Clearing the Air
9/11's toxic dust obscures answers about cancer and other health claims

http://www.villagevoice.com/news/073...n,77703,2.html

by Graham Rayman
September 4th, 2007 6:18 PM

To understand how deeply New Yorkers hold the conviction that 9/11 environmental fallout is killing people, you need only to have attended the August 21 public meeting that was held in a chamber across from City Hall.

The topic was the disastrous August 18 fire in the heavily contaminated Deutsche Bank building at 130 Liberty Street, which killed two firefighters. Only three weeks before the sixth anniversary of the terror attacks, here were city, state, and federal officials once again trying to downplay the possibility that the fire released environmental toxins into the neighborhood.

But the air was so thick with skepticism from the crowd that the assertions couldn't gain any traction. One resident described the debacle as a "religious kind of shame." Marc Ameruso, a lower-Manhattan community-board member, said, "The ghost of the World Trade Center is rearing its ugly head once again."

It was hard to blame the doubters. The Bush, Pataki, and Giuliani administrations have either misled or poorly informed the public about the toxic dangers of what has been described "as the largest acute environmental disaster that ever has befallen New York City."

In the early days following the attacks, even the men and women who worked on "the Pile" expressed skepticism about the negative health effects of 9/11's toxic cloud. But that initial doubt has given way to a popular view that blames the dust cloud for virtually every ailment experienced by someone who was at or near Ground Zero. And broad public acceptance of the notion that the cloud has sickened people is creating a powerful momentum for long-term government support for the vast number of people affected.

Based on a Voice count, more than 52 illnesses have been mentioned in connection with the 9/11 toxic cloud, either anecdotally in press reports, more broadly in government comments, or with some scientific underpinning in research studies. "In the six years since the attacks, we have accumulated a mountain of evidence that tens of thousands of those exposed are suffering from chronic respiratory disease and, increasingly, a variety of rare cancers," said Representative Jerrold Nadler, who has emerged as a leading advocate on the issue, during a June 25 congressional hearing.

More than 100 scientific papers have been written exploring a link between 9/11 and health ailments. Many of those strongly suggest that the dust was a factor in increased respiratory illnesses among people exposed to the cloud.

Even as they suggest a connection, however, researchers also often hedge their language, describe flaws in the research, or suggest that definitive links will be hard to establish. The question of what we know about those links—and what we don't know—is a subject that likely will occupy researchers and those affected for years to come. "More than 5 years after the World Trade Center disaster on September 11, 2001, uncertainty and controversy remain about the health risks posed by inhaling the dust from the collapse of the twin towers, the subsequent fires, and the cleanup effort," epidemiologists Jonathan Samet and Alison Geyh of the Johns Hopkins Bloomberg School of Public Health wrote in May in The New England Journal of Medicine.

The hard data leave little doubt that heavy exposure led to documented respiratory ailments, but there's far less certainty about more severe respiratory ailments, particularly the cancers that some have linked to Ground Zero.

"What's clearest and strongest is in the immediate persistence of effects on the respiratory system of the more exposed," Samet told the Voice in a recent interview. "Where the uncertainty begins is when one tries to understand the consequences for the broader public and the longer-term effects."

The World Trade Center health crisis is a saga told on a massive scale. Consider: 10,000 people have signed up for the pending class-action lawsuit against the city, and 71,000 for the city's World Trade Center Health Registry.

Nearly 20,000 people have been screened in Mount Sinai's medical-monitoring program. More than 1,300 people have been treated at the city-funded WTC clinic at Bellevue Hospital.

The estimated number of Ground Zero responders is 40,000, and the estimated number of people who came in contact with the dust is 410,000.

More than 600 firefighters have taken early retirement because of permanent, disabling respiratory illness, along with an unknown number of police officers, city workers, construction workers, and members of other groups.

In courtrooms, hearing rooms, and government offices, there is a paper war raging between people who claim they are sick, and the city, state, and federal agencies that must decide whether to pay for their medical coverage.

More than 3,000 police officers have filed disability claims, but the NYPD has approved just 116 cases, The New York Sun reported recently.

Last month, it was reported that 19,000 people had signed up with the state for workers' compensation benefits, but the true eligible population is believed to be 100,000. Take just one workers' comp case, that of former Sanitation Department employee Jack Saltarella, who drove barges filled with WTC dust and debris from Ground Zero to the Fresh Kills landfill.

Claiming respiratory illness, Saltarella and a dozen other barge workers sued the city, but a judge tossed the case out, citing a lack of evidence. However, that decision came before public opinion began to look more favorably on arguments linking the dust and illnesses.

"I used to be able to go for hours without stopping," Saltarella says. "Now I get exhausted just from breathing." He was subsequently diagnosed with chronic respiratory disorder, which the doctors concluded was related to dust exposure. Saltarella filed for workers' compensation; years later, he is still fighting for those benefits. A judge ruled in his favor five months ago, he says, but the city filed an appeal.

The experience has left him with a profound sense of bitterness. "The city acted like I was the only person complaining, but there's a whole bunch of people," Saltarella says. "They made you feel like you're a piece of shit—someone looking to take the city. There's a whole bunch of those guys. We didn't cause this; they caused us to have this."

At least 12 deaths from lung ailments and cancer have been blamed on the dust cloud in press reports. Among them is firefighter Ray Hauber, 47, who died of esophageal cancer. Friends and family say Hauber was a healthy man who didn't smoke.

In two of the cases—those of Police Officer James Zadroga, who died of pulmonary fibrosis, and lawyer Felicia Dunn Jones, who died of sarcoidosis—local medical examiners agreed that exposure to the dust was a factor.

Another was that of Cesar Borja, a police officer who died of pulmonary fibrosis. Initial reports said that he'd worked 16-hour shifts at Ground Zero, but records subsequently showed that he worked there only 17 days, starting in December 2001—casting doubt on whether his fatal illness stemmed from his time at Ground Zero.

Not long before she died from lung cancer, lower-Manhattan resident Etta Sanders wrote an essay blaming her own illness on the WTC exposures.

"If the government had said we're not sure about the safety of the air and it would be prudent for residents to stay away, I don't think I would have this cancer," she wrote in the essay, which was later published in the Tribeca Tribune. "I dearly hope that I am in a small minority of people who were so gravely harmed by the aftermath of the WTC attacks, but I fear otherwise."

In all, the deaths of 170 people who spent time at Ground Zero have been reported to the New York State Department of Health as part of an ongoing WTC fatality study. But it is unclear whether any of those deaths are related to the dust.

Indeed, there is much that remains unknown about the health effects of 9/11. The Samet and Geyh paper, for example, highlights a number of those questions. Even the actual size of the exposed population, they write, is still unclear.

Also, the government's failure to sample the air immediately after the disaster in a comprehensive manner means that hard data are missing on the types and levels of contaminants in the cloud during the period of the worst exposures, they write.

Paul Lioy, a professor of environmental and occupational medicine at Rutgers University, echoes that point in a paper published in a medical journal in November: "Five years after the attack, many people still do not know that the complex mixture of dust and smoke initially suspended in the air remains somewhat of a scientific mystery."

Even though people exposed to the cloud may be inclined to blame any future illness they contract on that exposure, Samet and Geyh write that the only way to confirm a link is through epidemiological studies that examine a large enough population of exposed people and compare it to a similar population of people who weren't. But that vast and difficult study has yet to be done.

"Even the full suite of research efforts in progress may never produce the evidence needed to answer all of the questions that will be raised about the long-term health effects of September 11," the authors conclude.

In March, Jeanne Stellman, a well- regarded epidemiologist at Columbia University, also sounded a cautionary note: "The current studies . . . cannot possibly provide us with insight into the overall burden of disease and disability because the diseases associated with WTC-like exposures are chronic and take many years to manifest themselves.

"Thus it is too early to know the full extent to which exposure to carcinogens and other toxic and stressful working conditions will lead to elevated rates of cancer or whether the rescue, recovery and cleanup workers will suffer from more cardiovascular disease or other chronic diseases."

The city's health registry, Stellman wrote, is useful but "far from complete. . . . No government or private agency has identified all the workers who participated in the operations."

Stellman compared the situation to that of the soldiers exposed to Agent Orange during the Vietnam War, an environmental calamity she's spent decades studying.

"Some 30 years after the end of the Vietnam War and more than 35 years after Agent Orange was sprayed, we still cannot tell our veterans and their loved ones what the effects of exposures to the herbicides are," she wrote.

David Carpenter, a professor of environmental health and toxicology in the School of Public Health at SUNY Albany, also notes the problems confronting researchers. "You need some limit on who was exposed, where they were, how long they were there," he says. "There's no reliable chemical measure, and we don't have a comprehensive list of the diseases we are going to be concerned about.

"It's pretty clear in adults that there is a greater increase in chronic respiratory disease, but it's very difficult to quantify that," he adds.

A common thread in the World Trade Center research has been a reliance on surveys. The city's World Trade Center Health Registry, for example, is basically a very large collection of surveys.

Some in the research community have raised questions about the validity of such data. Epidemiologists David Vlahov and Sandro Galea of the New York Academy of Medicine, for example, questioned the results of another study that used a self-administered survey to conclude that there were much higher rates of respiratory symptoms after 9/11 among the residents of lower Manhattan than among people on the Upper West Side. Vlahov and Galea caution that people in lower Manhattan would be more far likely to respond to the survey, since they have a greater interest in the results. Just over 2,300 people responded from lower Manhattan, and only 291 from the Upper West Side.

Because the survey was done some eight to 16 months after September 11, the accuracy of the memory of those surveyed is also questionable, the authors state.

"This study in some ways raises more questions than it answers," Vlahov and Galea write. "Inferences about individual exposures must be drawn with caution."

End Part I