to move that iceberg. And that job is to build a consensus and develop a common approach to a common problem: cancer. It’s high time all of us get together.
PUBLIC HEALTH CONTROL OF ENVIRONMENTAL ASBESTOS DISEASE: CONSUMER PRODUCTS Barbara Hackman Franklin
U S . Consumer Product Safety Commission Washington, D.C. 20207
The mission of the agency I represent, the Consumer Product Safety Commission (CPSC), is to protect the public from risks of injury, illness, and death associated with consumer products. A very broad mandate, it includes more than 10,000 items, ranging from toys and wearing apparel to home insulation and electrical wiring, and excludes some, too; automobiles, food, drugs, and cosmetics, for example. The bulk of our work over the first five years has been targeted at acute hazards, such as poisonings, burn injuries, fractures, lacerations, and electric shock. In directing the commission to look at illnesses and injuries, however, Congress thrust the commission into the area of chronic health hazards and the full range of challenges associated with this kind of public policymaking. What I will emphasize in my remarks is the commission’s experience with asbestos. But, as the title of my remarks suggests, asbestos is only the tip of the iceberg, not only for my agency but many, many others as well. Finally, I will conclude with some thoughts about how we can deal with carcinogens more effectively. For over 25 years, epidemiologic studies of the workplace have shown that exposure to high levels of free-form asbestos fibers, even for short periods of time, vastly increases a worker’s chances of developing cancer. The concern about exposure to consumer products in everyday use is much more recent. In 1973, our agency first opened its doors. By then, research suggested that families of workers and persons living near asbestos plants were more likely than the general population to get cancer. This information, coupled with similar studies on the effects of vinyl chloride outside the workplace, threw open the possibility that exposure to even low levels of free-form asbestos fibers could be dangerous, even fatal, to consumers. In 1975, the commission’s attention was called to free-form asbestos in artificial ashes and embers by environmental writer Rachel Scott. A year later, the Natural Resources Defense Council (NRDC), an environmental group, petitioned the commission to ban asbestos from patching compounds, which are widely used in home repair and remodeling. Even “brief exposures to asbestos such as those experienced by consumers [with] patching compounds have been shown to substantially increase the risk of cancer,” NRDC said. From then on, there was no doubt. The commission was actively involved. In 1977 and 1978, our efforts increased substantially. Last year, the commission placed a priority on developing mandatory safety rules for consumer products that contain respirable free-form asbestos. We directed the staff to undertake a systematic search for other consumer products that contain asbestos and that could be harmful to consumers. In addition, we began a survey of schools and homes in Puerto Rico, after concern arose that asbestos/cement construction materials may create higher than normal levels of asbestos fibers in the air. During the past six months, the commission has finalized rules that ban intention-
497 0077-8923/79/0330-0497
$1.75/0 0 1979. N Y A S
498
Annals New York Academy of Sciences
ally added asbestos in patching compounds and artificial embers and ashes. The rules now are in force. The agency also, has received preliminary results from a study on consumer products that contain asbestos. Fundamentally, it documents, to no one’s great surprise, that asbestos is used in a host of consumer products under our jurisdiction. Our best guess at this point is several thousand items, and at the moment, our staff is trying to identify which ones are likely to merit the closest attention of the commission in the immediate future. By the end of June 1978, I expect the commission will declare this work one of our highest priorities. In April, Dr. William J. Nicholson of the Environmental Sciences Laboratory, Mount Sinai School of Medicine forwarded his findings in the Puerto Rican study. Based on an analysis of 22 samples of chrysotile asbestos in schools and homes, he reports some higher than normal asbestos readings, especially in some of the schools. As a result, the commission immediately asked Dr. Nicholson to conduct another study to determine whether the higher concentrations are, in fact, linked to the use of asbestos/cement building materials. Already, I understand the Puerto Rican government has taken steps to cover the floors with sealants to contain the fibers at schools where the major concerns arose. Based on this and the report released in Washington on June 26, 1978 by the National Institute on Environmental Health Sciences (NIEHS) concerning the effects of sprayed asbestos in several New Jersey schools, we may have a bigger problem on our hands. It is quite possible that buildings, especially schools, that have sprayed-on asbestos finishes and asbestos/cement paneling and floors will become an urgent matter for action by the commission and other federal and state agencies in the days and months ahead. Now, I shall discuss briefly some of the questions and difficulties the commission must resolve as it regulates in this area. First, there is the practical difficulty of identifying the large universe of consumer products that contain free-form asbestos. We know enough from the preliminary results of the recent survey to know we need to know more, and we are making every effort to do this now. The report lists a wide variety of consumer products that contain asbestos, for example, textiles, paper products, floor and roofing materials, paint coatings, sealants, and reinforced plastics. The problem for the commission is to determine which ones have free-form asbestos readily available for human uptake and a high potential for consumer exposure. A complicating factor is that with few exceptions, products are not labeled to indicate whether they contain asbestos. To those who say the commission should ban asbestos from every consumer product, I can only reply that this is an impossible task. Until we have a better understanding of the items that contain free-form asbestos and how they are used, the commission could not do it, even if we wanted to. Second, asbestos is a ubiquitous fiber that can contaminate products a t any point during the manufacturing process. As we know, asbestos is found in our environment, both as a natural element and as a result of environmental emissions that occur after use of the material in many ways. As a result, even if a manufacturer intends to make an asbestos-free product, contamination may occur at the plant or even earlier, in other raw materials. A prime example of such contamination is patching compounds. The commission banned the “intentional addition” of respirable free-form asbestos to these compounds and included within the ban “knowing” additions of contaminants. The main idea was to stop the use of one component, talc contaminated with asbestiform tremolite. The
Franklin: Consumer Product Safety
499
big unanswered question, however, is how the manufacturer (or, for that matter, the commission) will know if contamination occurs and, if so, in what quantities. Third, science has so far not been able to develop an inexpensive or entirely reliable test method to count the tiny asbestos fibers. Reportedly, the best method currently in use is electron microscopy. However, the microscopes are costly, from $1 00.000 to $200,000 apiece, and not all laboratories can afford them. Even if the device were in the hands of all who could use it. there remains the complex problem of preparing samples for analysis so that an accurate fiber count is obtained. The current technique involves “rubbing” a sample onto a slide. But I am aware there is disagreement over the use of this methodology. Thus, what a scientist sees through the microscope may give a distorted picture. Fourth, another issue-how to enforce our patching compound ban with respect to contaminant levels of asbestos. The major thrust of our enforcement effort is, as I believe it should be, on removing from the marketplace those items that contain substantial amounts of asbestos. We now need to map a strategy to deal with the tougher issue of minor contaminant levels. I n my opinion, one partial answer might be to require suppliers to provide, in a uniform way, assurance to manufacturers on contaminants. Perhaps the commission should consider rulemaking to require manufacturers to state on the label that their products do not contain asbestos. Beyond this, I believe that manufacturers of other products that contain asbestos also might be required to label-this time, affirmatively-to indicate how much asbestos is present. At this point, I want to turn to some of the broader public policy questions we face, not only with asbestos, but with many, many other potential carcinogens in consumer products. At the top of my list is the question of threshold levels. For all regulators, the fact of life at the moment is that science has not determined if levels of exposure exist below which a potential carcinogen will not cause cancer. As a result, regulatory agencies, including the commission, are forced to assume that no safe level exists and that any amount of a carcinogen might be dangerous. So far, the commission has followed this assumption with its asbestos bans. But we must also recognize that the level of the public’s exposure to harmful substances in consumer products can be very different, and generally less predictable, than is the case with workplace exposure. A consumer might use a patching compound, for example, no more than ten times during his or her lifetime. The duration of use may vary from an hour to a day. The question is how much risk this poses. Because many workers are exposed daily to asbestos, it may make sense for the Occupational Safety and Health Administration (OSHA) to try to limit their exposure to one-half fiber of asbestos per cubic centimeter of air. Certainly, the commission must work very closely with OSHA. But at the same time, we should not, and did not, delay in regulating major amounts of the substance in consumer products until OSHA completes its debate on the finite details of its regulations. Does it make sense to regulate trace amounts of carcinogens in consumer products? Perhaps so or perhaps not, but scientific advances on threshold levels are desperately needed to tell us whether we are on the right track, or the wrong one. Other kinds of scientific agreement and advances in the state of the art also are needed.
SO0
Annals New York Academy of Sciences
For example, what tests should be run to determine the potential carcinogenicity of a substance? In the case of asbestos, the commission, at least, has had the results of epidemiologic studies. But for other carcinogens, we must rely on short-term screening tests in concert with animal testing as indicators. More reliable, more reproducible tests are essential now. Risk assessment is another example. The state of this art is improving, but even greater progress cannot come too soon if regulators are to make decisions that are fair, equitable, and lasting. Another major policy issue is what substitutes will be available if we ban. The basic question is this: Are the substitutes safe? When we banned certain products that contain asbestos, the truth of the matter is that we lacked information to evaluate the safety of the substitute materials. One of the likely replacements, attapulgate, also consists of small mineral fibers that might be respirable, although research on its effects is still very incomplete. There are other questions. How will the substitute affect the availability and utility of the product and the likelihood that consumers will still want it? If a substitute is used and there are costs to reformulate the product or change production methods, will the consumer want to pay the increased price? Stated another way, we are charged with making decisions that are in the public interest. This means weighing the need for adequate consumer safety against the possibility of greatly increased costs and burdens for industry and, ultimately, for the consumer. We have said in the commission’s carcinogens policy that the public health is our paramount concern. I believe this is the right approach. However, my agency also has a statutory obligation to analyze the economic impact of each regulation we issue and to determine that each is reasonably necessary to protect consumers. 1 do not take this responsibility lightly. This balancing process is perhaps most difficult when the carcinogenic substance is a minor contaminant and the costs of eliminating it are very high. How we allocate our resources is another question the commission faces. Our resources are far from unlimited, and as a practical matter, we must set priorities. In the immediate future, we will have to find better ways to rank the carcinogenic risks in consumer products to assure that we are dealing with the most important ones and not giving other vital product safety concerns the short shrift. The commission also greatly needs a boost in resources from Congress and the President, so that we can do the job that they expect and that the public deserves. The situation probably will be compounded, in light of the veritable flood of reports on suspected carcinogens that are expected to be released in the near future by the National Cancer Institute and other federal agencies. Under the commission’s new carcinogen policy alone, our staff estimates that over each of the next three years, we may screen 150 substances, classify 50, and possibly regulate five. Finally, let me stress the importance of your work. It is fundamental to our regulatory efforts. Without a solid scientific basis, our efforts to protect the public in a responsible way will fail. As one regulator who does not have an extensive scientific background, I sometimes find it difficult to understand complex scientific principles. But I know that I must when it is a critical part of any regulatory decision. However, you have a responsibility, too. Scientists, like anyone else, I have learned, often disagree, but the nuances of your disagreements are not always in a form that regulators or the general public can understand. The challenge is to find ways we all can communicate better about complex technical issues.
Franklin: Consumer Product Safety
50 I
Another Franklin at another time said we must hang together or hang separately. This Franklin thinks we must get together first, the scientific community, business, government, consumers, indeed all of us. Let’s face it: the same public policy issues in this area apply in others and are of concern to us all. This is why I have repeatedly urged President Carter over the last year to take the lead in developing a single national cancer policy. As 1 see it, the White House, as the highest level of our government, must take the lead responsibility, but the policy must be developed in concert with the public, industry, scientists, and many, many others. So far, it has not happened. But, in my view, the need for such a policy is more imperative than ever, if we are to have a strong, sustained, and coordinated commitment to control cancer. As I see it, a national policy should articulate-clearly, so that there is no misunderstanding-the posture and program of the federal government as a whole. At a minimum, I believe the issues to be addressed include the following: a uniform definition of carcinogens and agreement on the short-term and long-term tests that should be run, how they should be conducted, and how the test results should be interpreted. Consideration of factors other than public health also must be dealt with. Simply banning a substance may be one immediate way out. Indeed, it may be the proper approach. But the consequences of whatever we do must be anticipated, and alternative courses of action must be considered, so that we do not cause unnecessary economic upheaval. The policy must recognize the need for flexibility, so that developing scientific knowledge can be applied, so that the individual agencies can perform the jobs that the President and Congress expect, and so that industry can deliver. Most of all, a national policy on cancer must spell out the magnitude of the problem before us, the need to protect consumers, workers, and our environment, and a timetable for intelligent and informed action to achieve it. Let me close with this scenario: At the moment, products whose benefits consumers have enjoyed, sometimes for years, are headlined as hazards that may be garrotes around their throats. At the same time, there is a barrage of conflicting news reports that tell them there is absolutely no cause for concern. Is nothing safe any more, they ask? Are we victims of overdramatization by the media? Regulatory overkill or underkill? Industrial conspiracies? Is this the price we must pay for living in a highly industrialized society? The questions are good ones, and they are directed a t all of us. With cancer, there are no easy solutions, but I believe there are solutions. Unless we approach them together and with the very best of our efforts, however, we could face not merely a public health crisis, but a calamity. So, I say to you that we all have a job to do to move that iceberg. And that job is to build a consensus and develop a common approach to a common problem: cancer. It’s high time all of us get together.
