Woburn, MA and Causation     We think we know the cause when escalated negative health effects come to light in an industrial area.   Certainly pollution from industrial operations floating in the air and entering ground water is the most obvious cause of negative health effects in that industrial area.   However, how can we prove the pollution caused the health problems?   Environmental policy should lead regulators to remedy the situation by punishing the offenders.  However, regulation must prove the cause of the environmental or health damage before this can be done.  This is difficult because there are many different factors involved in finding the cause of the damage.  The case “Cancer and Environmental Hazards in Woburn, MA” deals with exactly this problem.  The problem is a problem of finding causation.      During 1979 the community of Woburn, MA found that they had a significantly higher rate of cancer deaths than the national average for a city of its size and population characteristics.  During that same year the community learned of a hazardous waste site that had been discovered on the land of a new industrial development in town.  Finally, the community learned that two of its wells were polluted and contaminated with two suspected carcinogens.  The immediate reaction was to conclude that the elevated cancer rates were caused by the pollution in the area.  However, the causation of the cancer rates could not be pinpointed that easily.     To find causation of cancer in Woburn four difficulties had to be overcome: Researchers had to find relevant data on cancer rates.   A theoretical connection had to be made.  Rival hypothesis had to be ruled out.  The issue of time order had to be resolved.  These four are at the heart of most environmental cases.   Unless these problems are remedied with clear, concise evidence, the environmental regulation can’t be effective.  Even though polluters are the bad guys, proof of environmental and health damage must still be proven in accordance with the law.     In 1979 the Department of Public Health (DPH) released a report on mortality data of Woburn residents.  The report showed Woburn as having a 13% higher rate of cancer deaths than was suspected.  However, the researchers found a significant stumbling block in that they had no way of finding what the current rate of cancer was in Woburn.  In addition there was no statewide cancer information from which a comparison could be drawn.  Even the initial evidence was flawed do to the fact that many cancer death cases were logged as death due to symptoms other than cancer.  The problem of finding relevant cancer data was not resolved.   The DPH called in the Center for Disease Control (CDC).      Between 1972 and 1979,  evidence collected by Woburn citizens of above average childhood leukemia cases created concern.  Little data existed concerning the rate of childhood leukemia.  However, evidence of childhood leukemia was still  a very real problem.  As the other Woburn problems surfaced, more attention was given to the possible link between pollution and leukemia.  The CDC assigned epidemiologist Dr. John Cutler to further review the situation.     Cutler began his research by attempting to find a theoretical connection between the hazardous pollution in Woburn and the leukemia cases.  He would conduct an experiment to find this hypothesized connection.  The CDC along with the DPH set up a 40 page survey to administer during the experiment.  The survey would be given to each family affected by leukemia (treatment group) and a control group for each case.  For each childhood leukemia case reviewed there would be two controls, one close in location to the case and another in a more distant part of the city.   Problems with the study included a lack of staffing, lack of time due to an overload of other cases, and that the researchers had never before conducted such a study. The study did leave recommendations for further research needed to reach a conclusion, but the results of the study found no evidence of a link between the pollution in Woburn and the leukemia cases.   A theoretical connection was not made.     In order to make a theoretical connection there needs to be specific evidence pointing towards that conclusion.  In addition, all rival hypothesis must be ruled out.  Ruling out rival hypothesis may be easier in an area with only one polluter and a good record of public health and cancer rates, but in Woburn it was a different case.  With a situation such as Woburn’s, where the list of possible causes of negative health effects was quite long, eliminating rival hypothesis was not easy.  In fact, evidence could not be found to conclusively link the pollution in the wells to the ground pollution at the industrial site.  The well water could not be found to relate with the elevated cancer and leukemia cases.  Finally, there was even dispute over whether the elevated cancer cases were anything but random.  With all these factors, a plethora of hypothesis could be suggested to account for the cancer situation in Woburn.  Because of these rival hypothesis, a conclusive finding could not be reached.      The final major problem faced by the citizens of Woburn and the various agencies trying to find a link between cancer and the hazardous pollution was to resolve the issue of time order.  In order to make a case the cause must come before the effect.  In respect to the Woburn case, to find a link between the polluted wells and the increased cancer rate, the time order had to be right.  The wells had to have come online before the the rate of cancer clearly increased.  After the 1981 study showing childhood leukemia deaths in Woburn from 1949 to 1978, the relevance of the contaminated wells in association with the cancer rate came into question.  Evidence from the study showed that rates of childhood leukemia began to rise in the early 1960’s, 8 years before both wells would be online.  In addition, the report was not very conclusive with only 14 cases to study.  However, the evidence remains that the leukemia was around before the wells.  This of course leads us to other questions.  Because the evidence of childhood leukemia is clearly high, what could have caused the raised rates of leukemia and cancer?      The citizens of Woburn were not prepared give up.  More research had to be done.   More data was needed as the 1979 CDC/DPH study suggested.  With new evidence, a possible link between cancer and pollution could be made.  With a theoretical connection, rival hypothesis could be ruled out.  With a conclusion that fit into the accepted time order and explained the causes for the Woburn problem, penalties, cleanup, and reconciliation would follow.     The Woburn case produces good examples of the problems found while searching for causation after environmental and public health damage.  In addition to all the problems associated with finding reliable data, a theoretical  connection, ruling out rival hypothesis, and fitting into time order, Woburn had to deal with a long and cloudy history of environmental offenders.  From 1859 to 1968 unimaginable amounts of chemicals and by-products from the production of textiles, leather goods, pesticides, glue, and grease were dumped into the land that became the hazardous waste site believed to have caused the adverse health effects.  Had this site become a superfund site the list of potentially responsible parties would have been quite lengthy.   In developing environmental policy meant to deal with situations such as Woburn’s, the shear amount of variables creates much difficulty.     Woburn seems like quite a nightmare from a policy point of view.  Without the proper evidence to prosecute the environmental offenders, regulation stemming from environmental policy is useless.  The cancer rates in Woburn could not even be linked to the hazardous pollution.  Had there been more Environmental Protection Agency (EPA), CDC and DPH staff to conduct studies and compile research,  completely different, and more positive findings would have been likely.  However, with little enforcement ability, and little funding these agencies found they had few answers for the Woburn residents.      The greater problem that stems from our state and federal level environmental agencies lack of power is that a broad base of affective, powerful environmental regulation efforts from policy cannot be established.  Case after case must be treated with the utmost importance, and the experience derived from working on these cases must be used to improve the power of the agency.  Eventually the agency would be made an effective tool for dealing with environmental problems. The amount of research needed to go into a case like Woburn’s is immense.  Without the proper staffing to make the case an environmental victory and a good example for other cases, the agencies just lose more power.  Agencies like the EPA must receive more funding in order to make all cases victories.  Victories,  in that experience is gained, and a genuine concern is shown by the experts for the cases.  The Woburn case is an example of the opposite of what policy should accomplish.  Although all the factors associated with the case made it extremely difficult, more could be done.      Woburn, MA is a very complicated and frightening environmental and health  situation.  The cancer problem is very clear, yet the evidence to conclude the cause simply isn’t distinct.  Causes for the cancer rate are evident as well, but the connection between these causes and the cancer are not distinct.  The shortage of thorough research and lack of agency power leads us to question the effectiveness of environmental policy.  The agencies clearly should have explored the situation in a more in depth way.  Finally, we must never assume that the cause of environmental and public health damage is clear.