Intervenor: Vol 23. No 1 January - March 1998

Book Review: Living Downstream

I read this book last summer during the time that I sat for many long hours with my sister as she died a tortuously slow and horrible death to pancreatic cancer. I sensed a book as important as Rachel Carson's Silent Spring, published in the early 60s and a potent motivator for environmental activism ever since. Recognizing that my perspective could have been skewed by personal circumstances and desperately numb and angry from that experience, this review has sat on my "to-do" list these many months.

Since then more friends, relatives, colleagues, friend's children, have fought cancer; all but one of them are or were under 40, some have died, others continue with gruelling treatment regimes with poor to fair odds of survival, often with permanent loss or disfigurement to their bodies and of course the ever-present chance of recurrence. I have felt utterly surrounded by cancer these many months. Also in that intervening time, Living Downstream has been hailed across North America as a remarkable achievement and Sandra Steingraber has been compared many times to Rachel Carson.

The book was written because Steingraber went looking for an answer to a very basic question: what is the relationship between cancer and environmental contaminants? Since the 1940s the industrialized world has released to the environment massive amounts of known or suspected human carcinogens. Cancer rates have risen accordingly, and dramatically. When she went looking for an answer the response from cancer researchers was the same as the response I received from the oncologist who cared for my sister: the evidence is preliminary, it is a possibility, but nobody really knows.

These frustrating answers revealed a scientific community that said, we don't know and we can't act because, as Steingraber saw it, nobody had pulled all the data together in one place so we could actually look at it. So she did it herself. The result is a stunning accomplishment reviewing all lines of evidence showing the strong link between cancer and the environment. It carefully includes the limits of the evidence and the gaps in our knowledge. Her scientific search is seamlessly blended with compassionate and intimate accounts of her own battle with cancer, Rachel Carson's battle with cancer, and those of her friends and family.

This book contains the brevity, power and compassion of a poet, the compelling narrative skill of a creative writer, the knowledge of an accomplished scientific scholar, and above all the holistic approach of an environmental ecologist.

In all of the glowing reviews, a single negative reaction came in the New England Journal of Medicine. However, the ensuing flap has served to heighten interest in the book since it was quickly revealed that the reviewer is employed by one of the largest chemical manufacturers in the United States. The Journal has since had to tighten its conflict of interest policy and apologise to Steingraber. Follow the story and find more information about Living Downstream at

What Others Are Saying

"Steingraber's focus on prevention goes to the heart of public health, and public health represents the best values of our society. Living Downstream is a rallying cry when we need it most."

David Ozonoff, M.D., M.P.H.,
Boston University School of Public Health

"Sandra Steingraber has an extraordinary knack for accurately rendering complex scientific issues in plain, even lyrical language. Her book deserves to be widely read."

Philip J. Landrigan, M.D.,
Mount Sinai School of Medicine


Kathleen Cooper is a researcher at CELA