Johns Hopkins Magazine
Johns Hopkins Magazine Current Issue Past Issues Search Get In Touch
  Cutting Through the Smoke

"Pollution itself never shows up on death certificates," laments environmental health expert Devra Davis, MPH '82. Her celebrated new book, rooted in a dramatic childhood experience, is a clarion call for immediate policy reform.

By Gregg A. Wilhelm
Photo by Sam Kittner

Halloween week, 1948. Thick fog hovers above a sleepy Pennsylvania steel mill town, not far from Pittsburgh. Plugged between ridges of Allegheny mountains, the fog acts like a cork bottling the valley while zinc and iron plants along the Monongahela River churn away, spewing plumes of smoke into the air. Cut to the scene of a Halloween parade creeping through town as costumed children materialize like ghosts out of an eerie haze and disappear again. Life goes on as usual, but two days before All Hallow's Eve, the fog weighs heavily, the smokestacks belch vehemently, and darkness falls... at noon.

On Halloween day, officials finally decide to shut down the zinc works.

By then, half the town's population had fallen ill and 18 people had died, in what the media dubbed a "killer smog."

The scenario could very well be the latest script treatment by Pittsburgh-area native George A. Romero, virtuoso of modern horror films and father of all things zombie. However, the events described actually happened, and they form the epicenter of another Pennsylvania native's first book, When Smoke Ran Like Water: Tales of Environmental Deception and the Battle Against Pollution (Basic Books).

The book, by Devra Davis, MPH '82, renowned for her studies of the environmental causes of breast cancer, is part science, part exposé, part memoir, and part clarion call for immediate policy reform. In a rare achievement for a first book, it vied for last year's National Book Award.

In When Smoke Ran Like Water, Davis ushers readers from accounts of cities choked by catastrophic levels of pollution (the central episode being Davis' hometown); through a primer on the work of exceptional scientists before her (such as Mary Amdur, the "mother of modern toxicology"); into a maze of political bureaucracy and nefarious corporate tactics (using as examples the automobile industry in general and, in particular, the Ethyl Corporation's fight to keep lead in gasoline despite evidence of its hazards). Davis concludes with the ironic realization that as her own political status grew, her ability to enact real change diminished -- prompting her to leave government service for academia.

Davis grew up in Donora, a town of 14,000 nestled in a bend of the Monongahela about 25 miles south of Pittsburgh. In October 1948, when she was just two years old, an inversion layer -- descending cold air that prevents warm air from rising -- flooded the valley. Hot exhaust fumes from mills, furnaces, and stoves could not dissipate above the hilltops. They eventually cooled and settled back to the ground. A photograph from the Pittsburgh Post-Gazette depicts Main Street at noon on October 29, 1948, with streetlights brightly lit. Meanwhile, officials at the Donora Zinc Works, a holding of the U.S. Steel Corporation, continued production, emitting gases that had nowhere to go.

People [in the town of Donora] literally asphyxiated. In a 12-hour period, 18 people died. Within a month, about 70 had died. The town funeral parlor ran out of caskets. People literally asphyxiated. In a 12-hour period, 18 people died. Another two deaths occured within five days. Within a month, about 70 people had died. The town funeral parlor ran out of caskets.

Davis is now a visiting professor at Carnegie Mellon University's H. John Heinz III School of Public Policy and Management. Ironically, she had left Donora before she learned about the calamity that had occurred there. "It wasn't until I was 17 at the University of Pittsburgh when I heard people talk about it [the 1948 smog]," Davis recalls.

In the book, she recounts a conversation with her mother about the possibility of there being other Donoras, the way there are other Pittsburghs and several Allentowns. Surely what she had read at school couldn't have been about her bucolic hometown.

"People just didn't talk about it," Davis says, admitting that only recently has her mother acknowledged a possible connection between Donora's pollution and her own cardiac ailments.

Every one of Davis' maternal grandmother's children developed heart problems. Over the course of 18 months in the mid-1940s, Bubbe Pearl deteriorated from being a vivacious matriarch to an invalid. Davis' fit and active Uncle Len died at age 50 from cardiac arrest. By the same age, her mother, Jean, had undergone three bypasses. Aunt Gert required two angioplasties. But none of their illnesses -- or the causes of death for those who died -- were linked to the place where they grew up and lived. These family members, and the thousands they represent whose terminal illnesses directly result from toxins percolating in pollution, comprise the "uncounted."

Davis laments how "pollution itself never shows up on death certificates." This oversight serves as the book's momentum. She writes: "The fifty people who died in the month following the smog are nowhere counted. The thousands who died over the following decade are nowhere counted. And there is no counting of the thousands... called the non-killed -- all those who went on to suffer in various poorly understood ways."

For Devra Davis, counting counts. She specializes in epidemiology -- the science of diseases' frequency, spread, and control among populations -- which is rooted in numbers: counting incidences, analyzing data, extrapolating patterns from stacks of statistics, and often contributing to policy decisions.

The manuscript that developed into the book was originally titled "Reckonings: The Education of a Numbers Woman." Each chapter of When Smoke Ran Like Water leads with an epigraph from sources ranging from Maimonides to Bella Abzug, from Charles Dickens to Roger Daltrey. Her favorite quote comes from Albert Einstein: "Not everything that can be counted, counts. Not everything that counts, can be counted."

Einstein's words capsulize Davis' work.

The 56-year-old has penned more than 170 peer-reviewed articles and popular pieces that have appeared in venues ranging from Journal of the American Medical Association, Lancet, Science, and Reproductive Toxicology, to the New York Times, the Washington Post, and the Los Angeles Times. She has held ringside seats to the environmental health debate as a senior adviser to the assistant secretary of health during the Clinton administration, a presidential appointee to the National Chemical Safety and Hazard Investigation Board, and as director and senior scientist of the World Resources Institute's Health, Environment, and Development Program, which she founded in 1995.

As executive director of a committee with the National Academy of Sciences (NAS) in 1983, Davis established parameters for a four-year, $500,000 study of smoking on airplanes. Before the study got started, she borrowed an ominous chunk of scientific equipment (a piezobalance) and tucked it under her grandmother's old mink coat during a cross-Atlantic flight. The aerosol monitor measures the weight of airborne particles as small as those produced by cigarette smoke. In one eight-hour flight, Davis determined what her committee would formally conclude four years later: identical levels of particles existed in the plane's smoking and non-smoking sections. Less than a year after the NAS report was published, smoking bans took effect on airplanes and in other public places.

The Donora Wire Mill in 1910 when the town was barely settled. Constantly on the go, Davis divides time between Jackson, Wyoming; Pittsburgh; and Washington, D.C. (where husband Richard Morgenstern, a former lead economist at the EPA, is senior fellow at Resources for the Future). She has emerged as a cross-over scientist who is capable of translating complex research into digestible information for public consumption -- via National Public Radio, CBC Radio, and CBS's 60 Minutes.

"She's not drab," says Lester Lave, professor of economics and finance at Carnegie Mellon University's Graduate School of Industrial Administration. An economist who pioneered changes in environmental health research 30 years ago, Lave's work is cited often in When Smoke Ran Like Water. The two researchers met during stints at the National Academy of Sciences.

"Devra knows how to get people to pay attention," he says. "She focuses on the important problems, recruits the best authors and experts to work with, and gets attention with effective write-ups presented to the public and policy- makers."

A packrat by nature, Davis had for years accumulated towers of notes and mounds of material that became parts of When Smoke Ran Like Water. However, she says that the book would have been impossible without the treasure trove of documentation available on government Web sites, old-fashioned "shoe leather librarian skills," and a group of talented young researchers who helped in conducting large-scale analyses and background sleuthing.

One such researcher is Michelle Bell, PhD '02, who first made contact with Davis after reading an article she had written about the indirect effects of climate change on human health. The two women discovered similar research interests and Davis sat on Bell's dissertation committee in Hopkins' Department of Geography and Environmental Engineering. Bell, now researching the effects of air pollution on health at Hopkins' Bloomberg School of Public Health, collaborated with Davis on researching one of the world's worst environmental disasters, an inversion smog in London. That "extreme" episode, which became known as "the Great Killer Smog of 1952," brought "the connection between air pollution and health to the attention of the government, public, and scientific community," Bell says. Bell and Davis discovered correlations between health indicators and air pollution concentrations, as well as lingering adverse health effects. Over the course of four months (December 1952 to March 1953), 13,000 more people died than would have been expected, given historical averages. In one week alone, 4,703 Londoners died (a drastic increase compared to the 1,852 who died during the same week the previous year). The duo's findings squelched accepted notions that the increased mortality rate had resulted from influenza. Their work was published in Environmental Health Perspectives and became the basis of a chapter in Davis' book, in which the author wrote that in 1952 London, "smoke ran like tap water from a million chimneys."

Says Bell, "Devra is different from some other scientists in that she is interested in all aspects of the problem -- data analysis, historical records, sources of pollution, modern policy implications -- which allows her to work on a variety of projects with people from diverse academic backgrounds."

After 20 years as an epidemiologist, Davis felt confident with handling the science when she set out to write her book. Weaving a narrative appropriate for general readers proved much more challenging, she says, because she ran the risk of alienating scientists and policy leaders who might find the science somehow less rigorous. "There's a fine line between being glib and getting the science right without being so technical," she says.

Drawing inspiration from Midrashic tradition, where rabbis interpret biblical literature for contemporary audiences, Davis employs the tool of storytelling. Throughout an examination of the connection between widely used chemicals like PCBs and DDT and exploding rates of breast cancer, and a general explanation of how epidemiologists go about counting breast cancer statistics, Davis laces stories of women who battled the disease, including environmentalist Rachel Carson, MA '32, and friend Bella Abzug, the New York congresswoman and women's rights advocate who died from breast cancer in 1998.

"Breast cancer research is at a crossroads that may not be apparent to those in the thick of it," Davis writes. "The millions allocated to research have produced what one editor of the Lancet describes as a glut of same old, same old studies. Different questions must be asked to break the logjam. For women confronting breast cancer today, the central question remains this: What avoidable factors cause 19 out of 20 cases of the disease?"

"I have a great respect for the rigors and demands of science, but I also understand the limits of what another article in JAMA, Lancet, or Science can do," says Davis. Faith is absolutely critical in Davis' work as a scientist, and a deeply spiritual vein runs through her book. "I am a scientist," she writes. "I am also religious."

"One can get discouraged with all that is going on in the world today with so many things you can't control," she says. "It can be difficult to come to terms with those things. Being a person of faith provides a certain comfort knowing that you may not always succeed, but you will always try."

Even with her faith, she admits to becoming frustrated when battling the bureaucratic quagmire. "The effort to establish the science of environmental epidemiology has been plagued by a sophisticated and completely legal disinformation campaign, the full extent of which is not appreciated even by those who have been its chief victims," she writes.

As an example, she points to what she describes as the "insidiously slow" process it takes to get harmful chemical agents listed in the Annual Report of Carcinogens, a "reverse Academy Awards system for chemicals," whose designation companies aggressively attempt to avoid.

In When Smoke Ran Like Water, she points as one example to trichloroethylene (TCE), used widely by American industry as an additive to household products such as paint removers, adhesives, and various cleansers. Going all the way back to the 1950s, toxicological studies have pointed to the danger TCE holds for humans, Davis notes, but years of legal wrangling and controversy prevented any progress from being made. Then, in the 1980s, two families living near a Xerox manufacturing plant in Rochester, New York, received a multi-million dollar settlement on a suit claiming that TCE contaminated their land and caused cancer in a five-year-old girl. The settlement's conditions included closing the health records, sealing possibly vital information from researchers' view, and forging, as the Washington Post reported in 1989, a "covenant of silence."

For the most part, animal studies had shown links between exposure to TCE and biological consequences. The question remained as to what extent studies with animals and cell cultures conveyed to effects in humans. Ultimately, as Davis reports in her book, epidemiologists enlisted by the Halogenated Solvents Industry Alliance (which represented Dow Chemical and others makers of TCE) responded to the specific question of whether human studies alone proved that TCE caused cancer. Their response: research to date showed "no consistent evidence of a relationship with cancer." The National Toxicology Program, which rules on which chemicals should be designated as carcinogens, agreed.

TCE (and other similarly hazardous chemicals) remains unlisted as a human carcinogen. And annually in the United States and Europe, 300,000 people die from pollution-related causes, her book relates.

In his review of When Smoke Ran Like Water for Reason, Todd Seavey -- editor of, a webzine published by the American Council on Science and Health -- suggests that Davis wants her readers to "fear that mass death caused by pollution may be going on all around us on a regular basis" and that she wants "fear to haunt us whether or not the hard numbers exist to prove that the fear is warranted." Such fear is unwarranted, he argues, because not enough epidemiological studies involving humans have been conducted to justify the costs of policy change and corporate retooling. He calls Davis' tactics "green politics masquerading as environmental science."

"I am not on anybody's payroll," Davis says, adamant. "My agenda is public health."

"Devra is not Chicken Little," says Carnegie Mellon's Lave, "because she pays attention to the science."

He adds, "Science is not always fully certain, but there is a lot of data and it would be imprudent not to act on it. We have choices: either wait and regret not acting sooner or act with the possibility of going too far. It's a delicate balance between the social ills of premature action and the ramifications of not acting at all."

During London's killer smog in December 1952, visibility was less than 30 feet. Buses were led by policemen with flares. Forty years after the Donora smog, Davis survived another disaster that provided the final impetus to write her book.

Davis recalls the place and date exactly: Athens, September 7, 1999. She had traveled to Greece for an international conference on public health, where she would present her first paper on Donora. But before she could get to the conference center, a violent 30-second earthquake rocked the city, trapping her in a hotel elevator. She freed herself, but later discovered that nearly 140 people had died and 100,000 were left homeless.

"To survive an experience where other people died, that made it clear that I better write this [book] while I could," she says.

After the quake, the conference resumed and Davis delivered her paper. The reaction of attendees astonished her. Victor Borja-Aburto, a researcher with Instituto Nacional de Salud Publica working on Mexico City's horrendous pollution problem, approached her, as did a colleague from China whom she declines to identify. "They pleaded with me to tell the story so that their countries would hear it, so that officials would understand that current patterns of air pollution are a serious threat to people in their country."

There is evidence that her message has found a receptive audience. John Topping, president of the Climate Institute, calls When Smoke Ran Like Water "the best book on the environment since [Rachel Carson's ] Silent Spring." Davis balks at comparisons to Carson, but striking similarities link the two women right down to their shared Hopkins affiliation. Both were born in river towns not far from Pittsburgh. Exactly 50 years separated the time Carson earned her master's degree at Hopkins and Davis hers. Carson won the National Book Award in 1952 for The Sea Around Us while Davis' book ranked as a finalist in 2002.

Davis is quick to note that their careers actually took quite different paths. "Carson did not spend 20 years of her life writing peer-reviewed papers and articles," says Davis. "She was always interested in writing for a broader audience and did a phenomenal job. I am much more of a novice at that; she was much more skilled."

Signs indicate that Davis' tenure as novice might be short-lived. Basic Books reports that When Smoke Ran Like Water is in its third printing. Davis is currently at work on a new book, slated for publication sometime in 2004. It will deal more specifically with workplace hazards and draw from her days at Hopkins' public health school, where she had studied with Abraham Lilienfeld, widely known as the "father of contemporary chronic disease epidemiology." Lilienfeld made significant contributions to studies establishing links between smoking and serious health risks.

Davis hopes that her late mentor would have been pleased by her book's being named a National Book Award finalist.

True to form, she calculated the probability of winning the award by giving fellow finalist and heavyweight biographer Robert A. Caro a grade of 5 and all others including herself a grade of 0.5. Caro, stiff competition with a Pulitzer Prize already to his credit, was nominated for Master of the Senate, the eagerly anticipated third volume in his Lyndon Johnson biography.

"Several of the other nominees had written [acceptance] speeches," she notes. "I didn't."

Caro won.

The source of the poison in Donora was never formally identified, although a consensus of opinion suggests it was toxic fluoride gas emitted from the mills. In 1948, the United States was still emerging from the shadow of wars and steel girded the country's return to prosperity. For obvious reasons, U.S. Steel wanted to put the incident behind it as quickly as possible, as did workers with families to support. U.S. Steel's records still remain closed to researchers and investigators.

The U.S. Public Health Service launched an investigation, but it also wanted to usher in a quick return to normalcy. It published just one inconclusive report on the incident and the matter received little official attention for years afterward. Ultimately, however, the tragedy served as the first evidence in the United States that air pollution could kill. Today, some point to the deadly Donora smog as one event that led to the Clean Air Act of 1970 and the formation of the Environmental Protection Agency.

Donora's story almost went unheard. While Davis has no intention of abandoning her quotidian job as a scientist, she does plan to incorporate storytelling into her future work as a writer. "I have a great respect for the rigors and demands of science, but I also understand the limits of what another article in JAMA, Lancet, or Science can do," she says. "There are a number of issues that still require serious scientific work, but I also think it is time to do a better job of telling the story so that people will understand that there's more we can do to protect ourselves."

Gregg A. Wilhelm writes from Baltimore.

Return to June 2003 Table of Contents

  The Johns Hopkins Magazine | The Johns Hopkins University | 3003 North Charles Street |
Suite 100 | Baltimore, Maryland 21218 | Phone 410.516.7645 | Fax 410.516.5251