Frustrated in their attempts to access information, seek compensation, and prevent future deaths, the families convinced the flamboyant lawyer, Jan Schlichtmann, to take on what was thought to be a hopeless cause. Suddenly, the case seemed to promise a multi-million-dollar settlement. Large industrial concerns, as well as government officials, began to pay close attention. Obsessed with the enormity of the apparent crime, the creative Schlichtmann amassed a huge amount of damning evidence through careful and expensive scientific research. But the accused companies also invested large sums in experienced lawyers and scientists who used other data and legal technicalities to refute the charges. The families lost their case in 1986, and Schlichtmann was financially and emotionally ruined. By that time, 21 cases of leukemia had been identified – 4 times the anticipated rate for the population. A public health report found “no significant differences” in exposure between the leukemia cases and controls, yet concluded that “it is not possible to rule out exposure to this water as a factor” (Cutler et al 1986). 

Author Jonathan Harr began work on A Civil Action in 1986 before the opening of the trial, and he accompanied Schlichtmann to almost all meetings, relied on court transcripts, and conducted many painstaking interviews with the families and opposing lawyers. The result is an omniscient yet intimate perspective on these true events that reads like an action-packed thriller, complete with dialogue. It won many awards and was on the New York Times bestseller list for 65 weeks. It stands as an interesting commentary on the nature of environmental health and on the American justice system. 

Three years later, Steve Zaillian wrote and directed the award-winning film, A Civil Action (1998), based on Harr’s book and starring John Travolta and Robert Duvall. Shlichtmann received $250,000 for the portrayal rights, but is quoted as saying, “John Travolta made more money playing me than I ever did playing me” (Kix 2009). Forty years later, now at age 75, he continues to champion environmental causes, aiming for settlements rather than court cases and recounting his “lessons learned” on the speakers’ circuit. 

Woburn and A Civil Action had coincided with other prominent environmental disasters, caused by industrial failures: Three Mile Island (1979), Love Canal (1977-1979), Times Beach, Missouri (1983), Bhopal (1984), to name only a few. The book and the film contributed to rising awareness about the health risks of environmental damage, and they added to increasing skepticism over the intentions of private entrepreneurs and the courts. They also heralded a period that saw a growing body of legislation aimed to define responsibilities and regulate industrial pollution – measures coming, alas all too frequently, after new problems arose and covering jurisdictions defined only by political boundaries, which have nothing to do with the flow of water and air. In 2022, the United Nations declared that a healthy environment is a human right. Dozens of countries, including Canada (2023) and several American states, have enshrined that ideal in law, even if practicalities and protections lag far behind. 

Less known is that fact that Woburn triggered a public-health preoccupation with “clusters” and the nature of proof (Alexander et al., 1999; Kingsley et al., 2007) Do clusters indicate important dangers or are they unfortunate but random occurrences? A decade later, the Center for Environmental Health Sciences at Massachusetts Institute of Technology reported on its vain “search for causes” in the industrial toxins of the Woburn leukemia cluster (Durant et al., 1995). In 2002, a controlled study, based on Woburn, failed to establish a causal correlation between disease and contamination; it pointed out that incidence had returned to anticipated levels, while 8 consecutive years had seen no leukemia cases at all (Costas et al., 2002). Woburn has also been cited in efforts to provide better statistical evaluation of “clusters” (Waller, 2000). Woburn prompted recommendations to incorporate qualitative methods into public heath reporting (Brown, 2003) and to recognize the value of citizen science and epistemic differences in lay and professional “ways of knowing” (Brown, 1992; Petteway et al, 2019). Woburn is still being cited in public health assessments of environmental causes of malignancy, often with ambiguous outcomes (Binczewski et al., 2026). 

A Civil Action helped prepare the terrain for these many studies with their controls, statistics, and tracking of chemicals–mind you, only those chemicals that are already recognized and detectable. We no longer question the harm in smog and smoking, while improvements in respiratory diseases proclaim the benefits of keeping air clean. It is dismaying that the idea of water pollution as a harm to human health continues to be such a hard sell, while disasters like Flint, Michigan, or Grassy Narrows, Ontario, roil on. 

Water degradation is bad for flora, for fauna, and for the planet. Therefore, it is bad for us too. But for industry, the courts, and even some epidemiologists in their many ways of knowing, it remains an unproven hunch. 

References 

• Alexander, Freda E. 1999. Clusters and clustering of childhood cancer: A review 
• European Journal of Epidemiology 15: 847-852.
• Binczewski, N.R., Morimoto, L.M., Wiemels, J.L., Richardson, D.B., Bartell. S.M., Metayer, C., Vieira, V.M. 2026. Spatial analysis of residential location at birth, PFAS in public water, and childhood cancers in Southern California (2000-2019). Journal of Exposure Science & Environmental Epidemiology 2026 Mar 5:10.1038/s41370-026-00850-1. doi: 10.1038/s41370-026-00850-1. Epub ahead of print. PMID: 41781477; PMCID: PMC13032745. 
• Brown, Phil. 1992. Popular epidemiology and toxic waste contamination: lay and professional ways of knowing. Journal of Health & Social Behavior 33(3):267-81. 
• Brown, Phil. 2003. Qualitative methods in environmental health research. Environmental Health Perspectives 111(14):1789-98.  
• Costas, K., Knorr, R.S., Condon, S.K. 2002. A case-control study of childhood leukemia in Woburn, Massachusetts: the relationship between leukemia incidence and exposure to public drinking water. Science of the Total Environment 300(1-3):23-35. 
• Cutler, J.J., Parker, G.S., Rosen, S., Prenney, B., Healey, R., Caldwell, G.G. 1986. Childhood leukemia in Woburn, Massachusetts. Public Health Reports 101(2):201-5. 
• Durant, J.L., Chen, J., Hemond, H.F., Thilly, W.G. 1995. Elevated incidence of childhood leukemia in Woburn, Massachusetts: NIEHS Superfund Basic Research Program searches for causes. Environmental Health Perspectives 103 Suppl 6:93-8. 
• Kingsley, B.S., Schmeichel, K.L., Rubin, C.H. 2007. An update on cancer cluster activities at the Centers for Disease Control and Prevention. Environmental Health Perspectives 115(1):165-71.  
• Kix, Paul. 2009. In the shadow of Woburn, Boston Magazine, City Life, 22 September:  https://www.bostonmagazine.com/news/2009/09/22/in-the-shadow-of-woburn
• Lagakos, S. W., Wessen, B. J., Zelen, M. 1986. An analysis of contaminated well water and health effects in Woburn, Massachusetts. Journal of the American Statistical Association 81(395):583–596.  
• Petteway, R, Mujahid, M., Allen, A., Morello-Frosch, R. 2019. Towards a people’s social epidemiology: Envisioning a more inclusive and equitable future for social epi research and practice in the 21st century. International Journal of Environmental Research and Public Health 16(20):3983. 
• Waller, L.A. 2000. A civil action and statistical assessments of the spatial pattern of disease: do we have a cluster? Regulatory Toxicology & Pharmacology 32(2):174-83. 
• Jonathan Harr discusses A Civil Action on C-Span 

Web image by Medhum.org

A child of unconventional, British-born parents, raised in the bucolic countryside of Vancouver Island, British Columbia, her relentless pursuit of science began in a love of animals, carrying her through two Canadian universities to a University of Chicago PhD in pharmacology and tenuous postdoctoral positions investigating the pituitaries of whales and armadillos. The research sent her to sea with grudging whalers and to inhospitable deserts by night. She married fellow pharmacologist Ellis Kelsey, followed him for his work, and became a mother of two daughters. Lack of paid opportunities for a woman scientist sent her commuting to medical school in Chicago where she obtained an MD degree in 1950 at age 36, while her husband kept the home and family together. She was working as a G.P. locum tenens and as an editor for JAMA. After a stint in South Dakota, the family relocated to Washington in 1960 where she began her lengthy career in the FDA, rising through the ranks to positions of prominence. Not long after the move, her stance on thalidomide earned her the Distinguished Federal Service Award of 1962, presented by President J​ohn​​ ​F. Kennedy. It also brought widespread admiration, mountains of fan mail, several other honours, and the resentment of male colleagues. Ellis died suddenly in 1966, but she kept working into her 90s, taking on the public-health challenges of other notorious “remedies” seeking approval. Kelsey’s fame eventually subsided but rose again in 2015 with late honours and her death at 101 years of age.  

Cheryl Krasnick Warsh​,​ who lives and works on Kelsey’s parental home of Vancouver Island, has given us a wonderful biography. With many previous publications in gender history and the history of alcohol and other drugs, Warsh is well placed to handle this vast and ​multifaceted​​ ​topic, sensitive to the misogyny of Kelsey’s century and with expertise on the nature and fortunes of licit and illicit substances.  

In twenty short chapters, Warsh divides this long life into three ​​segments– before​,​ during, and after thalidomide– and identifies her subject in three different ways. She describes “Frankie’s” early years in simple prose, reminiscent perhaps of Gertrude Stein or Emily Carr. Quirks and disputes in the Oldham home become evidence of a high-functioning, dysfunctional family. As a young woman, “Frances Oldham” delved into science studies at what would become University of Victoria and McG​i​ll in Montreal but made the ​trip ​back home every summer. She slipped into the laboratory of distinguished pharmacologist E.M.K. Geiling at the University of Chicago, when he believed the applicant was male. Despite his initial skepticism, Geiling fostered her career and supervised her doctorate. In 1937, she worked on the lethal side-effects of elixir sulfanilamide and determined that the solvent was responsible. At that time, she also became interested in researching harmful effects of pharmaceuticals on pregnancy and explored the legal protections (or lack thereof) for their consumers. With Geiling and Ellis Kelsey, Frances Oldham wrote a pharmacology textbook, one of the first in America, that went into four editions. These experiences, her medical degree and the work with JAMA were excellent preparations for her concerns about thalidomide. Now she was “Dr Kelsey,” one of two in the same home. 

Kelsey first doubted the value of this new drug when the side effect of peripheral nerve damage seemed to have been excluded from the incomplete applications and their inadequate trials. Further delay allowed for the early reports of fetal damage (coming from newspapers rather than manufacturers) to add to the concerns. While she succeeded in blocking the approval of thalidomide, it had managed to make its way into the US anyway, in the form of free samples given to practitioners sloppily engaged as researchers in shoddy “clinical trials.” Warsh carefully tracks the resultant American harm through reports of at least 56 damaged or dead infants documented in a survey of city health officers in 1962—probably merely the tip of an iceberg. She also probed the tragedy’s impact on attitudes to abortion, respect for the disabled, and increasing caution over medications. 

Beyond the thalidomide story, this biography provides a good sense of the evolving field of pharmacology and interesting chapters on the thorny history of several famous drugs–Krebiozen, laetrile, dimethyl sulfoxide (DMSO), artificial sweeteners, and diethylstilbestrol (DES)–and the harmful impact of Xrays on the pregnant belly. Kelsey found support from other women scientists, in particular Barbara Moulton and Helen Taussig​,​ who became her friends. 

Warsh has tapped into a wealth of sources—extending well beyond the numerous publications, FDA documents, and newspaper reports. She interviewed Kelsey, aged 99, in 2014 and spoke with her colleagues, daughters and other family members. She made excellent use of the personal papers, sorted by the pharmacologist herself with the help of FDA historian John Swann; they contain more than 78,000 items and occupy more than 100 feet of shelving in the Library of Congress. Moreover, Warsh follows the court decisions, changing legislation and rules governing not only drug approvals but ​also ​the ordering of female lives in terms of employment and reproductive freedoms. Yet she handles all this information with a deft light touch, accessible language and playful humour.  

A great read about a great scientist and a fascinating era in biomedical science. 

Frances Oldham Kelsey, the FDA, and the Battle Against Thalidomide
Warsh, Cheryl Krasnick
Oxford University Press. 
New York, 2024-03-15

Photos of Frances Oldham Kelsey from Wikicommons

Cheryl Krasnick Warsh Interviewed at Library of Congress

We look at two literary descriptions of self-poisoning through the novels, Belladonna and Madame Bovary, and compare them with classic biomedical texts. We focus on how vividly the literary texts depict what people can go through after having poisoned themselves with belladonna or arsenic, how well these descriptions represent or elaborate on biomedical texts and teaching, and the applications they offer to health care practitioners, students, and the general public.  

We are joined by Dr. Kamna Balhara and Dr. Andrew Stolbach, both of whom are associate professors and emergency medicine physicians at Johns Hopkins Medicine. Dr. Balhara also holds undergraduate and graduate degrees in French studies, is a founder and co-director of Health Humanities at Johns Hopkins Emergency Medicine (H3EM), and is a member of the Johns Hopkins Center for Medical Humanities and Social Medicine. Dr. Stolbach is also a medical toxicologist and holds a Master’s Degree in Public Health. Better guests for this episode could not be found. Their expertise on and enthusiasm for the topic and content sources make for an engaging episode.

Links to content sources:

Literary:
Belladonna, by Daša Drndić, translated by Celia Hawkesworth, New York, New Directions, 2017.
Madame Bovary, by Gustave Flaubert, Translated by Geoffrey Wall. New York, NY: Penguin Classics; 2003.

Biomedical:
Goldfrank’s Toxicologic Emergencies, 11e. McGraw Hill; 2019.
Goodman & Gilman’s The Pharmacological Basis of Therapeutics, 13e, New York, McGraw-Hill, 2018.
Case study: Unseasonal severe poisoning of two adults by deadly nightshade (Atropa belladonna). Journal of the Royal Society for the Promotion of Health. 2000;120(2):127-130.
The Poisoner’s Handbook, by Deborah Blum. New York, NY: Penguin Books; 2010.
Russell Teagarden’s blog pieces on Belladonna and Madame Bovary at According to the Arts.

The Clinic & The Person is a podcast developed by our editor Russell Teagarden to summon or quicken the attention of health care professionals, their educators, researchers and others to the interests and plights of people with specific health problems aided through knowledge and perspectives the humanities provide.

Feature image by Fulvio Ciccolo