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Welcome to Cornhole Champions. Iowa Starting Line’s weekly podcast where we throw bags at the state’s biggest stories. I’m Zachary Oren Smith. It’s Friday.
I keep thinking about my conversation with radiologist Dr. Andrew Nish. For our cancer investigation, The Hot Spot, I asked him about what stopped the state from addressing the cancer crisis. He put it simply:
“Politics and big money.”
Dr. Nish is the medical director at the John Stoddard Cancer Center, and he's watched Iowa climb to second in the nation for cancer rates. When I sat down with him in Des Moines, I expected to talk about lifestyle factors: diet, exercise—the usual suspects. Instead, we ended up discussing something much more systemic: how the same forces that shape our economy also shape our health.
The conversation stuck with me because it cuts to the heart of a frustrating pattern. We know tobacco causes cancer, so we regulated it through public policy. And that intervention worked. Smoking rates dropped from 42% in the 1970s to 11.6% for adults and 3.8% for youths, according to CDC data. But when it comes to other environmental factors—nitrates in our water, pesticide exposure, lack of green spaces—we seem stuck in a cycle of "more research needed" while our cancer rates keep climbing.
Dr. Nish connects Iowa's high cancer rates to everything from our drinking culture to our agricultural practices. But what struck me most was his point about causation: we'll never get the kind of definitive proof that tobacco gave us because cancer isn't caused by a single factor. It's what he calls the "exposome" - everything we're exposed to over a lifetime, from the food we eat to the stress we carry.
The exposome is potentially a license to do nothing. To wait. But if we take Nish seriously—which I think his experience demands—the exposome is a framework, a roadmap for what we need to for a healthier world.
As always, write in with the thoughts and questions this story left you with. I love hearing from you.
A crow’s feast
Welcome to Crow’s Feast. Our show within a show, where we eat crow early and eat crow often. It’s time for some correct some errors. Or maybe they’re errors by omission? And isn’t that the worst of all?
In Wednesday’s letter, I took the blood pressure of Iowa’s marquee races following Ernst’s announced retirement. There were two candidates in two races that I omitted.
The first, Iowa Tea Party founder Ryan Rhodes is running in Iowa’s 4th Congressional District. Rhodes, a Republican, directed Dr. Ben Carson’s presidential campaign in Iowa.
The other is in Iowa’s 3rd where Xavier Carrigan is in the Democratic Party primary.
Send your corrections in to zach@iowastartingline.com.
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Cornhole Champions is a weekly podcast powered by Iowa Starting Line. It’s produced by me and edited by Rebecca Steinberg. Our music is by Avery Mossman and show art by Desirée Tapia. We are a proud member of the Iowa Writers Collaborative.
Your friendly neighborhood reporter,
Zachary Oren Smith
Political correspondent
Iowa Starting Line
