Under the Radar: Cancer and the Cold War (review)

In September 1989, Irma Natanson, a housewife and mother from Wichita, Kansas, became one of the last casualties of the Cold War. She died not from a bullet or bomb, but of cancer caused by the radical cobalt-60 radiation "therapy" she had received for treatment of breast cancer more than forty years earlier. Natanson's tragic ordeal reveals the influence of the Cold War, as Ellen Leopold argues in Under the Radar, a wide-ranging and compelling analysis of the sometimes murky political, economic, and cultural forces behind Natanson's fate—and our own.

In explaining Natanson's tragedy, Leopold introduces the power dynamics that created the Cold War's cancerous environment: the unequal relationships between patients, the American public, the federal government, business interests, and the medical profession. After World War II, the federal government found itself blessed by potential military applications of nuclear technology and burdened by the need to test these innovations and defend them to a public that recognized, but did not fully grasp, the terrifying power of the atom. To encourage development of nuclear technology, the Atomic Energy Commission (AEC), established in 1946 to assume civilian control of the Manhattan Project, entered into "cozy relationships" with firms like General Electric, which jumped at the opportunity to use nuclear material distributed by the AEC. Doctors and radiologists also eagerly participated in developing new medical applications of the atom. Thus it was that Irma Natanson became one of the first dozen patients to undergo cobalt therapy, with isotopes provided by the AEC. The shared interests of government, industry, and the medical professional also led to shared secrets, such as tests in the early 1950s which subjected cancer patients to total-body radiation "treatment." The tests aimed to discover whether humans could tolerate levels of radiation that would be generated by the Air Force's planned Nuclear Energy for the Propulsion of Aircraft (NEPA) project. These patients joined other sacrifices to explorations in nuclear technology, including "downwinders" exposed to fallout from nuclear weapons tests in Nevada and the American public exposed to increasingly high and more diverse sources of radiation in their doctors' and dentists' offices.

The Cold War justified these sacrifices as necessary for the sake of national security and national prosperity. The AEC asserted that radioactive fallout was harmless, and those who drew attention to the potential (and soon confirmed) dangers found their security clearance suspended and their patriotism questioned. As epidemiological evidence of the link between radiation and cancer mounted, the AEC obfuscated, using abstractions such as dose reconstruction—an estimate of an individual's exposure to radiation—to avoid drawing a direct causal link. "Atomic energy enthusiasts" filled the rosters of regulation bodies like the National Committee on Radiation Protection (NCRP), which served as "facilitators rather than watchdogs" (151). Empowered by the Cold War and their possession of atomic material and knowledge, nuclear interests exercised nearly total control over the public's exposure to and knowledge about radiation. A similar power dynamic shaped the patient–doctor relationship: the position and knowledge of the doctor gave him the authority to determine treatment options, while the patient would accept the advice given her. As the tensions and pressures of the Cold War lessened, patients and the public asserted more power, which doctors and nuclear interests only accepted when tied to the doctrine of "informed consent." This placed the burden of responsibility on the patient and the public: with token knowledge of potential risks, patients and the public supposedly became informed consumers of nuclear technology, with its attendant benefits and risks.

By successfully weaving together and analyzing these evolving relationships of power, Leopold reveals the often obscured nuclear, chemical, and cancerous environment that evolved out of the Cold War. Leopold pays particularly close attention to the position and role of female cancer patients. Women like Irma Natanson were subject to the power of their doctors and nuclear interests, but also gradually...