Pain,Suffering,and Injustice: Toxic Exposures in the American Workplace Continue

The stories recounted in The Cancer Factory will not surprise readers of New Solutions. We know that U.S. workers have long been harmed by toxic exposures in the workplace. We know that early lessons learned and sometimes heeded in the European workplace (e.g., lead and painters) ¹ often had to be re-learned for workers in the United States in the hardest possible ways. We are also aware that more was known about workplace hazards than was communicated to workers in a range of industries, and that some industries controlled or influenced science to cast doubt on the health effects of toxic exposures in their efforts to slow or stymie protective regulations.^2–5 We also know that for many of its 50-plus years, OSHA (Occupational Safety and Health Administration) has effectively had its hands tied and has lacked the legal or human power to protect workers across many industries. ⁶ The toll on workers’ health from this combination of strategic suppression of science, obfuscation of risk, and political neutering has been immense, perhaps even incalculable. And even though the consequences of this broken system are felt in many families and communities, workers and their stories are rarely given the time of day.

Jim Morris does the opposite in The Cancer Factory. Workers and their stories are at the center of this book, and Morris places their voices, thoughts, feelings, struggles, and pain squarely in the foreground. The book humanizes the toll of occupational illness in ways that may be compelling to the general public, which is likely unaware of the extent to which the health of workers in the United States remains at risk from toxic exposures. Many are likely to believe, as Morris writes, that “surely someone has taken care of that by now.” ^{7 (p162)}

The Cancer Factory has a central focus on ortho-toluidine exposure linked to a large bladder cancer cluster in the Niagara Falls, New York Goodyear Plant. From the book's first page, readers are confronted with the harsh realities of occupational bladder cancer and the ripple effects on spouses, children, and communities. Morris is a journalist who does not use scientific euphemisms or other obfuscating language to gloss over the physical and emotional suffering induced by bladder cancer, but rather paints vivid pictures of its symptoms and consequences. He shares in detail the stories of Rod Halford, Harry Weist, Ray Kline, Hank Schiro, Bob Bailey, and several others, all former Goodyear workers, who urinate blood and undergo frequent and painful urethral probes (cystoscopy) to look for recurring bladder tumors, which are often found and must be removed. They lose control of their bladder function and must learn to catheterize themselves, and they lose sexual function or live in fear of it. Morris makes their suffering visible in excruciating detail.

Ortho-toluidine is an aromatic amine, a class of chemicals whose link to bladder cancer was first proposed in the late 1800s. ⁸ The ortho-toluidine used at the Niagara Goodyear plant was produced by Dupont in New Jersey. The Niagara Goodyear plant began using it in 1957, in a formulation called Nailax, meant to keep the synthetic rubber used in tire production from deteriorating. Workers called it Dominic. Conditions at the plant were such that workers often got ortho-toluidine on their clothing or bare skin, and intense exposure to the fumes induced chemical cyanosis which caused skin to turn blue as blood cells were starved of oxygen. Wives recalled their husbands reeking from the smell of the chemical on their clothes and emanating from their skin when they came home from the factory. Some even recounted that it left brown stains on bedsheets.

The full risks of the chemical, however, were allegedly not communicated to the workers at Goodyear, though Morris tells us that Dupont “knew by the 1950s that the yellowish liquid caused bladder cancer in laboratory animals, and was protecting its own production workers in New Jersey against exposure. But DuPont either didn’t adequately warn its customer, Goodyear, about the risks, or Goodyear didn’t listen.”7^(p2) Even after OSHA was established in 1970 and hazard communication was required in the early 1980s, Morris notes that the material safety data sheet (MSDS) that Dupont produced for Goodyear was incomplete and did not communicate the need to test worker's urine on a regular basis to monitor exposure.

As of 2021, 78 workers at the Niagara Falls Goodyear plant have been diagnosed with bladder cancer. In addition, bladder cancer has been found in at least one wife of a Niagara Goodyear worker. She reportedly washed her husband's chemical-soaked clothing for decades. Predictably, Goodyear workers have turned to the courts to get some measure of justice and compensation to offset the staggering medical bills that have contributed to the tremendous stress of their illnesses. They have been doggedly represented by Steve Wodka, formerly in a leadership position with the OCAW (Oil, Chemical, and Atomic Workers Union) with a long history of supporting working people, dating to his volunteer work as a college student in 1969 for the United Farm Workers. Morris recounts how Wodka not only tirelessly advocated for Goodyear workers in the courts, but also for more transparency and better regulation of ortho-toluidine by EPA (the Environmental Protection Agency) and OSHA. That 78 cases of bladder cancer have been found among Goodyear workers is also due to his determination and advocacy—the Goodyear screening program for former employees and retirees resulted from a class action brought by Wodka.

Yet, despite all that has been learned about this cluster, the federal government has still not set a health-protective standard for ortho-toluidine. The current OSHA permissible exposure limit (PEL) of five parts per million in air was set in the early 1970s and is known to be too lax to protect against bladder cancer. Even 10 parts per billion would not provide an adequate measure of safety, a level that was exceeded at the plant in 2019.9 In 2021, monitoring of workers’ urine found that ortho-toluidine levels increased during their shifts and they still faced an elevated risk of bladder cancer. ⁹

Morris places the Niagara Goodyear story in the larger context of ongoing toxic exposure risk workers in the United States face across many industries. An important and welcome feature of this book is a chapter that focuses on pregnant women and fetuses, centering on the electronics and semiconductor industries, where exposure to lead and solvents has been associated with a host of birth defects. He introduces us to women who experienced miscarriages, deaths of newborns, or children who are alive but live with painful and debilitating conditions. Despite knowledge of fetal harm from maternal workplace exposure to toxicants going back to at least the mid-1800s (in the case of lead), Morris emphasizes that the protection of pregnant women and their fetuses is still a glaring gap in occupational health regulation.

One of the many strengths of this book is Morris’ plain language exploration of some of the macro-level forces that have shaped this dismal landscape for worker protection in the United States, despite the initial promise of the 1970 Occupational Safety and Health Act and labor activism of the time. These include a relentless public narrative of over-regulation; a Supreme Court that decided in 1980 that workers should shoulder a risk of cancer of 1 in 1,000 (while 1 in 1,000,000 is often used for assessing risk outside of the workplace); the Eleventh Circuit Court of Appeals striking down OSHA's 1989 attempt to streamline the unwieldy chemical-by-chemical approach to standard setting by regulating 376 workplace chemicals in one rule; unions that have failed to consistently advocate for the health and safety of their members, particularly in the context of globalization and threats of job loss; and the steep decline of unionized workplaces. Morris concludes that when it comes to workplace toxic exposure, “workers are (mostly) on their own.”7^(p208)

Perhaps it is asking too much of any author, but Morris doesn’t really help us understand why, as a society, even during times of near full employment and good pay, we’ve been willing to accept so much preventable suffering, nor does he try to draw a detailed road map for reform. He points to efforts in the European Union to outlaw thousands of the most toxic chemicals, a paradigm-shifting approach that could have implications for the United States, but that effort appears far from certain. ¹⁰ The director of the National Institute for Occupational Safety and Health (NIOSH), John Howard, suggests to Morris that the amended Toxic Substances Control Act may lead to controls or bans on some of the most toxic workplace chemicals and that EPA will be able to make some headway where OSHA remains stalled.7^(p214) While these renewed efforts to regulate toxic chemicals could help decrease workplace exposures over time, Morris appears pessimistic about the political viability of both direct regulatory efforts targeting the workplace, and less ambitious secondary prevention efforts (e.g., systematic screening of high-risk private-sector workers).

Regardless, Morris’ clear and compelling prose, empathetic and clear-eyed telling of these devastating stories, as well as his deft ability to combine them with the larger story of how we got here, make this a book that every business school, medical school, and public health student should read, along with corporate lawyers, government policymakers, business leaders and health care providers. For those of us in public or occupational health who already know the broad outlines of this story, reading this book serves as a reminder of why we work in this field, and it is a call to redouble and reinvigorate our efforts to make work safe for all.