In 1981, a doctor in a small mill town in Maine read a study suggesting that prostate and colon cancers in his community were nearly double the national average. Spooked, he brought the research to the board of directors at the local hospital; they ignored it. A few years later, a survey conducted by the Maine Department of Health suggested that the town, Rumford, had an especially high incidence of cancer, aplastic anemia and lung disease. The state epidemiologist insisted that the data were inconclusive. In 1991, a TV news series christened the area “Cancer Valley” because of the number of people there who had been diagnosed with a rare form of lymphoma. Doc Martin, as the local doctor was known, got a call from the Dana-Farber Cancer Institute in Boston. Why, the institute wanted to know, were “all these kids with cancer” coming from Rumford? Martin believed the high cancer rate was caused by dioxin produced by the paper mill. (Dioxin, the generic name for a family of 75 related compounds, is an unintentional byproduct of the paper bleaching process.) For the rest of his life, Martin toiled to bring attention to the problem. He shared his concerns with his fellow residents, wrote editorials, implored officials at the mill and the hospital to investigate, and appealed to local, state and federal legislators. In the end, his career was demolished. The I.R.S., the state board of medicine, the state Medicaid program and Medicare all audited him; his bank told him he was unwelcome; and the Rumford Hospital terminated his affiliation. Then he died of cancer, too. In “Mill Town: Reckoning With What Remains,” Kerri Arsenault documents Doc Martin’s passionate and largely fruitless attempts to expose the mill’s role in making his patients sick, along with the efforts of a handful of other residents and scientists who also tried, over the years, to hold the company to account, even as its owners denied responsibility. Arsenault grew up in Mexico, a small town adjacent to Rumford, and she structures the book as a memoir, interweaving the story of the mill with her personal history and that of her Acadian family, who have lived in the area for generations. (Acadia was a French colony that spanned eastern Canada’s Maritime Provinces and parts of Maine. In 1755, during the French and Indian War, the British expelled the Acadians from the region in what is now considered an ethnic cleansing.) Arsenault’s narrative follows the path of her research, beginning with her interest in her family’s genealogy and branching out into explorations of the area’s social and environmental plight. ADVERTISEMENT Continue reading the main story Much of the book’s substance comes from interviews Arsenault conducted with residents. From the elderly Dot Bernard, she learns of the mill’s preference for hiring old men to work in the bleach room: “At first,” Bernard explains, “I thought the mill hired the older guys due to their experience or because it was a special job.” But the real reason, Bernard believes, was that the company didn’t want to care for “young guys who got sick”; it was cheaper to hire the aged, who’d retire soon and die shortly after. Arsenault’s grandfather worked in the bleach room; he died of metastatic stomach cancer not long after he retired. Bernard herself had cancer for more than 11 years; she died before Arsenault’s book was finished. When Arsenault asks why she never spoke publicly about her observations, the old woman says she didn’t want to cause problems. Image “Mill Town” is preoccupied with a poisonous irony: Rumford’s citizens live and work in a place that makes them unwell, yet they cling to their jobs with prideful obstinacy, ignoring patterns of illness, swallowing the mill’s denials and accepting their lot with a collective shrug that Arsenault, once she learns the extent of the cancer and the mill’s likely responsibility for it, finds mysterious and troubling. Why had her family, her friends, her acquaintances been so incurious, so passive, about the jobs on which they depended? She doesn’t spare herself from the accusation of complicity: Why had it taken her so long to wake up? Thanks for reading The Times. Subscribe to The Times Yet, as she soon realizes, the answer to her questions is bound up in their very formulation. Rumford relies wholly on the mill. Few have questioned the bargain that asked them to trade physical health for economic well-being because nobody has a choice about whether to accept it. The residents’ adversary is too powerful, their need too great. The founder of the Rumford mill, Hugh Chisholm, also co-founded International Paper, which remains the largest paper company in the world. (The Rumford mill has had multiple owners over the years; it was purchased two years ago by ND Paper, a subsidiary of the Chinese conglomerate Nine Dragons.) The scale of the problem and of the potential malfeasance could not be grander or more terrifying. Toward the end of the book, Arsenault interviews Stephen Lester, the science director at the Center for Health, Environment and Justice, about dioxin. Why, she asks, did nobody seem concerned about the pollutant, when everything she found indicated it was a “critical health issue”? The Environmental Protection Agency doesn’t even list it as a carcinogen. Lester explains that the E.P.A. had performed two studies on dioxin: a cancer risk assessment and one that dealt with other health risks. The former was damning: It determined that “exposure to any amount of dioxin increased the risks of getting cancer,” Arsenault writes. But the agency published these findings only in draft form; when, years later, it released the non-cancer risk assessment, it announced that the cancer risk study was still being finalized. In Lester’s account, the agency has no intention of publishing it. Doing so would be far too explosive: “If the E.P.A. used cancer risk rate data to determine how much dioxin would be allowed in food,” he tells Arsenault, “you wouldn’t be able to buy a McDonald’s hamburger” — nearly all animal products, in other words, contain levels exceeding what would be deemed acceptable. Is the E.P.A.’s failure to publish the study a smoking gun? Arsenault claims she can’t really say. Because there are so many factors to consider, including other environmental triggers and people’s behavior and family histories, it’s nearly impossible to establish a causal relationship between the mill’s pollution and the incidence of cancer in Rumford. Arsenault comments repeatedly on the intractability of her material. Over the decades, numerous scientific studies in the area were abandoned. She could find no centralized storehouse of data. The evidence she could track down rarely appeared definitive. The book’s penultimate chapter finds her hunkered down in a basement room at the Maine Department of Environmental Protection, frantically scanning a pile of ancient and disorganized files. Editors’ Picks Our Food Staff’s 21 Favorite Thanksgiving Recipes ‘Wow, What Else Can Happen to Us This Year?’ The Uneasy Afterlife of Our Dazzling Trash Continue reading the main story ADVERTISEMENT Continue reading the main story By trade neither a scientist nor a science journalist, Arsenault is candid about her difficulties in making sense of her subject: “There’s no end to what I don’t know, can’t know, can’t translate, won’t ever have the time or capacity to understand,” she laments. But while she questions her wisdom in embarking on the project, she seems never to question the shape of the project itself. Casting her handicap as a virtue, she implies that her struggles demonstrate how hard it is for an ordinary citizen to access reliable information about environmental standards or corporate practices. Furthermore, as she makes clear, her ambition is not merely to reveal facts; she is concerned with human suffering: “How to chart that?” Arsenault is nothing if not an earnest writer. Yet the stakes are so high that this murkiness about her task — Is she an investigative journalist or a memoirist? And whose story, exactly, is she telling? — is unfortunate. Not treating the book as purely investigatory means she doesn’t have to establish anything definite. Not treating it as pure memoir means she can abandon character and drama as it suits her. I don’t fault her for getting diverted by her family tree, by the illnesses of her neighbors. Their trials deserve to be known. But a story rived by cover-ups and uncertainty is only further muddled by meditations on the uncertain nature of storytelling. We’ll just have to wait for the exposé containing incontrovertible evidence that leads to the lawsuit that finally brings about change.