Lorenzo Tomatis

Lorenzo (Renzo) Tomatis (Sassoferrato, Italy, 2 January 1929 - Lyon, France, 21 September 2007) was an Italian physician and experimental oncologist. He is best remembered as the Director from 1982 until 1993 of the prestigious International Agency for Research on Cancer in Lyon - (IARC), which evaluates and provides guidelines on the effects of chemical or physical carcinogens. During his tenure at IARC, Tomatis led the effort to create the IARC Monographs on the Evaluation of Carcinogenic Risk to Humans (the so-called “orange books”), a critical tool for the primary prevention of cancer, and IARC's most famous product.

Lorenzo Tomatis

With over 350 publications and 10 books, since the 1950s Tomatis was ahead of his time—developing carcinogenesis bioassays which recognized trans-placental and trans-generational carcinogenesis, thus highlighting the vulnerabilities of early-life exposure. Tomatis was a leader in the difficult task of translating animal experimental findings to human risk (reflected in the IARC monographs, which assess animal, molecular biology and human evidence on an agent). He used these many qualifications get enacted strategies for the primary prevention of cancer—that is, reduced exposure to carcinogens.

In addition Tomatis was committed to the sociology of science, especially the causes of the 'brain drain' from ' Italy.

In summary, Tomatis was one of the world's most distinguished experts on carcinogenesis and its primary prevention.

Biography

Tomatis was born in Sassoferrato, Italy, and began his professional career upon graduating from the University of Turin with a degree in medicine in 1953 and in hygiene and preventive medicine in 1955. After a brief stint as a medical officer with a regiment of Alpine troops, he obtained a degree in occupational health in 1957—his interest in the role of chemicals as potential causes of cancer having become evident.

In 1959, Tomatis joined Phillipe Shubik's team at the Division of Oncology in the Chicago Medical School, with a reputation in the field of chemical carcinogenesis. "According to Shubik: "He was a careful and thoughtful investigator who was able to think of probable advances before many others. He organized a tissue culture laboratory in my department before this field had achieved its present importance."[1]

By 1965 Tomatis was studying neonatal responses to carcinogen exposure, an important question that aided his 1967 recruitment to the World Health Organization's (WHO) newly established cancer agency, IARC in Lyon. There he formed the Unit of Chemical Carcinogenesis, concentrated on planning and implementing primary prevention of cancer through the identification of carcinogens. To date some 100 Monographs covering well over 1,000 agents have provided objective expert evaluation of the totality of evidence on the carcinogenicity of agents, mixtures, and their exposure circumstances.

Their first volume of the IARC Monographs in 1972 had instantaneous and enduring impact throughout the world. In fact, IARC quickly became known predominantly for the IARC Monographs. They came to be seen as one of two 'gold standard' carcinogenicity programmes (the other being the US NTP's animal testing program, so IARC's is the only one that evaluates the totality of evidence). Peers have said of them: "To [maintain] the series for 20 years at such a high level is an unprecedented achievement" and: "...A box of jewels of the knowledge of mankind on chemical carcinogenesis."[2]

The success of the IARC Monographs rested in part in the impartiality process initiated by Tomatis and his staff, who for each Monograph created working groups of independent scientists with deep knowledge of chemical carcinogenesis, to evaluate all available information on an agent; emphasizing their impartiality and transparency. Their conclusions were thus reliable enough to base government decisions on the primary prevention of cancer. Indeed, an agent's IARC classification as a carcinogen has been the basis of innumerable actions and proposals (not all successful) to stop and reduce exposure to chemicals.

In January 1982, in recognition of his outstanding career and contributions inunderstanding cancer causation and prevention, Tomatis was elected by the WHO member nations as the second director of IARC. He was reelected, serving as director for a full 12 years until retirement in December 1993. Throughout his tenure at IARC, Tomatis and the international IARC staff developed a mutual respect and appreciation for each other, unified in promoting the agency's mission of improving public health through primary disease prevention.

Upon retirement from IARC/WHO, he served as scientific director of the Institute of Child Health “Burlo Garofolo” in Trieste, Italy, from 1996 to 1999. Shortly thereafter, Tomatis joined the National Institute of Environmental Health Sciences (NIEHS) in North Carolina to focus on issues that he had little time to pursue while serving as the director of IARC. Under the International Scholar Program, Tomatis worked at the NIEHS for six summers, sharing his professional experience and writing important papers on environmental public health and prevention.

Tomatis spent his last years in public health advocacy: on 21 September 2007 he was Chairman of the Scientific Committee of the ISDE - International Society of Doctors for the Environment (Arezzo, Italy). His vast experience and expertise in this field prompted him to take politically courageous positions on certain topics, as on waste incineration: "It is dubious that new generations may forgive us for this environmental suicide."[3] Able to communicate effectively in Italian, French, English, and German, Tomatis traveled the world to spread his undiluted message of primary prevention of disease, especially cancer. He was as prolific as he was dedicated to protecting the environment, and he was an early champion of environmental and social justice.

As a renaissance man, Tomatis wrote books for the general public based on his medical, scientific, and humanitarian experiences. His contributions are well recognized in lives saved from disease and in the cadre of scientists he influenced. He will likely be remembered for his spirit and love of people—his generosity, compassion, honesty, and moral character. As of 2013, he is survived by his wife, Delia, in Trieste; and their son, Paolo, who lives and works between Switzerland and Italy. (The primary source for this section is Reference #1)

Notable quotes

“Despite the attraction of certain utopias and the convincing strength of some of the social and philosophical theories underlying attempts to change the social structure and to achieve a more egalitarian society, social inequalities have not disappeared and seem even to be increasing worldwide. Inequalities in health are part of the social inequalities present in our society and one of their most convincing indices. Sanitary conditions are worse, mortality higher, survival rates of cancer patients lower, and life expectancy shorter in developing countries than in industrialized countries. Similar if not identical differences can be seen within industrialized countries between socioeconomically less and more favoured population groups. In many areas of the industrialized countries social and environmental conditions comparable with those existing in the poorest countries last century have been recreated. Occupational risks are becoming a serious problem in developing countries, largely as a consequence of the transfer of hazardous industries from industrialized countries where certain industries are judged to be unacceptable. A similar double standard is applied to tobacco advertising and sales in the industrialized and developing countries. The projections of the total number of cancer cases in the next decades indicate a generalized increase, proportionally greater in developing than in industrialized countries.[4]

“When it comes to cancer prevention, everyone thinks of the so-called early detection, but there is a prevention that can be done upstream, trying not to limit the damage of the disease by early diagnosis, but rather to avoid the emergence of cancer by preventing exposure to substances that cause it. Primary prevention is concerned with this: to do research on natural or synthetic substances to understand which are carcinogenic and, once identified, to suggest to the health authorities of public health measures to remove them from circulation. It is a strategy that protects all – so the rich as the poor - but unfortunately it is neglected by scientists, politicians and health authorities”.[5]

“The researchers more closely resemble sociologists than revolutionary innovators, identifying themselves, and ending up loving dogmas. As the sociologists find great difficulties imagining real changes that would force them to question dogmas. The heretics are rare among social scientists as they are among researchers and for years those who dared to hypothesize fundamental mechanisms outside of the DNA-dogma risked ostracism, if not to die at the stake.”[6]

“In his introduction to Demorbis artificum diatriba, Bernardino Ramazzini states modestly that his book was not inspired by a desire for glory but by a sense of duty; he had no pretensions to write a great work of art but wrote it for the good of thecommunity and workers. Ramazzini exemplifies how science, legal justice, andsocial equity can harmoniously and efficiently coexist in a competent, sensible, committed physician. In our society, these three qualities rarely converge. Social equity is the most consistently maltreated of the three, while scienceis generally considered, by definition, to be above criticism while deliberately ignoring the possibility that its objectivity is often blurred by conflicts of interests (…) The sort of aristocratic tendency that between the time of Hippocrates and that of Bernardino Ramazzini led to dismissal of the occupational diseases of the working class by scientific medicine, or at least by a large sector of the biomedical establishment, is continuing today with the priority given to intellectually stimulating research, which usually has potential economic outcomes as its implicit but rarely declared goal. In this context, the pharmaceutical industry plays both a direct and an indirect roleby the conditioning effect of its conspicuous financial support”.[7]

Published tributes from peers

“On Friday, 21 September 2007, in Lyon, France, we lost a great human being, a staunch advocate for public health, a thorough and delving scientist, and a humanitarian par excellence. Lorenzo Tomatis, MD, above all, was a learned teacher and creative innovator. His accomplishments are legion, and his far-reaching impact on human health, including the well-being of future generations, will be impossible to replace. Tomatis was clearly a true pioneer and admired leader in primary disease prevention. He stands tall among other giants and trailblazers of environmental health science and public health advocacy including Cesare Maltoni, Norton Nelson, David Rall, and Irving Selikoff. At the same time, Tomatis was respected, admired, and loved by his colleagues and fellow public health advocates as a man whose warmth, humor, strength, and sweetness were as compelling as his command of science.”[8]

“Renzo’s name and scientific prestige are intimately linked to the International Agency for Research on Cancer (IARC) programme on the Monographs on the evaluation ofcarcinogenic risk of chemicals to man, three volumes of which have been prepared every year since 1972 and whose 100th volume (for a total of well over one thousand agents) is expected for 2009. (...) When the Monograph programme started, forty years ago, three ideas of Renzo were revolutionary: evaluating scientific data meant a multidisciplinary approach by a working group, interpreting findings for the purpose of public health required a majorcontribution from basic science, and the working group had to explain hisrationale and the sequence of thoughts leading to evaluation in a transparent way, using terms understandable also to the lay people, with no loss of rigour. Absence of conflicts of interest of the members of working groups was crucial but in those days it was implicit and not spelled out”.[9]

“The leading 20th century proponent for primary prevention of environmental cancer was Dr. Lorenzo Tomatis, the former Director of the International Agency for Research on Cancer and founder of the IARC Monographs program (…) eminent scientist, scholar, teacher, humanitarian, and public health champion--and includes many perspectives that he promoted throughout his career, with original quotations from some of his scientific writings on primary prevention of environmental cancer. Any attempt by us to simply summarize his viewswould only detract from the power and logic of his language. "Cancer still remains a mainly lethal disease. Primary prevention remains the most relevant approach to reduce mortality through a reduction in incidence".[10]

"ABSTRACT Lorenzo Tomatis [1929-2007] devoted his private and professional life to the betterment of mankind. As a physician, scientist, and humanitarian he championed against the plight of social injustice and promoted the obvious benefits of primary prevention of diseases compared to treatments that prevent or delay disease progression, especially occupational cancers. An avowed student and scholar of literature, the arts, the history of medicine and science, and chemical carcinogenesis, he believed in and wrote about these issues throughout his storied life. Some of his achievements, with excerpts from his writings, especially on primary prevention and on social injustice, are highlighted herein."[11]

Books by Renzo Tomatis

• Il laboratorio (The laboratory) - Einaudi, 1965
• La ricerca illimitata (Unlimited Research) - Feltrinelli, 1974
• Visto dall'interno (Seen from the inside) - Garzanti, 1981
• Storia naturale del ricercatore. Il mondo della ricerca visto dall'interno (Natural history of the researcher. The research world seen from the inside) - Garzanti, 1985
• La rielezione (The re-election) - Sellerio, 1996
• Il fuoriuscito (The fugitive) - Sironi publisher, 2005
• L'ombra del dubbio - Sironi publisher, 2007

Major published scientific findings

A list of 40 of Tomatis' most significant papers is on his Italian Wikipedia page.

References

1. H Vainio and K G Thigpen. A distinguished career in the service of cancer prevention. Environ Health Perspect. 1994 February; 102(2): 164–166.
2. H Vainio and K G Thigpen. A distinguished career in the service of cancer prevention. Environ Health Perspect. 1994 February; 102(2): 164–166.
3. Tomatis L. To incinerate waste remains a folly. Corriere di Forlì, 23 April 2007.
4. Tomatis L. Poverty and cancer. IARC Sci Publ.1997;(138):25-39.
5. Tomatis L. Tuttoscienze - The Release n° 1196, 7 September 2005.
6. Tomatis L. Natural History of the researcher. Seen from the world of research, Harper Collins Publishers, Inc., 1985, p .34.
7. Tomatis L. Identification of carcinogenic agents and primary prevention of cancer. Ann NY Acad Sci. September 2006;1076:1-14.
8. Huff J, Melnick R. In Memoriam: Lorenzo Tomatis 1929-2007 Environ Health Perspect. (2008);116(1):A16-17.
9. Terracini B. Lorenzo Tomatis and environmental cancer risk. Ann Ist Super Sanita. 2008;44(1):5-7.
10. Melnick RL, Huff J. Lorenzo Tomatis and primary prevention of environmental cancer Environ Health. 5 April 2011;10 Suppl 1:S14.
11. James Huff & Ronald Melnick. 2012. Environmental Justice & Primary Prevention of Cancer: The Odyssey & Legacy of Lorenzo Tomatis. New Solutions Vol. 22(1) 7-17.