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,PEOPLE 3 

,AU?OR 3 ,MURRAY ,BOOK*9 

,TEXT 3 

,\R ,SYN!TIC ,5VIRONM5T 

,MURRAY ,BOOK*9 

,*,A,P,T,] ,O,N,E3 ,! ,P,R,O,B,L,E,M 

  
,\R ,*ANG$ ,5VIRONM5T 

,LIFE 9 ! ,UNIT$ ,/ATES HAS *ANG$ SO RADICALLY OV] ! PA/ ONE HUNDR$ YE>S ?AT ! MO/ WE>ISOME HI/ORIANS T5D TO BECOME RHAPSODIC :5 !Y DESCRIBE ! NEW ADVANCES ?AT HAVE BE5 MADE 9 TE*NOLOGY1 SCI5CE1 & M$IC9E4 ,WE >E USUALLY TOLD ?AT E>LY 9 ! LA/ C5TURY MO/ ,AM]ICANS LIV$ H]OIC BUT N>R[ LIVES1 EK+ \T A MAT]IAL EXI/5CE ?AT WAS 9SECURE & CONTROLL$ BY SEASONAL *ANGES1 DR\<T1 & ! NATURAL F]TILITY ( ! SOIL4 ,DAILY WORK *ORES W]E EXTREMELY >DU\S2 KN[L$GE1 BELEAGU]$ BY SUP]/ITION1 WAS RELATIVELY CRUDE4 ,HI/ORIANS ) AN 9T]E/ 9 SCI5CE (T5 PO9T \T ?AT M$ICAL REM$IES W]E PRIMITIVE1 IF NOT USELESS2 !Y MAY HAVE SUFFIC$ TO RELIEVE ! SYMPTOMS ( COMMON DISEASES1 BUT !Y SELDOM EFFECT$ A CURE4 ,LIFE WAS H>D & PREC>I\S1 AFFLICT$ BY MANY TRAG$IES ?AT CAN EASILY BE AVOID$ TODAY4 

,9 CONTRA/ ) ! M5 ( ! LA/ C5TURY1 M5 TODAY1 WE >E TOLD1 HAVE DEVELOP$ NE>LY COMPLETE CONTROL OV] ! NATURAL =CES ?AT ONCE W]E ! MA/]S ( !IR ANCE/ORS4 ,ADVANCES 9 COMMUNICATION HAVE BR\<T KN[L$GE & SAFETY TO ! MO/ ISOLAT$ COMMUNITIES4 ,! MO/ >DU\S WORK HAS N[ BE5 TAK5 OV] BY MA*9ES1 & MAT]IAL EXI/5CE HAS BECOME SECURE1 EV5 AFFLU5T4 ,COMMON ILLNESSES ?AT ONCE CLAIM$ ! LIVES ( MILLIONS >E N[ EASILY CONTROLL$ BY A SCI5TIFIC KN[L$GE ( DISEASE1 EFFECTIVE DRUGS1 NEW DIAGNO/IC DEVICES1 & HI<LY DEVELOP$ SURGICAL TE*NIQUES4 ,! ,AM]ICAN PEOPLE1 IT IS CLAIM$1 5JOY MORE LEISURE1 BETT] HEAL?1 GREAT] LONGEVITY1 & MORE V>I$ & ABUNDANT DIETS ?AN DID !IR =EBE>S A HUNDR$ YE>S AGO4 

,ON ! FACE ( IT1 !SE /ATEM5TS >E TRUE1 BUT BY NO MEANS >E ALL ! ADVANCES AS B5EFICIAL AS ! HI/ORIANS W\LD HAVE US BELIEVE4 ,REC5T *ANGES 9 \R SYN!TIC 5VIRONM5T HAVE CREAT$ NEW PROBLEMS ?AT >E AS NUM]\S AS ?OSE :I* BURD5$ ! M5 ( ! PA/4 ,= EXAMPLE1 SOON NE>LY #g P]C5T ( ! ,AM]ICAN POPULATION WILL BE LIV+ 9 L>GE METROPOLITAN C5T]S1 SU* AS ,NEW ,YORK1 ,*ICAGO1 & ,LOS ,ANGELES4 ,!Y WILL BE EXPOS$ 9 EV]-GREAT] NUMB]S TO AUTOMOBILE EXHAU/S & URBAN AIR POLLUTANTS4 ,P]HAPS AN EV5 L>G] P]C5TAGE ( ! EMPLOY$ POPULATION WILL BE WORK+ 9 FACTORIES & (FICES4 ,!SE PEOPLE WILL BE DEPRIV$ ( SUNLI<T & FRE% AIR DUR+ ! BE/ H\RS ( ! DAY4 ,FACTORY & (FICE WORK1 :ILE LESS >DU\S ?AN 9 ! PA/1 IS BECOM+ MORE 9T5SIVE4 ,AL?\< ! WORK+ DAY E>LY 9 ! LA/ C5TURY WAS V]Y LONG1 0! WORK] WORK$ COMP>ATIVELY SL[LY1 & BO? ! EMPLOY] & EMPLOYEE GAVE RELATIVELY LITTLE ?\<T TO PRODUCTIVITY40 ,TODAY1 EMPLOY]S REQUIRE A GREAT] \TPUT P] H\R FROM EA* WORK]4 ,! USE ( MA*9ES T5DS TO MAKE WORK MONOTON\S & S$5T>Y1 (T5 EXHAU/+ HUMAN N]VES AS COMPLETELY AS MANUAL WORK EXHAU/$ HUMAN MUSCLES4 ,MOD]N MAN IS F> LESS PHYSICALLY ACTIVE ?AN HIS =EBE>S W]E4 ,HE OBS]VES RA!R ?AN P]=MS1 & USES LESS & LESS ( HIS BODY AT WORK & PLAY4 ,HIS DIET1 AL?\< MORE ABUNDANT1 CONSI/S ( HI<LY PROCESS$ FOODS4 ,!SE FOODS CONTA9 A DISCONC]T+LY L>GE AM\NT ( PE/ICIDE RESIDUES1 COLOR+ & FLAVOR+ MATT]1 PRES]VATIVES1 & *EMICAL 0TE*NOLOGICAL AIDS10 MANY ( :I* MAY IMPAIR HIS HEAL?4 ,HIS WAT]WAYS & ! AIR HE BREA!S CONTA9 NOT ONLY ! TOXIC WA/ES ( ! MORE FAMILI> 9DU/RIES BUT RADIOACTIVE POLLUTANTS1 ! BYPRODUCTS ( PEACETIME USES ( NUCLE> 5]GY & NUCLE> WEAPONS TE/S4 

,) ! RISE ( !SE PROBLEMS1 DRAMATIC *ANGES HAVE OCCURR$ 9 ! 9CID5CE ( DISEASE4 ,9 #a#i1 9FECTI\S DISEASES1 SU* AS PNEUMONIA1 9FLU5ZA1 & TUB]CULOSIS1 W]E ! PR9CIPAL CAUSES ( DEA?4 ,DEA? FROM HE>T DISEASE & CANC] OCCUPI$ A SECOND>Y PLACE 9 ,AM]ICAN VITAL /ATI/ICS4 ,FIFTY YE>S LAT]1 MORTALITY RATES FROM 9FECTI\S DISEASES HAD DECL9$ TO A FRACTION ( :AT !Y HAD BE51 BUT ! P]C5TAGE ( DEA?S FROM HE>T DISEASE & MALIGNANT TUMORS HAD MORE ?AN D\BL$4 ,IT IS V]Y DIFFICULT TO OBTA9 RELIABLE COMP>ATIVE /ATI/ICS ON ! 9CID5CE ( *RONIC1 OR P]SI/5T1 DISEASES1 BUT WE CAN REG>D IT AS ALMO/ C]TA9 ?AT ! PROPORTION ( *RONICALLY ILL 9DIVIDUALS 9 ! ,AM]ICAN POPULATION HAS 9CREAS$4 ,9 ANY CASE1 MILLIONS ( ,AM]ICANS TODAY SUFF] FROM MAJOR *RONIC DISORD]S4 ,NE>LY #e MILLION PEOPLE >E AFFLICT$ ) HE>T DISEASE2 ANO!R #e MILLION HAVE HI< BLOOD PRESSURE4 ,MORE ?AN #ab MILLION SUFF] FROM >?RITIS1 #d MILLION FROM A/HMA1 & AT LEA/ #g1 FROM CANC]4 ,ADDITIONAL MILLIONS SUFF] FROM DIABETES1 KIDNEY DISEASE1 & DISORD]S ( ! N]V\S SY/EM4 

,BECAUSE MANY ( !SE ILLNESSES CLAIM ! LIVES ( ELD]LY PEOPLE1 WE T5D TO ASSOCIATE *RONIC DISEASES ) ! AG+ PROCESS1 & WE USUALLY EXPLA9 !IR WIDESPREAD OCCURR5CE BY ! FACT ?AT PEOPLE >E LIV+ LONG]4 ,M5 MU/ DIE ( SOME?+4 ,) A R$UCTION 9 ! NUMB] ( DEA?S FROM TUB]CULOSIS1 9FLU5ZA1 & *ILDHOOD 9FECTIONS1 ! DISEASES ( AG+ PEOPLE1 IT IS CLAIM$1 %\LD BE EXPECT$ TO DOM9ATE \R VITAL /ATI/ICS4 ,BUT >E !SE DISEASES /RICTLY PRODUCTS ( ! AG+ PROCESS8 ,DO WE HAVE ANY EVID5CE ?AT !Y >ISE FROM BASIC PHYSICAL DI/URBANCES PECULI> TO S5ESC5CE8 ,! ANSW] IS ALMO/ C]TA9LY NO4 ,MANY DISORD]S :I* AFFLICT Y\NG PEOPLE >E PRECISELY ?OSE SO-CALL$ 0DEG5]ATIVE DISEASES0 ?AT PHYSICIANS & LAYM5 ASSOCIATE ) ! RETROGRESSIVE PHYSICAL *ANGES ( OLD AGE4 

,CONSID] ! AGE DI/RIBUTION 9 ! 9CID5CE ( CANC]4 ,AL?\< MANY TYPES ( CANC] >E F\ND MO/LY AFT] ! F\R? OR FIF? DECADE ( LIFE1 A SURPRIS+LY L>GE NUMB] ( V>IETIES OCCUR MO/ FREQU5TLY 9 *ILDHOOD1 Y\?1 & E>LY MATURITY4 ,CANC]S ( ! KIDNEY & ! ADR5AL GL&S USUALLY APPE> BE=E ! AGE ( F\R4 ,BONE CANC]S REA* !IR HI<E/ 9CID5CE 9 ! T5-TO-TW5TY-F\R AGE GR\P4 ,MALIGNANT TUMORS ( ! TE/ES USUALLY OCCUR 9 9FANCY & AT MATURITY4 ,SO DEEPLY 5TR5*$ WAS ! NOTION ?AT MALIGNANT TUMORS >E DISEASES ( ELD]LY PEOPLE ?AT = MANY YE>S PHYSICIANS (T5 DISC\NT$ E>LY SYMPTOMS ( C]TA9 CANC]S 9 *ILDR54 ,WE N[ KN[ ?AT CANC] 9 *ILDR5 OCCURS 9 NE>LY ALL ! MAJOR PHYSICAL ORGANS ( ! BODY4 

,TODAY1 CANC] IS SECOND ONLY TO ACCID5TS AS A LEAD+ CAUSE ( DEA? 9 ,AM]ICAN *ILDR5 OV] ONE YE> ( AGE4 ,AL?\< MORTALITY RATES = *ILDHOOD CANC]S FLUCTUATE FROM YE> TO YE>1 !Y HAVE MOV$ 9 A DECID$LY UPW>D DIRECTION OV] ! PA/ TWO DECADES2 = ,AM]ICAN *ILDR5 UND] FIFTE5 YE>S ( AGE1 !Y ROSE #bh P]C5T BETWE5 #aid & #a#i#e#e4 ,9 #a#i#e#i1 CANC] CLAIM$ #d1#a LIVES & ACC\NT$ = #ab P]C5T ( ALL DEA?S 9 *ILDR5 BETWE5 ! AGES ( ONE & F\RTE54 ,!SE /ATI/ICS MAKE IT HAZ>D\S TO SAY ?AT ! ILLNESS IS ESS5TIALLY P>T ( ! AG+ PROCESS4 ,/RONG REASONS EXI/ = SUSPECT+ ?AT 5VIRONM5TAL FACTORS CONTRIBUTE SIGNIFICANTLY TO 9CREASES 9 DEA? FROM CANC] AMONG Y\NG PEOPLE4 

,! SAME SUSPICIONS CAN BE EXT5D$ TO HE>T & VASCUL> DISORD]S4 ,UNTIL REC5TLY1 HE>T DISEASE 9 Y\NG PEOPLE WAS CAUS$ PRIM>ILY BY 9FECTI\S ILLNESSES4 ,RHEUMATIC HE>T DISEASE1 FOLL[+ /REPTOCOCCAL 9FECTIONS1 CLAIM$ ! LIVES ( MANY *ILDR5 BETWE5 ! AGES ( T5 & F\RTE54 ,=TUNATELY1 ! 9CID5CE ( RHEUMATIC FEV] HAS BE5 R$UC$ DRAMATICALLY BY ! USE ( ANTIBIOTICS4 ,ON ! O!R H&1 CORON>Y HE>T DISEASE WAS G5]ALLY REG>D$ AS A TYPICAL DEG5]ATIVE ILLNESS ( OLD] PEOPLE1 ATTRIBUTABLE TO ! ONSET ( VASCUL> DISORD]S WELL BEYOND ! PEAK ( LIFE4 ,! DISEASE SEEM$ TO BE A CULM9ATION ( ! AG+ PROCESS4 ,?IS VIEW1 TOO1 IS NO LONG] A DEEPLY 5TR5*$ M$ICAL OP9ION4 ,A!ROSCL]OSIS1 ! PRECURSOR ( CORON>Y HE>T ATTACKS1 IS NOT A UNIV]SAL FEATURE ( OLD AGE4 ,ON AUTOPSY1 MANY AN OCTOG5>IAN HAS BE5 F\ND TO HAVE CORON>Y >T]IES ?AT A MAN 9 HIS =TIES W\LD BE =TUNATE TO POSSESS4 

,EV5 MORE DISCONC]T+ IS ! UNEXPECT$LY HI< 9CID5CE ( CORON>Y ILLNESS N[ KN[N TO EXI/ AMONG Y\NG PEOPLE4 ,DUR+ ! ,KOREAN ,W>1 ! ,U4 ,S4 ,>M$ ,=CES ,9/ITUTE ( ,PA?OLOGY P]=M$ A S]IES ( AUTOPSIES ON ! BODIES ( #c ,AM]ICAN SOLDI]S1 MO/ ( :OM HAD BE5 KILL$ 9 FRONT-L9E >EAS4 ,C>EFUL ATTEMPTS W]E MADE TO EXCLUDE CASES 9 :I* !RE HAD BE5 CL9ICAL EVID5CE ( CORON>Y DISEASE4 ,! 9VE/IGATORS1 ,5OS1 ,HOLMES1 & ,BEY]1 OBS]V$ ?AT ! AV]AGE AGE 9 0#b CASES WAS #b#b4#a YE>S4 ,! AGES 9 ! FIR/ #ih CASES W]E NOT RECORD$ EXCEPT ?AT ! OLDE/ PATI5T WAS #c#c444 ,9 #g#g4#c.0 ( ! HE>TS1 SOME GROSS EVID5CE ( CORON>Y A!ROSCL]OSIS WAS F\ND40 

,9 AT LEA/ #ab P]C5T ( ! HE>TS1 ! OB/RUCTION ( ONE OR MORE MAJOR CORON>Y >T]IES EXCE$$ #e P]C5T ( ! >T]IAL PASSAGEWAY4 ,!SE >E EXTREMELY HI< FIGURES = Y\NG M5 :O PRESUMABLY W]E QUALIFI$ = MILIT>Y S]VICE4 ,A COMP>ATIVE /UDY P]=M$ ON ! BODIES ( #ce ,AM]ICANS 9 ,BO/ON & #ceb ,JAPANESE 9 ,FUKUOKA 0DISCLOS$ A CONSID]ABLE DIFF]5CE 9 ! SEV]ITY ( CORON>Y A!ROSCL]OSIS0 BETWE5 ! TWO NATIONAL GR\PS4 ,9 ! ,AM]ICAN GR\P EV]Y 9DIVIDUAL HAD SOME DEGREE ( A!ROSCL]OSIS BY ! SECOND DECADE ( LIFE1 :]EAS ,JAPANESE C\LD BE F\ND )\T ! DISEASE 9 ! FIF? & SIX? DECADES4 ,COMP>+ ! EXT5T ( ! >T]IAL SURFACE 9VOLV$ & ! SEV]ITY ( ! LESIONS F\ND 9 ! TWO GR\PS1 ! 9VE/IGATORS EMPHASIZE ?AT 0!RE WAS AT LEA/ A TWO DECADE DIFF]5CE 9 ! PROGRESSION ( A!ROSCL]OSIS4 ,! AV]AGE ,AM]ICAN ( AGE #d & ! AV]AGE ,JAPANESE ( AGE #f PRES5T$ COMP>ABLE >T]IAL DISEASE40 

,9 ALL PROBABILITY1 DATA ( ?IS SORT M]ELY SUPPLY US ) FRAGM5T>Y EVID5CE ( ! EXT5T TO :I* *RONIC & DEG5]ATIVE ILLNESSES >E 9VAD+ ! Y\NG] AGE GR\PS ( \R POPULATION4 ,MANY 9DIVIDUALS SEEM TO BE SUCCUMB+ TO DEG5]ATIVE DISEASES LONG BE=E !Y REA* ! PRIME ( LIFE4 ,NOT ONLY IS CANC] A LEAD+ CAUSE ( DEA? 9 *ILDHOOD & Y\?1 BUT ! RESULTS OBTA9$ BY ,5OS & HIS C[ORK]S SUGGE/ ?AT MANY ,AM]ICAN MALES BETWE5 TW5TY & ?IRTY YE>S ( AGE >E ON ! BR9K ( MAJOR C>DIAC DISEASE4 ,AL?\< MO/ ( !SE 9DIVIDUALS >E LIKELY TO EXHIBIT NO CL9ICAL SYMPTOMS ( VASCUL> DISORD]S-9DE$1 !Y W\LD PROBABLY BE REG>D$ AS HEAL?Y 9 R\T9E M$ICAL EXAM9ATIONS - IT IS REASONABLE TO SAY ?AT !Y >E ILL4 ,IF DISEASES ( ?IS K9D REPRES5T ! NORMAL DET]IORATION ( ! BODY1 !N HUMAN BIOLOGY IS TAK+ A PAT5TLY ABNORMAL TURN4 ,A L>GE NUMB] ( PEOPLE >E BREAK+ D[N PREMATURELY4 

,H]$ITY1 ( C\RSE1 MAY 0PLAY A ROLE0 - TO USE A WELL-WORN QUALIFICATION4 ,BUT M$ICAL HI/ORY W>NS US ?AT G5ETIC EXPLANATIONS ( DISEASE1 P>TICUL>LY COMMON DISEASES ?AT AFFLICT L>GE SECTIONS ( ! POPULATION1 >E (T5 A REFUGE = 9COMPLETE KN[L$GE4 ,MANY SU* EXPLANATIONS >E BE+ CONTRADICT$ BY RESE>*4 ,= EXAMPLE1 IT IS V]Y D\BTFUL :E!R ! 09H]5TLY' WEAK & SICK1 :O PRESUMABLY W]E RESCU$ BY MOD]N M$IC9E FROM ! FATAL 9FECTIONS ( ! PA/1 >E DE/9$ TO BE VICTIMS ( CANC]4 ,9 FACT1 !RE IS GOOD REASON TO BELIEVE ?AT ! BODY'S ME*ANISMS = RESI/ANCE TO CANC]S >E 5TIRELY DI/9CT FROM ?OSE ?AT COMBAT 9FECTIONS4 70,! OLD IDEA ?AT *RONIC DISEASES >E 'DEG5]ATIVE1' OR 9EVITABLE CONCOMITANTS ( AG+10 OBS]VES ,LE/] ,BRESL[1 ( ! ,CALI=NIA ,/ATE ,DEP>TM5T ( ,PUBLIC ,HEAL?1 0IS GIV+ WAY TO ! MOD]N IDEA ?AT ! ORIG9S ( *RONIC DISEASE LIE 9 SPECIFIC EXT]NAL CAUSES :I* CAN BE DISCOV]$ & ?US CONTROLL$407 ,) ALL DUE RESPECT TO G5ETICS & TO !ORIES ?AT ATTRIBUTE *RONIC DISEASE TO S5ESC5CE1 IT W\LD BE MORE REW>D+ TO EXAM9E ! *ANGES ?AT HAVE OCCURR$ OV] ! PA/ HALF C5TURY 9 MAN'S DIET1 HABITS1 =MS ( WORK1 & PHYSICAL SURR\ND+S4 

,T]M9AL CANC] PATI5TS1 :OSE 9ITIAL RESI/ANCE TO EXP]IM5TAL 9OCULATIONS ( CANC] CELLS IS VIRTUALLY NIL1 MAY NEV]!LESS (F] M>K$ RESI/ANCE TO H>MFUL BACT]IA & VIRUSES4 ,A TEAM ( ,SLOAN-,KETT]+ RESE>*]S 9OCULAT$ FIFTE5 T]M9AL CANC] PATI5TS ) LIVE CANC] CELLS & G]MS4 ,?IRTE5 PATI5TS %[$ NO RESI/ANCE TO ! CELLS1 :I* TOOK ROOT & =M$ VIGOR\S CANC]S4 ,?IS WILL NOT ORD9>ILY OCCUR 9 9DIVIDUALS :O DO NOT HAVE CANC]4 ,BUT ! SAME CANC] PATI5TS PRODUC$ EFFECTIVE ANTIBODIES AGA9/ 9OCULATIONS ( DISEASE-CAUS+ BACT]IA & VIRUSES4 

 ,5,V,I,R,O,N,M,5,T ,& ,I,L,L,N,E,S,S 

,A BALANC$ ATTITUDE T[>D 5VIRONM5TALLY 9DUC$ ILLNESS HAS G5]ALLY BE5 ! EXCEPTION RA!R ?AN ! RULE4 ,9 ! PA/1 AS M$ICAL FA%IONS *ANG$1 OP9ION W\LD T5D TO SW+ FROM ONE OV]SIMPLIFICATION TO ANO!R4 ,= A LONG TIME1 ! G]M !ORY ( DISEASE DISC\RAG$ GIV+ S]I\S ATT5TION TO ! 5VIRONM5T AS A MAJOR FACTOR 9 ILLNESS4 ,ATTEMPTS TO 9VE/IGATE ! RELATION%IP BETWE5 5VIRONM5TAL *ANGE & DISEASE W]E VIEW$ AS A REGRESSION TO ! PRE-,PA/EUR DAYS ( M$IC9E4 ,! GOALS ( RESE>*1 IT WAS DECL>$1 >E TO DISCOV] & DE/ROY ! MICROORGANISMS ?AT CAUSE ILLNESS4 ,! PHYSICIAN WAS CONCEIV$ TO BE LOCK$ 9 A /RUGGLE ) MICROBES1 & ! HUMAN ORGANISM WAS REG>D$ AS VIRTUALLY ! ONLY LEGITIMATE >5A = WAG+ ?IS CONFLICT4 ,! SYN!TIC & SOCIAL 5VIRONM5TS \TSIDE MAN'S BODY SEEM$ IRRELEVANT TO ! BASIC PROBLEMS ( DIAGNOSIS & !RAPY1 EXCEPT :]E SANITATION & ! ISOLATION ( 9DIVIDUALS ) COMMUNICABLE DISEASES W]E 9VOLV$4 7,9 A BRILLIANT SURVEY ( ?IS P]IOD1 ,IAGO ,GALD/ON OBS]VES ?AT AS LATE AS ! #a#i#bS 0FEW AMONG ! M$ICAL LEAD]S GAVE MU* CONSID]ATION 7O!R ?AN ISOLATION1 /]ILIZATION7 TO ! 'CONDITIONS ( P]SON & 5VIRONM5T' ?AT FAVOR$ ! AG5TS ( 9FECTION4 ,! ATTITUDE ( ! M$ICAL PR(ESSION & ( ! PUBLIC HEAL? WORK]S WAS WELL REFLECT$ 9 ! CAMPAIGN SLOGANS =ECA/+ ! /AMP+ \T ( ?IS OR ?AT 9FECTI\S DISEASE BY ! 5D ( SOME T51 FIFTE51 OR TW5TY YE>S4 ,! TALK WAS ( W>1 & ! 5EMY WAS ! TUB]CLE BACILLUS1 ! GONOCOCCUS1 ! SPIRO*ETE607 

,?IS VIEW HAS NEV] FULLY EXPLA9$ SOCIETY'S EXP]I5CE ) TUB]CULOSIS4 ,9 ,EUROPE1 TUB]CULOSIS HAD ALWAYS FL\RI%$ AMONG ! URBAN POOR1 BUT EXCEPT = OCCASIONAL FL>E-UPS H]E & !RE1 ! DISEASE HAD NEV] ASSUM$ ! EPIDEMIC PROPORTIONS ( *OL]A & TYPHUS4 ,) ! ,9DU/RIAL ,REVOLUTION1 H[EV]1 TUB]CULOSIS BECAME ESPECIALLY WIDESPREAD & VIRUL5T4 ,! CR[D+ ( UPROOT$ RURAL FOLK 9TO CITIES1 ! IMPOV]I%M5T & OV]CR[D+ ( ! NEW 9DU/RIAL LABOR+ CLASSES1 & ! DECL9E 9 NE>LY ALL /&>DS ( NUTRITION1 HEAL?1 & SANITATION RAIS$ TUB]CULOSIS FROM A T5ACI\S BUT CONTROLL$ URBAN DISEASE TO AN ILLNESS P&EMIC ?R\<\T ! ,WE/]N WORLD4 ,! DISEASE DID NOT BEG9 TO REC$E UNTIL SWEEP+ RE=MS W]E MADE 9 ! ECONOMIC LIFE ( ,EUROPE & ,AM]ICA4 ,IT WAS BR\<T UND] CONTROL ONLY AFT] ! WORK+ CLASSES HAD A*IEV$ %ORT] WORK+ H\RS1 HI<] 9COME1 BETT] H\S+1 & IMPROV$ SANITATION - 9 %ORT1 AFT] ! /&>D ( LIV+ HAD BE5 RAIS$4 ,IT IS NO OV]/ATEM5T TO DECL>E ?AT ! SOCIAL RE=M]S :O W]E 9/RUM5TAL 9 GETT+ *ILDR5 REMOV$ FROM ! FACTORIES & HELP$ BR+ AB\T HI<] WAGES & ! EI<T-H\R WORK+ DAY DID MORE TO CONTROL TUB]CULOSIS ?AN DID ,KO*1 :O DISCOV]$ ! TUB]CLE BACILLUS4 

,:5 IT BECAME EVID5T ?AT ! 9CID5CE ( TUB]CULOSIS C\LD BE ATTRIBUT$ TO SOCIAL FACTORS AS WELL AS TO ! PRES5CE ( A G]M1 ANO!R OV]SIMPLIFICATION TOOK HOLD 9 M$ICAL CIRCLES4 ,! DISEASE WAS TRANS=M$ 9TO A MODEL ( 5VIRONM5TALLY 9DUC$ ILLNESS4 ,9 RESPIRATORY TUB]CULOSIS1 A SIMPLE1 DRAMATIC 9T]ACTION SEEMS TO EXI/ BETWE5 AN 9FECTI\S AG5T & 5VIRONM5TAL CONDITIONS4 ,ON ! ONE H&1 )\T ! TUB]CLE BACILLUS !RE CAN BE NO TUB]CULOSIS2 ! G]M IS A DISEASE-CAUS+1 OR PA?OG5IC1 AG5T4 ,ON ! O!R H&1 MANY HEAL?Y PEOPLE 9 ,EUROPE & ! ,UNIT$ ,/ATES HAVE HAD >RE/$ CASES ( TUB]CULOSIS )\T EV] KN[+ IT4 ,! BACILLUS MAY CONT9UE TO EXI/ 9 AN 9DIVIDUAL'S BODY ) NO NOTICEABLE IMPAIRM5T ( ! LUNGS OR OCCURR5CE ( ! ILLNESS4 ,9 MO/ CASES1 ! G]M BECOMES H>MFUL ONLY :5 PHYSICAL RESI/ANCE IS L[]$4 ,ALL ! ELEM5TS 9 ! RELATION%IP BETWE5 ! ILLNESS & ! 5VIRONM5T SEEM TO BE EASILY DET]M9$4 ,A KN[N & OBS]VABLE MICROORGANISM CAN BE ISOLAT$ FROM ! SPUTUM ( ALL TUB]CUL> PATI5TS4 ,! 5VIRONM5TAL *ANGES ?AT FO/] TUB]CULOSIS1 SU* AS A DET]IORATION 9 DIET & WORK+ CONDITIONS1 CAN BE 9T]PRET$ 9 T]MS ( CALORIES1 M9]ALS1 VITAM9S1 & EV5 WORK+ H\RS4 ,NORMALLY ! DISEASE CAN BE >RE/$ BY SUFFICI5T QUANTITIES ( N\RI%+ FOODS1 BY RE/1 & BY ! ADM9I/RATION ( DRUGS4 

,9 CONTRA/ ) TUB]CULOSIS1 H[EV]1 ! SPECIFIC CAUSES ( MANY *RONIC & DEG5]ATIVE DISEASES >E V]Y OBSCURE4 ,ILLNESS MAY OCCUR UND] 0FAVORABLE0 AS WELL AS 0UNFAVORABLE0 5VIRONM5TAL CONDITIONS4 ,HE>T DISEASE1 CANC]1 >?RITIS1 & DIABETES - ! MO/ IMPORTANT DEG5]ATIVE DISEASES ( \R TIME - CLAIM !IR VICTIMS FROM ! WELL-TO-DO & POOR ALIKE4 ,! 5VIRONM5TAL CONDITIONS ?AT 5C\RAGE 9FECTI\S DISORD]S1 SU* AS POV]TY & >DU\S WORK1 >E (T5 ABS5T FROM ! LIVES ( P]SONS AFFLICT$ ) A DEG5]ATIVE DISEASE4 ,! C\RSE TAK5 BY A DEG5]ATIVE ILLNESS IS HI<LY COMPLEX1 V>Y+ M>K$LY FROM 9DIVIDUAL TO 9DIVIDUAL4 ,! RELATION%IP BETWE5 5VIRONM5TAL *ANGE & DEG5]ATIVE DISORD]S LACKS ! SIMPLICITY & DRAMA 5C\NT]$ 9 CASES ( TUB]CULOSIS4 ,H5CE1 ANY EMPHASIS ON 5VIRONM5TAL *ANGE 9 ! /UDY ( HE>T DISEASE1 CANC]1 & SIMIL> ILLNESSES /ILL MEETS ) A C]TA9 AM\NT ( RES]VE & DI/RU/4 ,EV]Y?+ SEEMS TO BE AMBIGU\S - ! 5VIRONM5T1 ITS RELATION%IP TO ! DISEASE1 &1 AT TIMES1 EV5 ! DISEASE ITSELF4 

,BUT ! PICTURE IS NOT SO BLEAK AS IT SEEMS4 ,AN ILLNESS IS OBVI\SLY 5VIRONM5TALLY 9DUC$ :5 IT BECOMES WIDESPREAD FOLL[+ A MAJOR 5VIRONM5TAL *ANGE4 ,%>P DIFF]5CES ( OP9ION >E LIKELY TO >ISE :5 ! *ANGE CONFLICTS ) AN 5TR5*$ PO9T ( VIEW 9 A P>TICUL> M$ICAL SPECIALTY4 ,A SPECIALI/ 9 TUB]CULOSIS1 = EXAMPLE1 WILL REG>D AN 5VIRONM5TAL *ANGE AS H>MFUL :5 IT RESULTS 9 A R$UC$ CONSUMPTION ( FOOD & 9 9CREAS$ PHYSICAL ACTIVITY4 ,MANY SPECIALI/S 9 HE>T DISORD]S1 H[EV]1 WILL REG>D ! SAME *ANGE AS B5EFICIAL4 ,! TRADITIONAL IMAGE ( A HEAL?Y MAN - A PLUMP & RELATIVELY 9ACTIVE 9DIVIDUAL ) A HE>TY APPETITE - WAS CREAT$ 9 ! LA/ C5TURY1 :5 TUB]CULOSIS WAS BY F> ! MAJOR DISEASE4 ,! NEW1 EM]G+ IMAGE ( A HEAL?Y 9DIVIDUAL IS REPRES5T$ BY A LEAN MAN :O EATS SP>+LY & :O 5GAGES 9 A GREAT DEAL ( PHYSICAL ACTIVITY4 ,AT FIR/ GLANCE1 WE SEEM TO 5C\NT] A %>P CONFLICT ( VIEWS OV] ! FACTORS ?AT PROMOTE OR 9HIBIT 5VIRONM5TALLY 9DUC$ ILLNESSES4 ,BUT ON CLOS] 9SPECTION IT BECOMES EVID5T ?AT BO? VIEWS HAVE A COMMON PO9T ( DEP>TURE1 NAMELY1 9 IMMOD]ATE PRESCRIPTIONS = DIET1 WORK1 & PLAY4 ,FROM ! EXTREMES ( MALNUTRITION & >DU\S LABOR1 ! 5VIRONM5TAL P5DULUM 9 ! ,WE/]N WORLD HAS BEGUN TO SW+ TO ! EXTREMES ( OV] N\RI%M5T & PHYSICAL 9ACTIVITY4 

,LET US EXAM9E SOME ( ! DIET>Y EXTREMES4 ,AT ! TURN ( ! C5TURY1 MANY ,AM]ICANS ATE TOO LITTLE TO MEET !IR PHYSICAL NE$S4 ,TODAY1 !Y EAT TOO MU*4 ,AL?\< ! AV]AGE CALORIC 9TAKE MAY BE FALL+1 ! DECL9E 9 ! NE$ = FOOD IS MOV+ AT A FA/] RATE ?AN ! DECL9E 9 ! 9TAKE ( FOOD4 ,A F>M LABOR] REQUIRES AB\T F\R ?\S& CALORIES A DAY TO MA9TA9 GOOD HEAL?4 ,5GAG$ 9 LI<T (FICE WORK1 ! SAME MAN W\LD SELDOM REQUIRE MORE ?AN TWO ?\S& CALORIES DAILY4 ,YET IT IS D\BTFUL :E!R MO/ ,AM]ICANS 5GAG$ 9 S$5T>Y WORK LIMIT !MSELVES TO SO MODE/ AN 9TAKE ( FOOD4 ,!Y T5D TO OV]EAT 9 RELATION TO ! WORK !Y DO4 ,9 FACT1 ! AV]AGE ,AM]ICAN MALE OV] ?IRTY YE>S ( AGE WEI<S AB\T T5 TO FIFTE5 P\NDS MORE ?AN HE %\LD4 

,NOT ONLY DOES HE OV]EAT1 BUT HE EATS TOO MU* ( ! WRONG FOODS4 ,! ANNUAL P] CAPITA CONSUMPTION ( SUG>1 = EXAMPLE1 HAS 9CREAS$ 5ORM\SLY 9 ! PA/ FIFTY YE>S4 0,9CLUD+ SUG> CONSUM$ 9 C&IES1 SYRUPS JAMS1 & JELLIES1 AS WELL AS = TABLE USE & 9 COOK+10 OBS]VES ,L4 ,JEAN ,BOG]T1 0SUG> CONSUMPTION 9 ! ,UNIT$ ,/ATES AM\NTS TO OV] #a P\NDS P] P]SON YE>LY1 OR AB\T A HALF P\ND EA* DAY = EV]Y P]SON 9 ! C\NTRY4 ,\R ANNUAL C&Y BILL IS OV] A BILLION DOLL>S & HAS 9CREAS$ OV] #a1 P]C5T 9 ! LA/ #f YE>S40 ,!RE HAS BE5 NO NOTEWOR?Y DECL9E 9 ! OV]ALL 9TAKE ( FATS4 ,AL?\< ! CONSUMPTION ( BUTT] HAS FALL5 (F1 ! P] CAPITA 9TAKE ( M>G>9E & HYDROG5AT$ OILS HAS 9CREAS$4 

,HAS ?IS NEW =M ( AN OLD 5VIRONM5TAL EXCESS PLAY$ ANY ROLE 9 CREAT+ ! MOD]N DISEASE L&SCAPE8 ,! ANSW] IS ALMO/ ASSUR$LY YES4 ,OBESITY IS CLOSELY L9K$ ) DIABETES4 ,AL?\< A PR$ISPOSITION TO DIABETES IS H]$IT>Y1 ! DISEASE OCCURS PRIM>ILY 9 OV]WEI<T 9DIVIDUALS4 ,PROP] MANAGEM5T ( ! DISORD] 9VOLVES WEI<T REGULATION AS WELL AS DIET>Y CONTROL & ! USE ( 9SUL94 ,SURPRIS+LY1 !RE ALSO SEEMS TO BE /RONG /ATI/ICAL EVID5CE ?AT OBESE 9DIVIDUALS >E MORE DISPOS$ TO CANC] ?AN ?OSE :O MA9TA9 !IR PROP] WEI<T4 ,! EVID5CE HAS BE5 SUMM>IZ$ 9 A POPUL> WORK ON NUTRITION BY ,NORMAN ,JOLLIFFE1 ( ! ,NEW ,YORK ,CITY ,DEP>TM5T ( ,HEAL?4 0,LIFE 9SURANCE FIGURES %[ ,I ?AT ( ALL M5 :O B\<T !IR POLICIES AT AGE #de OR OV]1 A #be P]C5T HI<] DEA? RATE FROM CANC] IS NOT$ 9 ?AT PORTION ( ! GR\P :I* IS #ae P]C5T OR MORE OV]WEI<T4 ,OV]WEI<T WOM5 HAVE A #c TO #de P]C5T GREAT] *ANCE ( DEVELOP+ A CANC] ( ! UT]US ?AN ?OSE :O >E NOT FAT4 ,!RE IS ALSO EVID5CE FROM ! EXP]IM5TAL LABORATORY ?AT NORMAL WEI<T MICE >E LESS SUSCEPTIBLE TO BO? SPONTANE\S & 9DUC$ TUMOR =MATIONS ?AN FAT ONES40 

,A /RONG SUSPICION EXI/S ?AT DIETS HI< 9 DAIRY FATS1 ANIMAL FATS1 & HYDROG5AT$ OILS >E IMPLICAT$ 9 ! RIS+ 9CID5CE ( CORON>Y HE>T DISEASE4 ,DUR+ ,WORLD ,W> ,I,I1 ! R$UCTION 9 ! AM\NT ( FATTY GOODS 9 ! DIETS ( ! PEOPLE 9 ,G]MAN-OCCUPI$ C\NTRIES WAS FOLL[$ BY A %>P DECL9E 9 ! NUMB] ( DEA?S FROM CORON>Y HE>T ILLNESS4 ,:5 ! OCCUPATION CAME TO AN 5D & ANIMAL FATS RETURN$ TO ! DIET1 ! CORON>Y DEA? RATE ROSE DRAMATICALLY4 ,! DATA COLLECT$ FROM OCCUPI$ ,EUROPE L$ TO /UDIES ( ! EAT+ HABITS ( ,BANTU & :ITES 9 ,S\? ,AFRICA1 NATIVE & ,HAWAIIAN ,JAPANESE1 ,TRAPPI/ & ,B5$ICT9E MONKS1 & MANY O!R RELAT$ COMMUNITIES :]E ! EFFECTS ( L[- & HI< FAT DIETS C\LD BE COMP>$ 9 A MEAN+FUL WAY4 ,! ,BANTU1 ! NATIVE ,JAPANESE1 & ! ,TRAPPI/S1 :O CONSUME V]Y SMALL QUANTITIES ( MEAT & DAIRY FOODS1 >E NOT S]I\SLY BURD5$ BY CORON>Y HE>T ILLNESS4 ,!IR C\NT]P>TS1 :OSE DIETS >E RI* 9 FATTY FOODS1 HAVE A HI< 9CID5CE ( ! DISEASE4 ,IT HAS BE5 E/ABLI%$ BY MANY RESE>*]S ?AT ! CONSUMPTION ( ANIMAL FATS RAISES ! LEVEL ( *OLE/]OL 9 ! BLOOD4 ,! GREAT] ! AM\NT ( *OLE/]OL DEPOSIT$ 9 ! CORON>Y >T]IES1 ! GREAT] ! *ANCES ( A CORON>Y HE>T ATTACK4 ,IT %\LD BE EMPHASIZ$ ?AT ! LEVEL ( *OLE/]OL 9 ! BLOOD CAN BE RAIS$ BY NON-DIET>Y AS WELL AS DIET>Y FACTORS & ?AT HI< *OLE/]OL LEVELS DO NOT NECESS>ILY RESULT 9 VASCUL> DISORD]S4 ,NEV]!LESS1 !RE IS /RONG /ATI/ICAL SUPPORT = ! BELIEF ?AT ! HI< LEVELS ( *OLE/]OL 9 ! BLOOD PRODUC$ BY A NORMALLY FATTY DIET CONTRIBUTE TO ! RIS+ 9CID5CE ( CORON>Y HE>T ILLNESS4 

,!SE ILLU/RATIONS1 NE$LESS TO SAY1 DO NOT >GUE = ! ,G]MAN OCCUPATION ( ,EUROPE1 ! ,BANTU DIET1 OR ! VIRTUES ( MONA/IC LIFE AMONG ! ,TRAPPI/S4 ,! ,BANTU DIET IS S]I\SLY DEFICI5T 9 NUTRI5TS VITAL TO ! MA9T5ANCE ( GOOD HEAL?1 & ,TRAPPI/ MONKS 9 CONTRA/ ) ! ,B5$ICT9ES1 5GAGE 9 A GREAT DEAL ( PHYSICAL WORK4 ,MANY QUE/IONS C\LD BE RAIS$ AB\T NON-DIET>Y FACTORS ?AT MAY TIP ! SCALES = OR AGA9/ A HI< 9CID5CE ( CORON>Y HE>T ILLNESS4 ,:AT ROLE DO C]TA9 UNDESIRABLE HABITS1 SU* AS CIG>ETTE SMOK+1 PLAY 9 ! OCCURR5CE ( ! DISEASE8 ,IS CORON>Y HE>T ILLNESS PROMOT$ BY PHYSICAL 9ACTIVITY & OBESITY1 AS SOME AU?ORITIES HAVE SUGGE/$8 ,9DE$1 DOES ANY S+LE 5VIRONM5TAL FACTOR DET]M9E ! 9CID5CE ( VASCUL> & HE>T DISORD]S 9 A GIV5 COMMUNITY8 ,:ATEV] MAY PROVE TO BE ! RELATION%IP BETWE5 !SE DISEASES & DIET1 O!R FACTORS >E SUSPECT$ ( CONTRIBUT+ TO !IR OCCURR5CE1 NOTABLY /RESS1 S$5T>Y =MS ( WORK1 SMOK+1 & A POOR G5ETIC 5D[M5T4 

,! PROBLEMS ( RESE>* W\LD BE SIMPLIFI$ IMMEASURABLY IF EV]Y 5VIRONM5TAL FACTOR ?AT PLAYS A ROLE 9 DEG5]ATIVE ILLNESSES C\LD BE ISOLAT$ & ITS EFFECTS SUBJECT$ TO PRECISE ANALYSIS4 ,SU* CLE>-CUT RESULTS >E LIKELY TO BE ! EXCEPTION RA!R ?AN ! RULE4 ,MORE ?AN MAY BE SUGGE/$ BY COMP>ATIVE /UDIES ( DIET1 ! IMPORTANCE ( ANY FACTOR 9 *RONIC & DEG5]ATIVE DISEASES V>IES FROM 9DIVIDUAL TO 9DIVIDUAL1 FROM REGION TO REGION1 & FROM ILLNESS TO ILLNESS4 ,9 ! CASE ( CIG>ETTE SMOK+1 = EXAMPLE1 ! AM\NT ( NICOT9E1 T>S1 & O!R H>MFUL SUB/ANCES TAK5 9 V>IES ) ! BR& ( CIG>ETTE1 ! QUANTITY ( CIG>ETTES CONSUM$1 & ! AM\NT ( EA* CIG>ETTE ?AT IS SMOK$4 ,SOME 9DIVIDUALS MAY HAVE A /RONG] REACTION TO A GIV5 9TAKE ( NICOT9E ?AN O!RS4 ,?OSE :O EXHIBIT NO APP>5T ILL EFFECTS FROM ! LONG-T]M 9TAKE ( NICOT9E MAY RESPOND V]Y GRAVELY TO TOBACCO T>S4 ,F9ALLY1 9 MANY 9DIVIDUALS SMOK+ MAY TIP ! SCALES 9 FAVOR ( DEG5]ATIVE DISEASES ?AT >E BASICALLY CAUS$ BY A H>MFUL DIET1 AIR POLLUTION1 & /RESS4 ,! ANALY/ IS CONFRONT$ ) A CON/ELLATION ( FACTORS 9 :I* EA* FACTOR IS MEAN+FUL ONLY 9 RELATION TO ALL ! O!RS4 

,& H]E A TYPICAL DISAGREEM5T >ISES4 ,9 ! ABS5CE ( CONCLUSIVE EVID5CE ?AT A S+LE FACTOR CONTRIBUTES TO ALL CASES ( AN ILLNESS1 MANY RESE>*]S >E 9CL9$ TO DI/RU/ ! CON/ELLATION AS A :OLE4 ,COMPLEXITY IS REG>D$ AS 0AMBIGUITY10 & ! RELATION%IP BETWE5 5VIRONM5T & DEG5]ATIVE ILLNESSES IS DISMISS$ AS 0VAGUE40 ,?IS K9D ( ?9K+ IS *>ACT]I/IC ( \R MOD]N ,WELTGEI/4 0,WE PREF] TO /UDY SY/EMS ?AT CAN EASILY BE ISOLAT$ & APPROA*$ BY SIMPLE ME?ODS10 OBS]V$ ,ALEXIS ,C>REL MORE ?AN TW5TY YE>S AGO4 0,WE G5]ALLY NEGLECT ! MORE COMPLEX4 ,\R M9D HAS A P>TIALITY = PRECISE & DEF9ITIVE SOLUTIONS & = ! RESULT+ 9TELLECTUAL SECURITY4 ,WE HAVE AN ALMO/ IRRESI/IBLE T5D5CY TO SELECT ! SUBJECTS ( \R 9VE/IGATIONS = !IR TE*NICAL FACILITY & CLE>NESS RA!R ?AN = !IR IMPORTANCE4 ,?US1 MOD]N PHYSIOLOGI/S PR9CIPALLY CONC]N !MSELVES ) PHYSICO-*EMICAL PH5OM5A TAK+ PLACE 9 LIV+ ANIMALS1 & PAY LESS ATT5TION TO PHYSIOLOGICAL & FUNCTIONAL PROCESSES4 ,! SAME ?+ HAPP5S ) PHYSICIANS :5 !Y SPECIALIZE 9 SUBJECTS :OSE TE*NIQUES >E EASY & ALREADY KN[N RA!R ?AN 9 DEG5]ATIVE DISEASES1 NEUROSES1 & PSY*OSES1 :OSE /UDY W\LD REQUIRE ! USE ( IMAG9ATION & ! CREATION ( NEW ME?ODS40 

,?IS COMM5T IS /ILL VALID TODAY1 ESPECIALLY AS IT APPLIES TO ATTITUDES T[>D COMPLEX1 5VIRONM5TALLY 9DUC$ ILLNESSES4 ,! /UDY ( *RONIC & DEG5]ATIVE DISORD]S /ILL CALLS = IMAG9ATIVE DEP>TURES FROM CONV5TIONAL APPROA*ES TO DISEASE4 ,TUB]CULOSIS CAN BE EXPLA9$ BY A G]M & A NUMB] ( CLE>-CUT 5VIRONM5TAL FACTORS4 ,NO SU* EXPLANATION CAN BE F\ND = MANY *RONIC & DEG5]ATIVE ILLNESSES4 ,:]E A CONTRIBUTORY FACTOR1 SU* AS TOBACCO T>S OR A HI< 9TAKE ( FATTY FOODS1 IS EVID5T 9 ! OCCURR5CE ( A DISEASE1 IT MAY PROVE TO BE JU/ ONE ( MANY CAUSES4 ,MOREOV]1 :]EAS A G]M HAS ITS [N FIX$ NATURAL HI/ORY1 ! FACTORS ?AT PROMOTE DEG5]ATIVE ILLNESSES (T5 ORIG9ATE 9 MAN'S RAPIDLY *ANG+ SYN!TIC 5VIRONM5T4 ,! 9FLU5CE ( 5VIRONM5TAL FACTORS1 9 TURN1 CAN BE SE5 ONLY ?R\< ! HUMAN ORGANISM1 :OSE 9DIVIDUAL DIFF]5CES (T5 MAKE IT DIFFICULT TO A*IEVE CLE>-CUT ANALYZES4 

,BUT AS RESE>* PROGRESSES1 ! ROLE ( 5VIRONM5TAL *ANGE 9 =M+ ! MOD]N DISEASE L&SCAPE EM]GES MORE CLE>LY4 ,MANY PHYSICIANS >E N[ CONV9C$ ?AT CIG>ETTE SMOK+1 OBESITY1 /RESS1 & A FATTY DIET HAVE CONTRIBUT$ SIGNIFICANTLY TO ! HI< 9CID5CE ( A!ROSCL]OSIS & CANC]4 ,! L9K BETWE5 5VIRONM5T & ILLNESS IS BECOM+ DIFFICULT TO IGNORE4 ,?IS IS NOT TO SAY ?AT EV]Y DEG5]ATIVE DISEASE IS 5VIRONM5TALLY 9DUC$4 ,BUT IT IS BECOM+ EVID5T ?AT ALL ! REVOLUTION>Y *ANGES 9 \R SYN!TIC 5VIRONM5T1 FROM ! RISE ( AN URBAN SOCIETY TO ! USE ( NUCLE> 5]GY1 HAVE PR(\ND BIOLOGICAL IMPLICATIONS1 & ?AT !SE *ANGES HAVE ADD$ AN 5VIRONM5TAL DIM5SION TO NE>LY EV]Y >EA ( PUBLIC HEAL?4 

,! ,H,U,M,A,N ,B,O,D,Y ,& ,I,L,L,N,E,S,S 

,! EFFECT ( \R SYN!TIC 5VIRONM5T ON HEAL? IS DIFFICULT TO GAUGE = /ILL ANO!R REASON2 NAMELY1 ! RIGID1 RA!R S*EMATIC APPROA* TO ILLNESS ?AT G5]ALLY PREVAILS TODAY4 ,:AT1 IT MAY BE ASK$1 IS DISEASE8 ,OR TO PUT ! QUE/ION ANO!R WAY3 ,AT :AT PO9T DOES A HEAL?Y 9DIVIDUAL BECOME ILL8 ,!SE QUE/IONS >E NOT EASY TO ANSW]4 ,BUT ! DIFFICULTIES 9VOLV$ DES]VE C>EFUL EXAM9ATION1 = !Y >E CLOSELY RELAT$ TO ! PROBLEMS CREAT$ BY 5VIRONM5TALLY 9DUC$ DISEASE4 

,MANY PHYSICIANS T5D TO APPROA* ! HUMAN ORGANISM ) A FIX$ ?RE%OLD ( ILLNESS 9 M9D4 ,ON ONE SIDE ( ! ?RE%OLD1 ! BODY IS CONCEIV$ AS BE+ 9 GOOD HEAL?2 ON ! O!R SIDE1 IT IS DISEAS$ & REQUIRES TREATM5T4 ,! L9E BETWE5 HEAL? & DISEASE IS G5]ALLY DRAWN AS %>PLY AS POSSIBLE4 ,! BODY ORD9>ILY MU/ REA* A C]TA9 DEGREE ( DISEQUILIBRIUM & DAMAGE BE=E IT IS REG>D$ AS ILL4 ,?IS APPROA* W\LD BE EXCUSABLE IF IT C\LD BE ATTRIBUT$ M]ELY TO A FRAGM5T>Y KN[L$GE ( ! COMPLEX PROCESSES ?AT TAKE PLACE 9 ! HUMAN BODY4 ,BUT ! APPROA* IS DUE1 9 NO SMALL MEASURE1 TO A LACK ( 9T]E/ 9 ! 0HEAL?Y0 SIDE ( ! ?RE%OLD1 :]E ! CONDITIONS = ILLNESS >E SL[LY CREAT$ BY 9SIDI\S *ANGES 9 ! ORGANISM4 ,IGNORANCE IS P]PETUAT$ BY A COMPLAC5T 9DIFF]5CE TO MANY ( ! BASIC PROBLEMS 9VOLV$ 9 ! TRANSITION FROM HEAL? TO DISEASE4 

,! VALIDITY ( ?IS S*EMATIC APPROA* HAS BE5 *ALL5G$ REPEAT$LY BY ! F9D+S ( MOD]N RESE>* 9 BIO*EMI/RY1 P>TICUL>LY BY ! RESULTS OBTA9$ FROM /UDIES ( HUMAN CELLS4 ,IT %\LD BE A TRUISM ?AT ! MAJORITY ( HUMAN ILLNESSES >E F\<T \T ON ! CELLUL>1 EV5 ! MOLECUL>1 LEVEL ( LIFE4 ,:E!R WE SURVIVE AN ILLNESS OR NOT DEP5DS ON ! NUMB] & TYPES ( CELLS ?AT >E DAMAG$ DUR+ ! C\RSE ( ! DISEASE4 ,ORD9>ILY1 H[EV]1 WE T5D TO REG>D ! DAMAG$ TISSUES ( ! BODY AS ! PASSIVE VICTIMS ( PHYSICAL DISORD]S4 ,:5 9FECTIONS OCCUR1 WE ?9K ( :ITE BLOOD CELLS RU%+ TO DEV\R BACT]IA & ( ANTIBODIES 9HIBIT+ ! EFFECTS ( TOX9S4 ,WE SEEM TO BELIEVE ?AT RESI/ANCE TO DISEASE IS EXCLUSIVELY ! FUNCTION ( C]TA9 SPECIALIZ$ ORGANS & SY/EMS )9 ! BODY4 ,! HEAL? & RESI/ANCE ( CELLS ?AT >E 9VOLV$ 9 ! MORE R\T9E FUNCTIONS ( AN ORGANISM >E SELDOM REG>D$ AS IMPORTANT 9 ! PREV5TION OR \TCOME ( AN ILLNESS4 

,YET MANY HUMAN DISORD]S W\LD BE DIFFICULT TO EXPLA9 )\T ACKN[L$G+ ! SIGNIFICANCE ( G5]AL CELLUL> WELL-BE+4 ,AN EXAMPLE IS SUPPLI$ BY PELLAGRA4 ,PELLAGRA IS CAUS$ BY A DEFICI5CY ( NIAC91 A MEMB] ( ! VITAM9-,B COMPLEX4 ,A LACK ( NIAC9 OR ( ! AM9O ACID TRYPTOPHAN 7A *EMICAL PRECURSOR ( NIAC97 PRODUCES A BROAD SPECTRUM ( DISORD]S1 RANG+ FROM SK9 ]UPTIONS TO M5TAL AB]RATIONS4 ,AS ! DISEASE PROGRESSES1 *ANGES OCCUR 9 ! TISSUES ( ! M\? FOLL[$ BY ULC]ATIONS1 A SL\< ( DEAD CELLS1 & ! PROLIF]ATION ( DISEASE-CAUS+ G]MS4 ,AT ?IS /AGE1 SECOND>Y 9FECTIONS1 SU* AS TR5* M\?1 (T5 SET 94 ,! 9FECTIONS >E CAUS$ PRIM>ILY1 NOT BY ! G]MS1 MANY ( :I* >E PRES5T 9 HEAL?Y 9DIVIDUALS1 BUT RA!R BY MOLECUL> *ANGES )9 ! CELLS :I* SL[LY L[] ! DEF5SES ( TISSUES 9 ! M\?4 ,! CELLS ?AT L9E ! M\? & TONGUE >E 9 ILL HEAL?4 ,TO BORR[ ! WORDS ( A GREAT ,AM]ICAN NUTRITIONI/1 !Y HAVE SUFF]$ A LOSS ( 0TISSUE 9TEGRITY40 ,! DECL9E 9 CELLUL> HEAL?1 (T5 V]Y PROTRACT$ & 9SIDI\S1 MAY NOT BE CL9ICALLY P]CEPTIBLE = A LONG TIME4 

,! CONCEPT ?AT CELLS CAN BE 9 ILL HEAL? LONG BE=E ! APPE>ANCE ( SYMPTOMS 9 ! =M ( A CONV5TIONAL DISEASE1 RECEIVES /RONG SUPPORT FROM CANC]4 7,CANC] CELLS CAN BE REG>D$ AS ILL NOT ONLY BECAUSE !Y >E ABNORMAL & PRODUCE DISORD]S 9 ! ORGANISM AS A :OLE1 BUT ALSO BECAUSE !IR BIO*EMICAL PROCESSES SEEM TO BE IMPAIR$4 ,= EXAMPLE1 ,OTTO ,W>BURG1 ( ! ,MAX ,PLANCK ,9/ITUTE = ,CELL ,PHYSIOLOGY 9 ,B]L91 HAS ADVANC$ ! !ORY ?AT CANC] IS DUE TO *ANGES 9 ! MANN] 9 :I* CELLS OBTA9 5]GY4 ,ACCORD+ TO ,W>BURG1 CANC]-CAUS+ SUB/ANCES DAMAGE ! CELL'S RESPIRATORY ME*ANISMS1 CAUS+ IT TO OBTA9 5]GY BY F]M5TATION4 ,9 CASES 9 :I* CANC] IS CAUS$ BY VIRUSES1 ! CELLS CAN BE REG>D$ AS 9FECT$2 !IR REPRODUCTIVE APP>ATUS IS CONTROLL$ OR D]ANG$ BY ! PRES5CE ( AN ALI5 AG5T47 ,MANY FUNCTIONAL DIFF]5CES DI/+UI% CANC]\S FROM NON-CANC]\S CELLS4 ,CANC] CELLS NOT ONLY MULTIPLY UNCONTROLLABLY AT A GIV5 SITE2 9 MANY CASES !Y ALSO SPREAD1 OR META/ASIZE1 TO VITAL ORGANS ELSE:]E 9 ! BODY4 ,META/ASIS ACC\NTS = MO/ ( ! LIVES CLAIM$ BY ! DISEASE4 ,NORMAL CELLS MULTIPLY 9 A REGULAT$ MANN] &1 EXCEPT = C]TA9 HI<LY SPECIALIZ$ CELLS1 NEV] MIGRATE FROM ! TISSUES 9 :I* !Y ORIG9ATE4 ,C>EFUL /UDIES ( ! DEVELOPM5T ( CANC] 9 EXP]IM5TAL ANIMALS SUGGE/ ?AT CELLS SELDOM BECOME MALIGNANT UNTIL !Y HAVE PASS$ ?R\< MANY GRADATIONS ( ILL HEAL?4 ,ANY MEAN+FUL DISCUSSION ( ! DISEASE MU/ TAKE ACC\NT ( HEAL?Y CELLS1 CELLS 9 V>Y+ DEGREES ( ILL HEAL?1 PRECANC]\S CELLS1 :I* IMP>T ABNORMAL *>ACT]I/ICS TO TISSUES1 & F9ALLY TRUE CANC] CELLS1 :I* REPRODUCE UNCONTROLLABLY4 ,FEW IF ANY ( !SE GRADATIONS >E LIKELY TO MANIFE/ !MSELVES 9 NOTICEABLE SYMPTOMS ( DISEASE4 ,AL?\< ! TRANSITION FROM NORMAL TO PRECANC]\S & CANC]\S CELLS MAY OCCUR V]Y RAPIDLY1 IT IS HI<LY PROBABLE ?AT ! MAJORITY ( MALIGNANT TUMORS >ISE ONLY AFT] A CELL & ITS DESC5DANTS HAVE SIL5TLY TRAVEL$ A LONG ROAD FROM HEAL? TO A PRECANC]\S & !N A CANC]\S /ATE4 

,?AT ?IS K9D ( DET]IORATION CAN OCCUR %\LD NOT SURPRISE US4 ,CELLUL> METABOLISM IS SO COMPLEX ?AT MANY ?+S CAN GO WRONG 9 A CELL )\T PRODUC+ MAJOR SYMPTOMS ( DISEASE 9 ! ORGANISM AS A :OLE4 ,A LIV+ CELL 5GAGES 9 AN 5ORM\S V>IETY ( *EMICAL OP]ATIONS 9 :I* EXTREMELY COMPLEX MOLECULES >E BUILT UP & BROK5 D[N AT A RAPID PACE4 ,A DELICATE BALANCE EXI/S BETWE5 ! ABSORPTION ( NUTRI5TS & ! EXCRETION ( WA/E PRODUCTS4 ,IF ?IS BALANCE IS ALT]$ A TRIFLE = ANY L5G? ( TIME1 DYSFUNCTIONS WILL OCCUR 9 ! CELL4 ,IF IT IS ALT]$ A BIT MORE1 VAGUE SYMPTOMS ( ILLNESS MAY APPE>4 ,IF BLOOD OR OXYG5 IS D5I$ TO C]TA9 ORGANS ( ! BODY = A V]Y %ORT P]IOD ( TIME1 IRREP>ABLE1 EV5 FATAL1 DAMAGE WILL OCCUR4 

,BUT MANY DISORD]S MAY P]SI/ )\T EV] ASSUM+ AN OV]T =M4 ,! ACTIVITIES ( CELLS1 TISSUES1 & ORGANS MAY BE RET>D$2 ADV]SE *ANGES MAY OCCUR 9 ! BODY'S COMPLEX METABOLIC FUNCTIONS2 9 TIME1 PHYSICAL ACTIVITY MAY BE IMPAIR$ & LONGEVITY R$UC$4 ,IF *ANGES ( ?IS NATURE OCCUR 9 A L>GE NUMB] ( 9DIVIDUALS1 \R /&>DS ( PUBLIC HEAL? MAY BE L[]$ IMP]CEPTIBLY4 ,SU* 9DIVIDUALS WILL NOT BE REG>D$ AS ILL 9 ! CONV5TIONAL S5SE ( ! T]M4 ,9 FACT1 UNTIL !Y >E AFFLICT$ ) CANC] OR HE>T ATTACKS1 !Y WILL SATISFY ALL ! S*EMATIC CRIT]IA = GL[+ HEAL?4 

,=TUNATELY1 ! NE$ TO GIVE GREAT] ATT5TION TO COV]T1 OR SUBCL9ICAL1 DI/URBANCES 9 ! HUMAN BODY IS GA9+ 9CREAS+ RECOGNITION4 ,= EXAMPLE1 IT IS WOR? NOT+ ! WAY 9 :I* =M] ,U4 ,S4 ,SURGEON ,G5]AL ,L]OY ,E4 ,BURNEY DISCUSSES ! HAZ>DS ?AT >E CREAT$ BY L[-LEVEL CONC5TRATIONS ( *EMICAL TOXICANTS 9 WAT]4 0,!Y >E NOT KILL+ US OR MAK+ US CL9ICALLY ILL4 ,BUT H[ DOES ! HUMAN BODY REACT TO /EADY DOSES ( DILUT$ *EMICALS8 ,:AT HAPP5S IF ! CONC5TRATION 9CREASES1 EI!R SUDD5LY OR GRADUALLY8 ,WE CANNOT SAY ?AT WE KN[ ! ANSW]S40 ,! SAME PROBLEM IS RAIS$ BY ,ROB]T ,A4 ,KEHOE1 ( ! ,UNIV]SITY ( ,C9C9NATI4 ,AFT] A REVIEW ( ! TOXICANTS1 PHYSICAL HAZ>DS1 RADIOACTIVE POLLUTANTS1 & 0WELT] ( ACTIVITIES0 CREAT$ BY \R SYN!TIC 5VIRONM5T1 ,KEHOE ASKS3 0,BUT :AT >E ! CONSEQU5CES1 ?R\< ! WORK+ LIFE TIME1 ( ! FREQU5T1 ALMO/ DAILY1 IMPACTS ( 9DIVIDUAL & COLLECTIVE 9SULTS ( M9OR OR SUB-CL9ICAL SEV]ITY80 ,ATT5TION %\LD BE FOCUS$ ON ,BURNEY & ,KEHOE'S CONC]N = SUB CL9ICAL DAMAGE1 A CONCEPT ?AT IS NOT P>TICUL>LY CONG5IAL TO ! \TLOOK ( ! ,AM]ICAN M$ICAL COMMUNITY4 

,IT IS DIFFICULT TO SEE H[ ! PROBLEM ( SUB CL9ICAL DAMAGE CAN BE IGNOR$ 9 9VE/IGATIONS ( CANC] & NUTRITIONAL DISORD]S4 ,RESE>*]S >E CON/ANTLY SEEK+ BETT] ME?ODS = ! E>LY DIAGNOSIS ( MALIGNANT & PRE-MALIGNANT TUMORS4 ,BUT DIAGNO/IC TE*NIQUES1 H[EV] DESIRABLE1 >E NOT AT ISSUE H]E4 ,IF IT CAN BE 9F]R$ FROM ! COMPLEXITY ( MAN'S METABOLISM ?AT ILL HEAL? CAN EXI/ LONG BE=E IT BECOMES M$ICALLY EVID5T1 IT FOLL[S ?AT ! GREATE/ C>E %\LD BE EX]CIS$ 9 *ANG+ MAN'S 5VIRONM5T4 ,:]E *ANGES >E DESIRABLE1 !Y %\LD BE PREC$$ BY METICUL\S & IMAG9ATIVE /UDIES4 ,& :]E *ANGES >E NECESS>Y1 EV]Y PRECAUTION %\LD BE TAK5 TO M9IMIZE ANY ILL EFFECTS !Y MAY HAVE ON ! HUMAN BODY4 ,IT W\LD BE UTT] FOLLY TO 9TRODUCE NE$LESS *ANGES 9 MAN'S DIET1 =MS ( WORK1 HABITS1 & PHYSICAL SURR\ND+S )\T 9VE/IGAT+ !IR EFFECTS FROM ! BROADE/ P]SPECTIVE ( PUBLIC HEAL?4 

,5VIRONM5TAL *ANGES %\LD BE /UDI$ NOT ONLY 9 RELATION TO ! MORE DRAMATIC EFFECTS !Y HAVE ON MAN2 /UDY %\LD ALSO BE FOCUS$ ON ! SUBTLE *ANGES PRODUC$ 9 TISSUES & BODILY FUNCTIONS4 ,9 ADDITION RESE>* %\LD BE DIRECT$ T[>D DISORD]S ?AT MAY >ISE YE>S AFT] A NEW PRODUCT IS (F]$ = PUBLIC CONSUMPTION4 ,:5EV] AN 9ESS5TIAL PRODUCT IS SUSPECT$ ( BE+ H>MFUL TO MAN1 ITS SALE OR DI/RIBUTION %\LD BE PROHIBIT$4 ,! CONCEPT ( 5VIRONM5TALLY 9DUC$ ILLNESS %\LD 9CLUDE ALL /RUCTURAL LEVELS ( ! HUMAN ORGANISM & 5COMPASS NOT ONLY PRES5T BUT ALSO FUTURE G5]ATIONS4 

,M,A,N ,& ,! ,N,A,T,U,R,A,L ,W,O,R,L,D 

  

,UN=TUNATELY1 ! AM\NT ( RESE>* DEVOT$ TO 5VIRONM5TAL HEAL? FALLS F> %ORT ( CURR5T NE$S4 ,MANY IMPORTANT PROBLEMS >E BE+ NEGLECT$ = WANT ( FUNDS & TRA9$ P]SONNEL4 ,:]E RESE>* IS 9T5SIVE1 IT IS (T5 FRAGM5T>Y & UNCOORD9AT$4 0,SEP>ATE APPROA*ES TO SPECIFIC PROBLEMS HAVE HAD GREAT PRACTICAL VALUE10 NOTES A REC5T REPORT BY ! ,SURGEON ,G5]AL TO ! ,H\SE ,APPROPRIATIONS ,COMMITTEE4 0,!Y HAVE PROVID$ EFFECTIVE ME*ANISMS = GETT+ AT CRITICAL PHASES ( IMPORTANT PROBLEMS444 ,BUT ! MANY & COMPLEX 9T]RELATION%IPS AMONG ?OSE PROBLEMS HAVE BECOME 9CREAS+LY APP>5T1 & IT IS OBVI\S ?AT !Y MU/ BE CONSID]$ AS P>TS ( A :OLE444 ,TO A*IEVE A 'TOTAL VIEW1' !RE MU/ BE AN 9TEGRATION ( RESE>* & CONTROL ME?ODS4 ,! KN[L$GE & SKILLS ( MANY PR(ESSIONAL SPECIALTIES - PHYSICIANS1 5G9E]S1 PHYSICI/S1 *EMI/S1 $UCATORS1 /ATI/ICIANS AMONG !M - MU/ BE FUR!R COORD9AT$ 9 SEEK+ SCI5TIFICALLY S\ND ANSW]S TO ! MANY *ALL5G+ QUE/IONS 9 ! FIELD ( 5VIRONM5TAL HEAL?40 

,!SE WORDS >E MORE A COMPLA9T AGA9/ ! ABS5CE ( A 0TOTAL VIEW0 ?AN A TRIBUTE TO 0SEP>ATE APPROA*ES TO SPECIFIC PROBLEMS40 ,TIME IS RUNN+ \T4 ,MANY PASSAGES 9 ! ,SURGEON ,G5]AL'S REPORT W\LD BE DISMISS$ AS DOLEFUL EXAGG]ATIONS IF WE W]E NOT AW>E ( ! FACT ?AT !Y COME FROM AN (FICIAL & HI<LY RESPONSIBLE S\RCE4 0,NEW *EMICALS1 MANY ( !M ) TOXIC PROP]TIES OR CAPABILITIES1 >E BE+ PRODUC$ & M>KET$1 & PUT 9TO USE AT A RAPID RATE10 ! REPORT OBS]VES4 0,!SE 9CLUDE PLA/ICS1 PLA/ICIZ]S1 ADDITIVES TO FUELS & FOODS1 PE/ICIDES1 DET]G5TS1 ABRASIVES40 ,AN E/IMAT$ 0#d-#e TOTALLY NEW *EMICALS >E PUT 9TO USE EA* YE>444 ,AL?\< MANY COMMONLY US$ *EMICALS >E *ECK$ = TOXICITY1 MU* IS /ILL UNKN[N AB\T !IR LONG-T]M POT5TIAL HAZ>DS40 ,! REPORT W>NS ?AT :ILE 0! MOD]N SUP]M>KET & FROZ5 FOOD LOCK] P]MIT ! USE ( A WIDE V>IETY ( FOODS1 ) RESULT+ NUTRITIONAL B5EFITS1444 MOD]N ME?ODS ( GR[+ & PROCESS+ FOODS 9TRODUCE NEW HAZ>DS ( PE/ICIDE SPRAY RESIDUES1 PRES]VATIVES & O!R FOOD ADDITIVES1 & EV5 CONTAM9ANTS RELAT$ TO PACKAG+1 :I* REQUIRE ATT5TION = CONTROL40 ,AN OM9\S G5]ALIZATION AT ! BEG9N+ ( ! REPORT C\LD WELL S]VE = ITS CONCLUSION3 0,IT IS NOT BE+ OV] DRAMATIC TO SUGGE/ ?AT ?REATS FROM \R 5VIRONM5T1 ACTUAL & POT5TIAL1 CAN NOT ONLY G5]ATE :OLLY UNDESIRABLE EFFECTS ON ! HEAL? & WELL-BE+ ( ISOLAT$ 9DIVIDUALS1 BUT UND] C]TA9 CIRCUM/ANCES C\LD AFFECT L>GE SEGM5TS ( \R POPULATION & CONCEIVABLY ?REAT5 ! V]Y EXI/5CE ( \R ,NATION40 

,DESPITE ! FRANKNESS ( ! ,SURGEON ,G5]AL'S REPORT1 ! F$]AL GOV]NM5T NOT ONLY HAS FAIL$ TO MEET !SE PROBLEMS RESOLUTELY BUT HAS DIRECTLY & 9DIRECTLY CONTRIBUT$ TO !M4 ,! 9DIRECT CONTRIBUTION WAS MADE ?R\< 9ACTION4 ,IT TOOK NE>LY A HALF C5TURY ( DEBATE1 BO? 9 & \T ( ,CONGRESS1 TO OBTA9 NATIONAL LEGISLATION :I* MADE MANUFACTUR]S LEGALLY RESPONSIBLE = PRE-TE/+ FOOD ADDITIVES4 ,UNTIL #aiei ! JOB ( E/ABLI%+ :E!R A FOOD ADDITIVE WAS H>MFUL WAS P]=M$ BY ! ,FOOD & ,DRUG ,ADM9I/RATION1 & ATTEMPTS TO PROHIBIT ! USE ( SU* ADDITIVES (T5 9VOLV$ LONG & CO/LY JUDICIAL PROCE$+S4 ,! SAME LEGISLATIVE PROCRA/9ATION IS N[ BE+ 5C\NT]$ 9 CONNECTION ) NEW 5VIRONM5TAL HEAL? PROBLEMS4 ,AL?\< AIR & WAT] POLLUTION HAS REA*$ /AGG]+ PROPORTIONS1 NATIONAL LEGISLATION TO COMBAT IT IS CREEP+ =W>D AT A SNAIL'S PACE4 ,AT ! SAME TIME1 GOV]NM5T-SUBSIDIZ$ NUCLE> 5]GY PROGRAMS >E CREAT+ ONE ( ! MO/ HAZ>D\S S\RCES ( AIR & WAT] POLLUTION 9 MAN'S 5VIRONM5T4 ,! H>MFUL CONSEQU5CES ( !SE PROGRAMS \TWEI< ANY IMPROVEM5TS ?AT MAY HAVE RESULT$ FROM REC5T LAWS TO CONTROL FOOD ADDITIVES4 ,ON BALANCE1 ! OV]-ALL SITUATION IS DET]IORAT+ ) EV]Y PASS+ YE>4 

,! PROBLEMS ( \R SYN!TIC 5VIRONM5T CAN BE SUMM$ UP BY SAY+ ?AT NONHUMAN 9T]E/S >E SUP]S$+ MANY ( \R RESPONSIBILITIES TO HUMAN BIOLOGICAL WELF>E4 ,TO A L>GE EXT5T1 MAN IS NO LONG] WORK+ = HIMSELF4 ,MANY FIELDS ( KN[L$GE & MANY PRACTICAL 5DEAVORS ?AT W]E ONCE ORI5T$ T[>D ! SATISFACTION ( BASIC HUMAN WANTS HAVE BECOME 5DS 9 !MSELVES1 & TO AN EV]-GREAT] DEGREE !SE NEW 5DS >E CONFLICT+ ) ! REQUIREM5TS = HUMAN HEAL?4 ,! NE$S ( 9DU/RIAL PLANTS >E BE+ PLAC$ BE=E MAN'S NE$ = CLEAN AIR2 ! DISPOSAL ( 9DU/RIAL WA/ES HAS GA9$ PRIORITY OV] ! COMMUNITY'S NE$ = CLEAN WAT]4 ,! MO/ P]NICI\S LAWS ( ! M>KET PLACE >E GIV5 PREC$5CE OV] ! MO/ COMPELL+ LAWS ( BIOLOGY4 

,UND]/&ABLY1 A L>GE NUMB] ( PEOPLE HAVE REACT$ TO ! NONHUMAN *>ACT] ( \R SYN!TIC 5VIRONM5T BY V5]AT+ NATURE AS ! ONLY S\RCE ( HEAL? & WELL-BE+4 ,! NATURAL /ATE1 ALMO/ )\T RES]VATION1 IS REG>D$ AS PREF]ABLE TO ! WORKS ( MOD]N MAN & ! 5VIRONM5T HE HAS CREAT$ = HIMSELF4 ,! T]M 0NATURAL0 T5DS TO BECOME SYNONYM\S ) 0PRIMITIVE40 ,! MORE MAN'S SITUATION APPROXIMATES ?AT ( HIS PRIMITIVE =EBE>S1 IT IS ?\<T1 ! MORE HE WILL BE N\RI%$ BY C]TA9 QUASI-MY/ICAL WELLSPR+S ( HEAL? & VIRTUE4 ,9 VIEW ( ! M\NT+ PROBLEMS CREAT$ BY \R SYN!TIC 5VIRONM5T1 ?IS R5UNCIATION ( SCI5CE & TE*NOLOGY - 9DE$1 ( CIVILIZATION - W\LD BE ALMO/ TEMPT+ IF IT W]E NOT MANIFE/LY IMPRACTICAL4 ,AN UNQUALIFI$ IDEALIZATION ( ! NATURAL WORLD 9VOLVES AN ACCEPTANCE ( MANY 5VIRONM5TAL CONDITIONS ?AT >E DI/9CTLY UNFAVORABLE TO HUMAN LIFE4 ,UNTIL ! ADV5T ( CIVILIZATION1 NATURE %AP$ ! C\RSE ( HUMAN EVOLUTION ) SEV]ITY1 VISIT+ DEA? ON ALL 9DIVIDUALS :O C\LD NOT SATISFY H] RIGOR\S REQUIREM5TS = SURVIVAL4 ,MILLIONS ( PEOPLE >E LIV+ TODAY :O C\LD NOT HAVE MET ! DEM&S ( A MORE PRIMITIVE WAY ( LIFE4 ,!Y W\LD HAVE P]I%$ ON ! BATTLEGR\NDS ( NATURAL SELECTION AS SURELY AS ! Y\NG & FIT >E N[ DE/ROY$ ON ! BATTLEGR\NDS ( MOD]N W>4 

,A MU* GREAT] IMP$IM5T TO A RATIONAL \TLOOK1 H[EV]1 SPR+S FROM A T5D5CY TO IGNORE MAN'S DEP5D5CE ON ! NATURAL WORLD4 ,! EXT5T ( ?IS DEP5D5CE CANNOT BE EMPHASIZ$ TOO /RONGLY4 ,! GREAT DIV]SITY ( RACIAL TYPES REM9DS US ?AT HUMAN COMMUNITIES HAVE FOLL[$ !IR [N DI/9CTIVE L9ES ( EVOLUTION4 ,EA* HAS ADAPT$ ITSELF OV] MANY MILL5NIA TO DIFF]5T CLIMATIC & PHYSICAL CONDITIONS4 ,MANY SUBTLE DIFF]5CES 9 NE$S EXI/ AMONG HUMAN GR\PS1 9DE$ AMONG 9DIVIDUAL TYPES4 0,*ANG+ CONDITIONS ( LIFE AFFECT 9DIVIDUALS & GR\PS10 OBS]V$ ,WADE ,H4 ,BR[N1 ( ! ,ROCKEFELL] ,9/ITUTE1 A G5]ATION AGO1 0BUT AS 9DIVIDUALS DIFF] 9 RESPECT ( !IR 9H]5T CON/ITUTIONAL EQUIPM5T1 !Y DIFF] ALSO 9 !IR REACTIONS TO 9FLU5CES ( ALL K9DS4 ,SOME >E CAPABLE ( IMM$IATE & COMPLETE ADJU/M5T1 O!RS >E SL[ TO RESPOND OR >E 9CAPABLE ( ADJU/M5T1 SO ?AT :5 MEMB]S ( A GR\P >E SUBJECT$ TO A *ANGE 9 ! CONDITIONS ( LIFE OR >E EXPOS$ TO 9FECTION UND] FAVORABLE OR UNFAVORABLE CONDITIONS1 ! RESPONSE OBTA9$ V>IES ACCORD+ TO ! CAPACITIES ( ! 9DIVIDUAL40 ,M$IC9E & TE*NOLOGY >E PROVID+ ONLY P>TIAL COMP5SATION = ! H>MFUL EFFECTS ( NEW DIETS1 *ANG$ MODES ( WORK1 & UNFAMILI> CLIMATES4 ,TE*NICIANS CAN SUPPLY A FAIR-SK9N$ MAN ) AIR CONDITION+ 9 HOT TROPICAL REGIONS4 ,!Y CAN CLO! A ,NEGRO 9 EFFECTIVE HEAT-RETA9+ G>M5TS 9 ! COLD NOR?L&S4 ,BUT !SE MEASURES >E ONLY AD HOC SOLUTIONS TO ! ?REAT ( EXT9CTION4 ,9 !IR NEW 5VIRONM5T1 BO? M5 MU/ FUNCTION AS LIMIT$ 9DIVIDUALS1 RE/RICT+ !IR ACTIVITIES & NORMAL MODE ( LIFE4 

,AT ! SAME TIME1 WE %\LD NOT LOSE SI<T ( ! NE$S ALL M5 HAVE 9 COMMON4 ,EV]Y HUMAN BE+ HAS M9IMUM REQUIREM5TS = C]TA9 NUTRI5TS4 ,AL?\< HUMAN DIETS MAY BE MODIFI$ BY DIFF]5CES 9 CLIMATE WORK1 & AVAILABLE FOODS1 !SE MODIFICATIONS USUALLY REPRES5T DIFF]5CES 9 NUTRITIONAL EMPHASIS1 :E!R ON PROTE9S1 C>BOHYDRATES1 OR FATS4 ,! HUMAN BODY MU/ BE EMPLOY$ 9 A V>IETY ( PHYSICAL ACTIVITIES1 OR IT WILL WEAK5 & HEAL? & POSSIBLY LONGEVITY WILL BE ADV]SELY AFFECT$4 ,NEW TOXICANTS DANG]\S TO M5 ( ONE RACE >E EQUALLY HAZ>D\S TO M5 ( O!R RACES4 ,! APPE>ANCE ( !SE TOXIC AG5TS 9 ! ATMOSPH]E1 WAT]1 & FOODS ?REAT5S ! HEAL? ( EV]Y HUMAN BE+4 ,AS WE %ALL SEE LAT]1 ! EXT5T TO :I* !Y ?REAT5 MAN MAY DIFF] APPRECIABLY FROM ! EXT5T TO :I* !Y ?REAT5 O!R SPECIES1 SO ?AT EXP]IM5TAL WORK ) ANIMALS DOES NOT ALWAYS DISCLOSE ! DAMAGE ! NEW TOXICANTS PRODUCE 9 HUMAN BE+S4 ,= ! PRES5T1 IT %\LD BE EMPHASIZ$ ?AT ! LIMITS ( 5VIRONM5TAL *ANGE W]E /AK$ \T BY =CES WELL BEYOND HUMAN CONTROL4 ,AFT] EONS ( BIOLOGICAL EVOLUTION1 MAN IS SUBJECT TO UNREL5T+ ANATOMICAL & PHYSIOLOGICAL DEM&S4 ,IF !SE DEM&S >E IGNOR$1 HE FACES ! REV5GE ( HIS [N BODY 9 ! =M ( E>LY DEBILITATION & A %ORT5$ LIFE SPAN4 ,HIS BASIC NE$S = OPTIMAL HEAL? HAVE L>GELY BE5 DECID$ = HIM BY HIS LONG DEVELOPM5T AS A UNIQUE ANIMAL ORGANISM4 ,LA/LY1 MAN MU/ LIVE 9 H>MONY ) MYRIAD =MS ( PLANTS & ANIMALS1 MANY ( :I* >E 9DISP5SABLE TO HIS SURVIVAL4 ,9 ! LONG RUN1 A F]TILE SOIL IS JU/ AS IMPORTANT = HUMAN HEAL? AS CLEAN AIR & WAT]4 ,ADEQUATELY N\RI%$ ANIMALS >E AS NECESS>Y = MAN'S WELL-BE+ AS ADEQUATELY N\RI%$ HUMAN TISSUES4 ,ANY S]I\S DISORD]S 9 ! L& OR 9 PLANTS & ANIMALS EV5TUALLY PRODUCE DISORD]S 9 ! HUMAN BODY4 ,MAN T5DS TO WEAK5 & GIVE WAY TO ILLNESS AS ! NATURAL PRECONDITIONS = HIS HEAL? >E UND]M9$ BY ]OSION1 DISEASE1 OR POLLUTION4 ,NE>LY ALL ! ABUSES HE 9FLICTS ON SOIL1 PLANTS1 & ANIMALS >E RETURN$ TO HIM 9 K9D1 P]HAPS 9DIRECTLY1 BUT ALL ! MORE MALIGNANTLY BECAUSE ! DAMAGE IS (T5 F> ADVANC$ BE=E IT CAN BE SE5 & CORRECT$4 

,WE T5D TO VIEW PROBLEMS 9 ! WORLD ( LIV+ ?+S - ! BIOSPH]E - ) ! SAME S*EMATIC APPROA* ?AT WE BR+ TO 5VIRONM5TAL HEAL? PROBLEMS4 ,WE DEM& EVID5CE ( A M>K$ 9JURY TO MAN'S NATURAL SURR\ND+S BE=E WE >E READY TO AGREE ?AT !RE EXI/ PROBLEMS ?AT REQUIRE SOLUTIONS4 ,WE MAKE %>P DI/9CTIONS BETWE5 ORD] & DISORD] 9 NATURE1 JU/ AS WE DRAW A %>P L9E BETWE5 HEAL? & DISEASE 9 MAN4 ,NEV]!LESS1 ! SAME K9DS ( QUALITATIVE PROBLEMS WE 5C\NT] 9 ! PHYSIOLOGY ( HUMAN BE+S REAPPE> 9 ECOLOGY2 ?AT IS1 9 ! /UDY ( H[ LIV+ ?+S 9T]ACT ) ONE ANO!R & ) !IR 5VIRONM5T4 ,EV]Y ORGANISM HAS ITS [N 5VIRONM5TALLY 9DUC$ ILLNESSES4 ,! 5VIRONM5TALLY 9DUC$ DISEASES ( PLANTS & ANIMALS1 LIKE ! *RONIC & DEG5]ATIVE DISEASES ( MAN1 >E DUE TO A MULTIPLICITY ( FACTORS4 ,& JU/ AS MANY DISORD]S MAY P]SI/ 9 MAN )\T EV] ASSUM+ AN OV]T =M1 COV]T ILLNESS MAY P]SI/ 9 PLANTS & ANIMALS )\T EV] PRODUC+ CLE>-CUT SYMPTOMS ( DISEASE4 

,! CAUTION ?AT %\LD BE EX]CIS$ 9 *ANG+ \R SYN!TIC 5VIRONM5T %\LD ALSO BE EX]CIS$ 9 *ANG+ ! BIOSPH]E4 ,NEV] BE=E 9 MAN'S HI/ORY HAS !RE BE5 A GREAT] NE$ = :AT ,RALPH & ,MILDR$ ,BU*SBAUM CALL ! 0ECOLOGICAL VIEWPO9T0 T[>D MAN'S 9FLU5CE ON ! NATURAL WORLD4 ,?IS VIEWPO9T IS 0! CONS]VATIVE VIEW ( MAN'S RELATION TO HIS TOTAL 5VIRONM5T4 ,IT HOLDS ?AT AN 5VIRONM5TAL SETT+ DEVELOP$ BY NATURAL SELECTION OV] MANY MILLIONS ( YE>S MU/ BE CONSID]$ TO HAVE SOME M]IT4 ,ANY?+ SO COMPLICAT$ AS A PLANET 9HABIT$ BY MORE ?AN A MILLION & A HALF SPECIES ( PLANTS & ANIMALS1 ALL ( !M LIV+ TOGE!R 9 A MORE OR LESS BALANC$ EQUILIBRIUM 9 :I* !Y CONT9UALLY USE & REUSE ! SAME MOLECULES ( ! SOIL & AIR1 CANNOT BE IMPROV$ BY AIMLESS & UN9=M$ T9K]+4 ,ALL *ANGES 9 A COMPLEX ME*ANISM 9VOLVE SOME RISK & %\LD BE UND]TAK5 ONLY AFT] C>EFUL /UDY ( ALL ! FACTS AVAILABLE4 ,*ANGES %\LD BE MADE ON A SMALL SCALE FIR/ SO AS TO PROVIDE A TE/ BE=E !Y >E WIDELY APPLI$4 ,:5 9=MATION IS 9COMPLETE1 *ANGES %\LD /AY CLOSE TO ! NATURAL PROCESSES :I* HAVE 9 !IR FAVOR ! 9DISPUTABLE EVID5CE ( HAV+ SUPPORT$ LIFE = A V]Y LONG TIME40 

,FROM 3 ,AN>*Y ,>*IVES4 

,*RONOLOGY 3 
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,FEBRU>Y #a1 #bag 3 ,*APT] #a -- ,ADD$4 

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